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1.
Abdom Radiol (NY) ; 47(3): 923-947, 2022 03.
Artigo em Inglês | MEDLINE | ID: mdl-35076742

RESUMO

Splenosis is an acquired form of ectopic splenic tissue that typically arises after trauma or splenectomy. It is often an incidental image finding in an otherwise asymptomatic patient, but the spectrum of symptoms varies based on the site of implantation. Radiologists should be familiar with the imaging features of splenosis to avoid mistaking it for malignancy. Splenosis has identical imaging features to that of the native spleen on US, CT, MRI, and nuclear medicine examinations. Therefore, when the radiologic findings support the diagnosis of splenosis, the patient can be spared invasive procedures for tissue sampling.


Assuntos
Esplenose , Abdome/patologia , Humanos , Imageamento por Ressonância Magnética , Esplenectomia , Esplenose/diagnóstico por imagem
2.
Dtsch Med Wochenschr ; 147(19): 1277-1280, 2022 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-36126926

RESUMO

ANAMNESIS AND CLINICAL EXAMINATION: A 56-year-old male patient consulted our surgical department presenting repetitive pain in his right upper abdomen and already known cholecystolithiasis. There were no other findings in the clinical examination; fever or abnormalities concerning bowel movement or micturition were denied. Except from the extirpation of a melanoma and an appendectomy years ago there were no relevant previous illnesses. DIAGNOSIS: An external CT-Scan of the abdomen revealed a cholecystolithiasis and an unclear thickening of the gallbladder wall near the infundibulum. Blood results showed no relevant pathologic excursion. THERAPY AND CLINICAL COURSE: After uncomplicated laparoscopic cholecystectomy the results of the histopathologic examination revealed a metastasis of the melanoma, which was diagnosed and excised years ago. Additional staging showed pulmonal metastasis and resection in palliative intention was performed. CONCLUSION: Gallbladder metastasis of any cancer entities are a rare event, but some studies suggest that the number of events is underestimated concerning the malignant melanoma.If there is a corresponding medical history, symptoms should quickly lead to determined diagnosis and, if in doubt, to cholecystectomy.


Assuntos
Colecistolitíase , Neoplasias da Vesícula Biliar , Melanoma , Abdome/patologia , Neoplasias da Vesícula Biliar/diagnóstico , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , Neoplasias Cutâneas
3.
Eur J Radiol ; 154: 110454, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35917758

RESUMO

OBJECTIVES: Patients with cystic fibrosis (CF) increasingly require imaging for the diagnosis of abdominal complications. We prospectively evaluated the image quality and signal-to-noise ratio (SNR) of a modern radial volumetric encoding (RAVE) T2/T1 hybrid sequence for abdominal magnetic resonance imaging (MRI). RAVET2/T1 is a three-dimensional radial sequence with fat saturation and blood flow suppression that acquires T2- and T1-weighted contrasts in one scan in an identical slice position during free-breathing. METHODS: Sixteen CF patients underwent axial T2 HASTE (1000 ms/93 ms TR/TE), T1 DIXON (6.8 ms/2.4 ms/4.8 ms TR/TE1/TE2), and RAVE T2/T1 hybrid sequence (1200 ms/1.7 ms/3.3 ms/4.9 ms/102 ms TR/TE1/TE2/TE3/TE4) of the upper abdomen at 1.5 Tesla. The SNR values in six different regions were assessed and compared using the Wilcoxon signed-rank test. The image quality criteria were rated on a 5-point Likert scale. RESULTS: In all regions, the SNR was significantly higher in the T2 weighted aspect of the RAVE T2/T1 hybrid sequence compared to T2 HASTE (p < 0.05) and significantly lower in the T1 weighted in-phase aspect of the RAVE T2/T1 hybrid sequence compared to the T1 DIXON sequence (p < 0.05). Qualitatively the T2 weighted aspect of the RAVE T2/T1 hybrid sequence was rated significantly higher than the T2 HASTE in 6 of 7 categories (p < 0.05) and the T1 weighted in-phase aspect of the RAVE T2/T1 hybrid sequence was rated significantly higher than the T1 DIXON in 2 of 6 categories (p < 0.05). CONCLUSIONS: The abdominal radial RAVE T2/T1 hybrid sequence provided higher image quality and SNR than the T2HASTEsequence. Together with increased robustness against motion artifacts, the RAVE T2/T1 hybrid sequence appears to be a good tool for abdominal imaging in CF patients.


Assuntos
Fibrose Cística , Abdome/diagnóstico por imagem , Abdome/patologia , Artefatos , Fibrose Cística/diagnóstico por imagem , Fibrose Cística/patologia , Humanos , Imageamento por Ressonância Magnética/métodos , Respiração
4.
Clin Radiol ; 77(10): e711-e718, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-35948490

RESUMO

AIM: To assess if radiomic feature analysis could help to differentiate between the lipid-poor adenomas and metastases to the adrenal glands. MATERIALS AND METHODS: Eighty-six patients (women:men 42:44; mean age 66 years) with biopsy-proven adrenal metastases and 55 patients (women:men 39:16; mean age 67 years) with lipid-poor adenomas who underwent contrast-enhanced, portal-venous phase CT of the abdomen. Radiomic features were extracted using the PyRadiomics extension for 3D Slicer. Following elastic net regularisation, seven of 1,132 extracted radiomic features were selected to build a radiomic signature. This was combined with patient demographics to create a predictive nomogram. The calibration curves in both the training and validation cohorts were assessed using a Hosmer-Lemeshow test. RESULTS: The radiomic signature alone yielded an area under the curve of 91.7% in the training cohort (n=93) and 87.1% in the validation cohort (n=48). The predictive nomogram, which combined age, a previous history of malignancy, and the radiomic signature, had an AUC of 97.2% in the training cohort and 90.4% in the validation cohort. CONCLUSION: The present nomogram has the potential to differentiate between a lipid-poor adrenal adenoma and adrenal metastasis on portal-venous CT.


Assuntos
Adenoma , Neoplasias das Glândulas Suprarrenais , Abdome/patologia , Adenoma/diagnóstico por imagem , Adenoma/patologia , Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/secundário , Idoso , Feminino , Humanos , Lipídeos , Masculino , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
5.
Radiol Clin North Am ; 60(5): 717-730, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-35989040

RESUMO

Contrast-enhanced ultrasound (CEUS) is increasingly performed for focal liver lesion evaluation because of its high safety profile and ability to yield a definitive diagnosis in many patients, obviating multiphase CT or MRI. CEUS uses specific ultrasound contrast agents (UCAs) that are exceedingly safe, without the risk of renal or liver toxicity. UCAs are cleared rapidly from the body, allowing for multiple injections during a single examination, with no potential for deposition in the patient. This review highlights the performance of CEUS for liver lesion evaluation and illustrates the imaging appearance of common liver lesions in children and adults.


Assuntos
Neoplasias Hepáticas , Abdome/patologia , Adulto , Criança , Meios de Contraste , Humanos , Fígado/diagnóstico por imagem , Neoplasias Hepáticas/patologia , Ultrassonografia/métodos
6.
BMJ Case Rep ; 15(8)2022 Aug 02.
Artigo em Inglês | MEDLINE | ID: mdl-35918081

RESUMO

We describe the case of a woman in her 50s with abdominal pelvic masses suspected to be an ovarian lesion with metastases. At laparoscopy, it appeared as a possible abdominal location of neurofibromatosis type 1 (NF-1). A 50 cm of small bowel was resected to remove multiple nodular lesions. On histopathology, small bowel lesions (n=14) were all classified as GISTs. Clinicians should recognise and consider gastrointestinal manifestations of NF-1 in the diagnostic flow chart. Surgical treatment may resolve symptomatic cases and prevent local infiltration or malignant degeneration of abdominal neoplasms occurring in patients with NF-1.


Assuntos
Neoplasias Abdominais , Tumores do Estroma Gastrointestinal , Laparoscopia , Neurofibromatose 1 , Abdome/diagnóstico por imagem , Abdome/patologia , Neoplasias Abdominais/diagnóstico , Neoplasias Abdominais/cirurgia , Feminino , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Neurofibromatose 1/complicações , Neurofibromatose 1/diagnóstico , Neurofibromatose 1/cirurgia
8.
BMC Cancer ; 22(1): 916, 2022 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-36002810

RESUMO

BACKGROUND: Extralevator abdominoperineal excision (ELAPE) has been recommended for treating low rectal cancer due to its potential advantages in improving surgical safety and oncologic outcomes as compared to conventional abdominoperineal excision (APE). In ELAPE, however, whether the benefits of intraoperative position change to a prone jackknife position outweighs the associated risks remains controversial. This study is to introduce a modified position change in laparoscopic ELAPE and evaluate its feasibility, safety and the long-term therapeutic outcomes. METHODS: Medical records of 56 consecutive patients with low rectal cancer underwent laparoscopic ELAPE from November 2013 to September 2016 were retrospectively studied. In the operation, a perineal dissection in prone jackknife position was firstly performed and the laparoscopic procedure was then conducted in supine position. Patient characteristics, intraoperative and postoperative outcomes, pathologic and 5-year oncologic outcomes were analyzed. RESULTS: The mean operation time was 213.5 ± 29.4 min and the mean intraoperative blood loss was 152.7 ± 125.2 ml. All the tumors were totally resected, without intraoperative perforation, conversion to open surgery, postoperative 30-day death, and perioperative complications. All the patients achieved pelvic peritoneum reconstruction without the usage of biological mesh. During the follow-up period, perineal hernia was observed in 1 patient, impaired sexual function in 1 patient, and parastomal hernias in 3 patients. The local recurrence rate was 1.9% and distant metastasis was noted in 12 patients. The 5-year overall survival rate was 76.4% and the 5-year disease-free survival rate was 70.9%. CONCLUSIONS: Laparoscopic ELAPE with modified position change is a simplified, safe and feasible procedure with favorable outcomes. The pelvic peritoneum can be directly closed by the laparoscopic approach without the application of biological mesh.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Laparoscopia , Protectomia , Neoplasias Retais , Abdome/patologia , Abdome/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Períneo/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
10.
J Obstet Gynaecol Res ; 48(8): 2224-2230, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35793911

RESUMO

Leiomyosarcoma arising from the ovarian vein has rarely been reported. Herein, we report two cases from a single institute. Given their direct connections to ovarian vessels, both leiomyosarcomas were initially suspected to be gynecological malignancies. In one case, leiomyosarcoma was discovered incidentally without any clinical symptoms; it had a close connection with the ovarian vein, was removed surgically, and the patient has survived for over 12 years. In another case, bowel obstruction caused by the tumor helped to identify metastatic leiomyosarcoma. Blood flow was supplied by the ovarian artery and grew into the lumen of the ovarian vein without invading adjacent organs. After surgical resection, the patient underwent 18 months of chemotherapy prior to palliative care. We propose that leiomyosarcoma arising from the ovarian vein should be treated as a gynecologic malignancy, especially if it develops in the lower abdomen.


Assuntos
Neoplasias dos Genitais Femininos , Leiomiossarcoma , Neoplasias Vasculares , Abdome/patologia , Feminino , Humanos , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Pelve/patologia , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/patologia , Neoplasias Vasculares/cirurgia
11.
J Int Med Res ; 50(7): 3000605221113408, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35883281

RESUMO

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide; however, cases with metastasis to the oral cavity are extremely rare. Herein, we report a 68-year-old man who was diagnosed with HCC. Ten months after surgical removal of the right half of his liver, the patient developed gingival metastasis. Unfortunately, the patient died 4 months after the diagnosis. We discuss treatment options, pathological results, and disease prognosis. When a mandibular gingival mass is found, metastatic tumors should be considered in the differential diagnosis. In this regard, the patient's medical history and physical examination are valuable indicators for the diagnosis of mandibular gingival metastasis. This case provides a basis for the clinical diagnosis of metastatic HCC involving the oral cavity.


Assuntos
Carcinoma Hepatocelular , Neoplasias Hepáticas , Abdome/patologia , Idoso , Carcinoma Hepatocelular/patologia , Diagnóstico Diferencial , Gengiva/patologia , Gengiva/cirurgia , Humanos , Neoplasias Hepáticas/patologia , Masculino
12.
BMJ Case Rep ; 15(7)2022 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-35793846

RESUMO

Aggressive angiomyxoma (AA) is a rare neoplasm of mesenchymal origin. It most commonly occurs in young women, predominantly in the pelvi-perineal region. We describe a case of AA arising from the lesser curvature of the stomach in a young woman who presented with a lump in the abdomen for 6 months. The patient subsequently underwent en bloc resection of the tumour and the diagnosis was confirmed on histology. This is the first reported case of gastric origin of AA to the best of our knowledge.


Assuntos
Cavidade Abdominal , Mixoma , Abdome/patologia , Cavidade Abdominal/patologia , Feminino , Humanos , Mixoma/diagnóstico por imagem , Mixoma/cirurgia , Períneo/patologia , Estômago/patologia
13.
BMC Surg ; 22(1): 242, 2022 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-35733206

RESUMO

PURPOSE: Extralevator (ELAPE) and abdominoperineal excision (APE) are two major surgical approaches for low rectal cancer patients. Although excellent short-term efficacy is achieved in patients undergoing ELAPE, the long-term benefits have not been established. In this study we evaluated the safety, pathological and survival outcomes in rectal cancer patients who underwent ELAPE and APE. METHODS: One hundred fourteen patients were enrolled, including 68 in the ELAPE group and 46 in the APE group at the Beijing Chaoyang Hospital, Capital Medical University from January 2011 to November 2020. The baseline characteristics, overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were calculated and compared between the two groups. RESULTS: Demographics and tumor stage were comparable between the two groups. The 5-year PFS (67.2% versus 38.6%, log-rank P = 0.008) were significantly improved in the ELAPE group compared to the APE group, and the survival advantage was especially reflected in patients with pT3 tumors, positive lymph nodes or even those who have not received neoadjuvant chemoradiotherapy. Multivariate analysis showed that APE was an independent risk factor for OS (hazard ratio 3.000, 95% confidence interval 1.171 to 4.970, P = 0.004) and PFS (hazard ratio 2.730, 95% confidence interval 1.506 to 4.984, P = 0.001). CONCLUSION:  Compared with APE, ELAPE improved long-term outcomes for low rectal cancer patients, especially among patients with pT3 tumors, positive lymph nodes or those without neoadjuvant chemoradiotherapy.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Protectomia , Neoplasias Retais , Abdome/patologia , Abdome/cirurgia , Humanos , Períneo/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Resultado do Tratamento
14.
Abdom Radiol (NY) ; 47(8): 2937-2955, 2022 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-35690955

RESUMO

Involvement of the abdomen and pelvis is common in lymphoma. Nodal and extranodal abdominal and pelvic lymphoma may present with various complications. Complications are most common in high-grade lymphomas, especially diffuse large B-cell lymphoma. Complications may occur as the initial manifestation of lymphoma, during treatment course, or late following complete disease remission. Most complications are associated with worse prognosis and increased mortality. Imaging is essential in evaluation of disease extent and diagnosis of complications. Therefore, radiologists should be familiar with the clinical context and imaging features of abdominal and pelvic lymphoma complications. We provide a comprehensive, organ system-based approach, and clinical and imaging review of complications of abdominal and pelvic lymphoma along with radiologic images of illustrated cases of the most commonly encountered complications.


Assuntos
Neoplasias Abdominais , Linfoma Difuso de Grandes Células B , Linfoma não Hodgkin , Abdome/diagnóstico por imagem , Abdome/patologia , Humanos , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Linfoma Difuso de Grandes Células B/tratamento farmacológico , Pelve/diagnóstico por imagem , Pelve/patologia , Prognóstico
16.
BMC Surg ; 22(1): 202, 2022 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-35597932

RESUMO

BACKGROUND: Gastrointestinal stromal tumors (GIST) are rare abdominal tumors. Pretreatment biopsies may be used to diagnose a GIST and enable tailored treatment. Some experts are skeptical about biopsies because they fear tumor cell seeding. The objective of this study was to determine if pretreatment biopsy is associated with increased tumor recurrence. METHODS: We performed a systematic literature search and included studies assessing the oncological outcome of GIST patients who underwent a pre-treatment core needle biopsy or fine needle aspiration. We assessed methodological quality with the Newcastle-Ottawa-Scale for non-randomized studies. This review was registered in the PROSPERO database (CRD42021170290). RESULTS: Three non-randomized studies and eight case reports comprising 350 patients were eligible for inclusion. No prospective study designed to answer the review question was found. One case of needle tract seeding after percutaneous core needle biopsy of GIST was reported. None of the studies reported an increased rate of abdominal recurrence in patients with pretreatment biopsy. CONCLUSIONS: The existing evidence does not indicate a relevant risk of needle tract seeding or abdominal recurrence after pre-treatment biopsy of GIST. Biopsy can safely be done to differentiate GIST from other tumors and to select the most appropriate treatment.


Assuntos
Tumores do Estroma Gastrointestinal , Abdome/patologia , Biópsia por Agulha Fina , Tumores do Estroma Gastrointestinal/diagnóstico , Tumores do Estroma Gastrointestinal/patologia , Humanos , Estudos Prospectivos
17.
BMJ Case Rep ; 15(5)2022 May 19.
Artigo em Inglês | MEDLINE | ID: mdl-35589269

RESUMO

Neuroblastoma (NB) is the most common extracranial solid tumour in children after lymphoblastic leukaemias, brain tumours and lymphomas.We report a case of an NB in a previously healthy toddler. Though she had no abdominal complaints, on physical examination, she had a palpable mass identified over the right upper portion of the abdomen. Imaging studies demonstrated a heterogeneous tumour with an irregular capsule and visible calcifications.After initial diagnosis, the patient underwent chemotherapy and was subjected to a radical resection of the tumour 4 months later. One-year follow-up of the patient showed no recurrence.In children, oncological diseases are often asymptomatic or have non-specific symptoms, and in remote locations where specialised/paediatric services may not be available, the importance of medical training in paediatrics is highlighted, with emphasis on performing a complete clinical examination, namely abdominal palpation. The role of timely referral will be evident in such a situation.


Assuntos
Neuroblastoma , Pediatria , Abdome/diagnóstico por imagem , Abdome/patologia , Criança , Feminino , Humanos , Oncologia , Neuroblastoma/diagnóstico , Neuroblastoma/patologia , Neuroblastoma/terapia , Exame Físico
18.
Abdom Radiol (NY) ; 47(7): 2314-2324, 2022 07.
Artigo em Inglês | MEDLINE | ID: mdl-35583820

RESUMO

PURPOSE: To assess the diagnostic performance of quantitative and qualitative imaging features of hepatic cirrhosis on CT. METHODS: A single-center retrospective cohort study was performed on all patients who had undergone non-targeted liver biopsy < 3 months following abdominal CT imaging between 2007 and 2020. Histopathology was required as a reference standard for hepatic cirrhosis diagnosis. Two readers independently assessed all CT quantitative and qualitative features, blinded to the clinical history and the reference standard. The diagnostic performance of each imaging feature was assessed using multivariate regression and logistic regression in a recursive feature elimination framework. RESULTS: 98 consecutive patients met inclusion criteria including 26 with histopathologically confirmed hepatic cirrhosis, and 72 without cirrhosis. Liver surface nodularity (p < 0.0001), lobar redistribution (p < 0.0001), and expanded gallbladder fossa (p < 0.0016) were qualitative CT features associated with liver cirrhosis consistent between both reviewers. Liver surface nodularity demonstrated highest sensitivity (73-77%) and specificity (79-82%). Falciform space width was the only quantitative feature associated with cirrhosis, for a single reviewer (p < 0.04). Using a recursive feature elimination framework, liver surface nodularity and falciform space width were the strongest performing features for identifying cirrhosis. No feature combinations strengthened diagnostic performance. CONCLUSION: Many quantitative and qualitative CT imaging signs of hepatic cirrhosis have either poor accuracy or poor inter-observer agreement. Qualitative imaging features of hepatic cirrhosis on CT performed better than quantitative metrics, with liver surface nodularity the most optimal feature for diagnosing hepatic cirrhosis.


Assuntos
Cirrose Hepática , Tomografia Computadorizada por Raios X , Abdome/patologia , Humanos , Fígado/diagnóstico por imagem , Fígado/patologia , Cirrose Hepática/diagnóstico por imagem , Cirrose Hepática/patologia , Estudos Retrospectivos , Sensibilidade e Especificidade
19.
Medwave ; 22(2): e8710, 2022 Mar 28.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-35370289

RESUMO

Sclerosing angiomatoid nodular transformation is a benign vascular pathology of the spleen, developed from the red pulp, of unknown etiology; it is postulated that it may be related to IgG4 disease and Epstein-Barr virus infection. Most cases are asymptomatic, constituting incidental findings in imaging studies. We present a 41-year-old male patient with a history of thyroidectomy for papillary carcinoma who consulted for fever, received symptomatic treatment and performed a computed tomography of the abdomen for nonspecific abdominal symptoms, the same evidence in the lower pole of the spleen a solid-looking image with faint Peripheral enhancement with contrast, measures 62x 52x51 mm. A splenectomy measuring 14x 11x4 cm and weighing 284 grams was performed, identifying a solid, well-defined nodular formation, with a central fibrous-looking area, with whitish tracts that delimited purplish areas. Microscopy: rounded angiomatoid-like coalescing nodules, with vascular proliferation lined by endothelial cells without atypia, interspersed with spindle cells, infiltrated by lymphocytes and macrophages. The stroma between the nodules shows myofibroblastic proliferation with lymphocytes, plasma cells, and siderophages. Immunohistochemistry: positive labeling in vessels for CD34 and CD31, positive sectors for CD8 and negative for CD34. One IgG4 positive cell per high power field. The study for Epstein-Barr by Polymesara Chain Reaction was negative. For the diagnosis, the imaging studies are nonspecific, so the diagnostic confirmation is given by the histopathological study. Splenectomy is curative with no reported cases of malignant transformation or recurrence to date. There are no known risk factors and no triggering factors have been proven, except the association of cases with IgG4 and Ebstein-Barr virus. As it is a recently described pathological entity, it is necessary to collect large series and review our files, reevaluating some of its differential diagnoses to achieve a better understanding of it.


La transformación nodular angiomatoide esclerosante es una patología vascular benigna del bazo, desarrollada a partir de la pulpa roja, de etiología desconocida. Se postula que puede estar relacionada con la enfermedad por inmunoglobulina 4 y la infección por el virus de Epstein-Barr. La mayoría de los casos son asintomáticos, constituyendo hallazgos incidentales en estudios por imágenes. Presentamos el caso de un paciente masculino de 41 años con antecedentes de tiroidectomía por carcinoma papilar que consulta por fiebre. Recibió tratamiento sintomático y se realizó tomografía computarizada de abdomen por síntomas abdominales inespecíficos. La tomografía evidenció una imagen de aspecto sólido, con tenue realce periférico con el contraste que mide 62 por 52 por 51 milímetros en el polo inferior del bazo. Se realizó esplenectomía que midió 14 por 11 por 4 centímetros y pesó 284 gramos. Se identificó una formación nodular sólida, bien delimitada, con área central de aspecto fibroso, con tractos blanquecinos que delimitan áreas violáceas. La microscopía presentó nódulos coalescentes redondeados de aspecto angiomatoide, con proliferación vascular revestida por células endoteliales sin atipia, entremezclados con células ahusadas, infiltrado de linfocitos y macrófagos. El estroma entre los nódulos mostró proliferación miofibroblástica con linfocitos, plasmocitos y siderófagos. Inmunohistoquímica tuvo marcación positiva en los vasos para CD34 y CD31, sectores positivos para CD8 y negativos para CD34. Una célula positiva para inmunoglobulina 4 (IgG4) por campo de gran aumento. El estudio para Epstein-Barr por reacción en cadena de la polimerasa fue negativo. Para el diagnóstico los estudios de imagen son inespecíficos, por lo que la confirmación diagnóstica la da el estudio histopatológico. La esplenectomía es curativa sin casos reportados hasta la actualidad de transformación maligna o recidiva. No se conocen factores de riesgo y no se han comprobado factores desencadenantes, excepto la asociación de casos con IgG4 y virus de Ebstein-Barr. Por ser una entidad patológica recientemente descrita es necesario recopilar series grandes y revisar nuestros archivos, reevaluando algunos de sus diagnósticos diferenciales para lograr una mejor comprensión de la misma.


Assuntos
Infecções por Vírus Epstein-Barr , Histiocitoma Fibroso Benigno , Abdome/patologia , Adulto , Células Endoteliais/patologia , Infecções por Vírus Epstein-Barr/patologia , Herpesvirus Humano 4 , Histiocitoma Fibroso Benigno/diagnóstico , Histiocitoma Fibroso Benigno/patologia , Humanos , Masculino , Baço/patologia
20.
J Obstet Gynaecol Res ; 48(7): 1531-1537, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35403321

RESUMO

AIM: Pseudo-pseudo Meigs' syndrome is a rare entity of systemic lupus erythematosus, which is defined with the combination of pleural effusion, elevated serum CA-125 levels, and ascites. It has similar clinical aspects with gynecological malignancies which may lead gynecologists to perform unnecessary surgeries and lab workouts. This review seeks to point out the importance of diagnosing pseudo-pseudo Meig's syndrome (PPMS) and endeavors to inform gynecologists about the differential diagnoses. METHODS: This article includes a review of the literature on different cases of PPMS. We searched the PubMed database using the search terms in various combinations "Pseudo-pseudo Meig's syndrome," "Tjalma syndrome," and "SLE." RESULTS: According to the current literature, a majority of internal medicine specialists recognized this clinical condition in the past few years and discussed PPMS as a new onset of systemic lupus erythematosus. PPMS is one of the disregarding entities where gynecologists do not consider it as a differential diagnosis in case of less awareness. When a gynecologist evaluates ascites manifesting as acute abdomen; ectopic pregnancy, ovarian hyperstimulation syndrome, cyst rupture, and malignancy come to mind first. Four-thirds of those patients evaluated by gynecologists were performed hysterectomy leading to unnecessary interventions and economic burden on the health system. CONCLUSION: Although the mechanism is unrevealed and remains unclear, PPMS has been noticed in the literature for the past few years. In order to prevent unnecessary interventions, this syndrome should be considered as a differential diagnosis.


Assuntos
Abdome Agudo , Lúpus Eritematoso Sistêmico , Síndrome de Meigs , Abdome/patologia , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Abdome Agudo/cirurgia , Ascite/diagnóstico , Ascite/etiologia , Feminino , Humanos , Lúpus Eritematoso Sistêmico/diagnóstico , Síndrome de Meigs/diagnóstico , Síndrome de Meigs/patologia , Síndrome de Meigs/cirurgia
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