RESUMEN
A 62-year-old woman with triple-negative breast cancer underwent breast-conserving surgery followed by adjuvant chemotherapy and radiotherapy to the breast. The patient developed a solitary lung metastasis at the left hilum 44 months after the operation. The lung metastasis responded partially to capecitabine chemotherapy, but showed regrowth in 7 months. The patient received second-line oral cyclophosphamide (CPA) chemotherapy, resulting in marked tumor regression without new lesions for 10 months. To further control the lung metastasis, stereotactic body radiotherapy (SBRT; 5.1 Gy ×10 fractions) under breath holding without a localization device was given to the regressed lung metastasis after CPA therapy. Positron emission tomography at 24 months after the completion of SBRT did not show any recurrences, and the patient has been well for 100 months without any recurrences. Breast oncologist should take SBRT into consideration to treat lung oligometastasis of breast cancer especially locating at the lung hilum with curative intent.
RESUMEN
Eosinophilic granulomatosis with polyangiitis (EGPA), formerly called Churg-Strauss syndrome, is an uncommon disease with pathological features consisting of systemic necrotizing vasculitis, eosinophilic infiltration, and granulomatous or nongranulomatous extravascular eosinophilic inflammation. EGPA preferentially affects certain organ systems, including the airways, peripheral nerves, heart, kidney, and gastrointestinal tract. Although gastrointestinal involvement, such as ulcerations, is common in EGPA, gastrointestinal perforation is relatively uncommon and is associated with a poor prognosis. Ulceration, perforation, and stenosis of the gastrointestinal tract are assumed to be the result of ischemia caused by vasculitis. The histological finding in the biopsy specimens of EGPA is generally only eosinophil infiltration, and vasculitis is not often seen. Therefore, in biopsy specimens, it is difficult to distinguish eosinophilic gastroenteritis from the gastrointestinal involvement of EGPA. In addition, in general, steroid therapy is the first-choice treatment for EGPA, but some reports have described the frequent occurrence of acute ulcer or perforation of the gastrointestinal tract in association with steroid treatment. We herein report an EGPA patient who was treated with steroid therapy and subsequently developed perforation of the small intestine.
Asunto(s)
Síndrome de Churg-Strauss/tratamiento farmacológico , Glucocorticoides/efectos adversos , Perforación Intestinal/inducido químicamente , Intestino Delgado/efectos de los fármacos , Úlcera/inducido químicamente , Anciano , Síndrome de Churg-Strauss/patología , Progresión de la Enfermedad , Resultado Fatal , Humanos , Perforación Intestinal/diagnóstico por imagen , Perforación Intestinal/patología , Perforación Intestinal/cirugía , Intestino Delgado/diagnóstico por imagen , Intestino Delgado/patología , Intestino Delgado/cirugía , Masculino , Metilprednisolona , Recurrencia , Factores de Riesgo , Resultado del Tratamiento , Úlcera/diagnóstico por imagen , Úlcera/patología , Úlcera/cirugíaRESUMEN
This report presents the case of an 84-year-old woman who developed tetanus 3 days after the resection of a gangrenous small intestine caused by obturator hernia incarceration. The diagnosis of tetanus was clinically made after the appearance of generalized spastic contractions with opisthotonus. Clostridium tetani organisms residing in the gastrointestinal tract were presumed to have been endogenously inoculated into the strangulated intestine, where it produced tetanospasmin, causing tetanus. The patient successfully recovered after aggressive intensive care. There have been 16 case reports of tetanus occurring after gastrointestinal surgical procedures. Primary care physicians should thus be aware of the fact that, although extremely rare, C. tetani residing in the gastrointestinal tract can provide a possible endogenous source of tetanus infection.
Asunto(s)
Hernia Obturadora/cirugía , Íleon/cirugía , Ileus/cirugía , Laparoscopía/efectos adversos , Tétanos/microbiología , Anciano de 80 o más Años , Clostridium tetani/aislamiento & purificación , Femenino , Gangrena/complicaciones , Gangrena/cirugía , Hernia Obturadora/complicaciones , Humanos , Íleon/diagnóstico por imagen , Ileus/complicaciones , RadiografíaRESUMEN
Primary breast cancers with cartilaginous and osseous components are quite rare. We recently treated a 51-year-old woman suffering from primary breast cancer with predominant cartilaginous and osseous components, adjacent to a component of intraductal carcinoma. We discuss the management of this tumor with a review of the literature.