Endocardite marântica e adenocarcinoma de sítio primário oculto / Marantic endocarditis and adenocarcinoma of unknown primary site / Endocarditis marántica y adenocarcinoma de sitio primario desconocido

A endocardite trombótica não bacteriana é caracterizada pela deposição de trombos e fibrina sobre valvas cardíacas normais ou degeneradas na ausência de germes. A patologia está relacionada a estados inflamatórios crônicos, com maior incidência de fenômenos embólicos quando comparada à endocardite infecciosa. Os autores relatam o caso de um paciente masculino, 63 anos, com adenocarcinoma de sítio primário oculto e embolia sistêmica.

Nonbacterial thrombotic endocarditis (NBTE) is a disease characterized by deposition of thrombi and fibrin on normal or degenerated cardiac valves in the absence of microorganisms. This condition is more commonly seen in chronic inflammatory states, and is associated with higher incidence of thromboembolic events than infective endocarditis. We report the case of a 63-year old male patient with adenocarcinoma of unknown primary site and systemic embolism.

La endocarditis trombótica no bacteriana se caracteriza por el depósito de trombos de fibrina en las válvulas cardíacas normales o degenerados en ausencia de gérmenes. La patología se relaciona con estados inflamatorios crónicos, con una mayor incidencia de fenómenos embólicos cuando comparada a endocarditis infecciosa. Los autores refieren el caso de un paciente varón, de 63 años con adenocarcinoma de sitio primario desconocido y la embolia sistémica.

Membranoproliferative glomerulonephritis in a carcinoma with unknown primary: an autopsy study.

Kidney disease frequently complicates malignancy and its treatment. Although many solid and hematologic cancers may involve the renal parenchyma, clinical sequelae are usually not prominent. Published reports cite membranous nephropathy as the most common malignancy-associated glomerulopathy, occurring with many carcinomas and occasionally with leukemia and lymphoma followed by minimal change disease. Rarely membranoproliferative glomerulonephritis (MPGN) has been reported in patients with malignancy. The mechanism by which malignancy induces disease remains unproved, but may involve deposition of tumor antigen in the subepithelial space with in situ immune complex formation and subsequent complement activation. Treatment of the underlying malignancy may lead to resolution of nephrotic syndrome, lending indirect support to this theory. We report a rare autopsy case of a patient with metastatic carcinoma (with unknown primary) associated with MPGN. The association between MPGN and metastatic carcinoma with unknown primary is uncommon and has not been previously reported in the literature.

Dermatomyositis Associated with Cancer of Unknown Primary Site

Dermatomyositis (DM) is an uncommon inflammatory myopathy with characteristic rash accompanying, or more often preceding, muscle weakness. There is a well-recognized association between DM and several cancers, such as ovarian cancer, breast cancer, melanoma, colon cancer, and non-Hodgkin lymphoma. We report the first case of cancer of unknown primary site associated with DM. A 62-yr-old woman presented to us with both shoulder painful swelling and facial edema. She was diagnosed previously as cancer of unknown primary site, histologically confirmed with squamous cell carcinoma in a pelvic mass. For the following days, she complained of erythematous face followed by progressive weakness of the proximal muscles of upper and lower limbs. The laboratory tests showed an increased muscle enzyme and acute phase reactants. The electromyogram showed the typical findings of DM. After the treatment with high dose steroid and methotrexate, the proximal motor weakness improved, and she received palliative radiation therapy.

Adenocarcinoma da área pancreaticoduodenal de sítio primário desconhecido / Pancreaticoduodenal area adenocarcinoma of unknow primary site

Os autores relatam um caso de neoplasia maligna, cuja manifestação clínica inicial se fez pela metástase: umadenocarcinoma pouco diferenciado metastático, da área pancreaticoduodenal. No acompanhamento foram empregados métodos radiológicos, cirúrgicos, endoscópicos, anatomopatológicos e imuno-histoquímicos, na tentativa da identificação do sítio primário, sendo tal pesquisa importante no sentido de direcionar o tratamento paliativo da paciente, uma vez que o tratamento cirúrgico definitivo se tornou contra-indicado.

Occult malignancy in patients with idiopathic deep venous thrombosis

The relationship between deep venous thrombosis [DVT] and malignancy has long been recognized and documented, patients diagnosed with malignancy are clearly at risk for the development of venous thromboembolism and conversely some patients with deep venous thrombosis have subsequently been discovered to harbor an occult malignancy. This is a prospective study of 51 DVT patients who presented to Ain Shams University Hospitals between January 1997 and December 2000. These patients were chosen out of 188 DVT cases because of absence of any major thrombotic risk factor, their ages were over 40 years, and non were previously diagnosed with any form of malignancy. All patients were screened for any signs of occult cancer, which included careful history taking, thorough physical examination, laboratory screening including tumor markers, and abdominal ultrasonographic examinations. After the first level of screening; suspicious cases were subjected to the second level of specific laboratory, radiological, or endoscopic tests to reach a final diagnosis. Malignant neoplasms were detected in 11 cases [21.5%]. Carcino-embryonic antigen [CEA] and endoscopy were key in diagnosing 2 cases of early colon cancer and 2 cases of adenomatous colonic polypi. Cystoscopy followed by biopsy detected 2 cases of early urinary bladder cancer, and high levels prostate specific antigen, transrectal ultrasound and biopsy were used to diagnose cancer prostate in one patient. Biopsy of palpable axillary and cervical lymph nodes attracted our attention to one case of cancer breast, and one case of non-Hodgkin lymphoma. Oncofeotal proteins and scrotal ultrasound led to diagnosing one case of early testicular tumor. Computerized tomography scans of the abdomen discovered one case of cancer body of the pancreas. The most striking finding was that most of these cases were in the early stages of malignancy. These findings underscore the importance of screening for occult malignancy in idiopathic DVT patients especially in the elderly population and regardless of the cost, since we are sometimes rewarded by finding cancer at an early stage, giving the patient the best chance for survival

Metástasis de Origen Desconocido / Metastasis of Unknown Origin

Las metástasis de origen desconocido son aquellos tumores metastásicos cuyo sitio de origen no es sugerido por la historia clínica, el examen físico, los estudios imagenológicos, análisis de sangre, orina y la evaluación histopatológica; corresponden al 5-10 por ciento de los tumores en general. Los tipos histológicos de tumores encontrados en las metástasis de origen desconocido son adenocarcinoma (40 por ciento), carcinomas indiferenciados (40 por ciento), carcinomas escamosos (13 por ciento), melanoma maligno (4 por ciento) y neuroblastoma (1 por ciento); otras formas histopatológicas corresponden al 2 por ciento. En la identificación y determinación de las metástasis se utilizan las pruebas de histopatología, inmunoperoxidasas, microscopia electrónica, estudios radiológicos y bioquímicos. Los sitios mas frecuentes de metástasis son el pulmón, hígado y cerebro. El enfoque de los pacientes con metástasis de origen desconocido, busca establecer el origen primario del mismo; será primario si se observan transformaciones sucesivas en el tejido, al encontrar cambios consecutivos como metaplasia, displasia, carcinoma in situ y carcinoma invasor; será lesión metastásica si no se observa este gradiente de presentación. Los diferentes estudios radiológicos (rayos x, tomografía, resonancia magnética) informan la extensión del tumor, pero no ofrecerán una contribución a encontrar el tumor primario. En conclusión, es la historia clínica la que ayuda a establecer el posible sitio primario y a elegir el método diagnóstico a solicitar y emplear. Como tratamiento se debe intentar una prueba terapéutica con esquemas basados en el cisplatino o sus análogos, siendo la única limitante el mal estado funcional del paciente. Los dos esquemas más ampliamente utilizados son PEB (cisplatino, etopósido, bleomicina) y PVB (cisplatino, vinblastina, bleomicina)

Herpes zoster y neoplasia oculta: es real tal asociación? / Herpes Zoster and occult neoplasia: Is the association real?

Se realiza un estudio prospectivo con 80 pacientes portadores de herpes zoster (HZ), en los que se buscó la presencia de neoplasia oculta, durante un seguimiento promedio de 3,5 años. Los hallazgos obtenidos fueron comparados con dos grupos control de personas de igual edad y sexo. Se detecta la presencia de cáncer interno en 3 de 80 pacientes del grupo HZ y en 7/80 y 4/80 respectivamente de los grupos de control. La incidencia de neoplasia interna no es significativamente mayor en pacientes con HZ que en la población general, por lo que permite concluir que "el HZ no es un marcador de neoplasia oculta"

Metástasis óseas: informe de 117 casos con alteraciones biomecánicas musculoesqueléticas / Bone mestatases cancer with biomechanical muscle-scheletical alterations: report of 117 cases

Los casos clínicos de 117 pacientes con tumores óseos metastásicos y alteraciones biomecánicas fueron analizados retrospectivamente a partir de un enfoque interdisciplinario (ortopédia y oncológico). El 55 por ciento de los pacientes de esta serie fueron masculinos. El 50 por ciento del total cursaron con fractura, 23 por ciento con inminencia de fracturaq y 19 por ciento con compresión medular-radicular. Los carcinomas de mama, próstata, tiroides y pulmón fueron los tumores primarios que más frecuentemente diseminaron a los huesos; en 50 de los 117 casos no se determinó el sitio del tumor primario. El adenocarcinoma fue la estirpe histopatológica en 18 por ciento de los casos. El tercio proximal del fémur y las vértebras toracolumbares fueron los sitios más frecuentemente afectados. Se registraron 17 variables clínicas con sus agregados específicos en cada uno de los casos. Los datos encontrados fueron similares a los reportados en la literatura occidental, a excepción de que las metástasis óseas provocadas por cáncer pulmonar fueron menos frecuentes.