RESUMO
En la última actualización de las Guías de Práctica Clínica de la ATS/ERS/JRS/ALAT de fibrosis pulmonar idiopática (FPI) se propone una nueva forma de clasificar los patrones histopatológicos en 4 tipos: definitivo de neumonía intersticial usual (NIU), probable NIU, indeterminado y alternativo a NIU. Una remodelación fibrótica heterogénea de la arquitectura normal del parénquima pulmonar, con cicatrización destructiva en forma de "panal de abejas", presencia de focos fibroblásticos y distribución predominantemente subpleural y paraseptal, con escaso infiltrado inflamatorio intersticial de tipo crónico, asociado a la ausencia de elementos sugerentes de causas secundarias como distribución bronquiolocéntrica, predominio de infiltrados intersticiales inflamatorios o granulomas mal formados, permite un diagnóstico certero de FPI en un escenario clínico-radiológico adecuado.
In the latest update of the ATS/ERS/JRS/ALAT Clinical Practice Guidelines for idiopathic pulmonary fibrosis (IPF), a new way of classifying histopathological patterns in 4 types is proposed: definitive usual interstitial pneumonia (UIP), probable UIP, indeterminate and alternative to UIP. A heterogeneous fibrotic remodeling of the normal architecture of the pulmonary parenchyma, with destructive scarring in the form of "honeycomb", presence of fibroblastic foci and predominantly subpleural and paraseptal distribution, with scarce chronic interstitial inflammatory infiltrate, associated with the absence of elements suggestive of secondary causes such as bronchiolocentric distribution, predominance of inflammatory interstitial infiltrates or poorly formed granulomas, allows an accurate diagnosis of IPF in an appropriate clinical-radiological scenario.
Assuntos
Humanos , Fibrose Pulmonar Idiopática/classificação , Fibrose Pulmonar Idiopática/patologiaRESUMO
Introduction: Aspiration of gastric content is associated with a wide range of clinical conditions (acute lung injury, severe interstitial pneumonia or bronchiolitis obliterans following lung transplantation). Objective: To study the course of histological alterations in a model of intra-tracheal instillation of gastric juice in rats. Methods: Anesthetized rats were euthanized at different times: 4, 12 and 24 hours and 4 and 7 days after intratacheal (IT) instillation of gastric juice. Animals that were not intervened served as controls. The right inferior lobe was studied (H-E) and a histological injury score was given according to a recently published score system. Results: Between 4-24 h an inflammatory-hemorragic pattern with bronchiol-centric distribution was characterized by a large proportion of neutrophils in both alveoli and interstitium, alveolarfluid accumulation, proteinaceous material andfew hyaline membranes. Between 4 and 7 days, mononuclear cells were more prevalent, the hemorrhagic component disappeared, the percentage of abnormal bronchioles was significantly reduced and there was organization of the alveolar infiltrate, with Masson bodies, granulomas and giant cells associated with gastric juice particles. Conclusions: In rats, IT instillation of gastric juice induces diffuse alveolar damage that evolves towards an early granulomatous interstitial pneumonia along with lax fibrous tissue. Knowledge of the temporary course of the pulmonary responses helps to the understanding of the consequences of the several clinical conditions that favor gastric content aspiration.
Introducción: La aspiración de contenido gástrico se asocia con diversas condiciones clínicas (daño pulmonar agudo, neumonía intersticial severa o bronquiolitis obliterante post-trasplante). Objetivo: Estudiar el curso de las alteraciones histológicas en un modelo de instilación intra-traqueal (IT)de jugo gástrico en ratas. Métodos: Ratas anestesiadas recibieron vía ITjugo gástrico de un pool obtenido previamente. Los animales fueron sacrificados a las: 4, 12 y 24 h y 4 y 7 días post-instilación. Animales sin intervención sirvieron como controles. El lóbulo inferior derecho fue estudiado (H-E) para la asignación de un puntaje de daño histológico de acuerdo a un sistema de puntuación recientemente publicado. Resultados: Entre 4-24 h se observó un patrón inflamatorio-hemorrágico de distribución bronquíolo-céntrica, con predominio de neutrófilos intersticiales y alveolares, edema, material proteináceo alveolar y escasas membranas hialinas. Entre los 4 y 7 días, se observó predominio mononuclear y desaparición del componente hemorrágico, se redujo significativamente el porcentaje de bronquíolos afectados y se observó organización del infiltrado inflamatorio, con cuerpos de Masson, granulomas y células gigantes asociadas a partículas del jugo gástrico. Conclusiones: En ratas, la instilación IT de jugo gástrico induce daño alveolar difuso que progresa hacia una neumonía intersticial granulo-matosa temprana con tejido fibroso laxo. El conocimiento del curso de la respuesta pulmonar en este modelo, contribuye a comprender las posibles consecuencias de las condiciones clínicas que favorecen la aspiración de contenido gástrico.
Assuntos
Animais , Ratos , Aspiração Respiratória de Conteúdos Gástricos/patologia , Suco Gástrico/fisiologia , Pulmão/patologia , Modelos Animais de Doenças , Intubação Intratraqueal , Ratos Sprague-Dawley , Fatores de TempoRESUMO
El diagnóstico diferencial de nódulos pulmonares cavitados constituye un gran desafo en el cual, la clínica, la imagenología y los exámenes de laboratorio permiten una orientación etiológica en cutro grandes grupos: infecciosa, neoplásica, reumatológica y miscelánea. Presentamos el caso de una paciente gran fumadora y portadora de una diabetes mellitus descompensada, con nódulos pulmonares cavitados, en la cual el contexto clínico obligaba a plantear ciertas etiologías como las infecciosas y neoplásicas, pero cuya biopsia fue compatible con Granulomatosis con Poliangeítis (ex Granulomatosis de Wegener), sin una clínica ni exámenes de laboratorio concordantes con dicho hallazgo.
The differential diagnosis of cavitary pulmonary nodules is a great challenge, where the clinical context in addition to the image studies and laboratory tests are part of the key tools to guide the diagnostic process through 4 major etiological groups: infectious, neoplastic, rheumatologic and miscellaneous. We describe a case of a heavy smoker and complicated diabetic patient with cavitary pulmonary nodules, with a clinical context that induces certain etiologies such as infectious and neoplastic, but whose biopsy was compatible with Granulomatosis with polyangiitis (ex Wegener 's granulomatosis), without a clinical exam nor laboratory tests suggesting this finding.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pneumopatias/etiologia , Granulomatose com Poliangiite/complicações , Granulomatose com Poliangiite/diagnóstico , Vasculite/complicações , Vasculite/diagnóstico , Diagnóstico DiferencialRESUMO
Lupus erythematosus is a multisystemic disease that compromises principally women in fertile age. The principal affected organs are kidney, SNC, bone marrow and serous membranes. Cardiovascular affection includes pericardium, conduction system, myocardium, valves and coronary arteries. The most frequent valve disease is Libman-Sacks endocarditis, although valvulitis or valve dysfunction can exist as well. The mitral valve is the most affected, followed by the aortic valve. The most frequent valve abnormality is slight to moderate aortic insufficiency, while serious insufficiency or valve disruption is very rare. A physical examination has limited efficacy in the diagnosis of valve disease. A high degree of suspicion associated with echocardiography helps to establish the diagnosis. If surgery is not needed, antiplatelet therapy is recommended for asymptomatic patients, and oral anticoagulation treatment is advised for those with valve disease and evidence of thromboembolic phenomena. Recurrence of the disease has been observed in biological grafts, which makes the use of mechanical prostheses advisable when valve replacement indication exists. The following case shows the clinical evolution of a female patient with a rare but very serious lupus erythematosus complication.
Assuntos
Humanos , Feminino , Doenças das Valvas Cardíacas/etiologia , Lúpus Eritematoso Sistêmico/complicaçõesRESUMO
Solitary fibrous tumor of the pleura (TFSP) is an uncommon and mostly benign neoplasm. It grows slowly and presents with scant symptoms. Recurrence after surgical excision has been described. The aim of this report is to show our experience in managing this disease. Clinical as well as radiological, surgical, histopathological and follow-up data were analyzed in a clinical series. Forty one cases of TFSP that underwent surgery at our institution between 1991 and 2004 were retrospectively analyzed; 27 were females and 14 males with a median age of 60.4 years old; 24.4% of the cases were asymptomatic. All tumors were surgically excised, in average they weighed 945 g and 36.5% of the lesions showed a pedicle. Most of the lesions were originated in the visceral pleura. Surgical morbidity was 12.1% and no mortality was recorded. Three tumor recurred. TFSP is usually a benign neoplasm but it can recur. Complete surgical excision is the treatment of choice of primary and recurrent tumors.
Introducción: El tumor fibroso solitario de la pleura (TFSP) es una neoplasia infrecuente, considerada benigna, de crecimiento lento y poco sintomática pero que puede recidivar tras la resección quirúrgica. El objetivo de este estudio es mostrar la experiencia de nuestro centro con el manejo de estos tumores. Pacientes y Método: Análisis retrospectivo de 41 pacientes con TFSP intervenidos en nuestro Servicio entre 1991 y 2004. Se analizan datos clínicos, radiológicos, quirúrgicos, morbimortalidad, recurrencia y seguimiento. Resultados: De los 41 pacientes con TFSP resecados, 27 eran mujeres y 14 hombres. Edad media 60,4 años. 24,4% de los pacientes fueron asintomáticos. Todos los pacientes fueron intervenidos quirúrgicamente y se realizó estudio histopatológico en todas las piezas. El peso promedio de los tumores fue de 954 g y 36,5% eran tumores pediculados, el resto de base ancha. La mayoría (75,6%) se originaban de la pleura visceral. No hubo mortalidad operatoria y la morbilidad alcanzó el 12,1%. Tres tumores recidivaron. Conclusiones: El TFSP es una neoplasia rara generalmente benigna, pero que puede recidivar. El tratamiento es la resección quirúrgica completa y las recidivas deben ser resecadas nuevamente.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Tumor Fibroso Solitário Pleural/cirurgia , Tumor Fibroso Solitário Pleural/diagnóstico , Complicações Pós-Operatórias , Biópsia , Toracotomia , Radiografia Torácica , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Seguimentos , Tumor Fibroso Solitário Pleural/patologia , Tumor Fibroso Solitário Pleural/diagnóstico por imagem , Tempo de Internação , Recidiva Local de NeoplasiaRESUMO
Amyloidosis is a generic term for a group of diseases that share the common feature of extracelular deposit of pathologic proteins. Systemic and localized forms are recognized. Both can produce pulmonary involvement. The current classification is based on the nature of the precursor of the amyloid. It is an infrequent condition, in USA the incidence is 5.1 to 12.8 per million of people. We present a case of a 32 years old male, obese, light smoker with Diabetes Mellitus 2, asymptomatic, with a pneumonia and poor response to treatment. The first diagnostic approach was a malignant disease and the histological study showed Amyloidosis. The analysis of the case suggest the diagnosis of tracheobronchial amyloidosis.
La amiloidosis es un término genérico para un conjunto de enfermedades que comparten como hecho común el depósito extracelular de proteínas patológicas. A grandes rasgos se divide en sistémica y localizada. Ambas pueden presentar compromiso pulmonar. Actualmente, su clasificación, se basa en las proteínas precursoras del amiloide. Es una patología poco frecuente, reportándose en USA una incidencia de 5,1 a 12,8 por millón de personas. Presentamos un caso de un enfermo de 32 años de edad obeso con antecedentes de tabaquismo y Diabetes Mellitus 2, asintomático que frente a una neumonía con mala respuesta al tratamiento se plantea una patología maligna y el estudio histológico demuestra amiloidosis. El análisis del caso clínico configura el diagnostico de Amiloidosis localizada endobronquial.