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1.
Pan Afr Med J ; 36: 257, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33014253

RESUMO

Since asymptomatic infections as "covert transmitter", and some patients can progress rapidly in the short term, it is essential to pay attention to the diagnosis and surveillance of asymptomatic patients with SARS-COV2 infection. CT scan has great value in screening and detecting patients with COVID-19 pneumonia, especially in the highly suspected or probable asymptomatic cases with negative RT-PCR for SARS-COV2. This study aimed to detect incidentally COVID-19 pneumonia on medical imaging for patients consulting for other reasons.


Assuntos
Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico por imagem , Pulmão/diagnóstico por imagem , Pandemias , Pneumonia Viral/diagnóstico por imagem , Dor Abdominal/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Assintomáticas , Lesões Encefálicas/complicações , Dor no Peito/complicações , Criança , Pré-Escolar , Infecções por Coronavirus/complicações , Infecções por Coronavirus/diagnóstico , Feminino , Humanos , Achados Incidentais , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Masculino , Pessoa de Meia-Idade , Derrame Pleural/diagnóstico por imagem , Derrame Pleural/etiologia , Pneumonia Viral/complicações , Estudos Prospectivos , Tomografia Computadorizada por Raios X/métodos , Tunísia/epidemiologia , Adulto Jovem
2.
J Med Case Rep ; 14(1): 124, 2020 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-32771058

RESUMO

BACKGROUND: As the outbreak of coronavirus disease 2019 (COVID-19) has progressed, computed tomography has emerged as an integral part of the diagnosis alongside reverse transcriptase-polymerase chain reaction assays. Frequently encountered imaging findings include peripheral airspace consolidations; bilateral ground-glass opacities; and, less commonly, cavitation. Hilar lymphadenopathy is a rarely reported finding in the setting of COVID-19. CASE PRESENTATION: A 73-year-old Caucasian woman presented to our hospital with fever and fatigue. She had a maximum body temperature of 102.3 °F with lymphopenia and thrombocytopenia. She was diagnosed with severe acute respiratory syndrome coronavirus 2 infection on the basis of a positive result from a reverse transcriptase-polymerase chain reaction of a nasopharyngeal swab sample. Contrast-enhanced chest computed tomography revealed multifocal, subpleural ground-glass opacities with nodular consolidations bilaterally. Computed tomography also demonstrated atypical bilateral hilar lymphadenopathy, a rarely reported imaging feature of COVID-19. Chest computed tomography 1 month before the presentation did not show focal consolidations or lymphadenopathy. This indicated that the findings were due to the patient's severe acute respiratory syndrome coronavirus 2 infection. She received 5 days of oral hydroxychloroquine and experienced resolution of her symptoms. CONCLUSION: Chest computed tomography has been used extensively to diagnose and characterize the distinguishing radiological findings associated with viral pneumonia. It has emerged as an integral part of the diagnosis of COVID-19 alongside reverse transcriptase-polymerase chain reaction assays. Clinicians must be aware of uncommon clinical and radiological findings in order to diagnose this entity. Hilar lymphadenopathy is commonly seen with fungal infections, mycobacterial infections, and sarcoidosis. An extensive literature review found that bilateral hilar lymphadenopathy has not been reported in the setting of COVID-19. More data are needed to establish the clinical impact of this novel finding.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Linfadenopatia/diagnóstico por imagem , Linfadenopatia/etiologia , Pneumonia Viral/complicações , Tomografia Computadorizada por Raios X/métodos , Idoso , Infecções por Coronavirus/tratamento farmacológico , Inibidores Enzimáticos/uso terapêutico , Feminino , Humanos , Hidroxicloroquina/uso terapêutico , Pulmão/diagnóstico por imagem , Linfadenopatia/tratamento farmacológico , Pandemias , Pneumonia Viral/tratamento farmacológico
6.
BMC Infect Dis ; 20(1): 258, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32234012

RESUMO

BACKGROUND: Mycobacterial species other than Mycobacterium tuberculosis and Mycobacterium leprae are generally free-living organisms and Mycobacterium simiae is one of the slowest growing Non-tuberculous mycobacteria. This is the first case report of Mycobacterium simiae infection in Sri Lanka and only very few cases with extrapulmonary manifestation reported in the literature. CASE PRESENTATION: A 24-year-old, previously healthy Sri Lankan male presented with generalized lymphadenopathy with discharging sinuses, evening pyrexia, weight loss, poor appetite and splenomegaly. Lymph node biopsies showed sheets of macrophages packed with organisms in the absence of granulomata. Ziehl Neelsen, Wade Fite and Giemsa stains revealed numerous red coloured acid-fast bacilli within foamy histiocytes. Slit skin smear for leprosy was negative and tuberculosis, fungal and bacterial cultures of the lymph node and bone marrow did not reveal any growth. Later he developed watery diarrhea and colonoscopy revealed multiple small polyps and ulcers throughout the colon extending up to the ileum, Which was confirmed to be due to cytomegalovirus confirmed by PCR and successfully treated with ganciclovir. Positron emission tomography scan guided biopsies of the gut and lymph nodes confirmed presence of mycobacterial spindle cell pseudo-tumours and PCR assays revealed positive HSP65. The culture grew Mycobacterium Simiae. Flow cytometry analysis on patient's blood showed extremely low T and B cell counts and immunofixation revealed low immunoglobulin levels. His condition was later diagnosed as adult onset immunodeficiency due to anti- interferon - gamma autoantibodies. He was initially commenced on empirical anti-TB treatment with atypical mycobacterial coverage. He is currently on a combination of daily clarithromycin, ciprofloxacin, linezolid with monthly 2 g/kg/intravenous immunoglobulin to which, he had a remarkable clinical response with complete resolution of lymphadenopathy and healing of sinuses. CONCLUSIONS: This infection is considered to be restricted to certain geographic areas such as mainly Iran, Cuba, Israel and Arizona and this is the first case report from Sri lanka. Even though the infection is mostly seen in the elderly patients, our patient was only 24 years old. In the literature pulmonary involvement was common presentation, but in this case the patient had generalized lymphadenopathy and colonic involvement without pulmonary involvement.


Assuntos
Síndromes de Imunodeficiência/imunologia , Infecções por Mycobacterium não Tuberculosas/microbiologia , Mycobacterium/patogenicidade , Autoanticorpos/sangue , Ciprofloxacino/uso terapêutico , Claritromicina/uso terapêutico , Humanos , Biópsia Guiada por Imagem , Interferon gama/sangue , Linfonodos/microbiologia , Linfadenopatia/etiologia , Masculino , Infecções por Mycobacterium não Tuberculosas/tratamento farmacológico , Infecções por Mycobacterium não Tuberculosas/patologia , Tomografia por Emissão de Pósitrons , Sri Lanka , Adulto Jovem
7.
Ann R Coll Surg Engl ; 102(7): e167-e169, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32347740

RESUMO

Lymphadenopathy is a common presentation in surgical assessment units and has numerous differential diagnoses. In one-stop breast clinics, its discovery often raises concerns of malignancy. This case report focuses on the case of a 33-year-old pregnant woman presenting to the breast clinic with a right axillary lump, which was found to be the result of toxoplasmosis.


Assuntos
Linfadenopatia/etiologia , Complicações Parasitárias na Gravidez , Toxoplasmose/complicações , Adulto , Axila , Biópsia , Diagnóstico Diferencial , Feminino , Humanos , Linfonodos/patologia , Linfadenopatia/diagnóstico , Gravidez , Toxoplasmose/diagnóstico , Ultrassonografia Mamária/métodos
8.
BMC Infect Dis ; 20(1): 224, 2020 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-32171271

RESUMO

BACKGROUND: Cervical lymphadenopathy refers to a frequently observed clinical presentation in numerous pathological conditions. A wide spectrum of diseases can cause cervical lymphadenopathy, irrespective of the fact that the patients are infected with HIV or not. The present study focuses on validating whether the causes of cervical lymphadenopathy differ significantly in HIV and non-HIV patients by using fine-needle aspiration cytology (FNAC) combining cell block. METHODS: A total of 589 patients with cervical lymphadenopathy were recruited in the FNA clinic. The samples were obtained by an auto-vacuumed syringe that benefited the sampling more materials. The cytological smears were prepared by Hematoxylin and Eosin (HE), Periodic Acid Schiff (PAS), Gomori's methenamine silver (GMS) and acid-fast staining. Cell blocks were made if required, and immunohistochemistry stain was performed on the cell block section. RESULTS: The study found 453 (76.9%) patients with HIV and 136 (23.1%) patients without HIV infection. The average age of HIV-infected patients was 34.8 ± 10.2 years, which was significantly lower than that of non-HIV-infected patients (42.9 ± 18.1 years) (p < 0.01). Of all patients infected with HIV, 390 (86.1%) were males. This proportion was significantly higher than that of non-HIV-infected patients [65/136 (47.8%)] (p < 0.01). The major causes of cervical lymphadenopathy in HIV positive patients were mycobacterial infection (38.4%), reactive hyperplasia (28.9%), non-specific inflammation (19.9%), and malignant lesions (4.2%). In contrast, the most common causes in HIV negative patients were reactive hyperplasia (37.5%), malignancy (20.6%), non-specific inflammation (19.1%) and mycobacterial infection (12.5%). Opportunistic infections such as non-tuberculous mycobacteria (4.2%), cryptococcosis (1.5%), Talaromyces marneffei (1.5%) and other fungi (0.4%) were found only in HIV-infected individuals. Non-Hodgkin's lymphoma (2.4%) was the most common malignant lesion in patients with HIV infection, followed by Kaposi's sarcoma (0.9%) and metastatic squamous cell carcinomas (0.7%). However, the most common malignancy in non-HIV-infected patients was metastatic carcinomas (14%) including small cell carcinomas, adenocarcinomas, squamous cell carcinomas and hepatocellular carcinoma, which were noticeably greater than the HIV patients (p < 0.01). CONCLUSIONS: There were significantly different causes of cervical lymphadenopathy in HIV infected and non-HIV infected patients. FNAC was a useful diagnostic method for differential diagnosis of cervical lymphadenopathy.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , HIV/isolamento & purificação , Linfonodos/patologia , Linfadenopatia/diagnóstico , Linfadenopatia/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/virologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Biópsia por Agulha Fina/métodos , Criança , China/epidemiologia , Comorbidade , Diagnóstico Diferencial , Feminino , Humanos , Hiperplasia/complicações , Hiperplasia/diagnóstico , Incidência , Linfadenopatia/etiologia , Linfadenopatia/virologia , Masculino , Pessoa de Meia-Idade , Infecções por Mycobacterium/complicações , Infecções por Mycobacterium/diagnóstico , Pescoço , Adulto Jovem
9.
BMC Infect Dis ; 20(1): 216, 2020 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-32164559

RESUMO

BACKGROUND: Tick-borne lymphadenopathy (TIBOLA) is an infectious disease, mainly caused by species from the spotted fever group rickettsiae and is characterized by enlarged lymph nodes following a tick bite. Among cases of TIBOLA, a case of scalp eschar and neck lymphadenopathy after tick bite (SENLAT) is diagnosed when an eschar is present on the scalp, accompanied by peripheral lymphadenopathy (LAP). Only a few cases of SENLAT caused by Bartonella henselae have been reported. CASE PRESENTATION: A 58-year-old male sought medical advice while suffering from high fever and diarrhea. Three weeks before the visit, he had been hunting a water deer, and upon bringing the deer home discovered a tick on his scalp area. Symptoms occurred one week after hunting, and a lump was palpated on the right neck area 6 days after the onset of symptoms. Physical examination upon presentation confirmed an eschar-like lesion on the right scalp area, and cervical palpation revealed that the lymph nodes on the right side were non-painful and enlarged at 2.5 × 1.5 cm. Fine needle aspiration of the enlarged lymph nodes was performed, and results of nested PCR for the Bartonella internal transcribed spacer (ITS) confirmed B. henselae as the causative agent. CONCLUSION: With an isolated case of SENLAT and a confirmation of B. henselae in Korea, it is pertinent to raise awareness to physicians in other Asian countries that B. henselae could be a causative agent for SENLAT.


Assuntos
Angiomatose Bacilar/etiologia , Bartonella henselae/patogenicidade , Linfadenopatia/etiologia , Dermatoses do Couro Cabeludo/etiologia , Picadas de Carrapatos/complicações , Angiomatose Bacilar/tratamento farmacológico , Animais , Bartonella henselae/genética , Bartonella henselae/isolamento & purificação , Humanos , Linfadenopatia/tratamento farmacológico , Linfadenopatia/patologia , Masculino , Pessoa de Meia-Idade , Pescoço/microbiologia , Pescoço/patologia , República da Coreia , Dermatoses do Couro Cabeludo/tratamento farmacológico , Dermatoses do Couro Cabeludo/microbiologia
10.
Pediatrics ; 145(4)2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32217740

RESUMO

Idiopathic acute eosinophilic pneumonia is a rare and potentially life-threatening condition that is defined by bilateral pulmonary infiltrates and fever in the presence of pulmonary eosinophilia. It often presents acutely in previously healthy individuals and can be difficult to distinguish from infectious pneumonia. Although the exact etiology of idiopathic acute eosinophilic pneumonia remains unknown, an acute hypersensitivity reaction to an inhaled antigen is suggested, which is further supported by recent public health risks of vaping (electronic cigarette) use and the development of lung disease. In this case, a patient with a year-long history of vaping in conjunction with tetrahydrocannabinol cartridge use who was diagnosed with idiopathic acute eosinophilic pneumonia with associated bilateral hilar lymphadenopathy is described.


Assuntos
Dronabinol/toxicidade , Linfadenopatia/etiologia , Psicotrópicos/toxicidade , Eosinofilia Pulmonar/etiologia , Vaping/efeitos adversos , Adolescente , Corticosteroides/uso terapêutico , Sistemas Eletrônicos de Liberação de Nicotina , Feminino , Humanos , Linfadenopatia/diagnóstico , Linfadenopatia/tratamento farmacológico , Eosinofilia Pulmonar/diagnóstico , Eosinofilia Pulmonar/diagnóstico por imagem , Eosinofilia Pulmonar/tratamento farmacológico
12.
BMJ Case Rep ; 13(2)2020 Feb 09.
Artigo em Inglês | MEDLINE | ID: mdl-32041756

RESUMO

A 25-year-old woman presented a challenging diagnosis of acute rheumatic fever (ARF). Initial symptoms included dry cough and three minor Jones criteria (unabating fever (38.4°C, 0d), elevated acute phase reactants (C-reactive protein, 13d) and joint pain (monoarthralgia) in her neck (0d)). ARF was diagnosed only after presentation of two major Jones criteria (polyarthritis/polyarthralgia (16d) and erythema marginatum (41d)) and positive antistreptolysin O titre (44d). Parotid swelling, peripheral oedema, elevated liver enzymes and diffuse lymphadenopathy complicated the diagnosis. Throat swab, chorea and carditis were negative or absent. Atypical ARF is challenging to recognise. There is no diagnostic test and its presentation is similar to that of other diseases. While the 2015 Jones criteria modification increased specificity of ARF diagnosis, atypical cases may still be missed, especially by physicians in developed countries. Suspicion of atypical ARF, especially after travel to high incidence regions, would allow for earlier treatment and prevention of rheumatic heart disease.


Assuntos
Febre Reumática/complicações , Febre Reumática/diagnóstico , Adulto , Antiestreptolisina/sangue , Artralgia/etiologia , Artrite/etiologia , Região do Caribe/epidemiologia , Tosse/etiologia , Diagnóstico Tardio , Edema/etiologia , Eritema/etiologia , Feminino , Febre/etiologia , Humanos , Linfadenopatia/etiologia , Diagnóstico Ausente , Sensibilidade e Especificidade , Avaliação de Sintomas , Sinovite/etiologia
13.
Int J Pediatr Otorhinolaryngol ; 131: 109851, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31901484

RESUMO

OBJECTIVES: To systematically evaluate the clinico-diagnostic profile and management outcomes of otorhinolaryngologic manifestations of Extranodal Rosai-Dorfman Disease (ENRDD) in the pediatric population. METHODS: The search terms Rosai Dorfman Disease and Sinus Histiocytosis were used to query PubMed, Ovid/Medline, and Scopus databases from inception through September 30, 2018. Studies were systematically reviewed in accordance to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) protocol. All reports of ENRDD involving at least one otorhinolaryngologic subsite in children less than 18 years were eligible for inclusion. RESULTS: A total of 31 studies met inclusion criteria resulting in identification of 31 ENRDD cases with a mean age of 11.5 years. Of the 31 patients, 23 were male (74.2%) and 7 were female (22.6%). Extranodal lesions were limited to otorhinolaryngologic subsites in 24 patients (77.4%), while 7 patients (22.5%) were found to have extranodal lesions simultaneously involving otorhinolaryngologic and nonotorhinolaryngologic sites. The nasal vault was the most common otorhinolaryngologic site involved (n = 13, 41.9%), followed by the paranasal sinuses (n = 10, 32.3%). The most common non-otorhinolaryngologic site that was concurrently involved was the orbit (n = 4, 57.1%). Concurrent cervical lymphadenopathy was present in 19 patients (61.2%). While not documented for 2 cases, emperipolesis on histopathology was confirmed in 29 patients (93.5%). Single therapy with surgical excision was the most common modality of treatment (n = 15, 53.6%) and yielded highest remission rates (80%). In 11 instances (34.36%), ENRDD was misdiagnosed. CONCLUSION: Pediatric ENRDD is a rare disease entity that maintains a high misdiagnosis potential. The most common otorhinolaryngologic location for extranodal manifestation is the sinonasal compartment. Surgical excision remains the most common treatment modality yielding lowest persistence and/or recurrence rates.


Assuntos
Histiocitose Sinusal/complicações , Doenças Nasais/etiologia , Doenças Orbitárias/etiologia , Doenças dos Seios Paranasais/etiologia , Criança , Erros de Diagnóstico , Emperipolese , Cabeça , Histiocitose Sinusal/diagnóstico , Histiocitose Sinusal/patologia , Histiocitose Sinusal/cirurgia , Humanos , Linfadenopatia/etiologia , Cavidade Nasal , Pescoço
15.
Biomedica ; 39(4): 631-638, 2019 12 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31860175

RESUMO

Pediculosis capitis is the most frequent ectoparasitosis around the world. The infestation is caused by Pediculus humanus capitis (head louse), which affects hair, scalp, and skin. It rarely presents with more symptoms and in the majority of the cases, it shows a benign course if treated properly. We present the case of a nursery school girl with head lice infestation for 18 months. She did not improve after the shampoo treatment. This case was associated with furunculosis, skin lesions, multiple adenopathies, and anemia. Initially, the presence of boils, alopecia, and lymphadenopathy was evident. The persistence of pediculosis capitis and intense scratching induced changes on skin integrity, facilitating opportunistic bacterial superinfection that led to impetiginization, furunculosis, excoriations, hematic scabs, anemia, alopecia, and lymphadenopathies. Pediculosis capitis affected the patient triggering psychological, economic, social, and other health problems. The patient presented uncommon symptoms (furunculosis, anemia, fever, alopecia, and adenopathies) resulting from the persistence of risk factors and the absence of head inspection and mechanical removal of insects. The education about the risk factors, as well as sanitary controls, are essential to contain the infestation.


Assuntos
Infestações por Piolhos/complicações , Pediculus , Alopecia/etiologia , Anemia/etiologia , Animais , Pré-Escolar , Dermatoses Faciais/etiologia , Feminino , Furunculose/etiologia , Furunculose/patologia , Humanos , Resistência a Inseticidas , Inseticidas/administração & dosagem , Infestações por Piolhos/diagnóstico , Infestações por Piolhos/terapia , Linfadenopatia/etiologia , Permetrina/administração & dosagem , Pobreza , Prurido/etiologia , Escolas Maternais
16.
Blood ; 134(21): 1787-1795, 2019 11 21.
Artigo em Inglês | MEDLINE | ID: mdl-31751486

RESUMO

Common variable immune deficiency (CVID) is one of the most common congenital immune defects encountered in clinical practice. The condition occurs equally in males and females, and most commonly in the 20- to 40-year-old age group. The diagnosis is made by documenting reduced serum concentrations of immunoglobulin G (IgG), IgA, and usually IgM, together with loss of protective antibodies. The genetics of this syndrome are complex and are still being unraveled, but the hallmarks for most patients, as with other immune defects, include acute and chronic infections of the sinopulmonary tract. However, other noninfectious autoimmune or inflammatory conditions may also occur in CVID, and indeed these may be the first and only sign that a significant immune defect is present. These manifestations include episodes of immune thrombocytopenia, autoimmune hemolytic anemia, or neutropenia, in addition to splenomegaly, generalized or worrisome lymphadenopathy, and malignancy, especially lymphoma. These issues commonly bring the patient to the attention of hematologists for both evaluation and treatment. This article discusses 3 cases in which patients with CVID had some of these presenting issues and what hematology input was required.


Assuntos
Imunodeficiência de Variável Comum/complicações , Imunodeficiência de Variável Comum/diagnóstico , Anemia Hemolítica Autoimune/etiologia , Humanos , Linfadenopatia/etiologia , Linfoma/etiologia , Masculino , Pessoa de Meia-Idade , Esplenomegalia/etiologia
17.
Z Gastroenterol ; 57(11): 1298-1303, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31739375

RESUMO

BACKGROUND: Immunoglobulin G4-related disease (IgG4-RD) can involve different organs and is diagnosed by a combination of clinicopathological features, including storiform fibrosclerosis infiltrated by numerous IgG4-positive plasma cells that frequently forms tumor-like lesions with or without associated obliterative phlebitis. Involvement of the stomach is rare and can occur as part of a multiorgan involvement of IgG4-RD or as isolated gastric involvement. CASE REPORT: We report 2 female patients with therapy-refractory gastric ulcers associated with gastric wall thickening and lymphadenopathy that were highly suggestive of gastric cancer or lymphoma. Biopsies failed to confirm a diagnosis, and IgG4-RD was diagnosed only after surgical resection in both patients. The previous literature on gastric IgG4-RD is summarized and shows different characteristics in patients with multiorgan IgG4-RD and isolated gastric IgG4-RD. As reported for autoimmune pancreatitis type 1, patients with multiorgan IgG4-RD are mainly elderly men with frequently elevated serum IgG4 concentrations. In contrast, isolated gastric IgG4-RD predominantly affects female patients with normal serum IgG4 levels. Surgical resection is commonly performed due to the clinical suspicion of malignancy and the absence of findings indicative of IgG4-RD on biopsy. Today, diagnosis is confirmed histopathologically only after resection. CONCLUSION: IgG4-RD should be taken into account when gastric malignancy is suspected endoscopically or radiologically and biopsies fail to confirm the presence of a malignancy (especially subepithelial tumors or refractory gastric ulcers). Serum IgG4 concentrations are insufficient to confirm localized gastric IgG4-RD. Diagnostic workups need to be improved to avoid unnecessary surgical resections with the attendant potential morbidity and mortality.


Assuntos
Doença Relacionada a Imunoglobulina G4/diagnóstico , Imunoglobulina G/sangue , Plasmócitos/imunologia , Idoso , Biomarcadores/análise , Diagnóstico Diferencial , Feminino , Humanos , Doença Relacionada a Imunoglobulina G4/imunologia , Doença Relacionada a Imunoglobulina G4/cirurgia , Linfadenopatia/etiologia , Neoplasias Gástricas/diagnóstico
18.
Pathol Res Pract ; 215(12): 152699, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31708371

RESUMO

Amyloidosis is characterized by extracellular deposition of insoluble protein fibrils in a beta-pleated sheet configuration. Breast amyloidosis is a rare entity which has previously been reported to present with localized involvement, or as a late manifestation of systemic amyloidosis. However, descriptions of the clinicopathologic features of localized breast amyloidosis remain limited. A retrospective search for breast amyloidosis diagnosed at our institution yielded 10 cases of breast amyloidosis. All patients were female, with a mean age of 69. Median follow-up for survival or progression was 13 months. Indications for breast or axilla biopsy included mammographic calcifications, mass, and axillary lymphadenopathy. Amyloid showed positive staining with Congo red in all cases, and amyloid typing revealed light chain lambda in 3 cases, amyloid transthyretin in 2 cases, light chain kappa in 1 case, and iatrogenic insulin-derived amyloidosis in 1 case. Amyloid occurred within axillary lymph nodes and alongside both benign and neoplastic breast tissue, including atypical ductal hyperplasia, lobular carcinoma in situ and ductal carcinoma in situ. Most cases were associated with predisposing clinical conditions, including autoimmune disease in 4 cases, B cell lymphomas in 2 cases, and diabetes mellitus treated with insulin in 1 case. In contrast to previously published case series, no patient had clinical evidence of systemic amyloidosis. Amyloidosis of the breast should be considered in the differential diagnosis of all mammographic calcifications and masses of the breast or axilla. When recognized correctly on biopsy, the diagnosis of amyloidosis can not only prevent further unnecessary surgical interventions due to radiology-pathology discordance, but initiate the necessary amyloidosis work-up. Although rare, an awareness of the clinicopathologic characteristics of this easily overlooked entity is of great importance for every practicing pathologist reviewing breast biopsies.


Assuntos
Amiloidose/patologia , Doenças Mamárias/patologia , Neoplasias da Mama/patologia , Calcinose/patologia , Linfadenopatia/patologia , Idoso , Idoso de 80 Anos ou mais , Amiloide/análise , Amiloidose/etiologia , Amiloidose/metabolismo , Biópsia , Doenças Mamárias/etiologia , Doenças Mamárias/metabolismo , Calcinose/etiologia , Calcinose/metabolismo , Diagnóstico Diferencial , Feminino , Humanos , Linfadenopatia/etiologia , Linfadenopatia/metabolismo , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo
19.
BMJ Case Rep ; 12(11)2019 Nov 24.
Artigo em Inglês | MEDLINE | ID: mdl-31767610

RESUMO

Sinus histiocytosis with massive lymphadenopathy (Rosai-Dorfman disease) is a non-Langerhan cell histiocytosis which primarily involves lymph nodes. Extranodal involvement in the form of cutaneous plaques can occur and can pose a diagnostic challenge because of pleomorphic presentation and histopathological mimics. Rarely, systemic autoimmune involvement may complicate the disease process. We present a 28-year-old woman with slowly evolving scaly erythematous cutaneous plaques and fluctuating lymphadenopathy, associated with autoimmune haemolytic anaemia. The patient responded favourably to oral corticosteroids and acitretin with significant flattening of cutaneous plaques, reduction in size of neck nodes and improvement of anaemia.


Assuntos
Anemia Hemolítica Autoimune/complicações , Eritema/etiologia , Histiocitose Sinusal/complicações , Linfadenopatia/etiologia , Adulto , Feminino , Humanos
20.
BMC Oral Health ; 19(1): 223, 2019 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-31638953

RESUMO

BACKGROUND: Kikuchi-Fujimoto disease, known as histiocytic necrotizing lymphadenitis, is a benign, self-limiting and systemic disorder involving lymph nodes with unknown aetiology. First reported in Japan, there has been an increase in its incidence globally. Because of its non-specific clinical features, the disease can be easily mistaken for other forms of lymphadenitis with a high rate of misdiagnosis and mistreatment, posing a considerable challenge. CASE PRESENTATION: A case of young Chinese woman with fever and cervical lymphadenopathy is presented. Physical examinations and imaging techniques were used to rule out common forms of lymphadenitis (e.g. cat-scratch disease and tuberculous lymphadenitis). Laboratory tests were then conducted to exclude others such as systemic lupus erythematosus and non-Hodgkin lymphoma. After Kikuchi-Fujimoto disease was identified, the patient was managed with symptomatic treatments. Our case was compared with relevant cases in the literature. A diagnostic flow chart was proposed to facilitate the diagnosis and treatment. CONCLUSIONS: With its shared clinical features, Kikuchi-Fujimoto disease can be mistaken for other forms of lymphadenitis. A combined use of medical imaging and laboratory tests is the effective way to avoid misdiagnosis.


Assuntos
Linfadenite Histiocítica Necrosante/diagnóstico , Linfonodos/patologia , Linfadenopatia/etiologia , Grupo com Ancestrais do Continente Asiático , Feminino , Febre/etiologia , Linfadenite Histiocítica Necrosante/complicações , Linfadenite Histiocítica Necrosante/patologia , Humanos , Japão , Linfadenopatia/diagnóstico , Doenças Raras , Adulto Jovem
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