IgG4-related disease of the thyroid gland.

IgG4-thyroid-related disease (TRD) represents an uncommon spectrum of diseases, with four subcategories established so far, IgG4-related Hashimoto's thyroiditis, fibrosing variant of Hashimoto's thyroiditis, Riedel's thyroiditis and Graves disease with elevated IgG4 levels. We report the case of a 59-year-old woman presenting with painless cervical swelling and hypothyroidism. Thyroid gland was enlarged and distinctively very hard, with reduced mobility. Neck ultrasonography showed multiple nodularity and diffuse thyroid enlargement, which on CT scan conditioned slight deviation of the airway. Fine-needle aspiration of the biggest nodule was suggestive of lymphocytic thyroiditis. She developed compressive symptoms and was submitted to total thyroidectomy. Histology of the thyroid revealed extensive areas of fibrosis, oncocytic cells and lymphoplasmacytic infiltrates. Immunohistochemistry confirmed the predominance of IgG4-secreting plasma cells. IgG4-TRD is characterised by a rapidly progressive and destructive thyroiditis process. Typical presentation can often mimic malignancy; hence, an opportune recognition of IgG4-TRD may avoid unnecessary burdens.

Isolated Non-16/18 High-Risk Human Papillomavirus Cervical Infection: Re-Evaluation After One Year.

INTRODUCTION: High-risk human papillomavirus cervical infection is currently a well-established cause of cervical cancer. However, only a few women with persistent infections will develop cervical precancerous and malignant lesions. Approximately 20% of all cervical cancers are attributable to non-16/18 serotypes. This study aims to evaluate the results of our clinical approach to women with this infection. MATERIAL AND METHODS: We conducted an observational and prospective study from September 2012 to September 2017, which included women with isolated non-16/18 high-risk human papillomavirus infection (with normal cytology). After re-evaluation, two groups were compared: women with spontaneous regression of the infection and women with persistent infection. Clinical and demographic data were analysed as well as the rate of progression to precancerous and malignant lesions. RESULTS: We included 165 women, of which 121 were re-evaluated with co-test at least one year later. After re-evaluation, 13.2% of women revealed precancerous lesions but only two (1.7%) of them presented high-grade squamous intraepithelial lesions. Sixty-seven women (55.4%) showed spontaneous regression of the infection and 54 women (44.6%) maintained it. Women with persistent infection developed more precancerous lesions (27.8%; p < 0.001) and high-grade squamous intraepithelial lesions (3.7%; p < 0.001). There was also an association between persistent infection and postmenopausal status. DISCUSSION: Human papillomavirus 16/18 cervical infection is associated with higher risk of cervical cancer when compared with other serotypes. CONCLUSION: Re-evaluation with co-test one year after the diagnosis of isolated non-16/18 human papillomavirus infection seems to be a reasonable approach.

Introdução: O cancro cervical é causado pelo papiloma vírus humano de alto risco. No entanto, apenas algumas mulheres com infeções persistentes desenvolvem lesões pré-malignas e malignas. Aproximadamente 20% destas neoplasias são causadas por serotipos que não os 16 e 18. Este estudo surge com o objetivo de avaliar a nossa prática clínica neste âmbito. Material e Métodos: Realizámos um estudo observacional e prospetivo entre setembro de 2012 e setembro de 2017, com inclusão de mulheres com infeção cervical isolada com papiloma vírus humano de alto risco, excluindo os serotipos 16 e 18 (com citologia negativa). Após reavaliação, comparámos dois grupos: mulheres que apresentaram resolução espontânea da infeção e mulheres com infeção persistente. Foram analisados dados clínicos e demográficos bem como a taxa de progressão para lesões precursoras e malignas. Resultados: Incluímos 165 mulheres e reavaliámos com co-teste 121 delas com pelo menos um ano de intervalo. Após reavaliação, 13,2% desenvolveram lesões precursoras, mas apenas duas (1,7%) foram consideradas de alto grau. Sessenta e sete mulheres (55,4%) apresentaram resolução espontânea da infeção e 54 (44,6%) mantiveram-na. As mulheres com infeção persistente desenvolveram mais lesões precursoras (27,8%; p < 0,001) e de alto grau (3,7%; p < 0,001). Constatou-se uma associação entre a persistência da infeção e pós-menopausa. Discussão: A infecção cervical com serotipos 16/18 associa-se a uma maior risco de desenvolvimento de cancro cervical quando comparada com outros serotipos. Conclusão: A reavaliação com co-teste um ano após o diagnóstico de infecção cervical isolada com papiloma vírus humano de alto risco, excluindo os serotipos 16 e 18, parece ser uma abordagem adequada.

Angiosarcoma of the lung.

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

Angiosarcoma of the lung / Angiossarcoma pulmonar

Angiosarcoma is a rare malignant vascular tumor. Pulmonary involvement is usually attributable to metastasis from other primary sites, primary pulmonary angiosarcoma therefore being quite uncommon. We report a case of angiosarcoma with pulmonary involvement, probably primary to the lung, which had gone untreated for more than two years. We describe this rare neoplasm and its growth, as well as the extensive local invasion and hematogenous metastasis at presentation. We also discuss its poor prognosis.

O angiosarcoma é um tumor vascular maligno. O envolvimento pulmonar é geralmente atribuído à metástase de outros sítios primários, sendo o angiossarcoma pulmonar primário extremamente raro. Relatamos um caso de angiossarcoma com envolvimento pulmonar, provavelmente primário no pulmão com mais de dois anos de evolução. Descrevemos seu crescimento e sua extensa invasão local e hematogênica na apresentação. Documentamos ainda seu mau prognóstico.