ABSTRACT
RESUMEN Fundamento: los tumores de células granulares son lesiones benignas infrecuentes de crecimiento lento que pueden aparecer en cualquier sitio del organismo. La región de cabeza y cuello incluye las localizaciones más frecuentes (entre el 30 y el 50 % de todos los tumores de este tipo, hasta los del sistema nervioso central). Objetivo: presentar un caso de tumor de células granulares intratiroideo. Caso clínico: se presenta el caso de una paciente femenina de 37 años de edad con enfermedad nodular de la glándula tiroides de crecimiento lento con escasa sintomatología, con confirmación histológica tumor de células de la granulosa. Al examen físico se identificó aumento de volumen en la región anterolateral del cuello, en relación con el lóbulo derecho de la glándula tiroidea, que correspondía con lesión tumoral de 3 cm, mal delimitada, adherida a planos profundos, no dolorosa a la palpación. En la ecografía se observó: lóbulo derecho del tiroides de 4,3 cm x 1,2 cm x 1,4 cm, no homogéneo con lesión nodular de 2,8 x 1,4 cm mal delimitada, de bordes irregulares. Se realizó biopsia transoperatoria que se reportó como positiva de células neoplásicas malignas, sin embargo, el estudio histológico extemporáneo reveló un tumor benigno de células granulares intratiroideo. El tratamiento quirúrgico es curativo en este caso. Conclusiones: el diagnóstico de tumor de células granulares intratiroideo benigno, se presenta con las características de una lesión tumoral maligna, debe tenerse en cuenta en el diagnóstico diferencial de los tumores de la glándula tiroides.
ABSTRACT Background: the granular cells tumors are uncommon benign lesions of slow growth that can appear in any place of the organism. The head and neck region includes the most frequent localizations (between the 30 and 50% of all the tumors of this type, including those of the central nervous system). Objective: to present a case of intra-thyroid granular cell tumor. Clinical case: a case of a 37 year-old female patient with nodular illness of the thyroid of slow growth with scarce symptoms, with histologic confirmation of granular cells tumor is presented. To the physical exam, an increase of volume was identified in the anterolateral region of the neck, in connection with the right lobe of the thyroid gland that corresponded with a tumoral lesion of 3cm approximately, not well defined, stuck to deep planes, not painful to the palpation. In the echography, it was observed: right lobe of the thyroid of 4.3 cm x 1.2cm x 1.4 cm, not homogeneous with a nodular lesion of 2.8 x 1.4 cm not well defined, of irregular borders. During the surgery, a frozen section was examined and reported as positive of malignancy, however, the untimely histologic study revealed a benign intra-thyroid granular cell tumor. The surgical treatment is healing in this case. Conclusions: the diagnosis of intra-thyroid benign granular cell tumor is presented with the characteristics of a malign tumor, it should be kept in mind in the differential diagnosis of the tumors of the thyroid.
ABSTRACT
Abstract Perineural tumor spread refers to the migration of tumor cells along nerve tissues. It worsens the prognosis, increases the recurrence rate, and diminishes 5-year survival by up to 30%. It is an important finding on imaging tests employed in the staging of patients with head and neck cancers, because it cannot be assessed by the surgeon alone. Nevertheless, it is frequently overlooked. In this study, we reviewed the literature regarding the imaging and pathophysiological aspects of this type of dissemination. We also analyzed ten imaging tests, obtained from a teaching hospital in Brazil, in which there were radiological signs of perineural tumor spread.
Resumo Disseminação perineural de tumores refere-se à extensão de células tumorais ao longo do tecido dos nervos. Acarreta um pior prognóstico, aumenta a taxa de recorrência e diminui a expectativa de vida em cinco anos em até 30%. É um achado importante em exames de imagem quando se estadia pacientes com cânceres de cabeça e pescoço, já que não pode ser avaliado somente pelo cirurgião. Todavia, é uma alteração que frequentemente passa despercebida. No presente estudo, revisamos trabalhos científicos da literatura médica sobre os achados de imagem e os aspectos fisiopatológicos desse tipo de disseminação e analisamos 10 exames de imagem com sinais radiológicos de disseminação perineural oriundos de um hospital-escola brasileiro.
ABSTRACT
PURPOSE: To determine whether magnetization transfer ratio(MTR) helps differentiate malignant from benignlesions of the head and neck. MATERIALS AND METHODS: In 36 patients with pathologically proven head and necklesions (malignant tumor, n=22; benign tumor and inflammation, n=14), we prospectively obtained axial SE T1, TSET2, and pre-and post-MT images(2D FLASH; TR/TE/=500/12, flip angle=20 degree) using a 1.5T superconducting unit. TheMT pulse used for MT images was 7 msec gaussian, with 2 kHz off-resonance. The signal intensities of ROI oflesions, muscle, fat, and CSF were measured during pre- and post-MT imaging. MTRs and corrected MTRs(cMTRs) werecalculated and compared between benign and malignant lesions. Statistical differences were evaluated by Wilcoxonrank sum and student t test. RESULTS: Statistically significant differences were found between MTRs and cMTRs ofmalignant and benign lesions(p<0.01) and muscle (p<0.01). The differences in MTRs and cMTRs of benign andfat(p<0.01) or CSF(p<0.01) were also statistically significant. In the case of malignant tumors, mean MTR and cMTRwere greater than those of benign lesions(0.343 +/-0.024 and 0.328 +/-0.026, vs 0.228 +/-0.049 and 0.193 +/-0.047,p<0.01). Using a criterion of 0.3 for malignancy, the diagnostic sensitivity, specificity, and accuracy of MTR formalignancy are 91, 93, and 92%, respectively. Using a criterion of 0.28, the corresponding figures for cMTR 95,93, and 94%, respectively. CONCLUSION: MTR analysis of MT imaging could help to differentiate malignant andbenign lesions of the head and neck.