RESUMO
El sarcoma de Kaposi linfangiomatoso es una variante clínica rara del sarcoma de Kaposi. Tiene la característica de presentarse como cavidades con contenido líquido que muchas veces se confunden con enfermedades ampollares de la piel. Presentamos un paciente masculino con antecedente de infección por VIH asociado a sarcoma de Kaposi clásico, diseminado a nivel pulmonar, gastrointestinal y cutáneo. Tras dos ciclos de quimioterapia mejoró el compromiso sistémico, pero comenzó con ampollas en ambos muslos, por lo que junto con estudios clínicos y estudios complementarios se llegó al diagnóstico de sarcoma de Kaposi linfangiomatoso.
Lymphangiomatous Kaposi's sarcoma is a rare clinical variant of Kaposi's sarcoma. It has the characteristic of appearing as cavities with liquid content that are often confused with blistering skin diseases. We present a male patient with a history of HIV infection associated with classic Kaposi's sarcoma, disseminated to the pulmonary, gastrointestinal and skin levels. After two cycles of chemotherapy, the systemic involvement improved but she began with blisters on both thighs, from which, together with clinical studies and complementary studies, a diagnosis of lymphangiomatous Kaposi's sarcoma was reached.
Assuntos
Humanos , Masculino , Adulto , Sarcoma de Kaposi/complicações , Sarcoma de Kaposi/diagnóstico , Infecções por HIV/imunologia , Resultado do Tratamento , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/terapia , Diagnóstico PrecoceRESUMO
Introducción: La linfangioleiomiomatosis Pulmonar (LAM) es una rara y progresiva enfermedad; caracterizada por proliferación excesiva de células musculares lisas a partir de vasos linfáticos, sanguíneos y vías aéreas. En conjunto al anormal crecimiento celular descrito, se aprecia degeneración quística difusa del parénquima pulmonar, lo que puede reflejarse desde cuadros completamente asintomáticos hasta el deterioro severo del intercambio gaseoso con insuficiencia respiratoria fulminante. Descripción del caso: Paciente femenino de 41 años de edad, con cuadro clínico consistente en tos seca ocasional, asociada a dolor leve de características pleuríticas en 'puntada de costado ' derecha. Ante la no mejoría clínica, se indica estudio imagenológico donde se demuestra neumotorax espontáneo derecho. En estudio tomográfico se aprecian además lesiones pulmonares quísticas. El estudio anátomo-patológico demuestra cambios estructurales que se reportan compatibles con LAM. Conclusión: Dada la simplicidad de los síntomas con que la LAM puede debutar, su confirmación diagnóstica se genera en fases avanzadas de la enfermedad, cuando el daño pulmonar importante conlleva a la aparición de factores clínicos con mayor repercusión sobre el estado general de los pacientes por lo que la realización de estudios imagenológicos tempranos gana vital importancia.
Introduction: Pulmonary lymphangioleiomyomatosis (LAM) is a rare and progressive disease; characterized by airway, lymphatic and blood vessels-smooth muscle cells excessive proliferation. Added to the abnormal cell growth, parenchymal cystic degeneration is present, which can be reflected initially as a asymptomatic course and can progress to severe gaseous exchange deterioration and fulminating respiratory insufficiency. Case description: A 41-year-old female patient with a clinical course consisting of occasional dry cough, associated with mild pleuritic pain on the right side of thorax. As no improvement was achieved, thoracic imaging study was performed, where a right pneumothorax was found. Tomography images showed multiple lung cystic lesions. Anatomopathological study reports structural changes compatible with LAM. Conclusion: Given the simplicity of the symptoms that LAM can debut with, its diagnostic confirmation is generated in advanced stages of the disease, when the important pulmonary damage leads to the appearance of clinical factors with greater impact on the general state of patients so early thoracic imaging studies gain vital importance.
Assuntos
Humanos , Feminino , Adulto , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/terapia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/terapia , Pneumotórax/etiologia , Espirometria , Radiografia Torácica , Tomografia Computadorizada por Raios X , Linfangioleiomiomatose/complicações , Sirolimo/uso terapêutico , Cistos/etiologia , Neoplasias Pulmonares/complicaçõesRESUMO
A 27-year-old female patient was referred to our outpatient clinic with a 1-year history of shortness of breath when walking fast on level ground or when climbing stairs. Symptoms worsened after a second episode of spontaneous left pneumothorax, when a chest tube was placed in another hospital for complete lung expansion. During this hospitalization, an open lung biopsy was performed. There was no history of rhinorrhea, nasal congestion, cough, hemoptysis, wheezing, or expectoration.
Assuntos
Fibrose Cística/diagnóstico , Neoplasias Pulmonares/diagnóstico , Pulmão , Linfangioleiomiomatose , Nódulos Pulmonares Múltiplos/diagnóstico , Sirolimo/administração & dosagem , Esclerose Tuberosa , Adulto , Antibióticos Antineoplásicos/administração & dosagem , Diagnóstico Diferencial , Gerenciamento Clínico , Feminino , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/fisiopatologia , Linfangioleiomiomatose/terapia , Esclerose Tuberosa/diagnóstico , Esclerose Tuberosa/fisiopatologia , Esclerose Tuberosa/terapiaRESUMO
Multiple cystic lung disease represents a diverse group of uncommon disorders that can present a diagnostic challenge due to the increasing number of diseases associated with this presentation. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings. The combination of appearance upon imaging and clinical features, together with extrapulmonary manifestations, when present, permits confident and accurate diagnosis of the majority of these diseases without recourse to open-lung biopsy. The main diseases in this group that are discussed in this review are lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and folliculin gene-associated syndrome (Birt-Hogg-Dubé); other rare causes of cystic lung disease, including cystic metastasis of sarcoma, are also discussed. Disease progression is unpredictable, and understanding of the complications of cystic lung disease and their appearance during evolution of the disease are essential for management. Correlation of disease evolution and clinical context with chest imaging findings provides important clues for defining the underlying nature of cystic lung disease, and guides diagnostic evaluation and management.
Assuntos
Amiloidose , Síndrome de Birt-Hogg-Dubé , Histiocitose de Células de Langerhans , Neoplasias Pulmonares , Linfangioleiomiomatose , Pneumonia por Pneumocystis , Adulto , Amiloidose/diagnóstico , Amiloidose/epidemiologia , Amiloidose/terapia , Biópsia , Síndrome de Birt-Hogg-Dubé/diagnóstico , Síndrome de Birt-Hogg-Dubé/epidemiologia , Síndrome de Birt-Hogg-Dubé/terapia , Diagnóstico Diferencial , Progressão da Doença , Feminino , Histiocitose de Células de Langerhans/diagnóstico , Histiocitose de Células de Langerhans/epidemiologia , Histiocitose de Células de Langerhans/terapia , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/epidemiologia , Linfangioleiomiomatose/terapia , Masculino , Pneumonia por Pneumocystis/diagnóstico , Pneumonia por Pneumocystis/epidemiologia , Pneumonia por Pneumocystis/terapia , Valor Preditivo dos Testes , Prognóstico , Fatores de Risco , Tomografia Computadorizada por Raios XAssuntos
Imunossupressores/uso terapêutico , Linfangioleiomiomatose/terapia , Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Everolimo/uso terapêutico , Humanos , Transplante de Pulmão , Linfangioleiomiomatose/diagnóstico , Doenças Raras/diagnóstico , Doenças Raras/terapiaAssuntos
Humanos , Imunossupressores/uso terapêutico , Linfangioleiomiomatose/terapia , Sirolimo/uso terapêutico , Serina-Treonina Quinases TOR/antagonistas & inibidores , Everolimo/uso terapêutico , Transplante de Pulmão , Linfangioleiomiomatose/diagnóstico , Doenças Raras/diagnóstico , Doenças Raras/terapiaAssuntos
Dispneia/diagnóstico , Neoplasias Renais/diagnóstico , Pulmão/diagnóstico por imagem , Linfangioleiomiomatose/diagnóstico , Pneumotórax/diagnóstico , Adolescente , Dispneia/etiologia , Dispneia/terapia , Serviços Médicos de Emergência , Feminino , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/terapia , Linfangioleiomiomatose/complicações , Linfangioleiomiomatose/terapia , Nefrectomia , Pneumotórax/etiologia , Pneumotórax/terapia , Radiografia , Recidiva , ToracostomiaRESUMO
Pulmonary lymphangioleiomyomatosis is an uncommon disease of unknown etiology characterized by the proliferation of abnormal smooth muscle cells in the lungs, leading to parenchymal destruction and progressive respiratory failure. The natural history of this disease remains poorly understood, primarily seen in women of childbearing age. The diagnosis can be difficult because symptoms are nonspecific and very similar to other respiratory diseases like asthma, emphysema and bronchitis. Lymphangioleiomyomatosis may not be diagnosed until a pneumothorax, chylothorax, interstitial lung disease or angiomyolipomas are discovered. The recent advances in genetic and molecular research provide new hope to discover the intricate mechanism of disease and evaluate new therapies. Internists, primary care physicians and pulmonologists should be aware of this condition in order to avoid delay in the diagnosis and institute appropriate therapy. The clinical features, pathophysiology, molecular genetics and medical treatment will be reviewed.
Assuntos
Estrogênios , Neoplasias Pulmonares , Linfangioleiomiomatose , Neoplasias Hormônio-Dependentes , Diagnóstico por Imagem/métodos , Dispneia/etiologia , Estrogênios/fisiologia , Feminino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Transplante de Pulmão , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/epidemiologia , Linfangioleiomiomatose/genética , Linfangioleiomiomatose/patologia , Linfangioleiomiomatose/terapia , Masculino , Metaloproteases/fisiologia , Proteínas de Neoplasias/fisiologia , Neoplasias Hormônio-Dependentes/diagnóstico , Neoplasias Hormônio-Dependentes/epidemiologia , Neoplasias Hormônio-Dependentes/genética , Neoplasias Hormônio-Dependentes/patologia , Neoplasias Hormônio-Dependentes/terapia , Pneumotórax/etiologia , Pneumotórax/cirurgia , Distribuição por Sexo , Proteína 1 do Complexo Esclerose Tuberosa , Proteína 2 do Complexo Esclerose Tuberosa , Proteínas Supressoras de Tumor/deficiência , Proteínas Supressoras de Tumor/genética , Proteínas Supressoras de Tumor/fisiologiaRESUMO
A middle-aged female patient, previously diagnosed with asthma, presented with a large spontaneous left pneumothorax. She had a history of nephrectomy for a ruptured renal angiomyolipoma (AML) with a postoperative spontaneous pneumothorax when she was an adolescent. High-resolution CT chest revealed multiple scattered thin-walled lung parenchyma cysts consistent with lymphangioleiomyomatosis (LAM). Hepatic AMLs and adenoma sebaceum skin lesions were also noted, consistent with an overall diagnosis of tuberous sclerosis. Her acute management included lung re-expansion via chest tube insertion, antibiotics for concurrent chest infection, nebulisation and chest physiotherapy. Since discharge, the patient had only occasional shortness of breath, relieved by bronchodilators. She is considering expanded immunisation as well as enrolment in a clinical trial. Her hepatic AMLs will be monitored via ultrasound for growth. LAM treatment is generally aimed at its complications with lung transplantation reserved for severe disease; however, hormonal therapy and the mTOR inhibitor aim at targeting systemic disease.
Assuntos
Linfangioleiomiomatose/diagnóstico , Pneumotórax/etiologia , Esclerose Tuberosa/diagnóstico , Adulto , Diagnóstico Diferencial , Feminino , Humanos , Linfangioleiomiomatose/complicações , Linfangioleiomiomatose/terapia , Pneumotórax/terapia , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Esclerose Tuberosa/complicações , Esclerose Tuberosa/terapiaRESUMO
As doenças pulmonares intersticiais (DPIs) são conceituadas como distúrbios que acometem o parênquima pulmonar - o endotélio cailar, os alvéolos, o epitélio alveolar e os espaços entreestas estruturas, bem como os tecidos perivasculares e linfáticos - , podendo ser classificadas segundo critérios histopatológicos, distinguindo-se dois grandes grupos: 1. das associadas à inflamação e fibrose; e 2. daquelas com reação granulomatosa predominante na área intersticial u vasculas. A linfangioliomiomatose (LAM) é uma rara DPI, idiópática, e com altas taxas de morbimortalidade, sendo caracterizada por uma multiplicação acelerada de células musculares lisas imaturas em qualquer estrutura pulmonar. No presente artigo apresentar-se-á uma revisão da literatura enfocando a etiopatogenia, a epidemiologia, o quadro clínico, o diagnóstico - procedimentos, critérios e diagnóstico diferencial - o tratamento e o prognóstico da LAM.
The interstitial pulmonary diseases (IPDs) are a range of disorders that affect the pulmonary parenchyma - the capillary endothelium, alveoli, alveolar epithelium and the spaces between thesestructures, as well as the perivascular and lymphatic tissues. The IPDs may be classified according to histopathologic criteria, and are divided into two large groups: 1. those associated with inflammation and fibrosis; and 2. those associated with granulomatous reactions predominantly in the interstitial or vascular area. Lymphangioleiomyomatosis (LAM) ia a rare, idiopathic IPD with high morbimortality rates, which is characterized by an accelerated multiplication of immature smooth muscle cellsin any pulmonary structure. In this article, we present a review of the literature onthe etiopathogenesis, epidemiology, clinical picture, diagnosis and differential diagnosos, treatment, and prognosis of this condition.
Assuntos
Humanos , Feminino , Doenças Pulmonares Intersticiais/classificação , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/epidemiologia , Linfangioleiomiomatose/etiologia , Linfangioleiomiomatose/fisiopatologia , Linfangioleiomiomatose/terapia , Diagnóstico Diferencial , Esclerose Tuberosa/complicações , Estrogênios/efeitos adversos , Prognóstico , Perda de Heterozigosidade/genéticaRESUMO
La linfangioleiomiomatosis es una enfermedad rara con menos de 250 casos reportados en la literatura universal, que ocurre únicamente en mujeres, usualmente en edad reproductiva y que se caracteriza por la proliferación de células de musculo liso en tejido pulmonar y en los vasos linfáticos. Presentamos el caso de una mujer de 29 años, con disnea progresiva, tos con escasa espectoración y neumotórax espontáneo bilateral. El diagnóstico se realizó mediante biopsia pulmonar a cielo abierto, donde se encontró proliferación de haces de músculo liso los cuales se disponían preferentemente alrededor de las estructuras vasculares,bronquiales y septo alveolares. Comentamos los principales hallazgos clínicos, radiológicos e histopatológicos.