RESUMO
BACKGROUND: Presence of the vermiform appendix in an inguinal hernia sac is an uncommon finding (1%), exceptionally rare if it's inflamed (0.13%). Clinically simulating incarcerated inguinal hernia and proper preoperative diagnosis is exceptional. We present two unusual cases of Amyand's hernia, and review of the bibliography. CLINICAL CASES: 1. Male patient 78 year old with an incarcerated right inguinal hernia which was performed preoperatively the diagnosis of Amyand's hernia by abdominal Computed Tomography. Clinical case 2. Female patient 82 year old with symptoms of an incarcerated right femoral hernia that finally showed an Amyand's hernia through a right inguinal hernia. CONCLUSIONS: Amyand's hernia is a rare entity whose preoperative diagnosis is uncommon, that it should always be considered in the differential diagnosis in cases with clinical signs of incarcerated right inguinal hernia.
Antecedentes: encontrar el apéndice vermiforme en un saco herniario inguinal es un hallazgo infrecuente (1%), excepcionalmente raro si está inflamado (0.13%). Clínicamente simula una hernia inguinal incarcerada y el diagnóstico preoperatorio adecuado se establece en contadas excepciones. Se reportan dos casos excepcionales de hernias de Amyand y se revisa la bibliografía. Casos clínicos: 1. Paciente masculino de 78 años con una hernia inguinal derecha, incarcerada, en el que el diagnóstico de hernia de Amyand se estableció antes de la cirugía mediante tomografía computada abdominal. Caso clínico 2. Paciente femenina de 82 años de edad, con clínica de hernia crural derecha incarcerada con una hernia de Amyand a través de una hernia inguinal derecha. Conclusiones: la hernia de Amyand es una rara enfermedad cuyo diagnóstico preoperatorio es infrecuente y que siempre debe considerarse en el diagnóstico diferencial en los casos con signos clínicos de hernia inguinal derecha incarcerada.
Assuntos
Apendicite/complicações , Apêndice , Hérnia Inguinal/diagnóstico , Idoso , Idoso de 80 Anos ou mais , Antibioticoprofilaxia , Apendicectomia , Apêndice/patologia , Emergências , Feminino , Gangrena , Hérnia Inguinal/complicações , Hérnia Inguinal/diagnóstico por imagem , Herniorrafia , Humanos , Masculino , RadiografiaRESUMO
BACKGROUND: mammary fibromatosis is a rare pathology. It constitutes 0.2% of breast cancers, and case in men are exceptional. The definitive diagnosis is histological. CLINICAL CASE: we report the case of a male of 52 years, diagnosed with breast fibromatosis after pathologic study of tumor in the right breast. Programmed surgery for excision with wide margins was done. We performed a mastectomy of the subcutaneous fibromatosis with a pathologic study with clear margins. The postoperative course was uncomplicated and did not require adjuvant therapy. At 6 months follow-up he remains free of disease. The treatment of choice is surgical excision with wide margins. Adjuvant treatment is controversial. CONCLUSIONS: the fibromatosis in the breast is very rare and an exceptional occurrence in men. Surgery is the definitive treatment; few results exist for adjuvant therapy.
Antecedentes: la fibromatosis mamaria es una enfermedad rara; sus casos son 0.2% de las neoplasias de mama, y en los varones es aún más rara. El diagnóstico definitivo es anatomopatológico. Caso clínico: se comunica el caso de un varón de 52 años, con diagnóstico anatomopatológico de fibromatosis mamaria posterior al estudio de un tumor en la mama derecha. Se le practicó exéresis con amplios márgenes, luego mastectomía subcutánea, con estudio histológico de fibromatosis con márgenes libres. El postoperatorio transcurrió sin complicaciones y no requirió tratamiento coadyuvante. En el seguimiento a seis meses continuaba libre de enfermedad. El tratamiento de elección es la escisión con amplios márgenes y el oncológico coadyuvante es motivo de controversia. Conclusiones: la fibromatosis en la mama es poco frecuente y su aparición en el varón excepcional. El tratamiento quirúrgico es el definitivo, no así la terapia oncológica neoadyuvante que sigue suscitando controversia.
Assuntos
Neoplasias da Mama Masculina/diagnóstico , Fibroma/diagnóstico , Mastectomia Subcutânea , Biomarcadores Tumorais/análise , Neoplasias da Mama Masculina/patologia , Neoplasias da Mama Masculina/cirurgia , Fibroma/química , Fibroma/diagnóstico por imagem , Fibroma/patologia , Fibroma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Indução de Remissão , UltrassonografiaRESUMO
BACKGROUND: Merkel cell carcinoma is an aggressive neuroendocrine cell carcinoma arising in the epidermis of patients aged >60 years. This lesion is found in sun-exposed areas and presents as a small violet raised nodule. It is usually painless and rapidly growing. Although its clinical presentation and characteristic histology are usually sufficient, immunohistochemical features are helpful in making an accurate diagnosis. CLINICAL CASE: We present the case of a 62-year-old male with epidermoid carcinoma of the lung who was treated with surgery and local radiation for 2 months. He presented a painless 8-cm subcutaneous mass of some weeks of evolution, without inflammatory signs. Computerized tomography demonstrated a mass of probable lymph node origin. Fine-needle aspiration biopsy (FNAB) reported malignant cells and excisional surgery of the mass was performed, revealing a subcutaneous Merkel cell carcinoma. CONCLUSIONS: Merkel cell carcinoma is a rare entity that develops in mature patients, often in sun-exposed areas, and presents cutaneous injury in intact skin. Definitive diagnosis is done using immunohistochemistry.
Assuntos
Carcinoma de Célula de Merkel/cirurgia , Neoplasias Induzidas por Radiação/cirurgia , Segunda Neoplasia Primária/cirurgia , Neoplasias Cutâneas/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Axila , Biomarcadores Tumorais/análise , Carcinoma de Célula de Merkel/diagnóstico , Carcinoma de Célula de Merkel/tratamento farmacológico , Carcinoma de Célula de Merkel/patologia , Carcinoma de Célula de Merkel/radioterapia , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células Escamosas/diagnóstico por imagem , Carcinoma de Células Escamosas/secundário , Carcinoma de Células Escamosas/cirurgia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Diagnóstico Diferencial , Etoposídeo/administração & dosagem , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Neoplasias Pulmonares/cirurgia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias Induzidas por Radiação/diagnóstico , Neoplasias Induzidas por Radiação/tratamento farmacológico , Neoplasias Induzidas por Radiação/patologia , Neoplasias Induzidas por Radiação/radioterapia , Segunda Neoplasia Primária/diagnóstico , Pneumonectomia , Radiografia , Radioterapia Adjuvante , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/patologia , Neoplasias Cutâneas/radioterapia , Neoplasias Cutâneas/secundário , Baço/patologia , Tela Subcutânea/patologiaRESUMO
Presentamos el caso excepcional de paciente con angiosarcoma primario de mama y carcinoma papilar de tiroides sincrónicos. Mujer de 34 años con angiosarcoma primario en la mama derecha sometida a mastectomía simple. En el estudio de extensión se halló un incidentaloma tiroideo derecho compatible con carcinoma papilar que requirió tiroidectomía total y linfadenectomía del compartimento central en segundo tiempo. Los angiosarcomas primarios suponen menos del 0,05% de todos los tumores primarios malignos de la mama. El diagnóstico definitivo de estos tumores viene definido por el estudio anatomopatológico, que define tres grados: alto, bajo, intermedio, los cuales se relacionan de forma directa con la supervivencia. La prevalencia de los incidentalomas malignos tiroideos objetivados por PET varía del 14% - 30,9%. La planificación del tratamiento quirúrgico de las neoplasias incidentales tiroideas en pacientes con otro tumor primario debe analizarse de forma individualizada, según la supervivencia esperada del tumor primario
Present the exceptional case of a female patient with diagnostic of primary angiosarcoma of the breast and synchronous thyroid papillary carcinoma, we review the literature. Patient female 34 year old with diagnostic of primary angiosarcoma in the right breast, it was removed,in the extension study found an incidental thyroid papillary carcinoma that required total thyroidectomy and central lymphadenectomy in a second time. The primary angiosarcomas account for less than 0.05% of all primary malignant tumors of the breast. The definitive diagnosis is determined by the pathology study, which defines three grades: high, low and intermediate, which relate directlyto the survival. The prevalence of malignant thyroid incidentalomas was observed by PET varies from 14% to30,9%, according to different studies. Planning the surgical treatment of incidental thyroid malignancies in patients with other primary tumor should be analyzed individually,according the expected survival of the primary tumor
Assuntos
Feminino , Carcinoma Papilar/patologia , Linfonodos/patologia , Hemangiossarcoma/diagnóstico , Mastectomia Simples/métodos , Neoplasias da Mama/patologia , Neoplasias da Glândula Tireoide/patologia , OncologiaRESUMO
BACKGROUND: The "proximal-type" epithelioid sarcoma (PES) is a rare variant of conventional epithelioid sarcoma. It has been described in older patients in the proximal portion of the extremities with a predilection for the pelvis and perineum. It is clinically more aggressive, showing a higher incidence of recurrence, metastasis, resistance to chemotherapy and a higher mortality. We report the case of a patient with a PES of the pubic region and we review the previous literature. CLINICAL CASE: We report the case of a 57-year-old female with a painless, progressively growing mass in the region of the pubis. We performed surgical resection of the lesion with clear margins and histological and immunohistochemical study allowed the definitive diagnosis of PES. After 4 disease-free years, the patient had a tumor recurrence at the same location. We performed en bloc resection of the lesion and immunohistochemical study confirmed the recurrence of PES. The patient refused adjuvant therapy. Today, after 4 years of follow-up, the patient remains asymptomatic and without evidence of recurrence or distant disease. CONCLUSIONS: Diagnosis of PES is complex because histological findings may be confused with multiple tumors; therefore, immunohistochemical study is definitive. PES shows positivity for epithelial markers (cytokeratin and EMA), mesenchymal markers (vimentin) as well as CD34. According to what has been reported in the literature, surgical treatment with free margins is indicated, with adjuvant therapies when the risk of recurrence is high.
Assuntos
Neoplasias Ósseas/diagnóstico , Osso Púbico/patologia , Sarcoma/diagnóstico , Biomarcadores Tumorais , Neoplasias Ósseas/química , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/patologia , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Imagem Multimodal , Recidiva Local de Neoplasia/cirurgia , Tomografia por Emissão de Pósitrons , Osso Púbico/química , Osso Púbico/diagnóstico por imagem , Sarcoma/química , Sarcoma/diagnóstico por imagem , Sarcoma/patologia , Sarcoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: angiomyofibroblastoma is a soft-tissue lesion. The vulvovaginal region of middle-aged females is the most frequent localization. Angiomyofibroblastoma is a well-circumscribed subcutaneous tumor at the vulva and perineum region. It is a painful and slow-growing tumor. It is often thought to represent a Bartholin's gland cyst. Treatment of choice is surgical excision. CLINICAL CASE: We describe the case of a 49-year-old female with a right vulvar tumor that had been growing for 2 years. Ultrasonography, computed tomography and magnetic resonance revealed a tumor at the right ischiorectal fossa. Diagnosis after surgical excision was angiomyofibroblastoma. CONCLUSIONS: angiomyofibroblastoma must be considered in the differential diagnosis of vulvovaginal tumors because its treatment differs from others lesions of that region.