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Resumo: A úlcera aftosa recorrente (UAR) é uma lesão frequente na mucosa oral de etiologia variada e subdividindo-se clinicamente úlceras menores, maiores e hepertiformes. Caracterizada por formato ovoide, recoberto por uma pseudomembrana e um halo eritematoso, seu diagnóstico é essencial para distinguir outras lesões e o tratamento se faz necessário para tratar a lesão e prevenir recorrências. Desta maneira, o presente estudo teve como objetivo descrever de forma analítica sobre o diagnóstico diferencial e o tratamento da UAR em cavidade oral. Tratou-se de um estudo descritivo, exploratório caracterizado como revisão narrativa da literatura. Os critérios de inclusão estabelecidos foram: estudos que abordassem essa temática, com idiomas inglês e português. O levantamento ocorreu em agosto/2023 a janeiro/2024, através das buscas eletrônicas PubMed, LILACS, SciELO, além da literatura cinzenta Google acadêmico e busca livre secundária. Os Descritores em Ciências da Saúde (DeCS/MeSH) foram cruzados com o operador booleano: "differential diagnosis" AND "aphthous ulcer". A UAR é caracterizada por úlceras arredondadas superficiais que pode persistir por dias ou meses. O seu diagnóstico é fundamentado no histórico do paciente e nas características da lesão. É crucial eliminar possíveis causas de úlceras orais, para evitar confusão com outras lesões, como úlceras traumáticas, imunomedia das ou até mesmo um carcinoma. Diversas terapias são empregadas no manejo da UAR, tais como corticosteroides, suplementos vitamínicos, ozonioterapia e o laser de baixa potência. Portanto, compreender o histórico das lesões é fundamental para diferenciação e diante da diversidade de terapias, é essencial ter estudos que dê esse enfoque.
Abstract: Recurrent Aphthous Ulcer (RAU) is a common lesion in the oral mucosa with varied etiology, clinically subdivided into minor, major, and herpetiform ulcers. Characterized by an ovoid shape, covered by a pseudomembrane and erythematous halo, its diagnosis is essential to distinguish it from other lesions, and treatment is necessary to address the injury and prevent recurrences. Thus, the present study aimed to analytically describe the differential diagnosis and treatment of RAU in the oral cavity. It was a descriptive, exploratory study characterized as a narrative literature review. Inclusion criteria were established as studies addressing this theme in English and Portuguese. The survey took place from August 2023 to January 2024, through electronic searches on PubMed, LILACS, SciELO, in addition to grey literature such as Google Scholar and secondary free searches. Health Sciences Descriptors (DeCS/MeSH) were crossed with the boolean operator: "differential diagnosis" AND "aphthous ulcer." RAU is characterized by round, superficial ulcers that may persist for days or months. Its diagnosis is based on the patient's history and the characteristics of the lesion. It is crucial to eliminate possible causes of oral ulcers to avoid confusion with other lesions, such as traumatic, immunomediated, or even carcinoma ulcers. Various therapies are employed in the management of RAU, such as corticosteroids, vitamin supplements, ozone therapy, and low-level laser. Therefore, understanding the history of lesions is fundamental for differentiation, and given the diversity of therapies, studies focusing on this aspect are essential.
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Ferimentos e Lesões , Úlceras Orais , Úlceras Orais/tratamento farmacológico , Úlceras Orais/terapia , Diagnóstico Diferencial , BocaRESUMO
Fibrin-associated large B-cell lymphoma (FA-LBCL) is a rare type of lymphoma usually associated with Epstein-Barr virus (EBV) infection. We report a case incidentally detected in a right ovarian mass of a 53-year-old woman. The patient presented with bloating and weight gain over 8 months. Imaging studies showed a 20.7 cm, complex right adnexal mass. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Macroscopic examination revealed a 25 x 18.5 x 9.5 cm predominantly cystic right ovarian mass with focal solid areas. Microscopically, most of the mass was a leiomyoma with hyaline necrosis and extensive cystic degeneration. In areas, the cyst showed focally necrotic, fibrinous material associated with small aggregates of round and atypical lymphoid cells with prominent karyorrhexis and mitotic activity These large cells were confined within the cystic spaces. Immunohistochemical analysis showed that the atypical cells were positive for CD20, CD30, CD79a and MUM1/IRF4, and were negative for CD3, CD10 and BCL6, supporting B-cell lineage. In situ hybridization for Epstein-Barr virus-encoded RNA (EBER ISH) was also positive in the atypical cells supporting the diagnosis of EBV-positive fibrin-associated large B-cell lymphoma. The patient subsequently received four cycles of chemotherapy using rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP). Computed tomography (CT) scan of the neck, chest, abdomen and pelvis 5 months after the last chemotherapy cycle showed no evidence of disease. After a follow-up of 17 months, the patient is alive with no evidence of disease. This report is being used to discuss the salient features of this rare entity and its differential diagnosis.
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Infecções por Vírus Epstein-Barr , Herpesvirus Humano 4 , Leiomioma , Linfoma Difuso de Grandes Células B , Neoplasias Ovarianas , Humanos , Feminino , Pessoa de Meia-Idade , Diagnóstico Diferencial , Infecções por Vírus Epstein-Barr/complicações , Infecções por Vírus Epstein-Barr/diagnóstico , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/virologia , Linfoma Difuso de Grandes Células B/diagnóstico , Linfoma Difuso de Grandes Células B/patologia , Linfoma Difuso de Grandes Células B/virologia , Leiomioma/diagnóstico , Leiomioma/patologia , Herpesvirus Humano 4/isolamento & purificação , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêuticoRESUMO
A 43-year-old woman presented with dyspnea and cough, initially misdiagnosed as respiratory syncytial virus. Persistent symptoms led to pulmonary thromboembolism treatment, but worsening issues revealed recurrent pericardial effusion. Imaging and biopsy confirmed pulmonary artery intimal sarcoma, mimicking thromboembolism, and autoimmune disease, underscoring diagnostic challenges. Contrast-enhanced angiotomography showing filling defects suggestive of pulmonary thromboembolism. Echocardiogram with severe pericardial effusion. T2-weighted MRI with two heterogeneous masses on the right side and another adjacent to the left atrium. Biopsy confirming pulmonary artery intimal sarcoma.
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Tamponamento Cardíaco , Artéria Pulmonar , Sarcoma , Neoplasias Vasculares , Humanos , Feminino , Artéria Pulmonar/diagnóstico por imagem , Adulto , Sarcoma/complicações , Sarcoma/diagnóstico , Neoplasias Vasculares/complicações , Neoplasias Vasculares/diagnóstico , Neoplasias Vasculares/diagnóstico por imagem , Tamponamento Cardíaco/etiologia , Tamponamento Cardíaco/diagnóstico , Diagnóstico Diferencial , Ecocardiografia/métodos , Túnica Íntima/diagnóstico por imagem , RecidivaRESUMO
PURPOSE: Report the clinical and imaging findings of a patient with an intraretinal benign tumor that was documented as an unexpected clinical finding after an ischemic stroke in the context of mitral valve disease. This tumor must be distinguished from retinoblastoma and other malignant neoplasms. METHODS: A patient with intraretinal tumor of the inner nuclear layer (INL) underwent a combination of ophthalmic examination, fundus photography, fluorescein angiography, optical coherence tomography (OCT), and optical coherence tomography angiography (OCT-A). RESULTS: A 64-year-old male patient with unilateral benign tumor lesions dependent on the internal retina, centered in the posterior pole, and multifocal. OCT showed that these lesions were centered within the INL at the edge of the inner plexiform layer and were not associated with other findings in the posterior pole. CONCLUSIONS: Benign Lobular Inner Nuclear Layer Proliferations (BLIP) of the Retina are recently described lesions that should be considered, given their distinctive characteristics that set them apart from other benign and malignant retinal lesions.
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Angiofluoresceinografia , Neoplasias da Retina , Tomografia de Coerência Óptica , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia de Coerência Óptica/métodos , Angiofluoresceinografia/métodos , Neoplasias da Retina/diagnóstico , Neoplasias da Retina/patologia , Neoplasias da Retina/diagnóstico por imagem , Acuidade Visual , Retina/patologia , Retina/diagnóstico por imagem , Fundo de Olho , Diagnóstico DiferencialRESUMO
OBJECTIVE: To investigate the utility of voxel histogram analysis (HA) for differentiating hyperdense renal cysts from small solid masses on unenhanced CT scans. METHODS: A retrospective analysis of 99 hyperdense cystic lesions and 28 solid malignant lesions was conducted using a radiological database (from 2015 to 2021) and a pathological database (from 2010 to 2020). The study investigated the distribution of voxel attenuation values using percentiles to establish reliable criteria for differentiation after drawing a region of interest (ROI) in the centre of the lesions. The standard of reference was a histopathological diagnosis for malignant masses and contrast-enhanced CT or MRI for cysts. RESULTS: HA provided higher diagnostic accuracy than the conventional mean attenuation value of 70 Hounsfield Units (HU). For the 75th and 90th percentiles ± 1 standard deviation, accuracies of 77.2% (95% confidence interval 68.9%-84.2%) for the 75th and 68.5% (59.7%-76.4%) for the 90th were found, versus 37.0% (28.6%-46.0%) for the 70 HU threshold criterion. A Gaussian distribution of voxel attenuation values was observed in 88.9% of the lesions, suggesting that it is feasible to calculate these parameters from a single measurement. CONCLUSION: The study underscores the potential of HA as a valuable tool for characterizing hyperdense cysts on unenhanced CT by using the same ROI for measuring lesion attenuation. HA could offer additional value beyond the 70 HU criterion and possibly influence clinical decisions. Multi-institutional studies are necessary for external validation to confirm its generalizability and more extensive applicability. ADVANCES IN KNOWLEDGE: (1) A single measurement on unenhanced CT images, using mean attenuation and standard deviation, accurately reflects the voxel distribution of both cystic and solid masses, allowing for the application of histogram analysis. (2) The 75th percentile threshold of 65 HU or higher could potentially increase sensitivity in diagnosing hyperdense cysts, compared to the 70 HU mean attenuation threshold, without compromising specificity.
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Doenças Renais Císticas , Neoplasias Renais , Tomografia Computadorizada por Raios X , Humanos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos , Neoplasias Renais/diagnóstico por imagem , Neoplasias Renais/patologia , Feminino , Masculino , Pessoa de Meia-Idade , Diagnóstico Diferencial , Doenças Renais Císticas/diagnóstico por imagem , Idoso , Adulto , Idoso de 80 Anos ou mais , Rim/diagnóstico por imagemRESUMO
INTRODUCTION: Type 2 lepromatous reaction is a severe complication triggered by proinflammatory cytokines, it affects patients with lepromatous leprosy and border lepromatous leprosy. This reaction can occur before, during, or after treatment. CASE REPORT: We report a case of acute polyarthritis as type 2 lepromatous reaction debut. A 30-year-old male with a history of Hansen's disease 5 years ago received a complete therapeutic regimen with cure criteria. Consulted due to a 3-day history of arthralgia predominantly affecting the hands, knees, and feet. On the fifth day of hospitalization, the patient developed intensely painful, nodular erythematous lesions. The pathological history, clinical presentation, and the presence of polymorphonuclear cells led to the diagnosis of type 2 lepromatous reaction. CONCLUSION: Identifying individuals with risk factors or a history of leprosy, along with a high index of suspicion, positively impacts the early identification of leprosy reactions as an imitator of other causes of acute or chronic symmetrical polyarthritis.
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Artrite , Hanseníase Virchowiana , Humanos , Masculino , Adulto , Diagnóstico Diferencial , Artrite/diagnóstico , Artrite/etiologia , Artrite/tratamento farmacológico , Hanseníase Virchowiana/diagnóstico , Hanseníase Virchowiana/tratamento farmacológico , Doença Aguda , Valor Preditivo dos Testes , Biópsia , Resultado do Tratamento , Hansenostáticos/uso terapêuticoRESUMO
INTRODUCTION: Currently, high-resolution computed tomography (HRCT) is the imaging of choice for the differential diagnosis of various cystic lung lesions, including true cystic lung diseases (CLD) and lesions that may mimic them. However, the traditionally used inspiratory scan still presents a significant spectrum of overlapping radiological features. Recent studies have demonstrated variation in lesion size between inspiratory and expiratory phases, probably due to cyst-airway communication. In this study, we aimed to conduct a systematic review of paired inspiratory and expiratory HRCT in the assessment of cystic lesions as an additional tool to narrow the differential diagnosis. METHODS: A systematic search was performed in PubMed, Scopus, EMBASE, BVS, and Cochrane through August 2023. Full-text articles that performed paired inspiratory and expiratory CT scans in adult patients with cystic lung lesions were included, with the outcome measured as the reduction in lesion size according to the respiratory phase. Diagnoses were confirmed through histopathological or radiological features. RESULTS: Out of the 96 records, three studies met the criteria for inclusion and were analyzed, comprising a total of 149 participants and 513 cystic lesions. Pulmonary Langerhans Cell Histiocytosis (PLCH), Lymphangioleiomyomatosis (LAM) honeycombing and cystic bronchiectasis became considerably smaller during expiratory CT scans, while the size of emphysema tended to remain constant during respiratory cycles. CONCLUSIONS: This study has suggested that paired inspiratory and expiratory CT scans can be valuable for helping differentiate between emphysema and other diseases with a cystic pattern due to their ability to reveal dynamic properties of the lesions. However, the average reduction in cyst size as a single parameter is not sufficient for further refining diagnostics. Studies exploring advanced metrics to assess the reduction in lesion diameter emerge as potential opportunities to investigate the cyst-airway communication hypothesis and further enhance the diagnostic accuracy of paired methods.
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Cistos , Expiração , Pneumopatias , Tomografia Computadorizada por Raios X , Humanos , Diagnóstico Diferencial , Tomografia Computadorizada por Raios X/métodos , Pneumopatias/diagnóstico por imagem , Pneumopatias/diagnóstico , Cistos/diagnóstico por imagem , Inalação , Pulmão/diagnóstico por imagem , Pulmão/patologia , Pulmão/fisiopatologia , Linfangioleiomiomatose/diagnóstico por imagem , Linfangioleiomiomatose/diagnóstico , Histiocitose de Células de Langerhans/diagnóstico por imagem , Histiocitose de Células de Langerhans/diagnósticoRESUMO
The "acute undifferentiated febrile illness" (AUFI) encompasses a range of diseases characterized by the presence of fever, often prompting consultations in emergency services. During epidemics like COVID-19 or dengue, a surge in consultations occurs, resulting in long wait times for patients. Errors in first diagnosis can result in severe consequences. The objective is to provide a comprehensive review of the clinical approach to AUFI, focusing on certain viral infections (dengue, zika, Argentine hemorrhagic fever and COVID-19). This involves a detailed examination of the clinical presentation, laboratory and radiological findings, neurological manifestations, and definitive diagnosis through specific serological tests. AUFI is characterized by the onset of acute fever lasting less than seven days, accompanied by myalgia or headache without involvement of the upper respiratory tract and without a defined cause. Most cases are caused by common, self-limiting viral infections (e.g., influenza); however, they may also stem from more serious viral infections with a broad etiological spectrum. The differential diagnosis of acute febrile syndromes includes various infectious diseases, such as those previously mentioned. The definitive diagnosis is based on serological methods, PCR and IgM. Recommendations based on scientific evidence can help with early diagnosis and prevent possible serious complications.
El "síndrome febril agudo inespecífico" (SFAI) abarca una variedad de enfermedades que se distinguen por la presencia de fiebre, convirtiéndose en una causa común de consulta en los servicios de urgencias. Durante epidemias como la del COVID-19 o dengue (brote epidémico), se observa un aumento significativo de consultas con larga fila de pacientes esperando ser atendidos. Errores u omisiones en el diagnóstico inicial pueden acarrear graves consecuencias. El objetivo es ofrecer una revisión exhaustiva del enfoque clínico del SFAI, centrándose en determinadas infecciones virales (dengue, zika, fiebre hemorrágica argentina y COVID-19). Se examina detalladamente la presentación clínica, los hallazgos de laboratorio y radiológicos, las manifestaciones neurológicas y el diagnóstico definitivo mediante pruebas serológicas específicas. El SFAI se caracteriza por la aparición de fiebre aguda que dura menos de siete días, acompañada de mialgia o dolor de cabeza, sin afectación de las vías respiratorias superiores y sin una causa definida. La mayoría de los casos se deben a infecciones virales comunes, que suelen ser autolimitadas (ej. influenza); sin embargo, también pueden ser el resultado de infecciones virales más graves con un amplio espectro etiológico. El diagnóstico diferencial de los síndromes febriles agudos abarca diversas enfermedades infecciosas, como las mencionadas previamente. El diagnóstico definitivo se basa en métodos serológicos, PCR e IgM. Las recomendaciones basadas en evidencia científica pueden ayudar a un diagnóstico temprano y prevenir serias complicaciones.
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COVID-19 , Dengue , Febre , Infecção por Zika virus , Humanos , COVID-19/diagnóstico , Diagnóstico Diferencial , Infecção por Zika virus/diagnóstico , Infecção por Zika virus/complicações , Dengue/diagnóstico , Febre/diagnóstico , Febre/etiologia , Febre/virologia , SARS-CoV-2 , Doença Aguda , Pacientes Ambulatoriais , Febres Hemorrágicas Virais/diagnósticoRESUMO
Hemorrhagic cholecystitis, a rare complication of acute cholecystitis, poses diagnostic challenges due to its varied clinical presentation and relative infrequency. This case involves a 59-year-old male with untreated diabetes and obesity, who presented with nonspecific abdominal pain. Initial results were inconclusive, leading to a delayed diagnosis. The patient presented again with worsening symptoms, now including melena, prompting a repeat contrast-enhanced computed tomography (CT) scan that revealed a collapsed gallbladder and signs of intra-abdominal bleeding. Urgent exploratory laparoscopy exposed a gangrenous, perforated gallbladder with active bleeding. He required intensive care postoperatively and recovered without complications. Teaching points include the importance of considering hemorrhagic cholecystitis as a possible diagnosis in patients presenting with upper gastrointestinal bleeding. The case emphasizes the role of imaging, particularly contrast-enhanced CT scans, in diagnosis. Surgical intervention remains the gold standard, highlighting the significance of timely management.
La colecistitis hemorrágica, una complicación rara de la colecistitis aguda, plantea desafíos diagnósticos debido a su presentación clínica variada y a su relativa infrecuencia. Este reporte presenta el caso de un hombre de 59 años con diabetes no tratada y obesidad, que consultó por dolor abdominal inespecífico por guardia externa. Los resultados iniciales fueron inconclusos, lo que provocó un retraso en el diagnóstico. El paciente consultó nuevamente con síntomas agravados, que incluían melena. Esto llevó a la realización de una nueva tomografía computada (TC) con contraste, que reveló una vesícula biliar colapsada y signos de hemorragia intraabdominal. Una laparoscopia exploradora de urgencia reveló una vesícula biliar gangrenosa y perforada con sangrado activo. Cursó postoperatorio en unidad de cuidados intensivos y se recuperó sin complicaciones. Los puntos de aprendizaje incluyen la importancia de considerar la colecistitis hemorrágica como un posible diagnóstico en pacientes que se presentan con hemorragia digestiva alta. El caso enfatiza el papel de las imágenes, especialmente las TC con contraste, en el diagnóstico. La intervención quirúrgica sigue siendo el gold standard, destacando la importancia del tratamiento temprano.
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Tomografia Computadorizada por Raios X , Humanos , Masculino , Pessoa de Meia-Idade , Diagnóstico Diferencial , Colecistite Aguda/diagnóstico , Colecistite Aguda/cirurgia , Hemorragia/etiologia , Hemorragia/diagnóstico por imagem , Colecistite/diagnóstico , Colecistite/cirurgia , Colecistite/diagnóstico por imagem , Colecistite/complicações , Vesícula Biliar/diagnóstico por imagemRESUMO
OBJECTIVE: The aim of this study was to evaluate the serum hCG level in the differential diagnosis between non-molar miscarriage and complete hydatidiform mole in<11 weeks gestation. METHODS: This was a retrospective collaborative cohort study. This study included women with gestational age<11 weeks, with ultrasound evidence of failed pregnancy and available serum hCG pre-uterine evacuation, divided into two groups: the non-molar miscarriage group and the complete hydatidiform mole group. Serum hCG levels were compared according to gestational age. Statistical analysis used a nonparametric test with a 5% significance level (p<0.05). RESULTS: In total, 416 patients were included, out of which 79 were included in the non-molar miscarriage group and 337 in the complete hydatidiform mole group. The calculated power of the sample was more than 80%. Data analysis showed that the 75th quartile of the median in the non-molar miscarriage group was always lower than the 25th quartile of the median in the complete hydatidiform mole group [9,721 mUI/mL/16,435 mUI/mL (6-7 weeks), 20,229 mUI/mL/64,911 mUI/mL (8-9 weeks), and 29,633 mUI/mL/126,278 mUI/mL (10-11 weeks), respectively; p<0.001]. CONCLUSION: Facing failed pregnancies, hCG>16,435 mUI/mL at 6-7 weeks, hCG>64,911 mUI/mL at 8-9 weeks, and hCG >126,278 mUI/mL at 10-11 weeks were most prevalent on complete hydatidiform mole diagnosis. On the contrary, hCG<30,000 mUI/mL at 10-11 weeks was most prevalent in non-molar miscarriage diagnosis.
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Aborto Espontâneo , Gonadotropina Coriônica , Idade Gestacional , Mola Hidatiforme , Neoplasias Uterinas , Humanos , Feminino , Mola Hidatiforme/sangue , Mola Hidatiforme/diagnóstico , Gravidez , Gonadotropina Coriônica/sangue , Estudos Retrospectivos , Adulto , Aborto Espontâneo/sangue , Neoplasias Uterinas/sangue , Diagnóstico Diferencial , Primeiro Trimestre da Gravidez/sangue , Adulto Jovem , Valor Preditivo dos Testes , Valores de ReferênciaRESUMO
Epidemics and outbreaks caused by the dengue virus pose risks to populations and have high mortality rates, causing burdens and economic costs worldwide. Brazil recently experienced an explosive increase in the number of dengue cases and fatalities. Dengue is an acute febrile illness that can progress to severe forms. It affects more than 100 countries, presenting ongoing challenges in Brazil and globally since its identification. Other conditions may be overlooked or mistaken for dengue. The most important differential diagnoses are other infectious diseases and rheumatological, hematological, gastroenterological, and neurological disorders. In this article, we discuss the primary differential diagnoses of dengue and offer a literature review highlighting the key clinical differences among clinicians. This review emphasizes the critical importance of differentiating dengue fever from infectious diseases such as meningococcemia and malaria and autoimmune and rheumatological conditions such as systemic lupus erythematosus to ensure timely and appropriate management.
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Dengue , Humanos , Dengue/diagnóstico , Diagnóstico DiferencialRESUMO
BACKGROUND: Clinicopathological diagnosis and follow-up of oral lichen planus and leukoplakia are necessary due to its potential for malignant transformation and the need to differentiate it from other lichenoid diseases and proliferative verrucous leukoplakia. This study aimed to classify and compare sociodemographic and clinicopathological features among patients with oral lichen planus, oral lichenoid lesions and proliferative verrucous leukoplakia. METHODS: A transversal observational study in which oral leukoplakia and oral lichen planus patients were surveyed at the Oral Pathological Anatomy Service and Applied Biotechnology Laboratory was conducted. Sociodemographic and clinicopathological data were compared for the lesions studied with the chi-square test or Fisher's exact test. RESULTS: After classification, 21 oral lichen planus lesions, 34 oral lichenoid lesions and 12 proliferative verrucous leukoplakia lesions were evaluated. Reticular patterns are more characteristic of oral lichen planus and plaque lesions of proliferative verrucous leukoplakia. The buccal mucosa was the most affected site in oral lichen planus lesions, and it was bilateral in all patients. Epithelial dysplasia was present in almost all patients with proliferative verrucous leukoplakia. CONCLUSIONS: Compared with oral lichen planus and proliferative verrucous leukoplakia, oral lichenoid lesions presented intermediate features. This may delay proliferative verrucous leukoplakia diagnosis.
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Leucoplasia Oral , Líquen Plano Bucal , Erupções Liquenoides , Humanos , Líquen Plano Bucal/patologia , Masculino , Feminino , Leucoplasia Oral/patologia , Estudos Retrospectivos , Pessoa de Meia-Idade , Erupções Liquenoides/patologia , Idoso , Adulto , Estudos Transversais , Mucosa Bucal/patologia , Diagnóstico DiferencialRESUMO
OBJECTIVE: To investigate the value of Contrast-Enhanced Ultrasound (CEUS) combined with Procalcitonin (PCT) in differentiating Tuberculous Lymph Nodes (TLN) from Metastatic Lymph Nodes (MLN). METHODS: This prospective cohort study included 207 consecutive patients diagnosed with CTL. All patients underwent routine ultrasound and CEUS prior to pathology or laboratory confirmation. Serum indicators were measured by Enzyme-Linked Immunosorbent Assay (ELISA). Predictive modeling was performed by multifactorial logistic regression. Evaluate the diagnostic and calibration performance of the predictive model by drawing Receiver Operating Characteristic (ROC) curves and calibration curves, and using Area Under the Curve (AUC) and Hosmer-Lemeshow (H-L) tests. RESULTS: The diagnosis of MLN was confirmed pathologically or laboratory in 102 of 207 patients (49.27 %), and 50.8 % were confirmed to be TLN. According to imaging findings of CEUS, TLN was more commonly associated with enhanced concentric performance in the arterial phase (67.65 % vs. 40.95 %) and heterogeneous enhancement pattern in lymph nodes (70.59 % vs. 52.38 %). Peak Intensity (PI) of lesions was higher in patients with MLN. Increased age-enhanced concentric performance in the arterial phase, increased PI, and serum PCT greater than 5.39 ng/mL were independent risk factors for MLN. The prediction model of serum PCT combined with CEUS had a higher diagnostic value for MLN. The H-L test indicated a satisfactory model fit (all p > 0.05), and the calibration curve closely approximates the ideal diagonal. CONCLUSION: CEUS combined with serum PCT has better clinical application value in the differential diagnosis of TLN and MLN.
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Meios de Contraste , Linfonodos , Metástase Linfática , Pró-Calcitonina , Tuberculose dos Linfonodos , Ultrassonografia , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Ultrassonografia/métodos , Adulto , Estudos Prospectivos , Metástase Linfática/diagnóstico por imagem , Pró-Calcitonina/sangue , Linfonodos/diagnóstico por imagem , Linfonodos/patologia , Tuberculose dos Linfonodos/diagnóstico por imagem , Tuberculose dos Linfonodos/sangue , Tuberculose dos Linfonodos/diagnóstico , Idoso , Adulto Jovem , Diagnóstico Diferencial , Curva ROC , Valor Preditivo dos Testes , Ensaio de Imunoadsorção Enzimática , Sensibilidade e Especificidade , Reprodutibilidade dos Testes , AdolescenteRESUMO
Since the description of autoimmune encephalitis (AE) associated with N-methyl-D-aspartate receptor antibodies (anti-NMDARE) in 2007, more than 12 other clinical syndromes and antibodies have been reported. In this article, we review recent advances in pathophysiology, genetics, diagnosis pitfalls, and clinical phenotypes of AE associated with cell surface antibodies and anti-GAD associated neurological syndromes. Genetic studies reported human leukocyte antigen (HLA) associations for anti-LGI1, anti-Caspr2, anti-IgLON5, and anti-GAD. Follow-up studies characterized cognitive dysfunction, psychiatric symptoms, sleep disorders, and adaptative behavior dysfunction, mainly for anti-NMDARE. Late-onset anti-NMDARE and anti- GABA-B receptor (GABA-BR) encephalitis patients were described to have worse prognoses and different tumor associations. Additionally, the clinical spectrum of anti-LGI1, anti-AMPAR, anti-CASPR2, and anti-IgLON5 was expanded, comprising new differential diagnoses. The diagnostic criteria for AE were adapted to the pediatric population, and a diagnostic algorithm was proposed, considering potential mimics and misdiagnosis. We also review the limitations of commercial assays for AE and treatment recommendations, as well as clinical scales for short and long-term assessment of AE patients, along with cognitive evaluation.
Desde a descrição da encefalite autoimune (EA) associada a anticorpos contra o receptor N-methyl-D-aspartate (anti-NMDARE) em 2007, mais de 12 síndromes clínicas e anticorpos foram reportados. Neste artigo, revisamos avanços recentes na fisiopatologia, genética, diagnóstico e fenótipos clínicos da EA associada a anticorpos contra antígenos de superfície e das síndromes neurológicas associadas aos anticorpos anti-acido glutâmico decarboxilase (glutamic acid decarboxylase, GAD, em inglês). Estudos genéticos revelaram associações do antígeno leucocitário humano (human leukocyte antigen, HLA, en inglês) com as EAs anti-LGI1, anti-Caspr2, anti-IgLON5 e anti-GAD. Estudos de seguimento caracterizaram disfunção cognitiva, sintomas psiquiátricos, distúrbios do sono e disfunção do comportamento adaptativo, principalmente para anti-NMDARE. Apresentações tardias de anti-NMDARE e anti-GABA-BR foram associadas a outros tumores e a pior desfecho. Ademais, o fenótipo clínico de anti-LGI1, anti-AMPAR, anti-CASPR2 e anti-IgLON5 foi expandido, englobando outros diagnósticos diferenciais. Os critérios diagnósticos para a EA foram adaptados para a população pediátrica, e foi proposto um novo algoritmo diagnóstico levando em consideração potenciais condições mimetizadoras e erros diagnósticos. Foram revisadas também as limitações dos kits comerciais para testagem, recomendações atuais para o tratamento e escalas clínicas para o seguimento de curto e longo-prazo dos pacientes, incluindo a avaliação cognitiva.
Assuntos
Autoanticorpos , Encefalite , Humanos , Encefalite/imunologia , Encefalite/fisiopatologia , Encefalite/diagnóstico , Autoanticorpos/imunologia , Doença de Hashimoto/imunologia , Doença de Hashimoto/diagnóstico , Doença de Hashimoto/fisiopatologia , Receptores de N-Metil-D-Aspartato/imunologia , Diagnóstico DiferencialRESUMO
BACKGROUND: Castleman disease (CD) is a rare lymphoproliferative disorder, with intracranial involvement being exceedingly rare. Unicentric Castleman disease (UCD) is typically benign and localized, but its presentation can mimic other intracranial pathologies, complicating diagnosis. CASE DESCRIPTION: We reported a 52-year-old woman who presented with progressive headaches and language disturbances. Imaging, including MRI and CT, revealed an extra-axial left frontotemporal lesion initially diagnosed as an en plaque meningioma. Surgical resection of the lesion was performed. Histopathological examination revealed UCD with plasma cell predominance, characterized by lymphoid hyperplasia and concentric germinal centers. Immunohistochemical staining confirmed the diagnosis, with positive markers including CD20, CD3, and CD16. CONCLUSION: Intracranial UCD is a rare and challenging differential diagnosis for extra-axial lesions, often resembling meningiomas. Accurate diagnosis requires a combination of imaging and histopathology, with immunohistochemistry playing a crucial role. Complete surgical resection is the optimal treatment for localized UCD.
Assuntos
Hiperplasia do Linfonodo Gigante , Imageamento por Ressonância Magnética , Tomografia Computadorizada por Raios X , Humanos , Hiperplasia do Linfonodo Gigante/diagnóstico por imagem , Hiperplasia do Linfonodo Gigante/cirurgia , Feminino , Pessoa de Meia-Idade , Diagnóstico Diferencial , Imageamento por Ressonância Magnética/métodos , Meningioma/diagnóstico por imagem , Dura-Máter/diagnóstico por imagem , Dura-Máter/patologia , Encefalopatias/diagnóstico por imagemRESUMO
Paragangliomas are rare neuroendocrine tumors, often associated with catecholamine secretion. These tumors can arise in various locations, with the majority found in the abdomen and pelvis, while a smaller percentage occurs in the thorax and head and neck regions. Diaphragmatic paragangliomas are exceedingly rare, with only two documented cases in the literature. This report details a case of a primary diaphragmatic paraganglioma in a 59-year-old patient presenting with unexplained weight loss, tremors, and diaphoresis. Imaging studies revealed a mass in the right lobe of the liver, later identified as a diaphragmatic paraganglioma during surgery. The case underscores the importance of preoperative catecholamine assessment and careful surgical planning due to the risks associated with tumor manipulation. Complete surgical resection, although challenging, remains the definitive treatment, especially in hypervascular tumors located near major vascular structures.
Assuntos
Diafragma , Neoplasias Hepáticas , Paraganglioma , Humanos , Pessoa de Meia-Idade , Diagnóstico Diferencial , Diafragma/patologia , Diafragma/cirurgia , Diafragma/diagnóstico por imagem , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/cirurgia , Neoplasias Hepáticas/patologia , Paraganglioma/cirurgia , Paraganglioma/diagnóstico , Paraganglioma/patologia , Tomografia Computadorizada por Raios XRESUMO
Introducción: El aumento significativo de especies micobacterianas descritas como agentes patógenos implicó la necesidad de implementar métodos de identificación más avanzados que permitan acortar el tiempo diagnóstico. Desde el punto de vista clínico, es importante diferenciar el complejo Mycobacterium tuberculosis (MTBC) del resto de las especies micobacterianas no tuberculosas (MNT), con el fin de aplicar tratamiento específico. Objetivo: Identificar aislados micobacterianos procedentes de muestras clínicas pulmonares y extrapulmonares por las técnicas diagnósticas SD BIOLINE TB Ag MPT64 y Genotype Mycobacterium CM/AS. Material y métodos: Se recibieron 3.604 muestras clínicas procedentes de pacientes sintomáticos durante el período comprendido entre enero 2018enero 2024. Estas fueron procesadas en el Laboratorio Nacional de Referencia e Investigaciones de Tuberculosis, Lepra y Micobacterias del Instituto de Medicina Tropical "Pedro Kourí" (IPK). Para la identificación de MTBC, se utilizó el test inmunocromatográfico SD TB Ag MPT64; para la identificación de MNT, las técnicas diagnósticas moleculares Genotype Mycobacterium CM/AS. Resultados: Del total de muestras procesadas, se obtuvieron 325 aislados micobac - terianos; 252 (77,53%) identificados como MTBC y 73 (22,45%) especies micobacte- rianas no tuberculosas. De estas, la de mayor frecuencia de aislamiento fue: Myco- bacterium fortuitum 19 (26,02%), Mycobacterium avium 17 (23,80%) y Mycobacterium intracellulare 13 (17,80%). Conclusiones: Los resultados obtenidos reafirman que los métodos de identificación utilizados son adecuados, ambas técnicas logran el acortamiento del tiempo diagnós- tico, lo que permite la implementación temprana del tratamiento adecuado, y así evitar la diseminación de la infección, sobre todo en pacientes con algún tipo de deterioro en su barrera inmunológica.
Introduction: The significant increase in mycobacterial species described as pathoge - nic agents implied the need to implement more advanced identification methods that would shorten the diagnostic time. From a clinical point of view, it is important to diffe- rentiate Mycobacterium tuberculosis complex (MTBC) from the rest of the nontubercu- lous mycobacterial species (NTM), in order to apply specific treatment. Objective: Identify mycobacterial isolates from pulmonary and extrapulmonary clinical samples using the SD BIOLINE TB Ag MPT64 and Genotype Mycobacterium CM/AS diagnostic techniques. Materials and methods: 3,604 clinical samples were received from symptomatic patients during the period between January 2018January 2024. These were processed at the National Reference and Research Laboratory for Tuberculosis, Leprosy and Mycobacteria of the "Pedro Kourí" Institute of Tropical Medicine (IPK). For the identification of MTBC, the SD TB Ag MPT64 immunochromatographic test was used, and for the iden- tification of NTM, the Genotype Mycobacterium CM/AS molecular diagnostic techniques were used. Results: Of the total samples processed, 325 mycobacterial isolates were obtained; 252 (77.53%) identified as MTBC and 73 (22.45%) nontuberculous mycobacterial species, of which the highest frequency of isolation was: Mycobacterium fortuitum 19 (26.02%), Mycobacterium avium 17 (23. 80%) and Mycobacterium intracellulare 13 (17.80%). Conclusions: The results obtained reaffirm that the diagnostic methods used are adequate, both techniques achieve a shortening of the diagnostic time, which allows the early implementation of the appropriate treatment, thus avoiding the spread of the infection, especially in patients with some type of deterioration in their barrier immuno - logical.
Assuntos
Humanos , Técnicas de Diagnóstico Molecular/métodos , Infecções/diagnóstico , Mycobacterium/isolamento & purificação , Terapêutica , Fatores de Risco , Cromatografia de Afinidade/métodos , Diagnóstico Diferencial , LaboratóriosRESUMO
Introducción: La leiomiomatosis esofágica es una neoplasia benigna con una incidencia dentro de los tumores del esófago extremadamente baja y en ocasiones difícil de categorizar como neoplasia o miopatía. Caso clínico: Se reporta el caso de una joven de 24 años que consultó por disfagia pro- gresiva de un año de evolución y antecedente de haberle descubierto una "mancha" en el pulmón diez años atrás. Las imágenes muestran masa que ocupa el tercio medio e inferior del esófago y megaesófago proximal por obstrucción a nivel de cardias. Se rea- lizó esofagectomía total, tubulización y ascenso gástrico con piloroplastía más anastomosis esófago gástrica latero lateral a nivel cervical. La patología confirmó la histología de leiomiomatosis esofágica. Conclusión: Es una patología muy rara con pocos casos reportados.
Introduction: Esophageal leiomyomatosis is a benign neoplasm with an extremely low incidence of esophageal tumors and is sometimes difficult to categorize as a neoplasm or myopathy. Clinical Case: The case of a 24-year-old girl, who consulted for progressive dysphagia of one year of evolution and a history of having discovered a "spot" on her lung ten years ago, is reported. The images show a mass that occupies the middle and lower third of the esophagus and proximal megaesophagus due to obstruction at the level of the cardia. Total esophagectomy, tubulization and gastric ascent with pyloroplasty plus lateral esophagogastric anastomosis at the cervical level were performed. The pathology confirms the histology of esophageal leiomyomatosis. Conclusion: It is a very rare pathology with few reported cases.
Assuntos
Humanos , Feminino , Adulto , Neoplasias Esofágicas/cirurgia , Leiomiomatose/diagnóstico , Leiomioma , Biópsia , Diagnóstico por Imagem , Imuno-Histoquímica , Jejunostomia , Toracotomia , Transtornos de Deglutição , Esofagectomia , Diagnóstico Diferencial , EndoscopiaRESUMO
La proteinosis alveolar pulmonar (PAP) es una enfermedad que entra en el gran número de patologías pulmonares intersticiales, con una baja incidencia y prevalencia a nivel mundial. Consiste en un acúmulo de material proteináceo derivado del surfactante que se genera por diferentes causas (primaria, secundaria, congénita y no clasificada), dentro de las cuales la causa autoinmune o primaria es la más frecuente. Su tratamiento de elección es el lavado pulmonar total, con mejoría según el grado de afectación y avance de la enfermedad. En la actualidad, hay nuevas terapias y otras que están en estudio, pero en países en vías de desarrollo muchas veces no se encuentran disponibles. Presentamos el caso de una paciente femenina de 32 años de edad que se presentó en insuficiencia respiratoria tipo 1 y debutando con PAP.
Pulmonary Alveolar Proteinosis (PAP) is a disease that belongs to the large number of interstitial lung pathologies, with a low incidence and prevalence worldwide. It consists of an accumulation of proteinaceous material derived from surfactant, which is generated by different causes (primary, secondary, congenital and unclassified), within which the autoimmune or primary cause is the most frequent. Its treatment of choice is total lung lavage, with improvement depending on the degree of involvement and progression of the disease. Currently, there are new therapies and others that are being studied, but in developing countries they are often not available. We present the case of a 32-year-old female patient who presented with type 1 respiratory failure and debuting with PAP.
Assuntos
Humanos , Feminino , Adulto , Proteinose Alveolar Pulmonar/terapia , Tensoativos , Doenças Pulmonares Intersticiais/diagnóstico , Lavagem Broncoalveolar/métodos , Insuficiência Respiratória , Biópsia , Broncoscopia , Diagnóstico por Imagem , Tosse , Diagnóstico Diferencial , Dispneia , Hemoptise , HondurasRESUMO
La infestación por Paragonimus spp. clásicamente se da por la ingestión de crustáceos de agua dulce, crudos, poco cocidos o en forma de ceviches. Se presenta el caso de un paciente adulto que conscientemente ingería cangrejos crudos y desarrolló sintomatología pulmonar con tos y disnea, lo cual lo llevó a efectuarse estudios broncoscópicos cuyo resultado citológico del cepillado bronquial fue de adenocarcinoma pulmonar. Se le realizó biopsia pulmonar y la patología fue concluyente de la presencia de huevecillos y formas larvarias de Paragonimus spp., que es una entidad poco frecuente en Guatemala. El paciente recibió tratamiento con prazicuantel y mostró buena res-puesta clínica.
Infestation by Paragonimus spp. classically occurs through the ingestion of freshwater crustaceans, raw, undercooked or in the form of "ceviches". We present the case of an adult patient who consciously ingested raw crabs and developed pulmonary symptoms with cough and dyspnea, which leaded him to undergo bronchoscopic studies, whose cytological result of bronchial brushing was pulmonary adenocarcinoma. A lung biopsy was performed and the pathology was conclusive of the presence of eggs and larval forms of Paragonimus spp., which is a rare entity in Guatemala. Patient received treatment with praziquantel and showed a good clinical response.