ABSTRACT
Resumen El mielolipoma es un tumor benigno no funcional, la mayoría de ellos son asintomáticos y descubiertos de forma incidental a través de estudios de imagen o en es tudios de autopsia. Aun cuando la mayoría de los casos se presenta en la glándula suprarrenal, también se han informado en sitios extra-adrenales. Presentamos el caso de una mujer de 65 años de edad con un mielolipoma primario mediastinal. La tomografía computarizada de tórax mostró un tumor ovoide de bordes bien definidos de 6.5 × 4.2 cm, localizado en el mediastino posterior. Se realizó biopsia transtorácica de la lesión y el estudio microscópico reveló elementos hematopoyéticos y tejido adiposo maduro. Aun cuando los estudios de imagen como la tomografía computarizada y la resonancia mag nética son efectivos en el diagnóstico del mielolipoma primario mediastinal, la evaluación histopatológica es esencial para el diagnóstico definitivo.
Abstract Myelolipoma is a benign non-functional tumor. Most of them are asymptomatic and discovered incidentally, either through imaging studies or at autopsy. While it most commonly occurs in the adrenal gland, it has also been reported at extra-adrenal sites. We present the case of a 65-year-old woman with a primary mediastinal myelolipoma. Computer tomographic scan of the thorax showed an ovoid tumor with well-defined borders of 6.5 × 4.2 cm, located in the posterior mediastinum. A transthoracic biopsy of the lesion was made, and the microscopic observation revealed hematopoietic cells and mature adipose tissue. Although computed tomo graphy and magnetic resonance imaging are effective in diagnosing mediastinal myelolipoma, histopathological examination is essential for the definitive diagnosis.
ABSTRACT
Os tumores de mediastino são patologias raras porém com uma taxa de letalidade elevada. Devido ao quadro clínico inespecífico, estudos que possam esclarecer quais são os fatores que estão associados a sobrevida, podem delinear estratégias de conduta que futuramente possam mudar esta situação. O objetivo do estudo foi determinar a sobrevida e os fatores associados em pacientes com tumores de mediastino na Grande Florianópolis. Foi realizado um estudo de análise de sobrevida no HRSJ em São José, SC. A população incluiu 127 pacientes com tumores de mediastino de junho de 1995 à dezembro de 2014. Os dados foram extraídos por uso do instrumento de coleta desenvolvido para o estudo. A análise estatística foi feita no programa SPSS® versão 16.0 e aplicaram-se o método Kaplan-Meier para as funções de sobrevida e o teste de Log-rank para associação. Aprovado no CEP UNISUL e HRSJ. A sobrevida geral em 5 anos foi de 77,5%. A proporção quanto ao gênero foi 1:1, com idade média de 44,31 anos. Nos tumores benignos 61,7% eram assintomáticos e os nos tumores malignos 63,4% eram sintomáticos (p=0,03). A sobrevida tumores de células germinativas foi de 30% em 5 anos e nos cistos foi de 100% em 5 anos. Os tumores malignos se mostraram os mais letais (p=0,02), sendo os tumores de células germinativas o principal tipo histológico. O quadro clínico sintomático mostrou-se mais prevalente nos tumores malignos.
Mediastinal tumors are a rare type of disease, however it has a high lethality rate. Owing to the inespecific clinical, studies that can elucidate which are the associated factors to survival, can trace strategies that in the future can change this situation. The objective of the study is to determine the survival and the associated factors in patients with mediastinal tumors at Florianópolis and São José. A survival analysis held at HRSJ in São José, SC. 127 patients were included diagnosed with mediastinal tumors from June 1995 to December 2014. Data were extracted by the use of the data collection instrument developed for the study. Statistical analysis was performed in SPSS® version 16.0 and have applied Kaplan-Meier method for the survival analysis and the Log-rank test for association. Approved in Ethical Committee in Research of UNISUL and HRSJ. The overall survival in 5 years was 77,5%. The gender proportion was similar, the mean age was 44,31 years. In benign tumors, 61,7% were assymptomatic and in malignant tumors, 63,4% were symptomatic (p=0,03). The survival of germ cells turmors were 30% in 5 years and in the cists were 100% in 5 years.The malignant tumors showed to be more lethal (p=0,02), as germ cells tumors the main histological type. The symptomatic clinical features were more prevalent in malignant tumors.
ABSTRACT
El mediastino es un compartimento que aloja tumores de variado origen histológico, dada la diversidad de órganos y estructuras que lo ocupan o lo transitan. Debido a la gran capacidad de la cavidad torácica, los pacientes se presentan frecuentemente con tumores de gran tamaño, a veces ya invadiendo, órganos vitales, complicando el estado clínico, el eventual manejo anestésico y los procedimientos quirúrgicos necesarios. Actualmente no existe un método común para categorizar pacientes con tumores mediastinales. Lo que hoy se hace es estudiar las imágenes y describir la masa, indicando sus dimenciones y relaciones, y de ahí se deduce la gravedad o no de la situación. De existir un sistema, los médicos tratantes podrían comunicarse, describir y entender bien cada lesión, el grado de respuesta al tratamiento y el pronóstico de cada paciente. Siguiendo el TNM, se propone un método de estadiaje para pacientes con tumores mediastinales, utilizando algunas modificaciones importantes, utilizando las letras: T /I/ N/ M. La T no representa las medidas lineales de la masa como en ese sistema, sino que más bien expresa la relación del volumen del tumor con el de la cavidad torácica del mismo individuo, T igual R: vol tum / vol tórax. Estos datos se obtienen directamente del tomógrafo, o bien, calcularse según el software de cada equipo de tomografía. usualmente el estudio tomográfico de un tumor mediastinal comprende una gran cantidad de cortes realizados a milímetros de distancia entre sí. Primero se determina el rango del coeficiente de atenuación en unidades Hounsfield del tumor, y en cada corte se dibuja el perímetro de éste. Se pide a la computadora que sume todos los volúmenes con el rango de unidades que cubran el tumor, y se obtiene así el volumen de la masa...
The mediastinum is an anatomic compartment that frequently lodges tumors of different histology, given thediversity of organs and structures that either occupy it or go through it, in one or another direction. Since the chest cavity is so large, is not uncommon to see patients presenting with pretty big tumors, sometimes invading vital organs,complicating their clinical status, anesthetic management and needed surgical procedures. Currently a commonstaging system applicable to patients with mediastinal tumors does not exist; the size of the mass and its relationshipsto neighboring organs is described from the imaging studies. If a TNM like system existed for mediastinal tumors, treating physicians could communicate and asses a particular lesion better, follow its response to treatment and could best define a prognosis for the patients. Based on the TNM system wepropose herein an staging system for mediastinal tumors, utilizing the letters: T/I/N/M. The letter T expresses therelationship of volume of tumor, with the volume of the continent chest cavity; these volumes may be easily obtained from the CT scanner depending on its software. Otherwise the perimeter of the mass is drawn in the axial cuts, which are several millimeters thick and its density range is read inHounsfield units. The computer determines the total volume of tissue slices comprised between the established density limits, and that constitutes the tumor volume in cubiccentimeters. The volume of the chest cavity is obtained from the volume of the lungs, which is given by the amount of air filling them. The sum of it plus the tumor volume will give the whole chest cavity volume. Dividing tumor volume bythe total chest volume, gives the relationship or T. Since we all have heart, trachea and great vessels their volume is not computed...