RESUMO
A 39-year-old woman was referred to the neurology department due to headache, instability and difficulty walking for 5 months. Several ancillary tests were performed. The blood test showed leucocytosis and the cerebrospinal fluid revealed an increased total protein and glucose consumption. Other infections or autoimmune causes were excluded. The MRI showed non-specific brain and spinal cord lesions. Given the findings described, a differential diagnosis between granulomatous meningoencephalitis and primary tumour or metastasis was proposed. Empirical treatment with tuberculostatic agents and corticosteroids was started. The neurological state of the patient worsened, she fell into a non-responsive coma and died in few days. The clinical autopsy performed revealed an adenoid cystic carcinoma with involvement of the central nervous system that developed leptomeningeal dissemination along the spinal cord in a fluid 'wash' pattern.
Assuntos
Carcinoma Adenoide Cístico , Adulto , Encéfalo , Carcinoma Adenoide Cístico/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , MeningesRESUMO
OBJETIVO: Describir un caso de pseudotumor renal bilateral secundario a sarcoidosis en un paciente de 75 años en seguimiento por carcinoma de próstata y con historia de paquimeningitis hipertrófica. MÉTODOS: Se realizó ecografía-doppler abdominal, TC tóraco-abdomino-pélvico y biopsia renal guiada por TC, estudios analíticos, determinación de ECA y tratamiento de prueba con esteroides. RESULTADOS: En las pruebas de imagen se identificaron masa renales bilaterales y adenopatías mediastínicas calcificadas, insuficiencia renal y aumento de la ECA en la analítica y granulomas no caseificantes en la biopsia renal. Tanto la clínica neurológica como la función renal mejoraron con esteroides. CONCLUSIONES: La afectación renal pseudotumoral por sarcoidosis es una patología rara que debe incluirse en el diagnóstico diferencial de las masas renales, principalmente en pacientes con sospecha de enfermedad inflamatoria/autoinmune. Los hallazgos radiológicos del "sarcoide renal" son inespecíficos. Puede obtenerse biopsia guiada por TC/ecografía para diagnóstico histológico a partir de las masas renales(AU)
OBJECTIVE: To report one case of bilateral kidney pseudotumor due to sarcoidosis in a 75 year-old man with prostatic carcinoma and hypertrophic pachymeningitis. METHODS: Renal Doppler, body CT, CT-guided renal biopsy, blood analysis including angiotensin converting enzyme (ACE), blood levels and test-treatment (corticosteroid response) were performed. RESULTS: The radiological studies performed showed bilateral kidney masses and pulmonary calcified hilar adenopathies. Blood analysis showed renal failure and increased ACE levels. Renal biopsy showed non-caseating granulomas. Neurological symptoms and renal failure improved with corticosteroid therapy. CONCLUSION: Bilateral kidney pseudotumor due to sarcoidosis is a rare pathology. Sarcoidosis must be included in the differential diagnosis work up of patients with inflammatory or autoimmune disease and bilateral kidney pseudotumors. Radiological findings of kidney sarcoidosis are quite unspecific. Histological diagnosis with CT guided biopsy or US guided biopsy of kidney masses may be performed(AU)
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Renais/patologia , Neoplasias Renais , Neoplasias da Próstata/complicações , Neoplasias da Próstata/diagnóstico , Ultrassonografia/métodos , Diagnóstico Diferencial , Biópsia/métodos , Rim/patologia , Rim , Neoplasias da Próstata , Radiografia Torácica/métodosRESUMO
OBJECTIVE: To report one case of bilateral kidney pseudotumor due to sarcoidosis in a 75 year-old man with prostatic carcinoma and hypertrophic pachymeningitis. METHODS: Renal Doppler, body CT, CT-guided renal biopsy, blood analysis including angiotensin converting enzyme (ACE), blood levels and test-treatment (corticosteroid response) were performed. RESULTS: The radiological studies performed showed bilateral kidney masses and pulmonary calcified hilar adenopathies. Blood analysis showed renal failure and increased ACE levels. Renal biopsy showed non-caseating granulomas. Neurological symptoms and renal failure improved with corticosteroid therapy. CONCLUSION: Bilateral kidney pseudotumor due to sarcoidosis is a rare pathology. Sarcoidosis must be included in the differential diagnosis work up of patients with inflammatory or autoimmune disease and bilateral kidney pseudotumors. Radiological findings of kidney sarcoidosis are quite unspecific. Histological diagnosis with CT guided biopsy or US guided biopsy of kidney masses may be performed.
