RESUMEN
A ocorrência de neoplasia pulmonar em pacientes com SIDA é pouco freqüente. O total de casos registrados pela literatura entre 1984 e 1993 nao passa de 100. A doença neoplásica é mais agressiva que o usual e a sobrevida, após o diagnóstico, é inferior a 12 meses. OBJETIVO. Os autores descrevem caso de portador de SIDA e carcinoma brônquico com sobrevida de 28 meses após o diagnóstico e início do tratamento da neoplasia. APRESENTAÇAO DO CASO. Homem, branco, 57 anos, homossexual e grande tabagista, no qual se diagnosticou um adenocarcinoma de pulmao (T2 NO MO). Este paciente foi submetido, em diferentes épocas, a lobectomia inferior direita, quimioterapia, toracectomia por recidiva tumoral e radioterapia. Independentemente da agressividade do tratamento antineoplásico, o paciente obteve razoável qualidade de vida e foi a óbito em decorrência de causas nao relacionadas ao câncer de pulmao. CONCLUSOES. O retardo no diagnóstico do carcinoma brônquico e as profundas alteraçoes do sistema imunológico sao os principais fatores que respondem pelo mau prognóstico e baixas sobrevidas encontradas neste grupo de pacientes. De acordo com os dados de literatura, esta é a maior sobrevida até agora registrada. Os autores acreditam que, em relaçao à sobrevida, a neoplasia pulmonar em doentes com SIDA exerce um efeito negativo muito maior do que a SIDA exerce sobre a evoluçao da doença tumoral. O tratamento oncológico deve ser realizado independentemente da doença de base, desde que as condiçoes clínicas do paciente o permitam.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Carcinoma Broncogénico/etiología , Neoplasias Pulmonares/etiología , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Carcinoma Broncogénico/terapia , Factores Sexuales , Sobrevivientes , Neoplasias Pulmonares/terapia , Síndrome de Inmunodeficiencia Adquirida/mortalidadRESUMEN
BACKGROUND: Lung cancer associated with acquired immunodeficiency syndrome (AIDS) is unusual. Literature review between 1984 and 1993 showed less than 100 published cases of this association. From those cases it appears that the neoplasia is more aggressive and survival after diagnosis is less than 12 months. A case is reported of an HIV positive man with adenocarcinoma of the lung that survived 28 months after diagnosis, the longest published survival in such case described in the medical literature. CASE REPORT: A 57-year old Caucasian homosexual male and heavy smoker was diagnosed as having a bronchogenic carcinoma and underwent right upper lobectomy, chemotherapy, thoracic surgery for carcinoma recurrence and radiotherapy. He remained in good condition with reasonable life quality and died for reasons unrelated either to his tumor or the antineoplastic treatment. CONCLUSIONS: Diagnostic delay and the immuno-deficiency are the reasons for the dismal prognosis of lung cancer in AIDS patients. Aggressive treatment of the neoplastic disease should be done in such cases, as reasonable prolonged survival is possible, as shown by our report.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/complicaciones , Síndrome de Inmunodeficiencia Adquirida/mortalidad , Carcinoma Broncogénico/complicaciones , Neoplasias Pulmonares/complicaciones , Humanos , Masculino , Persona de Mediana Edad , SobrevivientesRESUMEN
O pulmao é um dos locais onde mais freqüentemente se desenvolvem metástases, sendo que 2 por cento a 5 por cento destes casos apresentam comprometimendo endobrônquico. Especificamente no câncer de mama, as metástases endobrônquicas (ME) podem ser identificadas em até 36 por cento dos pacientes. OBJETIVO. Relato de caso mostrando a importância de se reconhecer a presença de uma ME, já que as ME podem simular quadros de asma, bronquite, pneumonia e câncer de pulmao. RELATO DE CASO. Mulher branca, 38 anos, portadora câncer de mama, admitida com quadro de tosse seca e dispnéia de repouso. Radiologicamente, apresentava-se sinais de comprometimento pulmonar bilateral compatíveis com disseminaçao da neoplasia mamária. A endoscopia evidenciou pequenas lesoes elevadas, isoladas e esparsas por toda árvore brônquica, cujo anatomopatológico mostrou tratar-se de carcinoma em mucosa brônquica com características sugestivas de metástase por neoplasia de mama. CONCLUSAO. Os autores ressaltam a importância da broncoscopia na identificaçao das ME, já que estas podem ser detectadas via endoscópica em até 50 por cento dos casos. A broncoscopia tem alta especificidade e é um método diagnóstico que nesta situaçao apresenta raras complicaçoes.
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias de la Mama/patología , Carcinoma/patología , Neoplasias Pulmonares/secundario , Carcinoma Broncogénico/secundario , Broncoscopía , Neoplasias Pulmonares/diagnóstico , Carcinoma Broncogénico/diagnósticoRESUMEN
UNLABELLED: Frequently metastases are developed in the lung. Endobronchial involvement, in these cases, ranges from 2% to 5%. Particularly in breast cancer, endobronchial metastases (EM) carriers could be identified in approximately 36% of the cases. PURPOSE: Relate of a case showing the importance of the EM detection. The differential diagnosis is very important because EM can simulate asthma, bronchitis, pneumonia and lung cancer. CASE REPORT: 38 year-old caucasian woman, carrier of a breast cancer, who was referred to "Arnaldo Vieira de Carvalho" Cancer Institute with non-productive cough and rest dyspnea. On X-Ray she had bilateral lung infiltrates, which was due to disseminated breast neoplasm. Bronchoscopy showed little elevated and isolated lesions, dispersed along all bronchial tree. The histological examination showed a carcinoma of the bronchial mucosa suggesting breast cancer origin. CONCLUSIONS: The authors emphasize the importance of the bronchoscopic examination in the diagnosis of EM. These lesions can be detected by this way in 50% of the cases. Bronchoscopy has high specificity and it is a safe diagnostic method that in this way presents rare complications.
Asunto(s)
Adenocarcinoma/secundario , Neoplasias de la Mama/patología , Neoplasias de los Bronquios/secundario , Adulto , Broncoscopía , Femenino , HumanosRESUMEN
Pneumotórax espontâneo (PE) concomitante às doenças neoplásicas é incomum. Destas, as que mais se associam ao PE säo o câncer de pulmäo e o sarcoma osteogênico com metástases pulmonares. Objetivo. O presente artigo tem o intuito de registrar a ocorrência de PE relacionado a neoplasia de mama e discutir os principais fatores etiopatogênicos envolvidos no evento. Material e Métodos. Os autores descrevem caso de mulher com 43 anos, parda, näo tabagista e protadora de carcinoma ductal infiltrante de mama esquerda, com metástases pulmonares disseminadas bilateralmente. O PE ocorreu na vigência de poliquimioterapia e näo pode ser relacionado a outras causas. Conclusäo. Embora o pulmäo apresente metástases conseqüentes a neoplasia mamária em até 60 por cento dos casos, a coexistência de PE e carcinoma de mama é muito rara. Em revisäo de literatura dos últimos cinco anos, näo se encontraram relatos desta concomitância. Quanto à etiopatogenia do pneumotórax, acredita-se que os fatores relacionados ao episódio sejam múltimos, e os autores fazem comentários a respeito
Asunto(s)
Humanos , Femenino , Adulto , Neoplasias de la Mama/complicaciones , Carcinoma Ductal de Mama/complicaciones , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas , Neumotórax/complicacionesRESUMEN
BACKGROUND: Spontaneous pneumothorax with concomitant neoplastic diseases is unusual. Lung cancer and osteogenic sarcoma with pulmonary metastasis are the neoplasms that most frequently accompany the spontaneous pneumothorax. This article's purposes are to relate the occurrence of spontaneous pneumothorax associated with breast neoplasms and to discuss the main etiopathogenic factors involved in the process. MATERIAL AND METHODS: The authors report a case of a 43-year-old black woman carrier of a left breast ductal carcinoma with bilateral pulmonary metastasis. Spontaneous pneumothorax appeared during multidrug chemotherapy, so it cannot be related to other causes. CONCLUSIONS: Even though breast neoplasms cause lung metastases in about 60% of the cases, the coexistence of spontaneous pneumothorax and breast carcinoma is very rare. There was no report of this topic in the medical literature review during the last five years. The authors believe and discuss the multiple pneumothorax etiopathogenic factors related to this case.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Ductal de Mama/secundario , Neoplasias Pulmonares/secundario , Neumotórax/etiología , Adulto , Carcinoma Ductal de Mama/complicaciones , Femenino , Humanos , Neoplasias Pulmonares/complicacionesRESUMEN
A case of adenocarcinoma of the lung in a 57 years old patient associated with hypertrophic osteoarthropathy is reported by the authors. The paraneoplastic manifestation occurred after the pulmonary symptoms and receded spontaneously after a right inferior lobectomy was performed. Osteoarticular symptoms returned near after a tumoral recurrence. Articular pains disappeared 48 hours after the tumoral recurrence resection of the chest wall and clubbing disappeared completely after the 3rd. week.
Asunto(s)
Adenocarcinoma/complicaciones , Neoplasias Pulmonares/complicaciones , Osteoartropatía Hipertrófica Secundaria/etiología , Adenocarcinoma/cirugía , Humanos , Neoplasias Pulmonares/cirugía , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/complicaciones , Recurrencia Local de Neoplasia/cirugíaRESUMEN
This is a prospective study involving 300 persons with lung cancer admitted to the "Arnaldo Vieira de Carvalho" Cancer Institute (ICAVC). The intention of the survey was to detect delay in diagnosis after the initial symptoms. THe authors tried to identify causes of this delay and its implications. Patients were asked about the day that the symptoms started, medical care and specialists sought, number of physicians seen and their diagnosis, also examinations carried out and referrals. Results showed that 78 of cases were seen firstly by general practitioners and 69.6 looked for medical assistance at least 30 days after the clinical beginning of the disease. Chest X-rays could identify only 9 cases (3) without symptoms. The most common clinical diagnoses were: pneumonia (20), neoplasia (19), bronchitis/emphysema (9.3) and tuberculosis (8). The number of first appointments seen by the Public Health Services and Contracted Private Hospital Network was 64.1 and the second appointment was 70. Only 24 (8) of the patients were referred to ICAVC just after their first appointment and 64.4 after the third. The time lost between the first appointment and the diagnosis was longer than 90 days in 55.7 of cases. These people needed to see 3 to 4 doctors (as an average) to obtain a positive diagnosis. The diagnostic techniques used more frequently were bronchoscopy (59.7) and fine needle lung biopsy (18.4) and the delay was 20 and 10 days on average, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Humanos , Neoplasias Pulmonares , Accesibilidad a los Servicios de Salud , Factores de Tiempo , Estudios Prospectivos , Enfermedades Pulmonares , Diagnóstico DiferencialRESUMEN
This is a prospective study involving 300 persons with lung cancer admitted to the "Arnaldo Vieira de Carvalho" Cancer Institute (ICAVC). The intention of the survey was to detect delay in diagnosis after the initial symptoms. THe authors tried to identify causes of this delay and its implications. Patients were asked about the day that the symptoms started, medical care and specialists sought, number of physicians seen and their diagnosis, also examinations carried out and referrals. Results showed that 78% of cases were seen firstly by general practitioners and 69.6% looked for medical assistance at least 30 days after the clinical beginning of the disease. Chest X-rays could identify only 9 cases (3%) without symptoms. The most common clinical diagnoses were: pneumonia (20%), neoplasia (19%), bronchitis/emphysema (9.3%) and tuberculosis (8%). The number of first appointments seen by the Public Health Services and Contracted Private Hospital Network was 64.1% and the second appointment was 70%. Only 24 (8%) of the patients were referred to ICAVC just after their first appointment and 64.4% after the third. The time lost between the first appointment and the diagnosis was longer than 90 days in 55.7% of cases. These people needed to see 3 to 4 doctors (as an average) to obtain a positive diagnosis. The diagnostic techniques used more frequently were bronchoscopy (59.7%) and fine needle lung biopsy (18.4%) and the delay was 20 and 10 days on average, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
Asunto(s)
Accesibilidad a los Servicios de Salud , Neoplasias Pulmonares/diagnóstico , Diagnóstico Diferencial , Humanos , Enfermedades Pulmonares/diagnóstico , Estudios Prospectivos , Factores de TiempoRESUMEN
The authors report a case of synchronous male breast cancer and squamous cell carcinoma of the lung. Comments about etiopathogenic factors of this rare multiple primary neoplasm are made. The authors suggest that the relationship is casual, since the patient had been a heavy smoker, and the main age range for the two neoplasms in approximately the same.
Asunto(s)
Neoplasias de la Mama/patología , Carcinoma Intraductal no Infiltrante/patología , Carcinoma de Células Escamosas/patología , Neoplasias Pulmonares/patología , Neoplasias Primarias Múltiples/patología , Anciano , Humanos , MasculinoRESUMEN
The authors try to identify causes of delay in the diagnosis of lung cancer, such causes being liable for low survival rates in five years. With this in mind, they developed a prospective study involving 100 patients admitted to the "Arnaldo Vieira de Carvalho" Cancer Institute, who were asked as to the date symptoms started, medical care searched, first diagnostic impressions, and number of physicians seen till the moment of diagnosis. They observed that 73 patients looked for medical assistance up to the 30th day from the beginning of disease, and only in 10 occasions this interval was longer than 120 days. 46 patients had a confirmed diagnosis in less than 90 days after their first medical appointment, and in 41 cases the delay in diagnosis was longer than 4 months. Upon the first exam with the physician, neoplasia was suspected 25 times, but only 11 patients were immediately referred to the Cancer Institute. Of the remaining 89 patients, 57 were referred only after their third medical appointment. 80 patients were first seen by general practitioners and, on average, patients went to 3 or 4 physicians to obtain a definite diagnosis. The most commonly used method to identify neoplasia was bronchofibroscopy (67 cases), with an average of 20 days of delay for its performance. Lung biopsy using transparietal fine needle was the second most used (14 cases), with an average delay of 10 days. The authors conclude that delay in the diagnosis is mostly due to the inadequacy of medical services, delay in referrals and in the performance of subsidiary tests.(ABSTRACT TRUNCATED AT 250 WORDS)