RESUMO
We report a 64 years old female admitted with fever, cough, dyspnea and lung opacities in the chest X ray. A chest tomography scan (CTS) showed multiple-bilateral ring-shaped opacities and the reversed halo sign (RHS). The patient did not improve with antimicrobial therapy (AT). Infection and rheumatologic causes were excluded, therefore Cryptogenic organizing pneumonia (COP) was suspected with compatible percutaneous biopsy. Systemic steroids were started with a good clinical response. The patient was discharged four weeks after admission in good general conditions and practically no lungs opacities.
Assuntos
Pneumonia em Organização Criptogênica/diagnóstico por imagem , Pneumonia em Organização Criptogênica/patologia , Biópsia , Pneumonia em Organização Criptogênica/tratamento farmacológico , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pessoa de Meia-Idade , Prednisona/uso terapêutico , Radiografia Torácica , Tomografia Computadorizada por Raios XRESUMO
Adventitial cystic disease of the popliteal artery is a rare condition of uncertain etiology, which presents as intermittent claudication of the lower extremity in middle-age patients. We report a 44-year-old man presenting with intermittent claudication of his left leg. MR angiography showed cystic parietal lesions that caused compression with partial occlusion of the left popliteal artery. Surgical resection of the affected segment was performed, with venous graft interposition. The histopathological analysis of the surgical specimen was consistent with cystic adventitial disease.
Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Cistos/complicações , Cistos/diagnóstico por imagem , Claudicação Intermitente/etiologia , Artéria Poplítea/diagnóstico por imagem , Angiografia , Perna (Membro)RESUMO
We report a 64 years old female admitted with fever, cough, dyspnea and lung opacities in the chest X ray. A chest tomography scan (CTS) showed multiple-bilateral ring-shaped opacities and the reversed halo sign (RHS). The patient did not improve with antimicrobial therapy (AT). Infection and rheumatologic causes were excluded, therefore Cryptogenic organizing pneumonia (COP) was suspected with compatible percutaneous biopsy. Systemic steroids were started with a good clinical response. The patient was discharged four weeks after admission in good general conditions and practically no lungs opacities.
Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Pneumonia em Organização Criptogênica/patologia , Pneumonia em Organização Criptogênica/diagnóstico por imagem , Biópsia , Prednisona/uso terapêutico , Radiografia Torácica , Tomografia Computadorizada por Raios X , Pneumonia em Organização Criptogênica/tratamento farmacológico , Glucocorticoides/uso terapêutico , Pulmão/patologia , Pulmão/diagnóstico por imagemRESUMO
Adventitial cystic disease of the popliteal artery is a rare condition of uncertain etiology, which presents as intermittent claudication of the lower extremity in middle-age patients. We report a 44-year-old man presenting with intermittent claudication of his left leg. MR angiography showed cystic parietal lesions that caused compression with partial occlusion of the left popliteal artery. Surgical resection of the affected segment was performed, with venous graft interposition. The histopathological analysis of the surgical specimen was consistent with cystic adventitial disease.
Assuntos
Cistos , Claudicação Intermitente , Adulto , Angiografia , Cistos/complicações , Cistos/diagnóstico por imagem , Humanos , Claudicação Intermitente/etiologia , Perna (Membro) , Masculino , Pessoa de Meia-Idade , Artéria Poplítea/diagnóstico por imagemRESUMO
Background:: Pulmonary cystic nodules are a relatively frequent finding in chest computed tomography (CT). There is a possible association between this finding and lung cancer. Aim: To report eight patients with malignant lung cystic lesions. Material and Methods: Retrospective analysis of images in a CT database from 2007 to 2015, looking for cystic lesions of the lung with wall thickening, whose pathological diagnosis was lung cancer. Results: We identified eight patients with cystic nodules aged 44 to 77 years, of which five were women. Six were active and two former smokers. The pathological diagnosis was adenocarcinoma in seven cases and squamous cell in one. The mean diameter of the cystic lesions was 11.5 mm. The mean diagnostic delay time was 871 days (range 0-1592). The main finding was a gradual thickening of the nodule walls. Conclusions: The presentation of lung cancer as cystic nodules is uncommon. In this series, the change in morphology due to a thickening of the walls with or without a diameter increase, was the clue for the diagnosis.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Carcinoma de Células Escamosas/patologia , Adenocarcinoma/patologia , Cistos/patologia , Neoplasias Pulmonares/patologia , Biópsia , Carcinoma de Células Escamosas/diagnóstico por imagem , Adenocarcinoma/diagnóstico por imagem , Fumar/efeitos adversos , Estudos Retrospectivos , Cistos/diagnóstico por imagem , Carga Tumoral , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Neoplasias Pulmonares/diagnóstico por imagemRESUMO
BACKGROUND: Pulmonary cystic nodules are a relatively frequent finding in chest computed tomography (CT). There is a possible association between this finding and lung cancer. AIM: To report eight patients with malignant lung cystic lesions. MATERIAL AND METHODS: Retrospective analysis of images in a CT database from 2007 to 2015, looking for cystic lesions of the lung with wall thickening, whose pathological diagnosis was lung cancer. RESULTS: We identified eight patients with cystic nodules aged 44 to 77 years, of which five were women. Six were active and two former smokers. The pathological diagnosis was adenocarcinoma in seven cases and squamous cell in one. The mean diameter of the cystic lesions was 11.5 mm. The mean diagnostic delay time was 871 days (range 0-1592). The main finding was a gradual thickening of the nodule walls. CONCLUSIONS: The presentation of lung cancer as cystic nodules is uncommon. In this series, the change in morphology due to a thickening of the walls with or without a diameter increase, was the clue for the diagnosis.
Assuntos
Adenocarcinoma/patologia , Carcinoma de Células Escamosas/patologia , Cistos/patologia , Neoplasias Pulmonares/patologia , Adenocarcinoma/diagnóstico por imagem , Adulto , Idoso , Biópsia , Carcinoma de Células Escamosas/diagnóstico por imagem , Cistos/diagnóstico por imagem , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Estudos Retrospectivos , Fumar/efeitos adversos , Carga TumoralRESUMO
Fibroepithelial polyps are benign lesions, frequently found in the skin and genitourinary tract. Airway involvement is rare, and few case reports have been published. Our patient was a 79 y.o. male smoker, who was referred to us with a 3-month history of dry cough. At physical examination, the patient looked well, but a chest CT showed a 6-mm polyp lesion in his trachea. A flexible bronchoscopy confirmed this lesion, and forceps biopsies were performed. Argon plasma coagulation was used to completely resect and treat the lesion. Pathological analysis revealed a fibroepithelial polyp (FP). The aim of this manuscript is to report a case of FP with bronchoscopic management and to review the current literature about this condition.
Assuntos
Carcinoma Pulmonar de Células não Pequenas/genética , Genes erbB-1/genética , Neoplasias Pulmonares/genética , Mutação , Proteínas Tirosina Quinases/genética , Proteínas Proto-Oncogênicas/genética , Receptores Proteína Tirosina Quinases/genética , Adulto , Idoso , Idoso de 80 Anos ou mais , Quinase do Linfoma Anaplásico , Biópsia por Agulha Fina/métodos , Carcinoma Pulmonar de Células não Pequenas/patologia , Chile , Feminino , Humanos , Pulmão/patologia , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Tomografia Computadorizada por Raios X , Ultrassonografia de Intervenção/métodosRESUMO
Dendriform pulmonary ossification is a rare condition often diagnosed by either surgery or postmortem examination. We report a 43-y-old man with a history of nonproductive cough for 1 y. His physical examination was unremarkable. Chest computed tomography showed multiple bilateral micronodules in both lower lobes; however, the patient's pulmonary function was normal. Flexible bronchoscopy with transbronchial biopsies revealed branching ossification. Pulmonary ossification is a chronic process characterized by progressive metaplastic ossification. We reviewed a total of 42 cases of dendriform pulmonary ossification reported in the medical literature: most of these cases were diagnosed by autopsy. Despite its rarity, dendriform pulmonary ossification should be considered in the differential diagnosis of diffuse lung disease. Bronchoscopy with transbronchial biopsies must be considered as a potential diagnostic procedure.
Assuntos
Pneumopatias/diagnóstico , Ossificação Heterotópica/diagnóstico , Adulto , Biópsia , Broncoscopia , Chile , Tosse/etiologia , Diagnóstico Diferencial , Humanos , Pulmão/patologia , Pneumopatias/patologia , Masculino , Ossificação Heterotópica/patologia , Doenças RarasRESUMO
Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.
La neumonía de evolución tórpida son aquellas en que no se logra una respuesta clínica adecuada con el uso de terapia antimicrobiana. Existen múltiples causas a esta falta de respuesta: resistencia antimicrobiana, microorganismos no cubiertos o infecciones por microorganismos atípicos. Coccidioides immitis es un hongo causante de neumonía en el hemisferio norte, especialmente en E.U.A y norte de México. No existen reportes de casos pulmonares importados en Chile. Presentamos el caso de una mujer adulta con una neumonía que no respondió al tratamiento antimicrobiano habitual. Una vez realizado un estudio exhaustivo, se logró establecer mediante el estudio histopatológico la existencia de una coccidiodomicosis como entidad causal, logrando una respuesta clínica y radiológica favorable al tratamiento antifúngico.
Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Coccidioidomicose , Pneumopatias Fúngicas , Antifúngicos/uso terapêutico , Chile , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Diagnóstico Diferencial , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , México , Pneumonia/diagnóstico , Viagem , Falha de TratamentoRESUMO
Chondroid syringoma (CS) is an uncommon, benign epithelial skin mixed tumor. It is often located in the head and neck and is unusual in other parts of the body. It may be seen as a skin or soft tissue tumor. We present findings on high-resolution ultrasound and histology in a case of benign CS located on the right index finger. High-resolution ultrasound showed a solid hypoechoic, well-defined subcutaneous mass, adjacent to the tendon. Complete surgical excision was performed, and histopathology demonstrated an apocrine mixed tumor (CS). Although CS histological findings are well described, radiological features have been reported only in few cases and mainly in magnetic resonance. Chondroid syringoma should be suspected by high-resolution ultrasound as a differential diagnosis for a solid slow-growing soft tissue nodule in a finger, especially if the lesion has no contact with the underlying tendon.
Assuntos
Adenoma Pleomorfo/diagnóstico por imagem , Adenoma Pleomorfo/cirurgia , Neoplasias de Tecidos Moles/diagnóstico por imagem , Neoplasias de Tecidos Moles/cirurgia , Ultrassonografia/métodos , Diagnóstico Diferencial , Feminino , Dedos/diagnóstico por imagem , Dedos/cirurgia , Humanos , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Treatment failure in community-acquired pneumonia is defined as a clinical condition with inadequate response to antimicrobial therapy. Resistant and unusual microorganisms and noninfectious causes are responsible for treatment failure. Coccidioides immitis is a fungus that causes pneumonia in the northern hemisphere, especially in the United States and northern Mexico. We report a case of pulmonary coccidioidomycosis imported from Mexico to Chile. After a comprehensive study, histopathology was able to establish Coccidiodes immitis as the causative agent, achieving clinical and radiological improvement with antifungal therapy.
Assuntos
Coccidioidomicose , Pneumopatias Fúngicas , Antifúngicos/uso terapêutico , Chile , Coccidioidomicose/diagnóstico , Coccidioidomicose/tratamento farmacológico , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Diagnóstico Diferencial , Feminino , Humanos , Pneumopatias Fúngicas/diagnóstico , Pneumopatias Fúngicas/tratamento farmacológico , Pneumopatias Fúngicas/microbiologia , México , Pessoa de Meia-Idade , Pneumonia/diagnóstico , Viagem , Falha de TratamentoRESUMO
A six years old girl consulted due to mammary development. On physical examination, clitoris enlargement and a tumor localized in the abdominal-pelvic region were observed. Hormonal study disclosed elevated testosterone and estradiol levels. On exploratory laparotomy, a right ovarian tumor was observed and a right salpingooophorectomy was performed. The contemporary biopsy informed a disgerminoma, leading to a surgical staging of the tumor. The definitive pathological diagnosis was a juvenile granular cell tumor, limited to the ovary. In the postoperative period, estradiol and testosterone levels returned to normal values and the pseudopuberty reverted. The patient did not receive adjuvant treatment and after three years of follow up, there is no evidence of tumor recidivism.
Assuntos
Tumor de Células da Granulosa/complicações , Neoplasias Ovarianas/complicações , Puberdade Precoce/etiologia , Criança , Feminino , Tumor de Células da Granulosa/patologia , Tumor de Células da Granulosa/cirurgia , Humanos , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Puberdade Precoce/patologia , Puberdade Precoce/cirurgiaRESUMO
BACKGROUND: The pathological differential diagnosis between primary and metastatic ovarian malignant tumors is usually difficult, specially for tumors originating in the gastrointestinal system or breast. AIM: To define an immunohistochemical flow chart to discriminate these tumor types. MATERIAL AND METHODS: We performed a immunostaining analysis using a panel of six antibodies (CK 7, CA 125, CEA, CK20, BRST-2 and CA 15-3) in 3 tumor groups: 11 ovarian, 14 breast and 12 colonic primary tumors and in a study group of 38 ovarian tumors whose primary origin was unknown. RESULTS: We defined an ovarian immunohistochemical pattern (CEA-/CK20-, 45% in ovarian tumors, 0% in breast or colonic tumors, p < 0.001); an ovary/breast pattern (CEA+/CK20-, 0% in colonic tumors, p < 0.001): a breast pattern (CEA+/CK20-/BKST-2+, 64% in breast tumors and 0% in colonic and ovarian tumors, p < 0.001) and a colonic pattern (CEA+/CK20+/CK7-, 67% in colonic tumors and 0% in breast and ovarian tumors, p < 0.001). CONCLUSIONS: Employing a simple panel of antibodies, characteristic immunohistochemical patterns were defined for ovarian, breast and colonic tumors. These patterns allowed the identification of the origin of most tumors of the study group.