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1.
Urology ; 137: e3-e5, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899232

RESUMO

Multiparametric magnetic resonance imaging plays an important role in the detection of clinically significant prostate cancer. However, there is some overlap between prostate cancer and granulomatous prostatitis. We describe the imaging features of granulomatous prostatitis, which frequently mimics prostate cancer, and differential diagnosis between these conditions according to Prostate Imaging-Reporting and Data System (PI-RADS) version.12.


Assuntos
Granuloma/diagnóstico por imagem , Neoplasias da Próstata/diagnóstico por imagem , Prostatite/diagnóstico por imagem , Diagnóstico Diferencial , Granuloma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prostatite/complicações
2.
J Cardiothorac Surg ; 15(1): 7, 2020 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-31915034

RESUMO

BACKGROUND: Fluorodeoxyglucose (FDG)-positron emission tomography (PET)/CT is the most sensitive non-invasive imaging method for the detection of tumor metastasis and recurrence, but sometimes reveals false-positive results. Herein, we report two cases of false-positive results on PET/CT scans along with elevated serum carcinoembryonic antigen (CEA) levels, mimicking local recurrence after pulmonary segmentectomy. CASE PRESENTATION: Case 1; A 75-year-old woman underwent thoracoscopic left basal segmentectomy for primary lung cancer. Follow-up at 6 months after the surgery revealed serum CEA level elevation and chest CT showed a nodule measuring 25 × 22 mm in the residual left lower lobe. PET/CT revealed FDG uptake in the nodule diagnosed as local recurrence of lung cancer, and the patient underwent partial resection of the nodule. Microscopic examination of the resected specimen revealed granuloma caused by polyglycolic acid (PGA) sheet. Case 2; A 58-year-old man underwent VATS right S1 segmentectomy for lung metastasis from rectal carcinoma. Serum CEA levels gradually increased after surgery, and PET/CT revealed FDG uptake in the stump diagnosed as local recurrence of the lung metastasis. The patient underwent completion lobectomy 6 months after the segmentectomy, and the pathology of the resected specimen revealed an inflammatory granuloma caused by PGA suture. CONCLUSIONS: Although suture and stapler granulomas have been reported, granuloma caused by PGA sheets has never been reported. Postoperative recurrence of lung cancer should be diagnosed with not only PET/CT scans and serum tumor markers but also pathological findings, to avoid unnecessary treatment such as chemotherapy, radiation, and difficult reoperation.


Assuntos
Granuloma/diagnóstico por imagem , Neoplasias Pulmonares/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Idoso , Antígeno Carcinoembrionário/sangue , Diagnóstico Diferencial , Reações Falso-Positivas , Feminino , Fluordesoxiglucose F18 , Granuloma/etiologia , Granuloma/cirurgia , Humanos , Neoplasias Pulmonares/sangue , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/sangue , Recidiva Local de Neoplasia/cirurgia , Pneumonectomia , Ácido Poliglicólico/efeitos adversos , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Suturas/efeitos adversos
4.
BMC Infect Dis ; 19(1): 867, 2019 Oct 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638903

RESUMO

BACKGROUND: The therapeutic response of cervical tuberculous lymphadenitis (CTBL) may be delayed or paradoxical, with the frequent development of residual lymph nodes (LNs) during and after antituberculous treatment. We investigated the incidence of residual LNs and the clinical, radiological, microbiological, and pathologic responses of patients with CTBL after 6 months of antituberculous therapy. METHODS: The medical records of HIV-negative adult patients with CTBL diagnosed between July 2009 and December 2017 were analyzed. After 6 months of first-line antituberculous treatment, computed tomography (CT) scans were conducted to evaluate for residual LNs. Fine-needle aspiration biopsy (FNAB) was carried out if a patient presented with residual LNs > 10 mm in diameter with central necrosis, peripheral rim enhancement, or perinodal inflammation on CT scan. RESULTS: Residual LNs were detected in 35 of 157 patients who underwent follow-up CT scans and were more commonly observed in younger patients who completed the treatment (mean years ± standard deviation [SD]: 33 ± 13 vs. 44 ± 16, p < 0.001). The recurrence rate was approximately 5%, which was not significantly different in both groups. Among the 15 patients who underwent FNAB, 3 (30%) presented with granuloma, and 2 of 15 and 10 of 14 patients had positive AFB and TB PCR results, respectively. The TB culture results of 15 patients were negative. CONCLUSIONS: Residual LNs may still be observed after 6 months of antituberculous treatment. Although the radiologic and pathologic findings after treatment are still indicative of TB, not all residual LNs indicate recurrence or treatment failure. A six-month therapy may be sufficient for cervical tuberculous lymphadenitis.


Assuntos
Antituberculosos/uso terapêutico , HIV/imunologia , Linfonodos/patologia , Tuberculose dos Linfonodos/tratamento farmacológico , Adulto , Biópsia por Agulha Fina , Progressão da Doença , Feminino , Seguimentos , Granuloma/diagnóstico por imagem , Humanos , Inflamação/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Necrose/diagnóstico por imagem , Resultados Negativos , Estudos Prospectivos , Recidiva , Testes Sorológicos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Tuberculose dos Linfonodos/diagnóstico
6.
BMJ Case Rep ; 12(7)2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31320375

RESUMO

Thymic epithelial tumours (TETs) are rare lesions that represent less than 1% of all malignancies in adults. Presentation occurs in three ways: asymptomatic, with local thoracic symptoms or with paraneoplastic symptoms. Heterotopic ossifications are rare histological features in neoplasms and non-neoplastic lesions. Here, we present a 49-year-old male patient with a thymoma type B2 mimicking an aortic aneurysm. Alongside the thymoma, a cholesterol granuloma with unusual ossification features was found as well. This clinical presentation and pathological diagnosis are unusual findings.


Assuntos
Aneurisma Aórtico/diagnóstico , Calcinose/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Aorta/diagnóstico por imagem , Calcinose/cirurgia , Dor no Peito/etiologia , Colesterol , Diagnóstico Diferencial , Granuloma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Timoma/complicações , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Tomografia Computadorizada por Raios X
7.
World Neurosurg ; 130: e150-e159, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31203060

RESUMO

BACKGROUND: Xanthogranuloma is a chronic inflammatory mass characterized by cholesterol crystal deposition, which is rarely seen in the sellar region. The objective of this study is to identify the clinical features and cause of sellar xanthogranulomas. METHODS: We retrospectively analyzed manifestation, radiographic, and endocrinologic presentation in 9 patients (7 women and 2 men) whom we had previously treated. RESULTS: The patients were between 26 and 73 years of age (median, 56 years). The chief symptoms were visual symptoms in 3, polyuria in 3, headache in 4, and tiredness in 4 patients. Perimetry found visual field deficit in 6 patients. Anterior pituitary provocation tests disclosed impairment of ≥1 hormone in all patients: growth hormone in 8 patients and adrenocorticotropic hormone-cortisol axis in 8 patients. The lesions were suprasellar in 2 patients, intrasellar in 2 patients, and intrasuprasellar region in 5 patients. Three of the lesions were solid and 6 were single cystic to multicystic. Very low intensity area on T2-weighted magnetic resonance imaging was observed in 4 lesions. Postcontrast study performed in 7 lesions showed enhancement in solid parts or cyst walls. Surgical decompression improved visual disturbance in half of the patients but rarely improved hormonal deficits. Follow-up (median, 47 months) found no recurrence of the lesion. In addition to these 9 cases, we found 2 xanthogranulomatous lesions pathologically associated with ciliated epithelia, which also presented with severe hypopituitarism. CONCLUSIONS: Xanthogranuloma seems to be the last stage of the chronic inflammation affecting Rathke cleft cyst or craniopharyngioma presenting with severe anterior pituitary insufficiency.


Assuntos
Granuloma/complicações , Granuloma/patologia , Hipopituitarismo/complicações , Neoplasias Hipofisárias/complicações , Sela Túrcica/patologia , Xantomatose/complicações , Xantomatose/patologia , Adulto , Idoso , Feminino , Granuloma/diagnóstico por imagem , Humanos , Hipopituitarismo/diagnóstico , Hipopituitarismo/patologia , Masculino , Pessoa de Meia-Idade , Adeno-Hipófise/diagnóstico por imagem , Adeno-Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/patologia , Estudos Retrospectivos , Sela Túrcica/diagnóstico por imagem , Xantomatose/diagnóstico por imagem
8.
Dentomaxillofac Radiol ; 48(6): 20190082, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31188679

RESUMO

OBJECTIVES: To evaluate and compare the diagnostic potential of high resolution ultrasound with periapical radiographs (PR) and CBCT in assessing granulomas and radicular cysts. METHODS: This study included a total of 33 teeth from 33 patients with periapical lesions. Subjects were distributed among three groups. A consisted of teeth that were extracted. B consisted of teeth treated with root-canal treatment followed by apical surgery. C consisted of teeth treated with root-canal treatment only. Pre-treatment PR, ultrasound and CBCT images were obtained for Groups A, B and C and 6 month post-treatment PR and ultrasound images were obtained for Groups B and C. In addition, histopathological analysis was performed on lesions in Groups A and B. Lesions were classified as either cystic lesions or granulomas. Width, height, depth, surface area and volume of lesions were measured using the built-in softwares of the appropriate imaging modalities. Measurements were compared by Wilcoxon and paired sample t tests. Ultrasound and histopathological findings were compared with κ and Mc Nemar. Statistical significance was set at p < 0.05. RESULTS: κ coefficient (0.667; p = 0.002) suggested good agreement between ultrasound and histopathology. No statistically significant differences were found among periapical radiography, CBCT and ultrasound in the pre-treatment measurements of lesion width ( p = 0.308) or between CBCT and periapical radiography in the pre-treatment measurements of lesion height ( p = 0.863). In all cases, mean measurement values for all variables were lower for ultrasound than for CBCT. CONCLUSION: Ultrasound provided useful information for the diagnosis and assessment of granulomas and radicular cysts.


Assuntos
Granuloma , Cisto Radicular , Tomografia Computadorizada de Feixe Cônico , Feminino , Granuloma/diagnóstico por imagem , Humanos , Masculino , Cisto Radicular/diagnóstico por imagem , Tratamento do Canal Radicular , Ultrassonografia
9.
BMC Infect Dis ; 19(1): 454, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117976

RESUMO

BACKGROUND: Mycolicibacterium phlei (M. phlei) is known to be a non-pathogenic nontuberculous mycobacterium (NTM) which rarely causes diseases in humans. A disseminated NTM infection is mostly caused by the Mycobacterium avium complex (MAC) and is known to develop in immunocompromised hosts, like those with acquired immune deficiency syndrome (AIDS). Here, we report a case of disseminated M. phlei infection in an immunocompetent host carrying anti-interferon gamma (IFN-γ) autoantibodies. CASE PRESENTATION: We detected M. phlei in multiple organs of an elderly woman with no significant medical history except positivity for anti-IFN-γ autoantibodies. She tested negative for human immunodeficiency virus (HIV)-1, 2/ Human T-cell leukemia virus type 1 (HTLV-1) antibody. High-resolution computed tomography (HRCT) of the chest demonstrated a nodule in the left S1 + 2 segment, interlobular septal thickening, multi lymphadenopathy, and osteolysis. A maximum intensity projection image following fluorodeoxyglucose-positron emission tomography (FDG-PET) revealed multifocal hypermetabolic lesions in the nodule and all the swollen lymph nodes seen in HRCT. FDG also accumulated in multiple bones. Advanced primary lung cancer was suspected, and biopsies of each lesion were performed. The pathology revealed caseating granuloma, positive for acid-fast bacteria, and DNA sequencing of the acid-fast bacteria confirmed the organism to be M. phlei. The patient also tested positive for anti-IFN-γ autoantibodies. Based on these findings, she was diagnosed with disseminated M. phlei infection, with anti-IFN-γ autoantibodies. CONCLUSIONS: Though known to be non-pathogenic, we show that M. phlei can be pathogenic like the MAC in immunocompetent individuals carrying anti-IFN-γ autoantibodies.


Assuntos
Interferon gama/imunologia , Infecções por Micobactéria não Tuberculosa/imunologia , Micobactérias não Tuberculosas/patogenicidade , Idoso , Antibacterianos/uso terapêutico , Autoanticorpos , Osso e Ossos/diagnóstico por imagem , Osso e Ossos/patologia , Feminino , Granuloma/diagnóstico por imagem , Granuloma/tratamento farmacológico , Granuloma/microbiologia , Humanos , Imunocompetência , Infecções por Micobactéria não Tuberculosa/diagnóstico por imagem , Infecções por Micobactéria não Tuberculosa/tratamento farmacológico , Infecções por Micobactéria não Tuberculosa/microbiologia , Micobactérias não Tuberculosas/imunologia , Tomografia por Emissão de Pósitrons/métodos , Tomografia Computadorizada por Raios X/métodos , Virulência
10.
Acta Med Port ; 32(4): 316-320, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31067427

RESUMO

Granulomatous pneumonitis is a rare complication of bacillus Calmette-Guerin immunotherapy following intravesical administration of bacillus Calmette-Guerin. The authors present an unusual case of a 67-year-old man who developed mild and non-specific symptoms, following intravesical bacillus Calmette-Guerin instillations. Examinations revealed features of miliary tuberculosis and granuloma suggestive of mycobacterial infection. Anti-tuberculosis treatment resulted in a remarkable improvement in his symptoms and gradually upgrading of radiological appearance. The symptoms were less severe than some others described but this case provides evidence that, even in some cases, specific treatment may be necessary. We highlight the importance of recognizing miliary Mycobacterium bovis as a probable complication of bacillus Calmette-Guerin immunotherapy. The clinical disease course can be mild, despite extensive bilateral miliary nodules on primary presentation.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Granuloma/etiologia , Pneumonia/etiologia , Doenças Raras/etiologia , Neoplasias da Bexiga Urinária/tratamento farmacológico , Adjuvantes Imunológicos/administração & dosagem , Administração Intravesical , Idoso , Vacina BCG/administração & dosagem , Granuloma/diagnóstico por imagem , Humanos , Imunoterapia/efeitos adversos , Masculino , Pneumonia/diagnóstico por imagem , Doenças Raras/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Tuberculose Miliar/diagnóstico , Tuberculose Miliar/etiologia
11.
Medicine (Baltimore) ; 98(16): e14718, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31008920

RESUMO

Xanthogranuloma of choroid plexus is an extremely rare, benign, and mostly asymptomatic intracranial lesion. We report a case of symptomatic lateral ventricular xanthogranuloma resected via a neuronavigator-guided ventriculoscopic approach. Then we review recent English medical literature and notice that craniotomies have been the most popular treatment. But our choice of a ventriculoscopic approach possesses unique advantages such as minimized neural tissue damage, shortened operative time, less blood loss, and safer access to central structures over conventional open surgeries. Informed consent has been obtained from the patient and his immediate family regarding this case report.


Assuntos
Encefalopatias/diagnóstico , Plexo Corióideo , Granuloma/diagnóstico , Ventrículos Laterais , Xantomatose/diagnóstico , Adulto , Encefalopatias/complicações , Encefalopatias/diagnóstico por imagem , Encefalopatias/cirurgia , Granuloma/complicações , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética , Masculino , Neuroendoscopia , Exame Neurológico , Neuronavegação , Xantomatose/complicações , Xantomatose/diagnóstico por imagem , Xantomatose/cirurgia
15.
Clin Nucl Med ; 44(6): 489-490, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30829860

RESUMO

F-FDG PET/CT was performed on a 70-year-old man to stage the newly diagnosed multiple myeloma. A hypermetabolic lesion in the gallbladder fundus was revealed incidentally and suspected for gallbladder carcinoma, but was finally proven to be a cholesterol granuloma by the pathology of cholecystectomy.


Assuntos
Carcinoma/diagnóstico por imagem , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Masculino , Compostos Radiofarmacêuticos
16.
An Bras Dermatol ; 94(1): 93-95, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30726472

RESUMO

Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that allows visualization of the epidermis and papillary dermis with cellular-level resolution. Granulomatous reactions such as sarcoidosis could be assessed using RCM. The identification of bright beaded-like structures that could correspond to reticulin fibers overlying granulomas, in association with dermoscopy, may be a very useful approach in the diagnosis of sarcoidosis and for the differentiation of this granulomatous entity with superficial cutaneous metastasis.


Assuntos
Microscopia Confocal/métodos , Sarcoidose/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem , Idoso , Biópsia , Dermoscopia/métodos , Feminino , Granuloma/diagnóstico por imagem , Granuloma/patologia , Humanos , Sarcoidose/patologia , Dermatopatias/patologia
17.
An. bras. dermatol ; 94(1): 93-95, Jan.-Feb. 2019. graf
Artigo em Inglês | LILACS | ID: biblio-983740

RESUMO

Abstract: Reflectance confocal microscopy (RCM) is a noninvasive imaging technique that allows visualization of the epidermis and papillary dermis with cellular-level resolution. Granulomatous reactions such as sarcoidosis could be assessed using RCM. The identification of bright beaded-like structures that could correspond to reticulin fibers overlying granulomas, in association with dermoscopy, may be a very useful approach in the diagnosis of sarcoidosis and for the differentiation of this granulomatous entity with superficial cutaneous metastasis.


Assuntos
Humanos , Feminino , Idoso , Sarcoidose/diagnóstico por imagem , Dermatopatias/diagnóstico por imagem , Microscopia Confocal/métodos , Sarcoidose/patologia , Dermatopatias/patologia , Biópsia , Dermoscopia/métodos , Granuloma/patologia , Granuloma/diagnóstico por imagem
19.
Asian J Psychiatr ; 39: 98-100, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30599452

RESUMO

Lesion-based investigations of psychopathology have preceded contemporary network-neuroscience initiatives. However, brain-lesions detected in routine psychiatric practice are often considered incidental and therefore ignored. Here, we illustrate a strategy to combine individual subject-level lesion information with open-source normative functional-connectomics data to make putative, neuroscience-informed symptom interpretation. Specifically, we report a patient with left precuneus granulomatous lesion and seizures followed by two distinct symptoms - kinetopsia and delusions of nihilism and guilt - which had a differential treatment response. The lesion-based brain-mapping approach could identify correlated (default-mode) and anti-correlated (temporo-parieto-occipital) networks, which enabled a neurobiological formulation of these diverse clinical manifestations.


Assuntos
Neoplasias Encefálicas/complicações , Transtorno Depressivo Maior/complicações , Granuloma/complicações , Imagem por Ressonância Magnética/métodos , Lobo Parietal/diagnóstico por imagem , Esquizofrenia Paranoide/complicações , Anticonvulsivantes/uso terapêutico , Antidepressivos de Segunda Geração/uso terapêutico , Antipsicóticos/uso terapêutico , Mapeamento Encefálico/métodos , Neoplasias Encefálicas/diagnóstico por imagem , Neoplasias Encefálicas/terapia , Transtorno Depressivo Maior/psicologia , Transtorno Depressivo Maior/terapia , Diagnóstico Diferencial , Eletroconvulsoterapia , Feminino , Fluoxetina/uso terapêutico , Granuloma/diagnóstico por imagem , Granuloma/terapia , Humanos , Pessoa de Meia-Idade , Fenitoína/uso terapêutico , Fumarato de Quetiapina/uso terapêutico , Esquizofrenia Paranoide/psicologia , Esquizofrenia Paranoide/terapia , Convulsões/complicações , Convulsões/tratamento farmacológico
20.
BJU Int ; 123(2): 246-251, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-29959824

RESUMO

OBJECTIVES: To investigate the need to biopsy erythematous lesions of the bladder after bacille Calmette-Guérin (BCG) treatment as well as the diagnostic value of voided urine cytology in the detection of recurrence. MATERIALS AND METHODS: Data on 206 consecutive patients with non-muscle-invasive bladder cancer treated with one or more BCG instillations in the period 2009-2015 at Satakunta Central Hospital and Turku University Hospital were reviewed. Biopsy histology was pooled according to lesion cystoscopy appearance regarding growth pattern and presence of erythema. Voided urine cytology grading before resection was reviewed. We correlated the cystoscopy findings with histology and calculated the sensitivity, specificity, and positive (PPV) and negative predictive value (NPV) for voided urine cytology. RESULTS: In total, 159 patients with a median follow-up of 35 months were included in the study. Altogether, 367 biopsies were analysed. In the case of papillary or flat tumours, 76% of biopsies showed malignant histology and the diagnostic value of cytology was very limited (sensitivity 33%, specificity 84%). Erythematous lesions constituted 57% of all biopsy targets, with the majority being either chronic non-specific inflammation or granulomatous inflammation; 10% of erythematous lesions were malignant at pathological examination. In contrast to papillary and flat tumours, cytology proved to be more accurate in the case of erythematous lesions with a sensitivity, specificity, PPV and NPV of 59%, 76%, 23% and 94%, respectively. CONCLUSION: Bladder lesions after BCG instillations pose a challenge during follow-up and the appropriate management strategy is not clear. Lesions should not be overlooked as being BCG-induced irritation because they may harbour significant malignancies. The presence of papillary or flat tumour always warrants a biopsy or resection. In the case of erythematous lesions, our results suggest that biopsy may be avoided if voided urine cytology is negative.


Assuntos
Adjuvantes Imunológicos/efeitos adversos , Vacina BCG/efeitos adversos , Granuloma/diagnóstico por imagem , Inflamação/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/patologia , Neoplasias da Bexiga Urinária/diagnóstico por imagem , Neoplasias da Bexiga Urinária/patologia , Urina/citologia , Idoso , Idoso de 80 Anos ou mais , Biópsia , Cistoscopia , Feminino , Granuloma/induzido quimicamente , Granuloma/patologia , Humanos , Inflamação/induzido quimicamente , Inflamação/patologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Retrospectivos , Neoplasias da Bexiga Urinária/tratamento farmacológico
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