Pseudotumor inflamatorio hepático: caso clínico y revisión de la literatura / Hepatic Inflammatory Pseudotumor Mimicking Cholangiocarcinoma: A Rare Case and Literature Review

Presentamos el caso de un paciente de 49 años, de sexo masculino, que consulta en el servicio de urgencias por un cuadro de dos meses de evolución, caracterizado por compromiso del estado general, baja de peso, dolor abdominal, sensación febril y elevación de los parámetros inflamatorios. Al estudio imagenológico se observa una voluminosa lesión hepática, asociada a dilatación de la vía biliar y adenopatías en hilio hepático, espacio porto-cavo y retroperitoneales (inter-cavo-aórticos), que plantea dentro de los diagnósticos diferencias un colangiocarcinoma intrahepático. Basados en esta sospecha se realiza una segmentectomía y linfadenectomía regional. El estudio histopatológico e inmunohistoquímico de la pieza quirúrgica, evidencia un proceso inflamatorio linfoplasmocitario, con la presencia de células plasmáticas IgG4 positivas, compatible con una enfermedad asociada a IgG4. Posterior a la resección se decide manejo expectante, evolucionando el paciente de forma favorable, asintomático y sin signos de recurrencia. Presentamos un caso y una breve revisión de la literatura de un pseudotumor inflamatorio hepático, entidad poco frecuente y de comportamiento benigno.

We report the case of a 49-year-old man who attended the emergency department for a two-month history of compromised general condition, weight loss, abdominal pain, fever, and elevated inflammatory parameters. An imaging study demonstrates a bulky liver tumor associated with dilation of the bile duct and retroperitoneal adenopathies (hepatic hilum, intermediate, and right lumbar groups). These findings raise intrahepatic cholangiocarcinoma within the differential diagnoses, reason why segmental hepatectomy and regional lymphadenectomy were performed. Histopathology and immunochemistry revealed a lymphoplasmacytic inflammatory process with IgG4-positive plasma cells compatible with IgG4-associated disease. After the resection, expectant management was decided, with the patient evolving favorably, asymptomatic, and without signs of recurrence. We present a case and a brief literature review of an hepatic inflammatory pseudotumor, a rare entity with a benign behavior.

Superior caval vein syndrome and cardiac inflammatory myofibroblastic tumour in an infant.

The inflammatory myofibroblastic tumour, although very rare, must be considered in the differential diagnosis of intracardiac masses in children as it has systemic implications. We present a case of an infant whose diagnosis was suspected on clinical basis and echocardiogram, but the anatomopathological analysis with immunohistochemical study was essential for the conclusion of the histological type and orientation of the clinical follow-up.

IgG4 inflammatory pseudotumor mimicking primary lung cancer.

Introduction: IgG4 related disease (IgG4-RTD) is an infrequent disease with possible multiple organ involvement. It is characteristic to find inflammatory nodules with IgG4 positive plasma cell infiltration, storiform fibrosis and obliterative phlebitis. We present a patient with an inflammatory pseudotumor in the right upper lobe, mimicking a primary lung tumor. Case report: Our patient, a 48-year old heavy smoker (25 pack/year) with no relevant medical background, referred chest pain, non-productive cough and sporadic nightly fever. Image findings revealed a mass in the right upper lobe, with increased SUV in PET-scan, and mediastinal lymphadenopathies. Primary lung tumor was suspected and right upper lobectomy was performed. Due to absence of cellular atypia and the intense plasmacytic activity in the lesion, immunohistochemical analysis was performed: abundant IgG4 plasma cells were identified, with a IgG4/IgG relation of 74%. Diagnosis of IgG4- inflammatory pseudotumor was made. Discussion: After an extensive bibliographic review, we found just one similar case reported with an IgG4-lung pseudotumor without systemic disease.  Due to the broad spectrum of clinical features of IgG4-RTD, and the  potential multiple organ involvement, it is hard to find a classification and diagnostic criteria with high sensitivity and specificity, nevertheless they can be useful in clinical practice. Conclusion: There are several benign inflammatory diseases which can mimic a primary lung tumor. Although incidence is low, IgG4 pseudotumor should be considered as a differential diagnosis in the absence of malignancy.

Introducción: La enfermedad relacionada con IgG4 (IgG4-RTD) es una enfermedad poco frecuente con posible afectación multiorgánica. La presencia de infiltrados linfoplasmocitarios con células plasmáticas positivas para IgG4, fibrosis y flebitis obliterante. Presentamos el caso de un paciente con un pseudotumor inflamatorio en el lóbulo superior derecho, con presentación clínica compatible con tumor primario de pulmón. Caso clínico: Nuestro paciente de 48 años de edad, tabaquista severo (25 paquetes / año) sin antecedentes médicos relevantes, consulta por dolor torácico, tos no productiva y registros subfebriles aislados. Presenta una masa en el lóbulo superior derecho en estudio por imagen, con aumento de la captación en el PET, asociado a adenopatías mediastínicas. Con diagnóstico inicial de cáncer de pulmón, se realizó lobectomía superior derecha. Debido a la ausencia de atipia celular y la presencia de infiltrados linfoplasmocitarios en la lesión, se realizó análisis inmunohistoquímico: se identificaron abundantes células plasmáticas positivas para IgG4, con una relación IgG4 / IgG del 74%. Se realizó el diagnóstico de pseudotumor inflamatorio por IgG4. Discusión: Tras una extensa revisión bibliográfica, sólo encontramos un caso similar, de una paciente con un pseudotumor pulmonar IgG4 sin enfermedad sistémica. Debido a la variabilidad de la presentación clínica de la enfermedad relacionada a IgG4, y su potencial afectación multiorgánica, es difícil encontrar una clasificación y criterios diagnósticos con alta sensibilidad y especificidad, sin embargo estos suelen ser útiles en la práctica clínica. Conclusión: Múltiples enfermedades inflamatorias son diagnóstico diferencial de tumor primario de pulmón. Si bien la incidencia es baja, el pseudotumor IgG4 debe considerarse como un diagnóstico diferencial cuando no hay evidencia de enfermedad neoplásica.

[Hepatic Inflammatory Pseudotumor Mimicking Cholangiocarcinoma: A Rare Case and Literature Review]. / Pseudotumor inflamatorio hepático: caso clínico y revisión de la literatura.

We report the case of a 49-year-old man who attended the emergency department for a two-month history of compromised general condition, weight loss, abdominal pain, fever, and elevated inflammatory parameters. An imaging study demonstrates a bulky liver tumor associated with dilation of the bile duct and retroperitoneal adenopathies (hepatic hilum, intermediate, and right lumbar groups). These findings raise intrahepatic cholangiocarcinoma within the differential diagnoses, reason why segmental hepatectomy and regional lymphadenectomy were performed. Histopathology and immunochemistry revealed a lymphoplasmacytic inflammatory process with IgG4-positive plasma cells compatible with IgG4-associated disease. After the resection, expectant management was decided, with the patient evolving favorably, asymptomatic, and without signs of recurrence. We present a case and a brief literature review of an hepatic inflammatory pseudotumor, a rare entity with a benign behavior.

Histomorphological evaluation, cell proliferation and endothelial immunostaining in oral and maxillofacial myofibroblastic lesions.

BACKGROUND: Myofibroblasts (MF) are mesenchymal cells with features of both fibroblasts and smooth muscle cells. Although these are usually reactive cells, they can lead to myofibroblastic tumors that may share clinical and histomorphological characteristics but with different prognosis. The aim of this study is to perform a histomorphological evaluation as well as to compare and evaluate two different cell proliferation immunomarkers and two endothelial markers in a group of oral and maxillofacial myofibroblastic lesions (MFL). MATERIAL AND METHODS: Cross-sectional and retrospective study. Demographic, clinical, histomorphological and immunohistochemical characteristics of 39 cases of MFL were analyzed. Immunohistochemical reactions were performed with the Ki67, MCM2, CD34 and CD105 antibodies. Kruskal-Wallis test and Spearman correlation analysis were used. RESULTS: Four cases of nodular fasciitis (NF), 18 myofibromas (My), 6 desmoplastic fibromas (DF), 7 inflammatory myofibroblastic tumors (IMT) and 4 myofibroblastic sarcomas (MFS) were studied. There were twenty women (51.2%); the median age was 13 [Q1-Q3: 8-24] years and most cases occurred in the mandible (48.7%). A statistically significant difference with MCM2 immunostaining (p=0.0221) was observed between the MFL; furthermore, a correlation between CD34 and CD105 immunostaining in NF (p <0.0001) and IMT (p=0.0408), between MCM2 and CD34 in IMT (p=0.0362) and between MCM2 and CD105 in MFS (p <0001) were found. CONCLUSIONS: MCM2 immunostaining could assess more clearly the cell growth fraction in MFL. The correlation between MCM2 and CD34 in IMT and between MCM2 and CD105 in MFS are indicative of the high activity of these lesions. These results emphasize the importance of the studied immunohistochemistry markers as possible tools for a better characterization of some of the MFL.

Pseudotumor inflamatorio hepático, una entidad de difícil diagnóstico / Inflammatory pseudotumor of the liver: a condition hard to diagnose

RESUMEN El pseudotumor inflamatorio hepático es una lesión muy infrecuente, sin una etiología ni patogenia claras. Su diagnóstico preoperatorio no es habitual pero, en caso de realizarse, puede evitar la cirugía. Presentamos el caso de un paciente joven, con antecedente de lupus cutáneo que, tras debutar con una pancreatitis aguda, presenta episodios de colangitis y cuyos hallazgos radiológicos no permiten descartar la presencia de un colangiocarcinoma, por lo que se realiza hepatectomía izquierda, siendo el diagnóstico histológico final de pseudotumor inflamatorio hepático.

ABSTRACT Inflammatory pseudotumors of the liver are rare and lack clear etiology and pathogenesis. The preoperative diagnosis is seldom made but it avoids unnecessary surgery. We report the case of a young male patient with a history of cutaneous lupus and episodes cholangitis after an acute pancreatitis. As the imaging tests could not rule out cholangiocarcinoma, a left liver resection was performed, and the final histologic diagnosis was inflammatory pseudotumor of the liver.

Intracranial Inflammatory Myofibroblastic Tumor: A Review of 49 cases

Inflammatory Myofibroblastic Tumor (IMT) is a rare pathologic entity that was first described in 1973. This lesion is most commonly found in the lungs, but other organs' involvement has also been reported. Intracranial location of Inflammatory Myofibroblastic Tumor is rare, and the first case was reported in 1980. An intriguing fact about the intracranial IMT is its resemblance with meningioma on clinical presentation and neuroimaging. We came across a case of intracranial Inflammatory Myofibroblastic Tumor (IIMT) in a 27-year-old male who presented with recurrent episodes of seizures and was diagnosed as meningioma on neuroimaging. The lesion did not subside with medical management and kept on progressing in size. The patient had to undergo surgery, and diagnosis of Inflammatory Myofibroblastic Tumor was ascertained on histopathology. This 'surprise' diagnosis prompted us to review the literature on all cases of IIMTs reported to date to better understand the entity and its implications. In this review article, we present our observations regarding various studied parameters, including patient profile, clinical presentation, site of involvement, focality of the lesion, special associations, and lines of management of the 49 published cases of IIMTs.

[Relevance of histopathological diagnosis in the treatment of brainstem lesions in adults]. / Importancia del diagnóstico histopatológico en el tratamiento de las lesiones del tronco cerebral en adultos.

Brainstem tumors are uncommon beyond childhood. Controversies arise regarding the need of histological diagnosis in this eloquent area of the brain, weighting the benefits of a reliable diagnosis against the disadvantages of invasive procedures. There are scant publications about the surgical management of brainstem tumors in adults, all of them involving small retrospective cohorts. We are reporting our experience with the aim of contributing to the decision making process. Out of a series of 13 patients, 10 were approached surgically. According to Guillamo's classification the lesions were: focal (n:7), diffuse infiltrative (n:1), tectal (n:1), and exophytic (n:1). According to the Karnofsky Performance Status scale, the neurological status was = 70 in 6 cases and < 70 in 7. Histopathology was confirmed in all 10 treated cases and the samples were obtained by a direct microsurgical approach or by stereotactic biopsy. Histopathological findings were: pilocytic astrocytoma (n:1), low grade glioma (n:1), glioblastoma (n:1), cellular haemangioblastoma (n:1), subependimoma (n:1), pseudotumoral lesions (n:4; 3 cavernomas, 1 inflammatory pseudotumor), and disgerminoma (n:1). As a broad variety of pathologies could be found in this brain localization, an accurate histopathological definition can not only determine the adequate therapy, but also avoid the disastrous consequences of empiric treatments.

Urological manifestations of the disease related to immunoglobulin G4. / Manifestaciones urológicas de la enfermedad relacionada con la inmunoglobulina G4

Immunoglobulin G4 related disease (IgG4-RD) is a fibro-inflammatory disease of unknown etiology, characterized by lesions in the form of tumors, elevated serum IgG4 levels, plasma cells with significant IgG4 infiltration, accompanied by phlebitis obliterans and fibrosis. This disease usually has multiorgan disease, including pancreas, biliary tract, salivary glands, peri orbital tissues, kidneys, lungs, lymph nodes and retro peritoneum. IgG4-RD mainly affects men with a predominance of age by young adults until old age. The clinical manifestations of IgG4-RD, depend mainly on the organs affected and the response to steroids. His forecast is not yet clear. Within the affected urogenital organs can be observed kidney, retroperitoneum, ureter, bladder, urachus, testis/epididymis, paratesticular region, prostate and urethra.

La enfermedad relacionada con la inmunoglobulina G4 (ER-IgG4) es una enfermedad fibroinflamatoria de etiología desconocida, la cual se caracteriza por presentar lesiones en forma de tumoraciones, concentraciones séricas aumentadas de IgG4 y células plasmáticas con una infiltración importante de IgG4, junto con flebitis obliterante y fibrosis. Esta enfermedad suele tener afección multiorgánica, incluyendo el páncreas, el tracto biliar, las glándulas salivares, los tejidos periorbitarios, los riñones, los pulmones, los ganglios linfáticos y el retroperitoneo. La ER-IgG4 afecta principalmente a hombres, con un predominio de edad por los adultos jóvenes y hasta la vejez. Las manifestaciones clínicas de la ER-IgG4 dependen principalmente de los órganos afectados y de la respuesta a los esteroides. Su pronóstico aún no es del todo claro. Dentro de los órganos urogenitales afectados pueden incluirse el riñón, el retroperitoneo, el uréter, la vejiga, el uraco, el testículo/epidídimo, la región paratesticular, la próstata y la uretra.

Inflammatory Myofibroblastic Tumor: Rare Manifestation in Face.

Inflammatory myofibroblastic tumor, also known as inflammatory pseudotumor and plasma cell granuloma, is a tumor that occurs most often in the lungs, abdomen, skin, soft tissue, genital system, and mediastinal. Before surgery, the diagnosis is difficult to establish because of its diverse manifestations. In the head and neck, manifestation is rare and may occur in the upper respiratory tract, soft tissues, orbits, and skull base. This article aims to report a rare manifestation of the disease in the face, highlighting the importance of a correct diagnosis to determine the most appropriate form of treatment, in male patient, leucoderma, 22 years old, with complain of a painless unilateral growth in the left cheek, beginning 2 months before and with progressive growth.

Chronic Localized Fibrosing Leukocytoclastic Vasculitis Associated With Lymphedema, Intralymphatic and Intravascular Lymphocytosis, and Chronic Myelogenous Leukemia: A Case Report of Unilateral Erythema Elevatum Diutinum.

One of the pathogenic causes of cutaneous inflammatory pseudotumors is chronic localized fibrosing leukocytoclastic vasculitis (CLFLCV), a vasculitic reaction pattern seen in granuloma faciale (GF), a localized vasculitis, and erythema elevatum diutinum (EED), a generalized vasculitis. Patients with myelodysplastic syndromes (MDSs) are at risk for a diverse spectrum of cutaneous neutrophilic dermatoses such as EED. Herein, we report a 74-year-old man who presented with a large ulcerative, fungating tumor affecting the right flexor ankle caused by CLFLCV. During his workup and management, MDS and Philadelphia chromosome-negative chronic myeloid leukemia was diagnosed. Surgical excision of the inflammatory mass promptly triggered tumor recurrence, whereas antineutrophil therapy (dapsone coupled with hydroxyurea, and prednisone) lead to tumor regression. Histopathologic examination revealed an eosinophilic-rich small-vessel neutrophilic vasculitis associated with storiform and angiocentric fibrosis (GF-like). In the regions of fibrosis, dilated lymphatic and vascular spaces were numerous, some of which were congested with small CD3-positive lymphocytes (intralymphatic and intravascular lymphocytosis). These findings indicate coexisting localized lymphedema. By direct immunofluorescence, IgM and C4d vessel deposits were detected. The pathogenesis of the fibrotic nodules and plaques of CLFLCV is suspected to be due to recurring bouts of immune-complex vasculitis, creating a cycle of vessel damage followed by reparative granulation tissue. Poor lymphatic drainage may be the underlying factor initiating and maintaining recurrent, localized episodes of immune-complex vasculitis and progressive fibrosis. Although his tumor histopathology resembled GF-eosinophilic rich CLFLCV-the clinical context points to a solitary and paraneoplastic case of EED.

Plasma cell granuloma in oral cavity: a case report / Granuloma de células plasmáticas en cavidad oral: informe de un caso

Plasma cell granuloma is a rare benign tumor lesion that is classified and described under the pseudo inflammatory tumor category. Its occurrence in the oral cavity is rare, making diagnosis and treatment really difficult, as it bears some clinical similarity with malignant tumor diseases. Proper diagnosis and treatment of PCG requires performing biopsy and a histopathological/immunohistochemicalstudy to rule out possible plasma and neoplastic cell dyscrasias. Consequently, the use of these auxiliary diagnostic devices will enable us to provide the appropriate treatment for the patient. In this study, we present the case of a 63-year-old female patient with a tumor/ulcerative lesion of the left buccal mucosa of a month of evolution and a tumor/ulcerative lesion on the right buccal mucosa of 15 days of evolution after the onset of the first lesion. The patient was treated successfully for a period of one year with immunosuppressive drugs, and to date the disease is inactive. The purpose of this paper is to show one of the most unusual locations in the oral cavity affected by this pathological entity, its clinical and histological features, and establish the differential diagnosis correctly with other malignant or benign disease entities, suggesting the most suitable treatment for this type of condition...

El Granuloma de Células Plasmáticas es una rara lesión tumoral benigna descrita dentro de la clasificación de tumores pseudoinflamatorios, es rara su aparición dentro de la cavidad oral, haciendo realmente complicado su diagnóstico y tratamiento, ya que presenta similitud clínica con patologías tumorales malignas. Para el adecuado diagnóstico y tratamiento del GCP, se requiere de la realización de biopsia y estudio histopatológico/inmunohistoquímico, para descartar posibles discrasias de las células plasmáticas y neoplásicas, de tal forma que el uso de estos auxiliares de diagnóstico nos permitirá sustentar de manera adecuada el tratamiento otorgado al paciente. Se presenta el caso de paciente femenino de 63 años de edad, con una lesión tumoral/ulcerativa de la mucosa yugal izquierda de un mes de evolución y lesión tumoral/ulcerativa de la mucosa yugal derecha de 15 días de evolución posterior a la aparición de la primera lesión, tratada por un periodo de un año con inmunosupresores de forma exitosa ya que a la fecha la paciente presenta inactiva la enfermedad. El propósito de este manuscrito es mostrar una de las localizaciones más extrañas de esta entidad patológica en la cavidad oral, sus características clínicas e histológicas, establecer de forma correcta el diagnóstico diferencial con otras entidades patológicas malignas ó benignas y así emplear el tratamiento requerido para la forma en que se presente la misma...

[Inflammatory pseudotumour of the liver. Importance of intra-operative histopathology]. / Pseudotumor inflamatorio hepático. Importancia de la anatomía patológica intraoperatoria.

BACKGROUND: Inflammatory pseudotumour is a rare entity, considered benign, and characterised by inflammatory cell mesenchymal proliferation. CLINICAL CASE: The case is presented 70 year-old man with fever of unknown origin syndrome. He was diagnosed with liver abscesses (one segment IV, adjacent to gallbladder fundus and segment VI), who progressed slowly after antibiotic treatment. In the absence of a diagnosis, although fine needle puncture-aspiration and different imaging tests were performed, elective surgery was decided. The intra-operative histopathology reported the existence of an inflammatory pseudotumour. CONCLUSIONS: Inflammatory pseudotumours are clinically classified into different types according to their aetiology, varying therapeutic management based on the same. It is very difficult to diagnose because of the absence of symptoms, blood disorders, or specific radiological findings. Definitive diagnosis often requires histopathological confirmation, in most cases by percutaneous liver puncture, but sometimes exploratory laparotomy or even performing a hepatectomy for confirmation is necessary. The natural history of inflammatory pseudotumour is its regression; thus conservative management may be used through regular checks until resolution, or can be treated with antibiotics, anti-inflammatories and even corticosteroids. Surgical resection is indicated for persistent unresolved systemic symptoms despite medical treatment, in those situations where growth is evident, with or without symptoms, when involving the hepatic hilum, and finally, in case where the possibility of malignancy cannot be ruled out.

[Intrathoracic-mediastinal myofibroblastic tumor. Report and experience of one case]. / Tumor miofibroblástico intratorácico-mediastinal. Reporte y experiencia en un caso.

BACKGROUND: Inflammatory pseudotumor is a little known and uncommon condition. The debate continues whether it represents an inflammatory lesion or is a true neoplasm. It is considered a reactive process usually characterized by irregular growth of inflammatory cells. It has been described at various sites, the most common being the lung. The aim of this report is to emphasize the difficulty in the initial diagnosis. CLINICAL CASE: We present the case of a 56-year-old male who reports an 8-month history of dry cough, dyspnea, fatigue, weakness and weight loss of 20 kg. We performed two biopsies, one positive for malignancy without response to medical treatment and the second reporting chronic granulomatous inflammation. The patient underwent sternotomy, revealing a tumor of 20 × 17 × 10 cm, weighing approximately 2 kg. The tumor was dependent on the anterior mediastinum surrounding large vessels, and venous brachiocephalic, pericardium and both pleuras with firm adhesions to the right lung. Pathological report was as follows: inflammatory myofibroblastic tumor with positive immunohistochemistry for CD20 and CD3. Postoperative course was satisfactory and 1 year after surgery there was no evidence of recurrence. CONCLUSION: Inflammatory pseudotumor is a benign neoplasm of unknown origin with a chronic course. It can simulate a malignant tumor, causing constitutional manifestations, airway obstruction, cardiac alterations or other symptoms according to their location. Diagnosis is based on radiological features and direct biopsy. Treatment of choice is complete resection of the tumor with a favorable long-term outcome.

ANTECEDENTES: el pseudotumor inflamatorio es una afección poco frecuente y conocida de la que aún se debate si es una lesión inflamatoria o se trata de una verdadera neoplasia. Se considera un proceso generalmente reactivo caracterizado por crecimiento irregular de células inflamatorias. Se ha descrito en diversos sitios y la localización más frecuente es el pulmón. El objetivo de este caso es denotar la dificultad diagnóstica inicial. Caso clínico: paciente masculino de 56 años de edad, con ocho meses de evolución del padecimiento, con tos seca, disnea progresiva, astenia, adinamia y pérdida ponderal de 20 kg. Se realizaron dos biopsias; una positiva a malignidad sin respuesta al tratamiento médico y la segunda que reportó inflamación crónica granulomatosa. En la esternotomía se encontró un tumor de 20 × 17 × 10 cm, con peso aproximado de 2 kg, dependiente del mediastino anterior que rodeaba grandes vasos, el tronco braquiocefálico venoso al igual que el pericardio; ambas pleuras con adherencias firmes al pulmón derecho. El reporte histopatológico fue de: tumor miofibroblástico inflamatorio con inmunohistoquímica positiva para CD20 y CD3. La evolución postoperatoria fue satisfactoria y a un año de la cirugía sin evidencia de recurrencia. CONCLUSIÓN: el pseudotumor inflamatorio es una neoplasia benigna de origen indeterminado y de evolución crónica que puede simular un tumor maligno, con manifestaciones constitucionales y de obstrucción aérea, cardiaca o según su localización. El diagnóstico se basa en las características radiológicas y la biopsia directa, el tratamiento de elección consiste en la resección completa del tumor, con resultado favorable a largo plazo.

Seudotumor pulmonar inflamatorio: presentación de caso / Inflammatory pulmonary pseudo tumor: Presentation of a case

El seudotumor inflamatorio es un proceso no neoplásico poco frecuente, caracterizado por un crecimiento irregular de células inflamatorias. Puede originarse en cualquier lugar del organismo y, en la mayoría de los casos, presenta un asentamiento local único y de características benignas. Se presentó el caso de un varón de 51 años, en el que se manifestó el seudotumor inflamatorio de forma nodular en el pulmón derecho, con evolución a un empiema pleural(AU)

The inflammatory pseudo tumor is a few frequent non neoplastic process, characterized by an irregular increase of inflammatory cells. It can be originated in any place of the organism, and in most of the cases it has only one local settlement with benign characteristics. We presented the case of a male patient, aged 51 years who had the inflammatory pseudo tumor of nodular form in the right lung, with evolution to a pleural empyema(AU)

[Primary hydatid disease of the tibia. case report]. / Hidiatidosis osea primaria de tibia: presentación de un caso.

Hydatidosis is an endemic disease in different parts of the world. Its causal agent is the cestode from the genus Echinococcus. The most commonly affected organs in humans are liver and lung. Bone hydatid disease is a very rare entity, accounting for 0.5 to 4% of total cases. We report a case of a 58 year-old woman from La Rioja, Argentina, who consulted for left infapatellar pain and walking disability of eight months duration. Imaging studies showed a cystic lesion which involved metaphysis and diaphysis of left proximal tibia. Surgical resection was performed and histopathological study confirmed that it was a hydatid cyst. The patient did well and completed three cycles of treatment with albendazole. Currently, she has no evidence of disease and she recovered motility of her left leg. Primary hydatid bone disease, where there is no evidence of systemic disease, is even more unusual. Tibia involvement occurs in up to 15% of the cases. These lesions clinically manifest when they suffer any type of complications. Preoperative diagnosis is mainly made by imaging studies. Lesions are usually osteolytic and can involve cortical bone and extend to soft tissues. Differential diagnosis with inflammatory processes and bone tumors should is mandatory. Treatment is surgical and prognosis is poor due to its high morbi-mortality rate and recurrence risk from 70 to 80%.