ABSTRACT
Mesothelial/monocytic incidental cardiac excrescences (MICE) are unusual findings during the histological analysis of material from the pericardium, mediastinum, or other tissues collected in open-heart surgery. Despite their somewhat worrisome histological appearance, they show a benign clinical course, and further treatment is virtually never necessary. Hence, the importance of recognizing the entity relays in its differential diagnosis, as an unaware medical pathologist may misinterpret it for a malignant neoplasm. Other mesothelial and histiocytic proliferative lesions, sharing very close histological morphology and immunohistochemistry features with MICE, have been described in sites other than the heart or the mediastinum. This similarity has led to the proposal of the common denomination "histiocytosis with raisinoid nuclei." We report three cases from the pathology archives of the Heart Institute of São Paulo University (Incor/HC-FMUSP), diagnosed as "mesothelial/monocytic incidental cardiac excrescence," with immunohistochemical documentation, and provide a literature review of this entity.
Subject(s)
Humans , Male , Adult , Middle Aged , Aged , Heart Diseases/pathology , Histiocytes , Diagnosis, Differential , Epithelium/injuries , Incidental FindingsABSTRACT
BACKGROUND AND OBJECTIVES: One of the most common complaints physicians face is dizziness. Patients with dizziness may have an array of conditions, from benign vertigo to potentially fatal cardiac arrhythmias, and including diverse conditions such as Parkinson`s disease and hyponatremia. This is a systematic review of the classification of dizziness, aiming at a more efficient and comprehensive clinical management of the condition, prompted from the presentation of an actual clinical case. METHODS: A 63-year-old man, with a 1-year history of dizziness predominantly on walking, was presented. The complaint prompted a search of the Pubmed and Scielo databases, for flow-charts and systematizations of the approach to the condition. RESULTS: Some approaches were identified that were useful in primary care, chiefly Drachman`s 4-type classification, which minimizes diagnostic biases. The clinical case was then discussed according to the information found, and a sequence of physical examination maneuvers, to beimplemented whenever a patient with dizziness is seen, waspresented. CONCLUSION: Approaching a patient complaining of dizziness and making its differential diagnosis is a huge intellectual challenge to any physician. There are tools that allow for correct classification of the patients, reduce diagnostic biases, discourage incorrect treatments and reduce expenses...
JUSTIFICATIVA E OBJETIVOS: Uma das queixas mais prevalentes e que mais confunde médicos é a tontura. Esses pacientes podem ter desde vertigens benignas até arritmias cardíacas potencialmente fatais, passando ainda por condições tão diversas quanto a doença de Parkinson e a hiponatremia. Este estudo tem por objetivo apresentar uma revisão sistemática sobre as classificações das tonturas, de forma a permitir uma abordagem clínica mais eficiente e abrangente, a partir da apresentação de um caso clínico real. MÉTODOS: é apresentado um paciente de 63 anos com queixa de tontura há cerca de 1 ano, principalmente para caminhar. A partir do quadro, foi feita revisão sistemática da literatura no Pubmed e Scielo, buscando os fluxogramas e sistematizações disponíveis para a abordagem da tontura. RESULTADOS: foram encontradas algumas formas de abordagem da tontura, muito úteis em atenção primária e clínica médica, especialmente a classificação nas 4 categorias de Drachman, a qual minimiza os vieses diagnósticos. Por fim, foi exposto o desfecho e a discussão do caso, juntamente com uma sugestão de sequência de exame físico a ser realizada em todo paciente com tontura. CONCLUSÃO: Saber abordar essa queixa e realizar seu diagnóstico diferencial é um grande desafio intelectual ao médico de qualquer especialidade. Há ferramentas disponíveis que permitem enquadrar o paciente em categorias, evitando vieses diagnósticos, tratamentos incorretos e gastos desnecessários...