ABSTRACT
Um caso de carcinomatose peritoneal extraovariana é relatado em associação com um padrão imunoistoquímico semelhante ao dos carcinomas pancreáticos e biliares. Uma paciente de 74 anos foi hospitalizada com náuseas, vômitos, dor abdominal e ascite, associados com emagrecimento. Apresentou gradiente de albumina soro-ascite inferior a 1,1 g/dL, e citologia positiva com algumas células de aspecto característico em anel de sinete, e elevação do nível de CA-125 no soro. As ecografias e as tomografias computadorizadas do abdome e da pelve não mostraram imagens de tumores primários originando em órgãos desses sítios. Investigações diagnósticas por gastroscopia, colonoscopia, mamografia e radiografias do tórax não revelaram anormalidades. O painel imunoistoquímico CK20 (-); CK7, CK17 e MUC1 (+) indicou origem pancreática. Este estudo de caso tem o objetivo de descrever essa condição desafiadora para o clínico, enfatizando-se algumas dificuldades diagnósticas.
A case of extra ovarian peritoneal carcinomatosis associated with an immunohistochemical pattern similar to that of pancreatic and biliary carcinomas is presented. A 74 year-old patient was admitted to the hospital with nausea, vomiting, abdominal pain, ascites, and loss of body weight. She had serum-ascitis albumin gradient lower than 1.1 g/ dL, positive cytology with some cells presenting the characteristic signet ring features, and elevated CA-125 serum level. Echography and computerized tomography of the abdomen and the pelvis did not show images of primary tumors with origin in organs found at these sites. Diagnostic investigations by gastroscopy, colonoscopy, mammography and chest x-rays revealed no abnormalities. Tumor specimens obtained by laparoscopy showed an immunohistochemical panel consisting of CK20 (-), CK7, CK17 and MUC1(+) consistent with a pancreatic origin. This case study aims at describing a challenging condition for clinicians, highlighting some diagnostic pitfalls.
ABSTRACT
The yellow nail syndrome is an uncommon condition characterised by dystrophic nails, pulmonary disturbances and lymph oedema. In Brazil as well as in India, this syndrome has been scarcely described, at least in part due to diagnosis pitfalls related with darker skin pigmentation. A case of adnexal malignancy developing several decades after initial signs of yellow nail syndrome is reported in a 61-year-old Brazilian female admitted for evaluation of peripheral oedema. She reported recurrent sinusitis and bronchitis, and three antecedent pneumonias. Physical examination showed yellow thickened nails and lower limb oedema, and a painless huge adnexal mass. Diverse tumours have been described associated with yellow nail syndrome; however, associations can also occur by chance. The present report attempts to raise the awareness about casual co-existence of malignancy and the syndrome.
Subject(s)
Female , Humans , Liver Neoplasms/secondary , Middle Aged , Ovarian Neoplasms/complications , Ovarian Neoplasms/pathology , Yellow Nail Syndrome/complicationsABSTRACT
The male breast cancer accounts for nearly 1% of all breast cancer cases and bilateral involvement occurs in less than 2% of the cases. Estrogen treatment for prostate cancer is a risk factor for primary breast cancer. Bilateral breast carcinomas were found in a 79-year-old Brazilian black man, following prostate cancer treatment with estrogen. Prostate cancer metastases could be found in breast tissue, and might be indistinguishable from primary breast tumours on histological evaluation without immunohistochemistry. Coexistence of prostate cancer with breast cancer increases future-longevity concerns.