RESUMO
Kikuchi and Fujimoto disease is a benign subacute necrotizing lymphadenitis, probably associated to a viral infection, that affects mostly young Asian women. We report a 19 years old women, with a vast familiar history of thyroid disease (three uncles with papillary thyroid carcinoma and one with a Hashimoto thyroiditis). After an upper respiratory infection, she presented with painless cervical adenopathies. Cervical ultrasound examination detected an 8 mm thyroidal nodule. She was operated with the diagnosis of thyroidal cancer. The pathological examination confirmed that the nodule was a papillary thyroidal cancer, but the study of the resected lymph nodes, revealed a Kikuchi and Fujimoto disease.
Assuntos
Carcinoma Papilar/complicações , Linfadenite/etiologia , Neoplasias da Glândula Tireoide/complicações , Adulto , Feminino , Humanos , Linfadenite/patologia , NecroseRESUMO
BACKGROUND: Adrenal tumors of more than 6 cm diameter, also called macrotumors, cause diagnostic and therapeutic problems. AIM: To perform an analysis of adrenal macrotumors diagnosed by CAT scan between 1984 and 1995. PATIENTS AND METHODS: Thirty three patients aged 9 to 86 years old, 15 female, with an adrenal macrotumor diagnosed by CAT scan, were analyzed. RESULTS: Thirty percent of tumors were functioning (70% secreted cathecolamines and 30% cortisol). Eighty two percent had an adrenal localization and 18% were para-adrenal. Thirty four percent were malignant. These tumors were mostly non functioning, 70% occurred in men and 67% were metastatic. CONCLUSIONS: Most adrenal macrotumors in this series were non functioning and 36% were malignant.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Angiomiolipoma/diagnóstico por imagem , Carcinoma/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
BACKGROUND: The correct management of thyroid nodules requires an accurate histological diagnosis to discard carcinoma. AIM: To assess the diagnostic value of fine needle aspiration biopsy of thyroid nodules as compared to cytology of the same sample and surgical biopsy. PATIENTS AND METHODS: One hundred and forty three thyroid nodules were punctured with a 21 G needle under continuous aspiration obtaining a sample for cytological and histological diagnosis. Fifty patients were subjected to a thyroidectomy. RESULTS: The age of studied patients ranged from 12 to 78 years old and 94% were female. Mean nodule diameter was 2.7 +/- 1.4 cm. Two percent of procedures were complicated with local hematomas, that subsided spontaneously. A diagnosis of cancer was reached in 16% of all patients and 46% of operated patients. Cytology had a 50% sensitivity, 87.5% specificity, a 89.4% positive predictive value and a 87.5% negative predictive value. The figures for fine needle aspiration biopsy were 82.6, 100, 100 and 87% respectively. CONCLUSIONS: Fine needle aspiration biopsy has a better diagnostic accuracy than cytology and is a simple and safe procedure.
Assuntos
Biópsia por Agulha , Nódulo da Glândula Tireoide/patologia , Adolescente , Adulto , Idoso , Criança , Técnicas Citológicas , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Sensibilidade e EspecificidadeRESUMO
We report a 29 years old female admitted due to a congestive cardiac failure that failed to respond to therapy with furosemide and enalapril. Serum thyroid hormone profile showed a TSH over 40 microIU/ml, a thyroxine of 0.8 microgram/dl and a triiodothyronine below 20 ng/dl. Levothyroxine therapy was started with remission of cardiac failure. The study of thyroid function in patients with cardiac failure of unknown origin and resistant to therapy, should be bone in mind.
Assuntos
Insuficiência Cardíaca/etiologia , Hipotireoidismo/complicações , Adulto , Feminino , HumanosRESUMO
We report a 33 years old male consulting for abdominal pain. Initial diagnostic work up showed high levels of alkaline phosphatases, that were confirmed in a new blood sample. Using electrophoresis, total alkaline phosphatases were 198 U/l (normal values = 30-117) and the bone fraction was 101 U/l (normal values = 0.35). Bone scintiscan and endocrinological assessment were normal. One year later, the same values persisted. Studying the family, three of four brothers had the same alterations in alkaline phosphatases. It was concluded that these subjects had the rare condition known as benign familial hyperphosphatasemia.
Assuntos
Fosfatase Alcalina/sangue , Adulto , Fosfatase Alcalina/genética , Criança , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , LinhagemRESUMO
We report a 28 years old woman who consulted for diarrhea of two years and a thyroid nodule. A medullary thyroid carcinoma was diagnosed and a thyroidectomy performed. There was a local relapse two months later and distant metastases were found five months later. A MIBG-1131 scintigraphic image of the adrenals lead to the suspicion of a bilateral pheochromocytoma. The surgical resection of the adrenals confirmed the diagnosis. There was no response to chemotherapy and the patient continued with severe hypercalcemia, repeated infections, persistent diarrhea and cachexia, dying one year after the diagnosis. There was no family history of the disease. We conclude that this is a particularly aggressive presentation of a multiple endocrine neoplasia type 2A.
Assuntos
Carcinoma Medular/diagnóstico , Neoplasia Endócrina Múltipla Tipo 2a/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias das Glândulas Suprarrenais/diagnóstico , Neoplasias das Glândulas Suprarrenais/secundário , Neoplasias das Glândulas Suprarrenais/terapia , Adulto , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Carcinoma Medular/terapia , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Neoplasia Endócrina Múltipla Tipo 2a/terapia , Feocromocitoma/diagnóstico , Feocromocitoma/secundário , Feocromocitoma/terapia , Neoplasias da Glândula Tireoide/terapiaRESUMO
Hypocortisolism derived from hypothalamic deficiency of corticotropin releasing hormone is a highly unusual cause of adrenal insufficiency, and its pathogenesis is still not fully understood. We report a mildly symptomatic patient having repeated low basal plasma cortisol levels with normal cortisol response to ACTH and Lysine-vasopressin; however, she showed a clearly limited response to deep hypoglycemia, while GH reached a normal concomitant response. After 7 years of cortisol replacement the endogenous cortisol returned spontaneously to normality. The rest of pituitary function has been always normal.