RESUMO
La infección por el virus SARS-CoV-2 provoca, además de cuadros respiratorios graves, episodios trombóticos en múltiples localizaciones debido a una mala regulación de la respuesta inmune. Presentamos el caso de un paciente con colecistitis incipiente que desarrolló trombosis portal aguda sin ningún otro antecedente salvo haber pasado de forma asintomática una infección por COVID-19. Dado que esta complicación es extremadamente infrecuente en pacientes sin factores predisponentes ni infecciones graves, consideramos que la infección por COVID-19 pudo ser un factor desencadenante de la trombosis portal y debemos de tenerlo en cuenta de cara al manejo y tratamiento de futuros casos similares.Severe acute respiratory syndrome coronavirus 2019 infection causes, in addition to severe respiratory symptoms, thrombotic episodes in multiple locations due to dysregulation of the immune response. We present the case of a patient with incipient cholecystitis who developed acute portal thrombosis with no other antecedents except having passed an asymptomatic coronavirus disease 2019 (COVID-19) infection. Since this complication is extremely rare in patients without predisposing factors or serious infections, we consider that COVID-19 infection could be a triggering factor for portal thrombosis and we must take it into account in the management and treatment of future similar cases.
Assuntos
COVID-19/complicações , Colecistite/complicações , Veia Porta , Trombose/etiologia , Doença Aguda , Infecções Assintomáticas , COVID-19/imunologia , Colecistite/diagnóstico por imagem , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Veia Porta/diagnóstico por imagem , Trombose/diagnóstico por imagem , Tomografia Computadorizada por Raios XRESUMO
Metastases to the thyroid gland are unusual, especially from a colorectal cancer. We present the case of an 85-year-old female with a history of colon cancer in 2004 treated with surgery, who 14 years later develop dysphonia and dysphagia associated to an elevation of carcinoembryonic antigen. A pathologic thyroid mass was evidenced in a positron emission tomography-computed tomography. The colorectal origin of the mass was confirmed with a biopsy. The patient received surgical treatment doing the right hemithyroidectomy. This entity must be suspected in patients with oncological history and a new thyroid nodule. Surgery is a therapeutic option with either curative or palliative intent.
Las metástasis sobre el tiroides son inusuales y las de origen colorrectal son extremadamente infrecuentes. Se presenta el caso de una mujer de 85 años con antecedente de cáncer de colon intervenido en 2004 que 14 años después presenta signos clínicos de disfonía y disfagia relacionados con elevación del CEA. Tras realizarse una PET-TC se evidencia una masa tiroidea y se confirma su origen colorrectal mediante biopsia. La paciente se sometió a una hemitiroidectomía derecha. Esta entidad debe sospecharse en pacientes con antecedentes oncológicos y un nódulo tiroideo de nueva aparición. La intervención es una opción terapéutica con intención curativa y paliativa.
Assuntos
Adenocarcinoma/secundário , Neoplasias do Ceco/patologia , Neoplasias da Glândula Tireoide/secundário , Adenocarcinoma/sangue , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/cirurgia , Idoso de 80 Anos ou mais , Antígeno Carcinoembrionário/sangue , Neoplasias do Ceco/sangue , Neoplasias do Ceco/cirurgia , Transtornos de Deglutição/etiologia , Disfonia/etiologia , Feminino , Humanos , Neoplasias Pulmonares/secundário , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias da Glândula Tireoide/sangue , Neoplasias da Glândula Tireoide/diagnóstico por imagem , Neoplasias da Glândula Tireoide/cirurgia , Fatores de TempoRESUMO
BACKGROUND: Differential diagnosis of a cervical lesion corresponding with papillary thyroid carcinoma (PTC) after benign total thyroidectomy can be a real challenge. METHODS: A cervical thyroid remnant compatible with papillary carcinoma was incidentally found ten years after total thyroidectomy for a non-functional multinodular goitre. Histological analysis of fine needle puncture aspiration (FNPA) was highly suggestive for PTC. Surgical excision of the cervical lesion was performed. Specimen study demonstrated a classic variant of PTC contacting a peripheral margin, applying ablative treatment with radioactive iodine postoperatively. RESULTS: The patient did not present signs of recurrence during follow-up. Small thyroid remnants after benign thyroidectomy are often left behind, although their risk of malignancy is exceptional. CONCLUSIONS: It is important to individualize therapeutic approach when facing this rare entity. We decided to treat the patient by removing the lesion followed by ablation therapy with successful results. PTC: Papillary thyroid carcinoma FNPA: Fine needle puncture aspiration.
