Caracterización de enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General "Freyre de Andrade" / Characterization of Patients with Thyroid Cancer Operated on in "Freyre de Andrade" General Clinical Surgical Hospital

Introducción: El cáncer de tiroides es el tumor más común de los malignos originados en órganos endocrinos (más del 92 por ciento) y comprende un grupo de tumores que son diferentes clínicamente, epidemiológicamente y en cuanto a pronóstico. Objetivo: Caracterizar a los enfermos con cáncer de tiroides operados en el Hospital Clínico Quirúrgico General "Freyre de Andrade". Métodos: Se realizó un estudio descriptivo, retrospectivo de corte longitudinal en el Hospital Clínico Quirúrgico General "Freyre de Andrade" en el período 2014-2019. El universo estuvo constituido por 32 enfermos operados de cáncer de tiroides. Fueron analizadas variables sociodemográficas, clasificación de Bethesda, diagnóstico histológico, técnica quirúrgica empleada y complicaciones. Resultados: El cáncer de tiroides predominó en mujeres (87,5 por ciento) entre 51 - 60 años (25,0 por ciento). Según la clasificación de Bethesda prevaleció la categoría VI (15,62 por ciento). Predominó el carcinoma papilar (65,62 por ciento). A todos los enfermos se le realizó una tiroidectomía total y las complicaciones fueron el hematoma posoperatorio (6,25 por ciento) y el granuloma (6,25 por ciento). Conclusiones: El cáncer tiroideo predomina en mujeres entre la quinta y sexta década de la vida. La técnica quirúrgica que se utiliza es la tiroidectomía total con baja morbilidad. Predomina la variante histológica del carcinoma papilar(AU)

Introduction: Thyroid cancer is the most common malignant tumor originating in endocrine organs (more than 92 percent) and comprises a group of clinically, epidemiologically and prognostically different tumors. Objective: To characterize patients with thyroid cancer operated on at Freyre de Andrade General Clinical Surgical Hospital. Methods: A descriptive, retrospective and longitudinal study was carried out at Freyre de Andrade General Clinical Surgical Hospital in the period 2014-2019. The universe consisted of 32 patients operated on for thyroid cancer. Sociodemographic variables, Bethesda classification, histological diagnosis, used surgical technique and complications were analyzed. Results: Thyroid cancer predominated in women (87.5 percent) between 51 and 60 years of age (25.0 percent). According to the Bethesda classification, category VI prevailed (15.62 percent). Papillary carcinoma predominated (65.62 percent). All patients underwent total thyroidectomy, while the complications were postoperative hematoma (6.25 percent) and granuloma (6.25 percent. Conclusions: Thyroid cancer predominates in women between the fifth and sixth decades of life. The used surgical technique is total thyroidectomy, reporting low morbidity. The histological variant of papillary carcinoma predominates(AU)

Sarcoid-like granulomatous myositis-associated hypercalcemia. An infrequent case to consider / Hipercalcemia asociada a miositis granulomatosa sarcoidea simil- sarcoidea. Un caso infrecuente a considerar

Abstract PTH-independent hypercalcemia due to granulomatous disease is well-documented and sarcoidosis is the most characteristic disease, although there are others. We describe a case of sarcoid-like granulomatous myositis. An 87-year-old man was referred with tetraparesis and hypercalcemia (albumin-corrected calcium of 13.4 mg/dl) following a trip to the Caribbean. The evaluation showed a suppressed PTH, 25-hydroxy vitamin D of 7.5 ng/ml, 18F-FDG PET/CT showed markedly increased uptake in intercostal, back, shoulder, but tock and thigh muscles and a deltoid biopsy confirmed extensive granulomatous myositis. He was prescribed glucocorticoids which resulted in normalized plasma calcium levels and complete recovery from tetraparesis. Sarcoid-like granulomatous myositis should be incorporated into the differential diagnosis of PTH-independent hypercalcemia, especially in the absence of clinical features of sarcoidosis and with special emphasis on the use of 18F-FDG PET/CT to ensure a correct approach.

Resumen La hipercalcemia PTH-independiente asociada a enfermedades granulomatosas está bien documentada y la sarcoidosis es la enfermedad más característica, a pesar de que existen otras. Des cribimos un caso de miositis granulomatosa simil-sarcoidea. Un hombre de 87 años consultó por tetraparesia e hipercalcemia (calcio corregido por albúmina 13.4 mg/dl) luego de un viaje al Caribe. La evaluación mostró una PTH suprimida, 25-hidroxivitamina D 7.5 ng/ml, 18F-FDG PET/CT mostró marcado aumento de captación a nivel de musculatura intercostal, dorsal, deltoidea, glúteos y muslos. Una biopsia deltoidea confirmó una miositis granulomatosa extensa. Se prescribieron glucocorticoides, resultando en normalización del calcio plasmático y completa recuperación de la tetraparesia. La miositis granulomatosa simil-sarcoidea debe ser incorporada den tro del diagnóstico diferencial de la hipercalcemia PTH-independiente, especialmente en ausencia de hallazgos clínicos de sarcoidosis y con especial énfasis en el uso de 18F-FDG PET/CT para su correcta aproximación.

Dermatite perioral granulomatosa com acometimento extrafacial na infância: boa resposta terapêutica com uso de azitromicina oral / Granulomatous perioral dermatitis with extra-facial involvement in childhood: good therapeutic response with oral azithromycin

RESUMO Objetivo: Apresentar um caso de dermatite perioral granulomatosa (DPG) com acometimento extrafacial e resposta terapêutica satisfatória ao uso de macrolídeo oral por curto período. Descrição do caso: Escolar de nove anos, sexo feminino, com quadro exuberante de DPG com acometimento extrafacial. Durante o período de evolução, submeteu-se a múltiplas terapêuticas ineficazes, apresentando melhora significativa das lesões após o uso de azitromicina por cinco dias. Comentários: A DPG é uma afecção dermatológica inflamatória representada por erupções papuloeritematosas em região perioral, nasal e periorbitária, mais comum em crianças e adolescentes. Raramente estende-se à região genital, ao tronco e às extremidades, caracterizando o comprometimento extrafacial. De etiologia ainda desconhecida, parece apresentar correlação com uso de corticosteroides tópicos e outros agentes.

ABSTRACT Objective: To present a case of granulomatous perioral dermatitis (GPD) with extra-facial involvement and good response to short-term treatment with oral macrolide. Case description: A 9-year-old girl presented with exuberant GPD with extra-facial involvement. During follow-up, she received multiple ineffective therapies, but showed significant improvement of the lesions after the use of azithromycin for five days. Comments: GPD is an inflammatory dermatological condition represented by papulo-erythematous eruptions on perioral, nasal and periorbital regions, more prevalent in children and adolescents. It rarely extends to the genital region, trunk, and extremities, which characterizes its extra-facial manifestation. Its etiology is unknown, but it seems to have a correlation with the use of topical corticosteroids and other agents.

Simultaneous Xanthogranulomatous Cholecystitis and Gallbladder Cancer in a Patient with a Large Abdominal Aortic Aneurysm

There have been reports of the coexistence of abdominal aortic aneurysm (AAA) with intra-abdominal malignancy including gastric, colonic, pancreatic, and renal. We herein report a case of a previously undiagnosed AAA and a presenting complaint consistent with acute cholecystitis. Following cholecystectomy, this was noted to be a rare form of chronic cholecystitis: xanthogranulomatous cholecystitis. There is a known possible association of this uncommon condition with gallbladder cancer. The management of concomitant pathologies can present a real challenge to the multidisciplinary team, especially with large aneurysms.

A Case of Idiopathic Granulomatous Hypophysitis

Granulomatous hypophysitis is a rare pituitary condition that commonly presents with enlargement of the pituitary gland. A 31-year-old woman was admitted to the hospital with a severe headache and bitemporal hemianopsia. Magnetic resonance imaging (MRI) showed an 18 x 10-mm sellar mass with suprasellar extension and compression of the optic chiasm. Interestingly, brain MRI had shown no abnormal finding 4 months previously. On hormonal examination, hypopituitarism with mild hyperprolactinemia was noted. The biopsy revealed granulomatous changes with multinucleated giant cells. We herein report this rare case and discuss the relevant literature.

Xanthogranulomatous Pancreatitis Presents as a Solid Tumor Mass: A Case Report

Xanthogranulomatous inflammation (XGI) is a rare, idiopathic process in which lipid-laden histiocytes are deposited at various locations in the body. Although XGI has been reported to occur in various organs such as the gallbladder, kidney, bone, stomach, colon, appendix, lymph nodes, urachus, and urinary bladder and in soft tissues, xanthogranulomatous pancreatitis (XGP) is extremely rare. Herein, we report a case of XGP occurring in a 70-yr-old woman, who presented with abdominal pain for several months. On physical examination, mild epigastric tenderness was noted. Abdomen CT scan revealed a low attenuated mass in uncinate process of pancreas, suggesting malignant lesion. Whipple's operation was performed and the final pathologic diagnosis was XGP. The patient's post-operative course was uneventful, and no recurrence was found within 7 months of the operation. When a pancreatic mass does not show clinico-radiological features typical of common pancreatic neoplasms, XGP should be considered for a differential diagnosis.

Xanthogranulomatous Pancreatitis Combined with Intraductal Papillary Mucinous Carcinoma In Situ

Xanthogranulomatous lesion is a rare condition in which lipid-laden histiocytes are deposited at various locations in the body. Xanthogranulomatous pancreatitis (XGP) associated with an intraductal papillary mucinous tumor (IPMT) is extremely rare. In this study, we described a case of XGP associated with IPMT and include a review of the literature. A pancreatic cystic mass was detected in a 72-yr-old woman by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed and diagnosis of XGP combined with intraductal papillary mucinous carcinoma in situ was made. After 13 months of follow-up, the patient is in good health without any evidence of tumor recurrence. Although XGP associated with IPMT is rare, we suggest that such cases should be brought to the attention of clinical investigators, as it may produce clinical features that mimic pancreatic cancer.

Hematoma del cordón umbilical: a propósito de un caso interesante / Umbilical cord hematoma: an interesting case

Se presenta el caso de un recién nacido que presentó tumoración del cordón umbilical, de 3 x 4 cm, coloración rojo violácea, consistencia blanda, no dolorosa, a 1 cm de la pared abdominal. En su evolución se observó disminución gradual de tamaño, sangramiento escaso y como complicación se presentó un granuloma umbilical, con retardo en la caída del cordón (21 días). A los 45 días de edad el ombligo estaba normal. Se realiza una caracterización clínica de la patología y se ofrece una revisión actualizada sobre el tema.

Authors present the case of a newborn presenting a 3 x 4 cm umbilical cord tumor of red-violet color, soft consistency and painless located at 1 cm of abdominal wall. During its evolution there was a gradual decrease size, low bleeding, and as a complication the presence of an umbilical granuloma and delay of fall cord (21 days). At 45 days the navel was normal. We performed a clinical catheterization of the pathology and also offer updated review on this matter.

Economic evaluation of seizures associated with solitary cysticercus granuloma.

BACKGROUND: Patients with solitary cysticercus granuloma (SCG) develop acute symptomatic seizures because of the inflammatory response of the brain and the seizures are self-limiting. Thus seizure disorder associated with SCG provides a good model to study the total cost of illness (COI). MATERIALS AND METHODS: COI of new-onset seizures associated with SCG was studied in 59 consecutive patients registered at the epilepsy clinic. Direct treatment-related costs and indirect costs, man-days lost and wages lost were evaluated. The relative cost was calculated as the percentage of per capita gross national product (GNP) at current prices for the year 1997-1998. RESULTS: The total COI, for treating seizure disorder associated with SCG per the period of CT resolution of the lesion per patient was INR 7273.7 (US$ 174.66, I$ 943.16) and he/she would be spending 50.9% of per capita GNP The direct cost per patient was INR 5916 (US$ 137.14, 41.4% of per capita GNP). If the patient had received only AEDs for the period of resolution of CT lesion, the cost would be INR 5702.48 (US$132.2, 40% of per capita GNP). The extra expenditure on albendazole and steroid was INR 213.72 (US$ 4.95), 3.6% of the total direct cost and 20.7% of the medication cost. Indirect cost (average wage loss) per patient was INR 1312.7 (US$ 30.42) and it accounted for 9% of per capita GNP. The one-time expenditure at present costs (adjusted for inflation) to the nation to treat all the prevalence cases is to the tune of INR 1.184 billion (US$ 2.605) and 0.0037% of GNP. CONCLUSIONS: This study suggests that seizure disorder associated with SCG, a potentially preventable disorder, is a good model to study the total COI. The one-time expenditure at present costs to the nation to treat all the prevalence cases of seizure disorder associated with SCG is to the tune of INR 1.184 billion (US$ 2.605 million) and 0.0037% of GNP.

Progressive subretinal fibrosis and multifocal granulomatous chorioretinitis

Descrevemos um caso de fibrose sub-retiniana progressiva e corrioretinite multifocal granulomatosa junto com os achados de angiografia fluoresceínica e com indocianina verde e propomos uma nova fisiopatologia para a fibrose em anel justa-papilar. A síndrome de fibrose sub-retiniana progressiva é uma doença grave, rara e constitui um subtipo grave da coroidite multifocal. As múltiplas lesões com fibrose circundando o disco óptico podem significar que a doença é oriunda do fluxo do líquido céfalo-raqueano, ao redor do nervo óptico.

Idiopathic granulomatous hepatitis.

A 12-year-old male child reported with history of fever for last seven years. Hepatosplenomegaly, hepatic and bone marrow granulomas were the main features. Idiopathic Granulomatous Hepatitis (IGH), a rare syndrome amenable to immunosuppressive therapy was diagnosed.

Granulomatous hypophysitis mimicking pituitary adennoma

Granulomatous inflammation of the pituitary gland is a rare disease that mimics non-functioning pituitary adenoma. Its incidence is high in middle aged and elderly women. Two such cases of histopathologically confirmed granulomatous hypophysitis are reported which presented with clinical and radiological impression of pituitary adenoma

Xanthogranulomatous cholecystitis.

Twelve cases of xanthogranulomatous cholecystitis are reported. The clinical presentation was similar to chronic cholecystitis. All patients had associated gallstones. The diagnosis was achieved at histopathological examination of the resected gall bladders and none had any focus of malignancy. Cholecystectomy was curative.

Nasal granuloma gravidarum presenting with recurrent massive epistaxis.

Nasal granuloma gravidarum is a rare condition associated with pregnancy and minor trauma. This condition presents with a nasal mass with varying degree of bleeding and obstruction. We report a patient with nasal granuloma gravidarum in the third trimester of pregnancy. Surgical excision is the definite treatment for this condition in order to stop the vicious cycle of recurrent massive bleeding. Possible etiology, clinical features and management are discussed.

Pulmonary hyalinizing granuloma presenting with dysphagia.

We describe a middle aged, non-smoking female who presented with dysphagia and underwent repeated endoscopies and oesophageal dilatation for a period of six months without any response. On imaging she was found to be having a lobulated mass with a radiological differential diagnosis of malignancy, lymphoma or a rare inflammatory lesion. After an inconclusive CT guided biopsy the patient underwent thoracoscopy on which an unresectable mass was found. The biopsy from the mass revealed pulmonary hyalinizing granuloma (PHG). To best of our knowledge this is the first case of PHG presenting as dysphagia reported in the English Literature. Literature on this rare entity is reviewed.

A Case of Simultaneous Xanthogranulomatous Cholecystitis and Carcinoma of the Gallbladder

Xanthogranulomatous cholecystitis (XGC) is a rare inflammatory disease of the gallbladder. Not only does XGC occasionally present as a mass formation with adjacent organ invasion like a malignant neoplasm, it can also infrequently be associated with gallbladder cancer. In the situation, it is difficult to make a differential diagnosis between the diseases. Here, we describe a case of a simultaneous XGC and a carcinoma of the gallbladder in a 61-year-old woman. To the best of our knowledge, there are only a small number of reports on this combination of diseases.