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1.
J Med Case Rep ; 15(1): 178, 2021 Apr 18.
Artigo em Inglês | MEDLINE | ID: mdl-33865452

RESUMO

BACKGROUND: Sarcoidosis is pathologically characterized by the formation of non-necrotizing epithelioid cell granulomas. However, pathological findings of patients with sarcoidosis have rarely revealed necrosis. We report here on a patient with sarcoidosis which needed to be distinguished from infectious disease because of marked necrosis in the lymph nodes. CASE PRESENTATION: A 46-year-old Japanese woman was referred to our hospital due to a dry cough and appetite loss. A chest X-ray and computed tomography revealed markedly enlarged mediastinal and hilar lymph nodes and hepatosplenomegaly. Surgical biopsy of these lymph nodes was performed in order to make a diagnosis. Pathological findings revealed epithelioid cell granuloma with marked necrosis that suggested infectious etiology such as mycobacterial and fungal infections. In addition to the pathological findings, immunoglobulin A (IgA) antibody for Mycobacterium avium complex (MAC), enlargement of lymph nodes and hepatosplenomegaly indicated disseminated MAC, while sarcoidosis was considered as another important differential diagnosis according to elevated angiotensin-converting enzyme, soluble interleukin-2 receptor and uveitis. While waiting for the results of the cultures of acid-fast bacilli, the symptoms of cough and consumption had worsened, and initiation of therapy was required before the confirmed diagnosis. The therapy for MAC was initiated because it was feared that immunosuppressive therapy containing corticosteroid for sarcoidosis could worsen the patient's condition if MAC infection was the main etiology. However, the treatment for MAC was not effective, and it was clarified that no acid-fast bacilli were cultured in the liquid culture medium, so the diagnosis was corrected to sarcoidosis after reconsideration of clinical and pathological findings. Prednisolone (30 mg/day) was administered orally, and the patient's symptoms and radiological findings improved. CONCLUSION: Sarcoidosis must be considered even if pathological findings reveal marked necrosis, because rare cases of sarcoidosis exhibit extensive necrosis in lymph nodes. It is extremely important to carefully examine the clinical and pathological findings through discussion with the examining pathologist to reach the correct diagnosis.


Assuntos
Granuloma/patologia , Linfonodos/patologia , Linfadenopatia/diagnóstico por imagem , Necrose/patologia , Sarcoidose/patologia , Biópsia , Feminino , Granuloma/diagnóstico por imagem , Hepatomegalia/diagnóstico por imagem , Humanos , Japão , Linfonodos/diagnóstico por imagem , Pessoa de Meia-Idade , Prednisolona/uso terapêutico , Sarcoidose/diagnóstico , Sarcoidose/tratamento farmacológico , Esplenomegalia/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509865

RESUMO

Drug-induced sarcoidosis-like reactions (DISRs) are systemic granulomatous diseases that develop in the context of a new drug onset. Ipilimumab is an immune checkpoint inhibitor (ICI) approved for the treatment of advanced melanoma which has been associated with DISR. Differential diagnosis between tumour progression and DISR by positron emission tomography/computed tomography (PET/CT) in patients treated with an ICI can be a challenge. A 31-year-old woman was diagnosed with a stage IIIB melanoma in her back. Ipilimumab 10 mg/kg was initiated. After 1 month of finishing the treatment a routine, PET/CT showed multiple enlarged mediastinal and hilar lymph nodes FDG-positive. A transbronchial biopsy showed sarcoid-like granulomatous infiltration which favoured the diagnosis of DISR related to ipilimumab. The patient remained asymptomatic and lymphadenopathy regressed progressively after 11 months. Our work highlights the importance of differentiating DISR from tumour progression, before unnecessary changes in therapeutic strategies. PET/CT is a useful diagnostic tool for its follow-up.


Assuntos
Granuloma/induzido quimicamente , Ipilimumab/efeitos adversos , Linfadenopatia/induzido quimicamente , Melanoma/tratamento farmacológico , Neoplasias Cutâneas/tratamento farmacológico , Adulto , Dorso , Biópsia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Fluordesoxiglucose F18 , Granuloma/diagnóstico por imagem , Granuloma/patologia , Humanos , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/patologia , Mediastino , Melanoma/diagnóstico por imagem , Melanoma/patologia , Estadiamento de Neoplasias , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Neoplasias Cutâneas/patologia
3.
Gan To Kagaku Ryoho ; 48(1): 85-87, 2021 Jan.
Artigo em Japonês | MEDLINE | ID: mdl-33468730

RESUMO

A 53-year-old woman was admitted to our hospital because of hepatic dysfunction found during a medical checkup. Cholecystitis was suspected, and unenhanced computed tomography (CT) was initially performed because she had bronchial asthma. However, a tumor-like lesion was seen at the bottom of the gallbladder. Contrast-enhanced CT was performed 3 weeks later, and the tumor-like lesion was enhanced and had increased in size. Endoscopic ultrasound fine-needle aspiration did not reveal any signs of malignancy. Colonoscopy revealed ulcerations in the transverse colon, and invasion from gallbladder cancer was suspected. Our preoperative diagnosis was xanthogranulomatous cholecystitis, but gallbladder cancer could not be excluded. Gallbladder bed resection and partial resection of the transverse colon were performed. Intraoperative frozen section analysis did not reveal any malignant findings; hence, we considered that lymph node dissection was unnecessary. Pathological examination confirmed xanthogranulomatous cholecystitis with abscess formation. In cases of surgery for xanthogranulomatous cholecystitis, it is important to consider that this condition could coexist with gallbladder cancer.


Assuntos
Colecistite , Colo Transverso , Neoplasias da Vesícula Biliar , Colecistite/cirurgia , Feminino , Vesícula Biliar , Neoplasias da Vesícula Biliar/diagnóstico por imagem , Neoplasias da Vesícula Biliar/cirurgia , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Humanos , Pessoa de Meia-Idade , Xantomatose
5.
No Shinkei Geka ; 48(10): 957-961, 2020 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-33071233

RESUMO

A 77-year-old man presented with a 6-month history of progressive right optic neuropathy secondary to compression by the ipsilateral internal carotid artery(ICA). We performed anterior clinoidectomy and optic canal unroofing. Subsequently, we wrapped the ICA with a polytetrafluoroethylene tape, pulled the vessel laterally, and sutured the tape to the dura mater at the anterior skull base for optimal decompression. An inflammatory mass lesion was observed around the ICA, which led to further compression of the optic nerve. Histopathological examination of the resected specimen showed an inflammatory granuloma. The patient's visual field deficit showed partial improvement postoperatively. Transposition using a tape might be an effective surgical alternative for compressive optic neuropathy.


Assuntos
Artéria Carótida Interna , Doenças do Nervo Óptico , Idoso , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/cirurgia , Descompressão Cirúrgica , Granuloma/complicações , Granuloma/diagnóstico por imagem , Granuloma/cirurgia , Humanos , Masculino , Nervo Óptico/diagnóstico por imagem , Nervo Óptico/cirurgia , Doenças do Nervo Óptico/diagnóstico por imagem , Doenças do Nervo Óptico/etiologia , Doenças do Nervo Óptico/cirurgia
6.
Medicine (Baltimore) ; 99(41): e22478, 2020 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-33031279

RESUMO

RATIONALE: Pleomorphic xanthoastrocytoma (PXA) is a rare low-grade glial neoplasm of the central nervous system, which is difficult to distinguish from other neoplastic and non-neoplastic entities. Herein, we report 2 cases of PXA that had been misdiagnosed as an inflammatory granuloma. PATIENT CONCERNS: The first case was a 22-year-old man who originally presented with a generalized seizure 7 years previously. Magnetic resonance imaging (MRI) revealed a lesion in the right parietal lobe, leading to a diagnosis of inflammatory granuloma. The second case was a 43-year-old man who presented with repeated generalized seizures. MRI revealed a nodular lesion in the left temporal lobe. The magnetic resonance spectrum showed elevated Cho and NAA peaks and a decreased Cr peak. An inflammatory granuloma was suspected. DIAGNOSIS: After surgical treatment, histopathological examination revealed PXA. INTERVENTIONS: In the first case, after 10 months of anti-inflammatory treatment, the lesion was significantly reduced in size. During the following 7 years, the patient experienced generalized seizures 3 to 4 times annually. To control intractable epilepsy, the lesion was resected. In the second case, conservative treatment provided no benefit, and then the lesion was resected. OUTCOMES: In the first case, during a follow-up period of 14 months, the patient was seizure-free with no tumor recurrence. In the second case, after a 6 months of follow-up, the patient remained seizure-free with no tumor recurrence. LESSONS: The preoperative differential diagnosis of PXA is challenging due to the nonspecific symptoms and imaging manifestations. Considering the potential risk of malignant transformation of PXA, early surgery should be highlighted, and gross total resection is associated with a favorable prognosis.


Assuntos
Astrocitoma/diagnóstico por imagem , Neoplasias Encefálicas/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Adulto , Astrocitoma/patologia , Astrocitoma/cirurgia , Neoplasias Encefálicas/patologia , Neoplasias Encefálicas/cirurgia , Cérebro , Diagnóstico Diferencial , Erros de Diagnóstico , Humanos , Imagem por Ressonância Magnética , Masculino , Convulsões/etiologia , Adulto Jovem
7.
Vet Radiol Ultrasound ; 61(4): 409-416, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32436257

RESUMO

Xanthogranulomatous disease is a rare condition, which can be caused by infection, inflammation, hemorrhage, immunologic disease, or inherited lysosomal disorders. It is characterized by non-intracellular lipid and cholesterol deposits among an inflammatory infiltrate of vacuolated macrophages and giant cells. The diagnosis of xanthogranulomatous disease is challenging, with nonspecific imaging findings often misinterpreted as aggressive neoplastic processes in humans. In this retrospective case series study, we describe the diagnostic imaging characteristics of a disseminated xanthogranulomatous condition identified in five eclectus parrots (Eclectus roratus). Decreased serosal detail and celomic distension were present in all three birds radiographed, with multifocal variably sized celomic mineralization (3/3 birds), and extracelomic mineralized masses (1/3 birds). Celomic effusion with foci of celomic mineralization and hepatomegaly were identified in all birds (3/3) imaged with ultrasound. Finally, a mineralized mural ventricular mass was present in one of three patients imaged with CT, multifocal celomic mineralization with moderate to severe celomic effusion in two of three patients, diffuse severe proventricular and intestinal dilation in all three patients, and atherosclerosis of the major arterial trunks in all three patients. Veterinary radiologists should be aware of this inflammatory condition in birds, especially in eclectus parrots, and should be able to recognize the imaging features of xanthogranulomatous inflammation.


Assuntos
Doenças das Aves/diagnóstico por imagem , Granuloma/veterinária , Papagaios , Xantomatose/veterinária , Animais , Feminino , Granuloma/diagnóstico por imagem , Inflamação/veterinária , Estudos Retrospectivos , Xantomatose/diagnóstico por imagem
9.
Clin Nucl Med ; 45(5): 398-400, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32149806

RESUMO

We present a case with an unexpected nodule in the thymus showing increased F-FDG uptake on PET/CT. The nodule was surgically removed. Histopathologic examination revealed granuloma in the thymus. This case indicates physicians and radiologists must be aware that although thymic granuloma is rare, it should be included in the differential diagnosis of the thymic lesions with F-FDG accumulation along with neoplastic and nonneoplastic conditions.


Assuntos
Fluordesoxiglucose F18 , Granuloma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias do Timo/diagnóstico por imagem , Adulto , Diagnóstico Diferencial , Feminino , Granuloma/patologia , Humanos , Neoplasias do Timo/patologia
10.
Vet Radiol Ultrasound ; 61(3): 269-278, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32020759

RESUMO

Cholesterinic granulomas are mass-like lesions that form at the choroid plexus of the ventricular system. Large cholesterinic granulomas within the lateral ventricles have been reported to cause severe neurological signs. However, little data are available about their prevalence or appearance in the overall population. The objective was to report the prevalence of presumed cholesterinic granulomas on CT in a population of horses, and investigate associations between presumed cholesterinic granuloma presence, lateral ventricle size, age, and neurological signs. The study was cross sectional, CT scans of the head were assessed for presumed cholesterinic granuloma presence and size, and lateral ventricle height. Computed tomography findings and clinical information were compared using nonparametric testing. Computed tomography scans of 139 horses were included. Presumed cholesterinic granulomas were found in 22 horses (15.8%), nine were unilateral and 13 bilateral. A significant increase in prevalence was observed with age (P < .0001), with 38% of horses over 15 years old affected. The median volume of presumed cholesterinic granulomas was 242 mm3 with a range from 51 to 2420 mm3 . The mean lateral ventricle height was significantly increased in horses with presumed cholesterinic granulomas present (P = .004), with a median of 7.3 mm compared to 4.9 mm without. Neurological signs were not associated with presumed cholesterinic granuloma presence or lateral ventricle height. Fourth ventricle mineralizations were found in seven horses, which may represent cholesterinic granulomas. In conclusion, presumed cholesterinic granulomas occurred in a large proportion of the examined population and are associated with increased lateral ventricle dilation and advanced age.


Assuntos
Encefalopatias/veterinária , Calcinose/veterinária , Quarto Ventrículo/diagnóstico por imagem , Granuloma/veterinária , Doenças dos Cavalos/diagnóstico por imagem , Animais , Encefalopatias/diagnóstico por imagem , Encefalopatias/patologia , Calcificação Fisiológica , Calcinose/diagnóstico por imagem , Calcinose/patologia , Plexo Corióideo/patologia , Estudos Transversais , Feminino , Quarto Ventrículo/patologia , Granuloma/diagnóstico por imagem , Granuloma/patologia , Doenças dos Cavalos/patologia , Cavalos , Ventrículos Laterais/patologia , Masculino , Tomografia Computadorizada por Raios X/veterinária
12.
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 , Imageamento por Ressonância Magnética Multiparamétrica , Neoplasias da Próstata/diagnóstico por imagem , Prostatite/diagnóstico por imagem , Diagnóstico Diferencial , Granuloma/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Prostatite/complicações
13.
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
14.
Clin Nucl Med ; 45(4): 314-315, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31977494

RESUMO

On restaging FDG PET/CT for an 81-year-old man with oral cavity cancer, a large FDG-avid mesenteric mass suspicious for either metastasis or second primary was incidentally noted. Surgical pathology showed necrotizing granulomatous inflammation without evidence of tumor. All stains were negative for microorganisms. An elastin stain was negative as well, which excluded an origin of damaged blood vessels or vasculitis. The patient had no prior abdominal surgery or known gastrointestinal disease. Granuloma always poses a dilemma in the interpretation of PET/CT, due to its high FDG avidity and mass-like appearance which mimics neoplastic disease.


Assuntos
Granuloma/diagnóstico por imagem , Neoplasias Bucais/patologia , Neoplasias Peritoneais/secundário , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso de 80 Anos ou mais , Diagnóstico Diferencial , Fluordesoxiglucose F18 , Humanos , Masculino , Neoplasias Bucais/diagnóstico por imagem , Necrose , Neoplasias Peritoneais/diagnóstico por imagem , Peritônio/patologia , Compostos Radiofarmacêuticos
17.
Clin Nucl Med ; 45(3): 234-235, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31833933

RESUMO

An old woman with abdominal pain complained a palpable mass on the right anterior abdominal wall. On PET/CT images, the lesion presented as a soft tissue mass with irregular shape, invading adjacent peritoneum and showing intense FDG uptake. Based on imaging findings, a malignancy was suspected, and she underwent surgical resection. However, the abdominal wall mass was diagnosed as granulomatous inflammation with a little necrosis by pathological results. Awareness of this benign disease is helpful for an accurate diagnosis of abdominal wall mass.


Assuntos
Neoplasias Abdominais/diagnóstico por imagem , Parede Abdominal/diagnóstico por imagem , Fluordesoxiglucose F18 , Granuloma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Idoso , Diagnóstico Diferencial , Feminino , Humanos
18.
Clin Nucl Med ; 45(3): e169-e170, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31876826

RESUMO

We report herein the case of a 33-year-old woman who was referred for FDG PET/CT staging prior to pregnancy after a 4-year lost to follow-up for a breast invasive ductal carcinoma (pT2N1 SBRII). FDG PET/CT revealed right supraclavicular lymphadenopathy potentially caused by breast carcinoma recurrence. No additional site was involved. Supraclavicular ultrasonography showed typical "snowstorm" appearance. MRI revealed signs of breast implant intracapsular rupture and signal intensity of silicone within a supraclavicular node. Fine-needle aspiration and microbiopsy of adenopathy finally confirmed silicone granuloma and ruled out breast cancer recurrence.


Assuntos
Neoplasias da Mama/cirurgia , Fluordesoxiglucose F18 , Granuloma/diagnóstico por imagem , Granuloma/etiologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Silicones/efeitos adversos , Adulto , Idoso , Biópsia por Agulha Fina , Neoplasias da Mama/complicações , Feminino , Seguimentos , Granuloma/patologia , Humanos , Pessoa de Meia-Idade
19.
Int J Neurosci ; 130(5): 435-437, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31679396

RESUMO

Neurosarcoidosis is a rare inflammatory neurological condition. We describe a challenging radiological presentation of neurosarcoidosis. The eclipse sign refers to hypo T1-weighted parenchymal or leptomeningeal images surrounded by circular gadolinium enhancement. The eclipse sign was identified in 3 out of 46 patients with histologically-proven neurosarcoidosis. The eclipse sign may correspond to necrotizing parenchymal or leptomeningeal granuloma. This sign expands the spectrum of radiological presentations of neurosarcoidosis.


Assuntos
Encéfalo/diagnóstico por imagem , Doenças do Sistema Nervoso Central/diagnóstico por imagem , Granuloma/diagnóstico por imagem , Meninges/diagnóstico por imagem , Sarcoidose/diagnóstico por imagem , Adulto , Encéfalo/patologia , Doenças do Sistema Nervoso Central/patologia , Feminino , Gadolínio , Granuloma/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Meninges/patologia , Pessoa de Meia-Idade , Sarcoidose/patologia
20.
Orbit ; 39(1): 31-37, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31021176

RESUMO

Adult xanthogranulomatous disease of the orbit is a rare and incompletely understood entity. It can be limited to the orbit or be associated with systemic disease. While routine systemic surveillance is the standard of care for patients with orbital xanthogranulomatous disease, there is no universally accepted protocol for managing periorbital and orbital involvement. The authors report a case of adult orbital xanthogranuloma, without systemic disease, who, after 10 years of observation, demonstrated sustained radiographic regression of the lesions. To the authors' knowledge, this represents one of the first reports of spontaneous regression of untreated orbital xanthogranuloma, and supports observation of lesions that do not compromise ocular function. We present our case in the context of a major review of various treatment strategies described in the literature, including surgical resection, radiotherapy, plasmapheresis, corticosteroids, multiple immunomodulatory medications.


Assuntos
Granuloma/patologia , Imagem por Ressonância Magnética/métodos , Doenças Orbitárias/patologia , Remissão Espontânea , Xantomatose/patologia , Idoso , Biópsia por Agulha , Meios de Contraste , Granuloma/diagnóstico por imagem , Humanos , Imuno-Histoquímica , Masculino , Doenças Orbitárias/diagnóstico por imagem , Doenças Raras , Xantomatose/diagnóstico por imagem
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