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INTRODUCTION: Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare neoplasm most frequently associated with textured implant placement. The classic presentation consists of a persistent periprosthetic seroma. Implant removal and individualized adjuvant treatment are potentially curative interventions. Most BIA-ALCL present with a seroma, not with a breast and/or axillary mass. Knowledge of this presentation and how to manage it allows an adequate diagnosis, and appropriate treatment with excellent results. PRESENTATION OF CASE: A 44-year-old woman presented with a 3-month history of a right breast mass located in the lower medial quadrant, with associated right axillary lymphadenopathy. Medical history was significant for a mastoplasty with textured implants 15 years before the onset of her symptoms. Imaging studies and histological analysis helped to confirm the diagnosis of BIA-ALCL. A bilateral capsulectomy was performed and adjuvant chemotherapy and immunotherapy were administered. With these interventions, the patient had complete resolution of her symptoms, good cosmetic results, and absence of tumor activity detectable by positron emission tomography with fluorodeoxyglucose (PET-CT FDG) at a 2.5-year follow-up. DISCUSSION: This case describes an atypical presentation of BIA-ALCL as a breast mass, as well as lymph node and bone marrow involvement. Knowledge of the different presentation modalities of this pathology is necessary for a correct diagnosis and treatment. Through a multidisciplinary approach, adequate treatment was given with excellent results. CONCLUSION: Anaplastic large cell lymphoma associated with breast implants is a clinicopathological entity still little known in some medical fields. A variety of presentations must be considered, and high clinical suspicion must be maintained in patients with a history of textured breast implant placement to optimize diagnosis and avoid delays in treatment.
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BACKGROUND: Extraskeletal myxoid chondrosarcoma (EMC) accounts for the 3% of all soft tissue sarcomas and it's categorized as a tumour of uncertain differentiation. This entity has shown to have the recurrent balanced chromosomal translocation t(9;22) (q22;q12.2), which leads to the oncogenic fusion gene EWSR1-NR4A3. This sarcoma usually presents as a slow growing, palpable mass in the extremities. EMC arising from the lung is extremely infrequent. We report one case of pulmonary extraskeletal mixoid chondrosarcoma and a review of the world literature. CASE REPORT: A 69-year-old male patient presented with intermittent hemoptysis for the last 6 months. A PET/CT scan showed a hypermetabolic solid mass with lobulated borders of approximately 29×26mm in the inferior right lobe. We performed a right thoracotomy with inferior lobectomy and lymphadenectomy of levels VII, VIII, X, and XI levels. The neoplasm was constituted by cords of small cells with small round nucleus and scarce cytoplasm immerse in an abundant myxoid matrix. The immunophenotype was positive for MUM-1, CDK4, MDM2, and showed focal expression for S-100 protein and CD56. The final pathology report revealed a pulmonary extraskeletal mixoid chondrosarcoma. No further surgical interventions or adjuvant therapies were needed. CONCLUSION: EMC is an intermediate-grade neoplasm, characterized by a long clinical course with high potential for local recurrence and distant metastasis. Treatment for EMC is surgical and non-surgical treatment is reserved for recurrence or metastatic disease. Pulmonary extraskeletal myxoid chondrosarcoma is a rare neoplasm with only isolated case reports found in the literature.
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Los glucocorticoides son base de la terapéutica del Lupus Eritematoso Sistémico (LES). En ocasiones el control de la enfermedad requiere dosis altas que resultan inconvenientes. Los pacientes con LES tienen defectos hormonales que resultan en bajos niveles séricos de andrógenos, principalmente dehidroepiandrosterona (DHEA). En estudios recientes la administración de DHEA permitió reducir la dosis de glucocorticoides necesaria para controlar la enfermedad. Objetivo. Corroborar el papel coadyuvante de la DHEA en el tratamiento de LES. Métodos. Diez mujeres con LES de leve a moderada actividad y múltiples manifestaciones clínicas recibieron 200 mg/día de DHEA por vía oral así como otros medicamentos clínicamente indicados. Las pacientes fueron evaluadas mensualmente a través de MEX-SLEDAI, un cuestionario, una escala visual analógica y estudios de laboratorio. Resultados. Ocho pacientes completaron el estudio. Después de 3 meses de tratamiento con DHEA mejoraron los índices de actividad de LES incluyendo la puntuación MEX-SLEDAI y la sensación de bienestar de los pacientes (78.4 por ciento y 24.7 por ciento respectivamente). La DHEA fue bien tolerada; los efectos adversos observados fueron menores y reversibles al suspender el fármaco.Conclusión. La DHEA parece ser un coadyuvante útil en el tratamiento de LES.