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1.
BMJ Case Rep ; 14(1)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33408107

RESUMO

A 38-year-old male patient presented to the ear, nose and throat department with shortness of breath over last 2 months. The CT scan of the neck and chest revealed a 3.3×3 cm tumour behind the right thyroid lobe extending into the tracheo-oesophageal (TO) groove with tracheal compression. The ultrasound scan of the neck and targeted fine needle aspiration followed by core biopsy raised a suspicion of Hodgkin's lymphoma. The patient underwent a right hemithyroidectomy and incisional biopsy of the right TO groove tumour. The histology confirmed a Hasenclever's three nodular sclerosing Hodgkin's lymphoma for which he received adjuvant chemotherapy. An incidental pT1a pN0 thyroid papillary microcarcinoma in the adjacent thyroid parenchyma was completely excised. This represents a case of TO Hodgkin's lymphoma, of which there are no current published case reports. We aim to raise awareness about this rare condition by sharing the diagnostic work up and successful management in a multidisciplinary team setting.


Assuntos
Carcinoma Papilar/diagnóstico , Neoplasias Esofágicas/diagnóstico , Doença de Hodgkin/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Sons Respiratórios , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Traqueia/diagnóstico , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biópsia com Agulha de Grande Calibre , Carcinoma Papilar/complicações , Carcinoma Papilar/patologia , Carcinoma Papilar/terapia , Quimioterapia Adjuvante , Diagnóstico Diferencial , Dispneia/etiologia , Aspiração por Agulha Fina Guiada por Ultrassom Endoscópico , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/terapia , Esôfago/diagnóstico por imagem , Esôfago/patologia , Esôfago/cirurgia , Doença de Hodgkin/complicações , Doença de Hodgkin/patologia , Doença de Hodgkin/terapia , Humanos , Achados Incidentais , Masculino , Esvaziamento Cervical , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/terapia , Tireoidectomia , Tomografia Computadorizada por Raios X , Neoplasias da Traqueia/complicações , Neoplasias da Traqueia/patologia , Neoplasias da Traqueia/cirurgia , Resultado do Tratamento , Ultrassonografia
2.
Medicine (Baltimore) ; 99(50): e23587, 2020 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-33327321

RESUMO

RATIONALE: Angiosarcoma is a rare malignant tumors. The objective of this study is to report a patient who suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months, After diagnoses, this was identified as an extremely rare case of primary multiple angiosarcoma of vertebra. PATIENT CONCERNS: A 54-year-old man with a history of 2-year hypertension and 8-year diabetes, both of which were well controlled by drug management. Lately, he suffered from a progressive low back pain and left lower extremities radiation pain for about 8 months. DIAGNOSES: Magnetic resonance imaging of lumbar showed a clear pathological fracture and primary multiple angiosarcoma of all vertebra. Postoperative pathology and High-throughput sequencing confirmed the diagnosis of primary multiple angiosarcoma of vertebra. INTERVENTIONS: The patient underwent minimally invasive pedicle screw fixation combined with bone cement augmentation for the purpose of stabilizing the damaged vertebrae. Following operation, he received both radiotherapy and chemotherapy for a period of time. OUTCOMES: The operation has achieved positive results in relieving pain and stabilizing the spine. No wound problem or operative complications occurred after operation. The patient reported an obvious remission of low back pain and was only capable to perform restricted physiological activities. A long-term palliative radiotherapy and chemotherapy were performed after operation. Unfortunately, the patient died 18 months later. CONCLUSION: This article emphasizes primary multiple angiosarcoma of vertebra. Despite being rare, it should be part of the differential when the patient manifested back pain and radiculopathy. We recommended the minimally invasive pedicle screw fixation for angiosarcoma of vertebra. Osteoplasty by bone cement augmentation was also an ideal choice for surgical treatment. It also advocates the use of specific targeted radiotherapy drugs based on gene analysis of tumors.


Assuntos
Fraturas Espontâneas/diagnóstico , Hemangiossarcoma/diagnóstico , Vértebras Lombares , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias da Coluna Vertebral/diagnóstico , Terapia Combinada , Fraturas Espontâneas/complicações , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/cirurgia , Hemangiossarcoma/complicações , Hemangiossarcoma/diagnóstico por imagem , Hemangiossarcoma/cirurgia , Humanos , Dor Lombar/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neoplasias Primárias Múltiplas/cirurgia , Parafusos Pediculares , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia
3.
Chirurgia (Bucur) ; 115(5): 670-676, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33138905

RESUMO

In the actual pandemic context, cancer patients are at additional risk, and protocols are always changing. We present the case of a 62-year-old patient who develops three types of cancer over four years and who was admitted to the hospital in the Emergency Room for hematemesis, melena, and abdominal pain. We know from the pathological antecedents that he was operated in 2017 for a left scapular tumour (basal cell carcinoma). The current clinical examination reveals another right scapular tumour (malignant melanoma), and the hematemesis comes from a gastro-esophageal junction tumour (squamous cell carcinoma). SARS CoV2 infection changes the rules of treatment in such a case. Thus, the patient is operated for the right scapular tumour, the gastrectomy being delayed due to the lung lesions given by SARS CoV2. Finally, the patient undergoes surgery for the gastric tumour, the RT-PCR retest being negative.


Assuntos
Infecções por Coronavirus/complicações , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/cirurgia , Pneumonia Viral/complicações , Betacoronavirus , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Resultado do Tratamento
5.
Endocr Regul ; 53(4): 263-267, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31734654

RESUMO

OBJECTIVES: Pituicytomas are rare, solid, well-circumscribed, low grade (grade I), non-neuroendocrine, and noninfiltrative tumors of the neurohypophysis or infundibulum, which appear in the sellar/suprasellar regions. Herein, we present a case with Cushing's disease (CD) caused by an ACTH-secreting pituitary adenoma in association with an infundibular pituicytoma. Subject and Results. A 37-year-old male patient presented to the hospital with a six-month history of blurry vision. Physical examination demonstrated plethora, excessive sweating, weight gain, moon facies, and acne. Basal serum cortisol and ACTH levels were 16 µg/dl and 32 pg/ml, respectively. The results of screening tests were suggestive of Cushing syndrome. It was also 1.97 µg/dl following 8 mg dexamethasone suppression test which was consistent with CD. Pituitary MR imaging revealed a single lesion measuring 6x6.5 mm on the pituitary stalk. Infundibular mass excision and pituitary exploration by extended endoscopic endonasal approach were applied. On immunohistochemistry, strong diffuse immunolabeling for both S100 and TTF-1 was noted for the cells of infundibular mass, diagnosed as pituicytoma. Because the developed panhypopituitarism postoperatively, patient was discharged with daily desmopressin, levothyroxine, hydrocortisone, and intramuscular testosterone, once a month. CONCLUSIONS: Pituicytoma is an uncommon noninvasive tumor of the sellar and suprasellar regions. In this case report, we described a patient with Cushing's disease to whom MRI displayed only an infundibular well-circumscribed lesion, but not any pituitary adenoma. Despite the absence of any sellar lesion, awareness of other undetected possible lesion and exploring hypophysis during the transsphenoidal surgery is mandatory for the correct diagnosis.


Assuntos
Adenoma Hipofisário Secretor de ACT/diagnóstico , Adenoma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Hipersecreção Hipofisária de ACTH/diagnóstico , Hipófise/patologia , Neoplasias Hipofisárias/diagnóstico , Adenoma Hipofisário Secretor de ACT/metabolismo , Adenoma Hipofisário Secretor de ACT/patologia , Adenoma/metabolismo , Adenoma/patologia , Hormônio Adrenocorticotrópico/metabolismo , Adulto , Humanos , Masculino , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/metabolismo , Hipersecreção Hipofisária de ACTH/metabolismo , Hipersecreção Hipofisária de ACTH/patologia , Neoplasias Hipofisárias/metabolismo , Neoplasias Hipofisárias/patologia
6.
World J Surg Oncol ; 17(1): 166, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590673

RESUMO

BACKGROUND: The coexistence of hematological malignancy with endometrial cancer is a rare phenomenon. We report a case of coexistence of endometrial cancer with follicular lymphoma which we suspected preoperatively and diagnosed during surgery by a multidisciplinary intraoperative assessment. CASE PRESENTATION: A 67-year-old woman was referred to our hospital due to a suspicion of an endometrial cancer. Endometrial biopsy revealed grade 1 endometrioid adenocarcinoma. MRI showed invasion of the tumor into the outer half of the myometrium, and abdominal CT showed para-aortic and atypical mesentery lymphadenopathy which was suspected to be metastasis of endometrial cancer or malignant lymphoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, partial omentectomy, and mesentery lymph node biopsy for endometrial cancer were performed. The mesentery and para-aortic lymph nodes that were sent for frozen section analysis showed no metastasis of the endometrial cancer. We simultaneously conducted an unusual intraoperative emergent four-color flow cytometry and intraoperatively diagnosed a B cell lymphoma in the mesenteric lymph nodes. Because this multidisciplinary assessment, we were able to avoid an unnecessary intestinal resection. The final pathological diagnosis was an endometrioid carcinoma (G1, FIGO stage IA), with a synchronous follicular lymphoma. CONCLUSION: Although a rare event in endometrial cancer surgery, it is necessary to be alert to the possibility of a synchronous lymphoma in cases of unusual site adenopathy.


Assuntos
Neoplasias do Endométrio/diagnóstico , Cuidados Intraoperatórios , Linfoma/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Adenocarcinoma , Idoso , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/cirurgia , Feminino , Humanos , Linfoma/complicações , Linfoma/cirurgia , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/cirurgia , Prognóstico
10.
World Neurosurg ; 132: 53-56, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31470151

RESUMO

BACKGROUND: Collision tumors of the spine are extremely uncommon. Prior reports have detailed intracranial collision tumors comprising meningiomas and astrocytomas, as well as metastases to meningiomas. Spinal collision tumors are even rarer, with only 5 cases in the literature, none involving the osseous spine. In this report, we highlight the salient features of a case of lymphoma metastasis to a preexisting benign osseous hemangioma, resulting in cord compression. CASE DESCRIPTION: An 81-year-old woman with a known typical T8 vertebral body hemangioma stable for over 6 years was evaluated for increasing back pain, new gait instability, and urinary retention. Magnetic resonance imaging showed a change in the appearance of the T8 hemangioma, with marrow replacement and new associated epidural soft tissue causing cord compression. A biopsy was performed, which showed diffuse large B-cell lymphoma within blood elements, consistent with lymphoma metastasis to a vertebral body hemangioma. The patient was treated with intravenous steroids and radiation therapy. CONCLUSIONS: Collision tumors of the spine are extremely rare. New or increasingly aggressive appearance of a previously benign spinal osseous lesion should prompt consideration for a collision tumor or malignant transformation of the benign tumor. Biopsy of the lesion should be strongly pursued whenever feasible, as the treatment strategy may vary depending on the histology of the tumor.


Assuntos
Hemangioma/patologia , Linfoma Difuso de Grandes Células B/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias da Coluna Vertebral/patologia , Idoso de 80 Anos ou mais , Feminino , Hemangioma/diagnóstico por imagem , Humanos , Linfoma Difuso de Grandes Células B/complicações , Linfoma Difuso de Grandes Células B/diagnóstico por imagem , Metástase Neoplásica , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/complicações , Neoplasias da Coluna Vertebral/diagnóstico por imagem
11.
Clin Nucl Med ; 44(10): 844-847, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31441833

RESUMO

Parathyroid carcinoma is uncommon, and its coexistence with parathyroid adenoma is extremely rare. A 28-year-old woman with hyperparathyroidism underwent dual-phase Tc-sestamibi SPECT/CT scan for presurgical evaluation. The images showed intense activity inside the left side thyroid and mild activity inside the right side of the thyroid. The histopathologic findings showed intrathyroidal parathyroid carcinoma on the left side and intrathyroid parathyroid adenoma on the right side.


Assuntos
Adenoma/complicações , Hiperparatireoidismo/diagnóstico por imagem , Hiperparatireoidismo/etiologia , Neoplasias Primárias Múltiplas/complicações , Neoplasias das Paratireoides/complicações , Adulto , Feminino , Humanos , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Tecnécio Tc 99m Sestamibi
12.
BMJ Case Rep ; 12(8)2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31439570

RESUMO

A constellation of newly diagnosed benign tumours and glioblastoma is an uncommon occurrence in a single individual. We present a case of a patient with a history of skin lipomas who presented with seizures and was found to have a left frontotemporal multifocal enhancing mass on MRI. Work-up for metastatic disease revealed a benign lung carcinoid tumour, a cervical schwannoma, adrenal masses, a growth hormone-secreting pituitary adenoma, and lastly a glioblastoma following brain biopsy.


Assuntos
Neoplasias Encefálicas/diagnóstico , Tumor Carcinoide/diagnóstico , Glioblastoma/diagnóstico , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico , Neoplasias de Cabeça e Pescoço/diagnóstico , Neoplasias Pulmonares/diagnóstico , Neoplasias Primárias Múltiplas/diagnóstico , Neurilemoma/diagnóstico , Idoso , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/diagnóstico por imagem , Tumor Carcinoide/complicações , Tumor Carcinoide/diagnóstico por imagem , Vértebras Cervicais , Evolução Fatal , Lobo Frontal , Glioblastoma/complicações , Glioblastoma/diagnóstico por imagem , Adenoma Hipofisário Secretor de Hormônio do Crescimento/complicações , Adenoma Hipofisário Secretor de Hormônio do Crescimento/diagnóstico por imagem , Neoplasias de Cabeça e Pescoço/complicações , Neoplasias de Cabeça e Pescoço/diagnóstico por imagem , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico por imagem , Neurilemoma/complicações , Neurilemoma/diagnóstico por imagem , Convulsões/etiologia , Tomografia Computadorizada por Raios X
13.
Fam Cancer ; 18(4): 445-449, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31240424

RESUMO

A 51-year old presented with a 6-month history of increasing pelvic/lower back pain with nocturnal waking and episodes of anorexia and vomiting. Examination revealed right torticollis and Horner's syndrome, and a large abdominal mass arising from the pelvis. Magnetic resonance and positron emission tomography imaging revealed (A) a 14 cm heterogeneous enhancing mass, abutting the left kidney with standardised uptake value max = 2.9, (B) a large heterogeneous enhancing pelvic mass (C) mesenteric adenopathy standardised uptake value max = 10.3 and (D) 6 cm right lung apex mass standardised uptake value max = 4.3. Computerised tomography-guided biopsy of lesion A was reported as neurofibroma with occasional atypia, lesion B a benign uterine leiomyoma and lesion C follicular lymphoma world health organisation Grade 2. Although she had been given the diagnosis of Neurofibromatosis Type-1 (NF1) 25-years previously following removal of an intradural extramedullary schwannoma she had no cutaneous stigmata of NF1. Genetic analysis of blood lymphocyte DNA identified a pathogenic variant in SMARCB1 confirming a diagnosis of schwannomatosis. Following 6-months chemotherapy for lymphoma, surgery was performed to remove lesion A. Histology revealed a malignant peripheral nerve sheath tumour with areas of low and high-grade change. An incidental, well-differentiated small bowel neuroendocrine carcinoma was also excised. Close surveillance continues with no recurrence after 6 years. This case study describes a novel finding of three separate synchronous primary malignancies in a patient with schwannomatosis and a proven SMARCB1 pathogenic variant.


Assuntos
Hemangioma/genética , Neoplasias Primárias Múltiplas/genética , Neurilemoma/genética , Neurofibromatoses/genética , Neurofibrossarcoma/genética , Proteína SMARCB1/genética , Neoplasias Cutâneas/genética , Feminino , Hemangioma/terapia , Síndrome de Horner/diagnóstico por imagem , Humanos , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/patologia , Neoplasias Primárias Múltiplas/terapia , Neurilemoma/complicações , Neurilemoma/patologia , Neurilemoma/terapia , Neurofibromatoses/complicações , Neurofibromatoses/terapia , Neurofibrossarcoma/patologia , Neurofibrossarcoma/terapia , Neoplasias Retroperitoneais/genética , Neoplasias Retroperitoneais/terapia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/terapia
17.
Indian J Dermatol Venereol Leprol ; 85(4): 393-396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30971535

RESUMO

Basal cell carcinoma (BCC) is the most common malignant skin tumor which occurs more frequently over the sun exposed parts of body. Its adenoid variant is a rare histological subtype. We report a case of multiple adenoid basal cell carcinomas at unusual sites in a middle-aged male patient.


Assuntos
Carcinoma Basocelular/patologia , Neoplasias Primárias Múltiplas/patologia , Neoplasias Cutâneas/patologia , Úlcera Cutânea/etiologia , Dorso , Carcinoma Basocelular/complicações , Carcinoma Basocelular/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/cirurgia , Neoplasias Cutâneas/complicações , Neoplasias Cutâneas/cirurgia , Extremidade Superior
18.
Melanoma Res ; 29(3): 325-327, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31022058

RESUMO

Meyerson phenomenon (MP), also called halo eczema or halo dermatitis, was first described in 1971 as a symmetric eczematous halo around acquired melanocytic nevi. Since then, cases of MP have been described in any kind of melanocytic nevi and also in non-melanocytic tumors. To the best of our knowledge, only four cases of melanoma associated with MP have been reported. We report the singular case of a young adult diagnosed with two primary melanomas in the context of dysplastic nevi syndrome who presented several flares-up associated with MP in both benign and malignant melanocytic tumors. MP usually manifests as a halo of erythema and scaling similar to plaques of eczema symmetrically surrounding a central cutaneous tumor. Dermoscopic findings of MP show it as similar to other forms of dermatitis. Histopathology usually shows epidermal changes compatible with subacute eczematous dermatitis. Immunohistochemical studies have shown inflammatory infiltrate composed mainly of CD4+ lymphocytes, which supports the suggested pathogenesis of an immune-mediated reaction. It usually resolves spontaneously, and the use of topical corticosteroids has a good response. In conclusion, MP is not specific for benignity, even when multiple simultaneous lesions are affected. Inflammatory changes can make melanocytic lesions difficult to interpret, both on dermoscopic regression features and on histopathologic examination. Therefore, it is recommended to consider the complete excision of melanocytic lesions with atypical vessels and/or extensive regression phenomena more than 50%. Further studies are needed to know whether the presence of a melanoma could induce a remote immune response in other benign melanocytic lesions.


Assuntos
Dermatite/patologia , Síndrome do Nevo Displásico/patologia , Melanoma/patologia , Neoplasias Primárias Múltiplas/patologia , Nevo Pigmentado/patologia , Adulto , Dermatite/complicações , Síndrome do Nevo Displásico/complicações , Humanos , Masculino , Melanoma/complicações , Neoplasias Primárias Múltiplas/complicações , Nevo Pigmentado/complicações , Prognóstico , Adulto Jovem
19.
Hormones (Athens) ; 18(3): 325-328, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30905030

RESUMO

INTRODUCTION: Parathyroid carcinoma (PC) is a rare neoplasm with a high rate of recurrence and an indolent course. It is frequently functional, causing nearly 1% of the cases of primary hyperparathyroidism (HPT), and in some cases, it may be complicated by brown tumors, mimicking bone metastases. Synchronous parathyroid and papillary thyroid carcinomas are rare. CASE REPORT: We present a patient with HPT due to PC, misdiagnosed at first evaluation, which exhibited multiple hypermetabolic lytic lesions in the skeleton, suggesting bone metastases. Their regression after PTH reduction suggested the diagnosis of brown tumors due to severe HPT. Given the persistence of HPT, the patient underwent a number of neck surgeries, and a papillary thyroid microcarcinoma with a nodal metastasis was diagnosed. A genetic test discovered a previously unreported mutation of the CDC73 (HRPT2) gene, codifying for parafibromin and resulting in a premature stop codon (c.580A>Tp.Arg194). Because of the persistence of HPT, cinacalcet therapy was started in order to control hypercalcemia. CONCLUSION: This is a very unusual patient with a newly discovered variant of the CDC73 gene and a phenotype characterized by recurrent PC, brown tumors, and N1a metastasized thyroid carcinoma. The present case confirms that PC may not exhibit clear malignant properties at first assessment, contributing to inadequate initial surgical treatment. Although infrequently, PC can be associated with papillary thyroid cancer. The diagnosis of brown tumor should be considered in patients with severe HPT and multiple destructive bone lesions mimicking metastases on PET/CT imaging.


Assuntos
Carcinoma/terapia , Neoplasias das Paratireoides/terapia , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Carcinoma/diagnóstico , Carcinoma/patologia , Diagnóstico Diferencial , Feminino , Fluordesoxiglucose F18 , Humanos , Hiperparatireoidismo Primário/diagnóstico , Hiperparatireoidismo Primário/etiologia , Hiperparatireoidismo Primário/patologia , Hiperparatireoidismo Primário/terapia , Doenças Maxilomandibulares/diagnóstico , Doenças Maxilomandibulares/etiologia , Doenças Maxilomandibulares/terapia , Neoplasias Primárias Múltiplas/complicações , Neoplasias Primárias Múltiplas/diagnóstico , Neoplasias Primárias Múltiplas/terapia , Osteólise/diagnóstico , Osteólise/etiologia , Osteólise/terapia , Neoplasias das Paratireoides/diagnóstico , Neoplasias das Paratireoides/patologia , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Índice de Gravidade de Doença , Câncer Papilífero da Tireoide/complicações , Câncer Papilífero da Tireoide/diagnóstico , Câncer Papilífero da Tireoide/terapia , Neoplasias da Glândula Tireoide/complicações , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/terapia
20.
Endokrynol Pol ; 70(2): 213-217, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30742299

RESUMO

Acromegaly is associated with increased growth hormone (GH) and insulin-like growth factor-I (IGF-I) secretion which may support tumour development and growth. A 68-year-old woman was diagnosed with acromegaly due to typical clinical and hormonal characteristics. While contrast-enhanced MRI at diagnosis did not reveal a pituitary adenoma, a 5-mm lesion was identified on repeat scanning 13 months later. Abdominal and chest CT showed tumours of the stomach, right adrenal gland, and right lung. The CT also showed a hypodense lesion in the liver and heterogeneous echostructure of the thyroid gland with left lobe solid-cystic tumour. Somatostatin receptor scintigraphy revealed increased tracer accumulation in the right thyroid lobe. No tracer accumulation was noted at the location of the other tumours. The resected stomach, adrenal, chest, and thyroid lesions did not show GH secretion. The patient refused pituitary surgery, and her acromegaly is currently well-controlled with somatostatin analogue therapy. A CT scan 19 months later revealed a contrast-enhancing left kidney tumour that was a G1-grade clear cell carcinoma. Four years after the acromegaly diagnosis multiple myeloma were diagnosed with secondary renal amyloidosis. Genetic screening for a paraganglioma gene panel, AIP, MEN1, and CDKN1B mutations were negative. A next-generation cancer panel containing 94 cancer genes did not identify any possible unifying gene abnormality in her germline DNA. Coexistence of acromegaly and numerous other tumours suggests a common aetiology of these disorders. However, no genetic abnormality could be identified with the tests that have been performed.


Assuntos
Acromegalia/complicações , Neoplasias das Glândulas Suprarrenais/complicações , Neoplasias Intestinais/complicações , Neoplasias Renais/complicações , Neoplasias Pulmonares/complicações , Neoplasias Primárias Múltiplas/complicações , Tumores Neuroendócrinos/complicações , Neoplasias Pancreáticas/complicações , Neoplasias Gástricas/complicações , Acromegalia/patologia , Neoplasias das Glândulas Suprarrenais/patologia , Idoso , Feminino , Humanos , Neoplasias Intestinais/patologia , Neoplasias Renais/patologia , Neoplasias Pulmonares/patologia , Neoplasias Primárias Múltiplas/patologia , Tumores Neuroendócrinos/patologia , Neoplasias Pancreáticas/patologia , Neoplasias Gástricas/patologia
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