RESUMO
To our knowledge, recurrent dysgerminoma at the site of tumor removal by laparoscopy in a patient with stage IA disease has not been previously reported. A woman with ovarian dysgerminoma treated by laparoscopy and tumor removed through the cul-de-sac recurred the 17 months later at the site of tumor removal. She was successfully treated with etoposide, bleomycin, and cisplatin chemotherapy with complete response. This case illustrates the potential for surgical site implant of an ovarian dysgerminoma; surgeons should follow strict guidelines when performing laparoscopic procedures for ovarian malignancies in order to prevent this type of incident.
Assuntos
Disgerminoma/terapia , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Laparoscopia/efeitos adversos , Recidiva Local de Neoplasia , Neoplasias Ovarianas/terapia , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Bleomicina/administração & dosagem , Cisplatino/administração & dosagem , Disgerminoma/patologia , Etoposídeo/administração & dosagem , Feminino , Humanos , Neoplasias Ovarianas/patologia , Indução de RemissãoRESUMO
BACKGROUND: Cat scratch disease, whose etiologic agent is Bartonella henselae, is a benign disease in immunocompetent subjects, characterized by lymphadenopathy of prolonged course and occasional involvement of other organs such as liver, spleen, central nervous system, eye and lung. In immunocompromised patients, the infection is bacteremic and disseminated. AIM: To report Chilean cases of cat scratch disease. PATIENTS AND METHODS: Ten children (seven male, aged between 6 and 13 years old) with histologically or serologically confirmed cat scratch disease are reported. RESULTS: Lymphadenopathy location was pre auricular in four cases, axillary in two, inguinal in two and epitrochlear in two. Three children had fever over 39 degrees C and two had a parinaud syndrome. Nine children had a history of cat scratch and one of a cat byte. Six had an erythrocyte sedimentation rate over 40. Lymph node ultrasound examination was a useful diagnostic tool. Two patients had splenic granulomas. Lymph node biopsies were obtained in four cases, showing a suppurative granulomatous lymphadenitis in all and a positive Warthin-Starry stain in two. Serology, done in patients without histological confirmation was positive with titles ranging from 1:64 to 1:8192. All patients had a satisfactory outcome with regression of lymphadenopathy. CONCLUSIONS: Infections by Bartonella hemselae occur in the Chilean population and must be considered in the differential diagnosis of regional lymph node enlargement.
Assuntos
Bartonella henselae , Doença da Arranhadura de Gato/diagnóstico , Imunocompetência , Adolescente , Doença da Arranhadura de Gato/imunologia , Criança , Conjuntivite Bacteriana/diagnóstico , Feminino , Humanos , Doenças Linfáticas/diagnóstico , MasculinoRESUMO
Three gastric mucosal biopsies were obtained from 300 patients showing a normal upper digestive tract endoscopy. Histologically, in 9% of the patients the biopsies were normal: in 87%, showed a common-type chronic gastritis, and in 4% showed a reactive (chemical or reflux-type) gastritis. Helicobacter pylori was present in 25.9% of the patients without gastritis, in 33.3% of the patients with reactive gastritis, and in 87.7% of those with common-type gastritis. In 19.9% of the patients with common-type chronic gastritis there was intestinal metaplasia, consisting of type I metaplasia in 14.1%, type II in 3.1% and type III metaplasia in 2.3%. The association of type III intestinal metaplasia with the other forms of metaplasia, its lower frequency and its tendency to be present in older patients supports the hypothesis that type III incomplete colonic metaplasia represents a more advanced stage than complete and incomplete small bowed metaplasia of the gastric mucosa.
Assuntos
Mucosa Gástrica/patologia , Gastrite/patologia , Adolescente , Adulto , Fatores Etários , Idoso , Biópsia , Doença Crônica , Feminino , Helicobacter pylori/isolamento & purificação , Humanos , Masculino , Metaplasia , Pessoa de Meia-IdadeRESUMO
Nocardia asteroide infections, an aerobic actinomycete, have several forms and lungs, skin and brain are the organs most frequently involved. When the infection suspected, special staining methods must be ordered to identify the agent. We report three immunocompetent patients with disseminated nocardiosis, two presenting with nodular lesions of skin and lungs and one presenting with pulmonary involvement and brain abscesses. The importance of clinical suspicion and early diagnosis of nocardiosis is emphasized.
Assuntos
Nocardiose/diagnóstico , Adolescente , Adulto , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/microbiologia , Feminino , Humanos , Imunocompetência , Pneumopatias/diagnóstico , Masculino , Nocardiose/tratamento farmacológico , Nocardiose/mortalidade , Nocardiose/patologia , Nocardia asteroides/isolamento & purificação , Nocardia asteroides/patogenicidade , Prognóstico , Tomografia Computadorizada por Raios XRESUMO
Pneumocystis carinii pneumonia is frequent in patients with cellular immunity impairments, specially those with AIDS. We communicate our experience in 20 patients (15 with AIDS) with Pneumocystis carinii pneumonia confirmed by the finding of trophozoites or cysts. Clinical manifestations were cough in 75% of cases, dyspnea in 70% and fever in 65%. Eighty five percent of cases had diffuse reticular and nodular radiological densities. Nineteen patients had an increased alveolar-arterial O2 gradient. Nineteen patients were treated with trimethropim-sulphamethoxazole (TMP-SMX) and 4 with pentamidine isethionate (1 due to previous allergy and 3 due to poor response to TMP-SMX). Three patients died during the acute episode. Of the survivors, 13 died within 2 to 44 months later (14.5 +/- 12 months). It is concluded that AIDS is the most frequent underlying condition in patients with Pneumocysts carinii pneumonia and that long term survival is low.
Assuntos
Pneumonia por Pneumocystis/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/complicações , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Hospedeiro Imunocomprometido , Masculino , Pessoa de Meia-Idade , Pentamidina/uso terapêutico , Pneumonia por Pneumocystis/tratamento farmacológico , Pneumonia por Pneumocystis/etiologia , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Combinação Trimetoprima e Sulfametoxazol/uso terapêuticoRESUMO
This is a clinico-pathological report of a 30 years old male patient that presented with acute epigastric pain. Ultrasound examination showed a retroperitoneal tumor, thrombosis of the inferior vena cava and ascites. CAT scan disclosed thrombosis of hepatic vein and inferior vena cava with right atrium involvement. Necropsy showed a leiomyosarcoma of the inferior vena cava. There are seldom reports of this tumor in the last 5 years and an early diagnosis allows therapeutic interventions associating surgery, radiotherapy and chemotherapy.
Assuntos
Leiomiossarcoma/patologia , Veia Cava Inferior , Adulto , Biópsia , Diagnóstico Diferencial , Humanos , Leiomiossarcoma/diagnóstico , Masculino , Tomografia Computadorizada por Raios X , Doenças Vasculares/patologiaRESUMO
Vaginal tact is not sufficient for staging the extension of cervical Ca in its adnexal compromise. The use of transvaginal echography with a cytological hystological parametrial biopsy allow the diagnosis to be certified. In 23 cases studied, 21 epidermoid carcinoma and one adenocarcinoma related with of original cervical tumor were revealed. The clinical staging had a 8.3% error margin.
Assuntos
Adenocarcinoma/diagnóstico por imagem , Biópsia por Agulha/métodos , Carcinoma de Células Escamosas/diagnóstico por imagem , Neoplasias Uterinas/diagnóstico por imagem , Adenocarcinoma/patologia , Adulto , Idoso , Carcinoma de Células Escamosas/patologia , Feminino , Humanos , Pessoa de Meia-Idade , Invasividade Neoplásica , Estudos Prospectivos , Sensibilidade e Especificidade , Ultrassonografia , Neoplasias Uterinas/patologiaRESUMO
We report a 28 year old heterosexual male with AIDS that presented with progressive motor disturbances and malaise. Light and transmission electron microscopy of a stereotaxic brain biopsy demonstrated a progressive multifocal leukoencephalopathy. This is a demyelinating infectious cerebral disease attributed to JC virus and must be considered in the differential diagnosis of central nervous system disturbances in AIDS patients.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Leucoencefalopatia Multifocal Progressiva/complicações , Adulto , Encéfalo/ultraestrutura , Humanos , Leucoencefalopatia Multifocal Progressiva/diagnóstico , Masculino , Tomografia Computadorizada por Raios XRESUMO
A 48 years old male presenting with a painless tumor of the right thigh is reported. An initial surgical excision showed that the tumor was joint to the saphenous vein. The histopathological study showed that it was a venous vascular leiomyosarcoma of intermediate degree of malignancy. The patients was re-operated performing a resection of the abductor muscle and two weeks later was subjected to radiotherapy (50 Gray). The only postoperative sequel was a moderate lymphedema of the right limb. This is the first reported case in the Chilean literature.
Assuntos
Leiomiossarcoma/patologia , Veia Safena/patologia , Humanos , Leiomiossarcoma/cirurgia , Masculino , Pessoa de Meia-Idade , Prognóstico , Reoperação , Veia Safena/cirurgiaRESUMO
A 24-year-old male patient with AIDS diagnosed in 1989, and with several episodes of pneumocystosis, was admitted because of a chronic diarrheic syndrome and severe epigastric pain. Endoscopy showed a granular duodenal mucosa. Light microscopy showed a moderate villous atrophy with round-cell inflammatory infiltration of the chorion. Giemsa, Ziehl-Neelsen, and Gram stains showed microsporidial spores measuring between 1.5 and 2 microns in the supranuclear cytoplasm of some enterocytes. Electron microscopy showed sporoblasts and spores consistent with Enterocytozoon bieneusi, with an apparently non-tubular, rather electron-dense polar filament showing up to 7 coils and also a microtubular internal structure with annular disposition, a finding which has not been adequately emphasized in the pertinent literature, probably representing a contractile property of the polar filament, rather than a mere duct for the parasitic sporoplasm to be inoculated.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Diarreia/parasitologia , Enteropatias Parasitárias/complicações , Microsporida/isolamento & purificação , Infecções por Protozoários/complicações , Adulto , Animais , Chile , Humanos , Masculino , Microscopia EletrônicaRESUMO
A twenty nine year old male homosexual presented with malaise, weight loss, fever and profuse sweating. An ill defined abdominal mass was found during physical examination in the right lower quadrant and chest X rays disclosed a pleural effusion. HIV antibodies and hepatitis B surface antigen were positive and immunological parameters were altered. Light and electron microscopic examination of operative biopsies of the abdominal mass revealed the presence of Histoplasma capsulatum. Treatment with Amphotericin B was started with a favorable response and the patient was discharged. He was readmitted with a septic shock and died. Necropsy showed pulmonary histoplasmosis. This is the first case of disseminated histoplasmosis in a patient with AIDS described in Chile.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Histoplasmose/complicações , Síndrome da Imunodeficiência Adquirida/patologia , Adulto , Citoplasma/ultraestrutura , Histiócitos/ultraestrutura , Histoplasmose/patologia , Humanos , Masculino , Microscopia EletrônicaRESUMO
We report a patient with the acquired immunodeficiency syndrome who developed acute cholecystitis. Removal of the gallbladder revealed infection by Cryptosporidium spp. The clinical course after cholecystectomy was favourable. The pathogenesis and therapy of this complication in patients with AIDS is discussed.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Colecistite/parasitologia , Criptosporidiose/complicações , Doença Aguda , Colecistite/complicações , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
We report 2 patients with AIDS who developed Chagas infection, one with encephalitis, the other with acute myocarditis. The implications of immune depression for the manifestations and course of Chagas disease are discussed. Chagas disease should be considered in patients with AIDS who live in endemic zones and who develop cerebral or cardiac manifestations.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Doença de Chagas/complicações , Encefalite/complicações , Adulto , Cardiomiopatia Chagásica/complicações , Cardiomiopatia Chagásica/patologia , Doença de Chagas/patologia , Encefalite/patologia , Humanos , MasculinoRESUMO
Four patients with advanced germinal cell testicular tumors were treated with cisplatinum, vinblastine and bleomycin. Histopathologic studies revealed pulmonary damage and various degrees of respiratory insufficiency developed in all patients, one of whom died. There was no instance of opportunistic infections in any patient. The pathophysiology relating pulmonary damage to the action of bleomycin is discussed.
Assuntos
Antibióticos Antineoplásicos/efeitos adversos , Bleomicina/efeitos adversos , Fibrose Pulmonar/induzido quimicamente , Adulto , Carcinoma Embrionário/tratamento farmacológico , Carcinoma Embrionário/secundário , Evolução Fatal , Humanos , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/tratamento farmacológico , Seminoma/tratamento farmacológico , Seminoma/secundário , Neoplasias Testiculares/tratamento farmacológico , Neoplasias Testiculares/patologiaRESUMO
A patient with AIDS developed pulmonary infiltrates typical of infection by P. carinii. However, therapy for this agent was unsuccessful. Further studies including blood cultures revealed the presence of C neoformans. Specific therapy for this agent led to recovery. Concomitant opportunistic infections may cause diagnostic and therapeutic problems in patients with AIDS.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/complicações , Criptococose/complicações , Pneumonia por Pneumocystis/complicações , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Adulto , Criptococose/tratamento farmacológico , Humanos , Masculino , Pneumonia por Pneumocystis/tratamento farmacológicoRESUMO
A 24 year old man with AIDS diagnosed in 1989 and a history of several episodes of pulmonary pneumocystosis developed chronic diarrhea and severe epigastric pain. Endoscopy revealed a granular intestinal mucosa. There was atrophy of villi and Giemsa, Ziehl-Nielsen and Gram staining identified 1.5 to 2 u spores in the cytoplasm of intestinal cells. Transmission electron microscopy of the spores revealed a thick wall, a sporoplasm with a nucleus, ribosomes, a posterior vacuole and a polar filament with multiple coils; no mitochondria were seen. Thus, the patient had intestinal microsporidiosis caused by Enterocytozoon bieneusi. This is a rare pathogen recently identified in man.
Assuntos
Infecções Oportunistas Relacionadas com a AIDS/parasitologia , Microsporidiose/parasitologia , Adulto , Animais , Diarreia/parasitologia , Humanos , Intestino Delgado/parasitologia , Masculino , Microscopia Eletrônica , Microsporídios/patogenicidade , Microsporidiose/diagnósticoRESUMO
Se analizan los resultados de la cirugía conservadora sin vaciamiento axilar, seguida de radioterapia y la sobrevida en 127 pacientes con cáncer de mama en estadio T1 - T2 No Mo a 144 meses. La población en estudio está constituida por 59 pacientes (46,4%) en T1 y 68 (53,5%) en T2. La edad promedio fue de 53 años para T1 y de 56 años para T2. El 83,2% de las pacientes en T1 tiene una SSEE a 120 meses. La mediana de seguimiento es de 54 meses. La sobrevida total actuarial es de 89,9%. El 11,8% (7/59) fracasaron. Tres (5%) en la zona locorregional y 4 (6,6%) a distancia. El 8% de los fracasos locorregionales lo hicieron en axila, mientras que en mama fue el 1,7%. Dos pacientes tienen fracaso en 2 o más localizaciones simultáneas. El 60,5% de las pacientes en T2 tienen una SSEE a 120 meses. La mediana de seguimiento es de 61 meses. La sobrevida total actuarial es de 77,7%. El 30% (21/68) fracasaron, 4 en la zona locorregional y 17 a distancia. Dos de los fracasos locorregionales fueron en axila y dos en la mama. Seis pacientes tienen dos o más fracasos simultáneos (locorregionales a distancia). Se concluye que en comparación a publicaciones con tratamientos similares, los resultados obtenidos son semejantes; pero al compararlos con los resultados obtenidos con técnicas conservadoras, en que se hace vaciamiento axilar, aquéllos son significativamente superiores, especialmente por los resultados obtenidos en axila
Assuntos
Humanos , Feminino , Neoplasias da Mama/cirurgia , Axila/cirurgia , Neoplasias da Mama/radioterapia , Carcinoma , Estudos ProspectivosRESUMO
A case of histoplasmosis duboisii in a 30 year-old engineer is presented. The diagnosis was made with the help of light microscopy, electron microscopy and cultures. Although diagnosed in Chile, the patient probably acquired the disease in the endemic African area, more precisely in the Ivory Coast. Differential diagnosis between Histoplasma capsulatum var. capsulatum and Histoplasma capsulatum var. duboisii is based primarily on the larger in-vivo yeast form size of the latter. Electron microscopy study, the first done on the duboisii variety of Histoplasma capsulatum in human material to our knowledge, was not essential for this purpose. Differential diagnosis between Histoplasma capsulatum var. duboisii and Blastomyces dermatitidis is based on morphological tissue changes and mycologic characteristics. Once more, a case of an "exotic" or geographically restricted disease is detected far from its endemic area, thanks to easier means of transportation. Earth is a shrinking planet.
Assuntos
Histoplasmose/patologia , Adulto , África/epidemiologia , Blastomicose/diagnóstico , Chile , Diagnóstico Diferencial , Histoplasmose/diagnóstico , Histoplasmose/epidemiologia , Humanos , Masculino , Microscopia EletrônicaRESUMO
Sixteen patients with P. carinii infection were studied between 1977 and 1989; 12 were male and the age ranged from 4 months to 53 years old. 19 samples, 5 from autopsy, 7 from biopsy and 7 cytological aspirates were stained with hematoxylin-eosin, Gomori-Grocott, Giemsa and 0 toluidine. Autopsy material was studied by transmission electron microscopy. The diagnosis was made premortem in 11 patients. AIDS was the underlying disease in 6 patients, the rest having other immunodepressant conditions. P. carinii infection was limited to the lung in all patients. The Gomori Grocott stain gave positive results in all cases; cytological studies were generally noncontributory. Opportunistic agents were found in 4 patients (aspergillus, cytomegalovirus and C. neoformans).
Assuntos
Pneumonia por Pneumocystis/patologia , Adolescente , Adulto , Criança , Pré-Escolar , Chile , Feminino , Humanos , Lactente , Masculino , Microscopia Eletrônica , Pessoa de Meia-Idade , Pneumonia por Pneumocystis/parasitologiaRESUMO
Actinomycosis is a chronic bacterial infectious disease, characterized by multiple abscesses, draining sinuses and abundant dense fibrous tissue. The intra-abdominal variety is rarely found and difficult to diagnose. We report three cases of intra-abdominal actinomycosis successfully treated by surgery and by longterm antibiotic therapy. One patient had a liver actinomycosis and two had ileo-caecal disease. Pertinent literature is reviewed.