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2.
Rev. chil. endocrinol. diabetes ; 14(2): 77-80, 2021.
Article in Spanish | LILACS | ID: biblio-1283556

ABSTRACT

El carcinoma oculto de tiroides está poco reportado. Se presenta el caso de una mujer de 59 años. Durante un control por hipotiroidismo se solicitó ecografía cervical, la que mostró áreas hipoecogénicas en lóbulo derecho, una formación nodular hiperecogénica circunscrita no sospechosa de 8 mm y una adenopatía cervical periglandular derecha de 20 x 12 x 8 mm con áreas quísticas y microcalcificaciones, asociadas a hipervascularización. Se solicitó punción aspirativa por aguja fina del ganglio linfático, con resultado de citología negativa para células neoplásicas. El examen microscópico es compatible con tiroiditis, por lo que no es posible descartar metástasis. Se realizó biopsia del ganglio linfático, el que se informa como metástasis ganglionar linfática de 1.3 cm, histología de carcinoma papilar variedad folicular, sin invasión extracapsular. Se realizó tiroidectomía total y disección cervical derecha. El estudio anatomopatológico reportó una tiroiditis crónica de Hashimoto con un nódulo fibroso hialinizado de 0,4 cm negativo para tumor maligno y metástasis en 4 de 28 ganglios linfáticos, sin invasión extracapsular. El tamaño de la metástasis fue de 0,3 a 0,9 cm. Posteriormente se administró 100 mci de radioyodo. Actualmente, la paciente está en buenas condiciones y mantiene controles con ecografía y tiroglobulina periódicos.


Occult thyroid carcinoma is under-reported. The case of a 59-year-old woman is presented. During a check-up for hypothyroidism, a cervical ultrasound was requested, which showed hypoechogenic areas in the right lobe, an 8 mm nonsuspicious circumscribed hyperechogenic nodular formation and a 20 x 12 x 8 mm right cervical periglandular lymphadenopathy with cystic areas and microcalcifications, associated with hypervascularisation. Fine needle aspiration of the lymph node was requested, with negative cytology results for neoplastic cells. Microscopic examination was compatible with thyroiditis, so metastasis could not be ruled out. A biopsy of the lymph node was performed, which was reported as a 1.3 cm lymph node metastasis, histology of papillary carcinoma of the follicular variety, without extracapsular invasion. Total thyroidectomy and right cervical dissection were performed. The anatomopathological study reported chronic Hashimoto's thyroiditis with a 0.4 cm hyalinised fibrous nodule negative for malignant tumour and metastases in 4 of 28 lymph nodes, without extracapsular invasion. The size of the metastasis was 0.3 to 0.9 cm. Subsequently, 100 mci of radioiodine was administered. The patient is currently in good condition and maintains regular ultrasound and thyroglobulin monitoring.


Subject(s)
Humans , Female , Middle Aged , Thyroid Neoplasms/pathology , Thyroid Cancer, Papillary/secondary , Lymphatic Metastasis/pathology , Biopsy, Fine-Needle , Lymph Nodes/pathology
3.
Int. braz. j. urol ; 46(supl.1): 86-92, July 2020. tab, graf
Article in English | LILACS | ID: biblio-1134300

ABSTRACT

ABSTRACT Purpose: The aim of this work is to review and synthesize the existing evidence and recommendations regarding to the therapeutic and surgical indications as well as monitoring of patients with Penile Cancer in COVID-19 era and to propose an action protocol to facilitate decision-making. Material and Methods: A non-systematic review of the literature regarding the management of penile cancer during the COVID-19 pandemic was performed until April 30, 2020. We propose our recommendations based on this evidence. Results: Penile cancer is an uncommon but aggressive disease. Prognosis is determined by several characteristics, being the most important the presence of lymph nodes, in which case, treatment should not be delayed. For these reasons, an initial evaluation is mandatory. Priority classifications, based on the oncological outcomes when treatment is delayed, have been made in order to separate deferrable disease from the one that needs high priority treatment. In penile cancer with low risk of progression, surgical treatment can be delayed, but other options must be considered, like topical treatment or laser therapy. In cases with intermediate risk of progression, surgical treatment may be delayed up to three months, but we must consider radiation therapy and brachytherapy as effective options. When feasible, follow-up should by telemonitoring. Conclusions: In the COVID 19 era, initial evaluation of the patient is mandatory. Histological diagnosis with local staging is necessary before offering any therapeutic option. In case of superficial non-invasive disease, topical treatment is effective in absence of lymph node involvement. In selected patients, radiotherapy is an organpreserving approach with good results. Non-deferrable surgical treatment must be performed by an experienced surgeon and as an outpatient procedure when possible. When indicated, iLND should not be delayed since it is decisive for patient survival. Follow-up should be by telemonitoring.


Subject(s)
Humans , Male , Penile Neoplasms/surgery , Penile Neoplasms/therapy , Pneumonia, Viral/epidemiology , Coronavirus Infections/epidemiology , Pandemics , Betacoronavirus , SARS-CoV-2 , COVID-19 , Lymph Nodes/pathology , Neoplasm Staging
4.
Arch. argent. pediatr ; 118(1): 11-17, 2020-02-00. tab, graf
Article in English, Spanish | LILACS, BINACIS | ID: biblio-1095278

ABSTRACT

Introducción. Las causas más frecuentes de la linfadenopatía cervical son las afecciones inflamatorias y reactivas; solo unos pocos casos representan una patología seria. El objetivo fue evaluar la relación entre los hallazgos ecográficos y el diagnóstico histopatológico. Población y métodos. Este estudio retrospectivo abarcó la linfadenopatía cervical en los menores de 20 años seguidos en nuestro centro, entre enero de 2007 y diciembre de 2016. Según los informes anatomopatológicos, se dividió a los pacientes en dos grupos: benigno y maligno. Se compararon los resultados anatomopatológicos y los hallazgos ecográficos. Resultados. Después del análisis de los resultados histopatológicos y los hallazgos ecográficos, se incluyó a 107 pacientes con linfadenopatía cervical persistente (44 casos malignos; 63, benignos). La media de edad de los grupos maligno y benigno fue de 14 ± 6,1 años y de 11,9 ± 4,8 años, respectivamente. La presencia de vascularidad hiliar fue estadísticamente significativa (p < 0,0001) en la linfadenopatía benigna, mientras que el flujo periférico y la vascularidad mixta lo fueron (p < 0,05) en la linfadenopatía maligna. No se observó una diferencia significativa en el diámetro máximo (27,3 ± 11,1 mm y 29,8 ± 12,3 mm, respectivamente), pero sí en el diámetro mínimo entre los grupos benigno y maligno (13,7 ± 7,3 mm y 18,7 ± 8,8 mm, respectivamente). Conclusiones. Este estudio sugiere que existe una relación entre los hallazgos ecográficos y de la biopsia para la diferenciación entre la linfadenopatía benigna y maligna, en especial, en el patrón vascular intraganglionar y el hilio ganglionar.


Introduction. The most common causes of cervical lymphadenopathy (LAP) are inflammatory and reactive conditions; only a small proportion have serious pathology, such as malignancy. The objective of this study was to evaluate the relationship between USG findings and histopathological diagnosis of the cervical LAP. Population and Methods. This retrospective study comprised the cases of cervical LAP in patients aged under 20 years old followed in our center between January 2007 to December 2016. Based on pathology reports, we divided the patients into two groups: benign and malignant. Pathology results and USG findings were compared. Results. After the analyze of the histopathological results and USG findings, 107 patients with persistent cervical LAP (44 malignant; 63 benign) were included in the study. Mean age of malignant and benign group were 14 ± 6.1; 11.9 ± 4.8 years, respectively. Hilar vascularity for benign LAP was highly statistically significant (P < 0.0001) and peripheral flow and mixed vascularity for malignant LAP were also statistically significant (p < 0.05). There was not a significant difference in the maximum diameter (27.3 ± 11.1 mm and 29.8 ± 12.3 mm, respectively), however, there was a significant difference in the minimum diameter between benign and malignant groups (13.7 ± 7.3 mm and 18.7 ± 8.8 mm, respectively).Conclusions. The present study suggests that there is a relationship between US and biopsy findings for the differentiation of benign from malignant LAP, especially in terms of nodal hilus and intranodal vascular pattern.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Young Adult , Ultrasonography , Lymphadenopathy/diagnostic imaging , Reproducibility of Results , Retrospective Studies , Sensitivity and Specificity , Biopsy, Fine-Needle , Lymphadenopathy/pathology , Lymph Nodes/pathology , Lymphatic Diseases/physiopathology , Lymphoma/diagnosis , Lymphoma/etiology
5.
ABCD arq. bras. cir. dig ; 33(3): e1547, 2020. tab, graf
Article in English | LILACS | ID: biblio-1152619

ABSTRACT

ABSTRACT Background: The identification of prognostic factors of esophageal cancer has allowed to predict the evolution of patients. Aim: Assess different prognostic factors of long-term survival of esophageal cancer and evaluate a new prognostic factor of long-term survival called lymphoparietal index (N+/T). Method: Prospective study of the Universidad de Chile Clinical Hospital, between January 2004 and December 2013. Included all esophageal cancer surgeries with curative intent and cervical anastomosis. Exclusion criteria included: stage 4 cancers, R1 resections, palliative procedures and emergency surgeries. Results: Fifty-eight patients were included, 62.1% were men, the average age was 63.3 years. A total of 48.3% were squamous, 88% were advanced cancers, the average lymph node harvest was 17.1. Post-operative surgical morbidity was 75%, with a 17.2% of reoperations and 3.4% of mortality. The average overall survival was 41.3 months, the 3-year survival was 31%. Multivariate analysis of the prognostic factors showed that significant variables were anterior mediastinal ascent (p=0.01, OR: 6.7 [1.43-31.6]), anastomotic fistula (p=0.03, OR: 0.21 [0.05-0.87]), N classification (p=0.02, OR: 3.8 [1.16-12.73]), TNM stage (p=0.04, OR: 2.8 [1.01-9.26]), and lymphoparietal index (p=0.04, RR: 3.9 [1.01-15.17]. The ROC curves of lymphoparietal index, N classification and TNM stage have areas under the curve of 0.71, 0.63 and 0.64 respectively, with significant statistical difference (p=0.01). Conclusion: The independent prognostic factors of long-term survival in esophageal cancer are anterior mediastinal ascent, anastomotic fistula, N classification, TNM stage and lymphoparietal index. In esophageal cancer the new lymphoparietal index is stronger than TNM stage in long-term survival prognosis.


RESUMO Racional: A identificação de fatores prognósticos do câncer de esôfago permitiu prever a evolução dos pacientes. Objetivo: Avaliar diferentes fatores prognósticos da sobrevida em longo prazo do câncer de esôfago e avaliar um novo fator prognóstico da sobrevida em longo prazo chamado índice linfoparietal (N+/T). Método: Estudo prospectivo do Hospital Clínico da Universidade do Chile, entre janeiro de 2004 e dezembro de 2013. Incluiu todas as operações de câncer de esôfago com intenção curativa e anastomose cervical. Os critérios de exclusão incluíram: câncer em estágio 4, ressecções R1, procedimentos paliativos e operações de emergência. Resultados: Cinquenta e oito pacientes foram incluídos, 62,1% eram homens, a idade média foi de 63,3 anos. Um total de 48,3% eram escamosos, 88% eram cânceres avançados, a colheita média de linfonodos foi de 17,1. A morbidade cirúrgica pós-operatória foi de 75%, com 17,2% de reoperações e 3,4% de mortalidade. A sobrevida global média foi de 41,3 meses, a sobrevida em três anos foi de 31%. A análise multivariada dos fatores prognósticos mostrou que variáveis significativas foram elevação pelo mediastinal anterior (p=0,01, OR: 6,7 [1,43-31,6]), fístula anastomótica (p=0,03, OR: 0,21 [0,05-0,87]), classificação N (p=0,02, OR: 3,8 [1,16-12,73]), estágio TNM (p=0,04, OR: 2,8 [1,01-9,26]) e índice linfoparietal (p=0,04, RR: 3,9 [1,01-15,17]. As curvas ROC do índice linfoparietal, classificação N e estádio TNM apresentam áreas abaixo da curva de 0,71, 0,63 e 0,64, respectivamente, com diferença estatística significativa (p=0,01). Conclusão: Os fatores prognósticos independentes de sobrevida em longo prazo no câncer de esôfago são a elevação mediastinal anterior, fístula anastomótica, classificação N, estágio TNM e índice linfoparietal. No câncer de esôfago, o novo índice linfoparietal é mais forte que o estágio TNM no prognóstico de sobrevida em longo prazo.


Subject(s)
Humans , Male , Female , Middle Aged , Esophageal Neoplasms/mortality , Esophageal Neoplasms/pathology , Esophagectomy/methods , Cancer Survivors/statistics & numerical data , Esophageal Squamous Cell Carcinoma/mortality , Esophageal Squamous Cell Carcinoma/pathology , Lymph Nodes/pathology , Prognosis , Esophageal Neoplasms/surgery , Chile/epidemiology , Survival Rate , Prospective Studies , Survivors , Esophageal Squamous Cell Carcinoma/surgery , Lymph Node Excision , Neoplasm Staging
6.
Article in Chinese | WPRIM | ID: wpr-880818

ABSTRACT

OBJECTIVE@#To analyze the clinicopathological characteristics and risk factors of 4L lymph node metastasis in left non-small cell lung cancer.@*METHODS@#We retrospectively analyzed the data of 134 patients undergoing surgical resection of left non-small cell lung cancer and 4L lymph node dissection, including 60 patients with squamous cell carcinoma (SCC) and 74 with lung adenocarcinoma (ADC). The clinicopathological characteristics of the patients were analyzed, and logistic regression analysis was used to identify the predictors of station 4L metastasis.@*RESULTS@#Of these patients, 16.4% (22/134) presented with station 4L metastasis. The patients with SCC and ADC showed significant differences in age, gender, smoking history, neoadjuvant chemotherapy, tumor size, tumor location and type, visceral pleural invasion, Ki-67 index, 4L metastasis and pathological TNM stage (stage Ⅱ). The rate of station 4L metastasis was significantly lower in SCC group than in ADC group. Univariate analysis revealed that pathological types (SCC or ADC), visceral pleural invasion, lymphovascular invasion, tumor markerabnormality, and station 5 to 10 metastasis were all high-risk factors for station 4L metastasis. Multivariate analysis suggested that the pathological type (OR=0.120, @*CONCLUSIONS@#In patients with left non-small cell lung cancer, station 4L metastasis is not rare and is more likely to occur in patients with lung adenocarcinoma. Dissection of the 4L lymph nodes should be performed in cases with low risk of damages of the adjacent tissues and high risk of station 4L metastasis.


Subject(s)
Carcinoma, Non-Small-Cell Lung/pathology , Humans , Lung Neoplasms/pathology , Lymph Node Excision , Lymph Nodes/pathology , Lymphatic Metastasis , Neoplasm Staging , Prognosis , Retrospective Studies , Risk Factors
7.
Acta cir. bras ; 34(10): e201901002, Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1054669

ABSTRACT

Abstract Purpose: To evaluate the effect of garlic on formation of postoperative adhesions in rats. Methods: Twenty-four Sprague dawley rats were divided into three groups. In Group 1 (sham), laparotomy was performed and stitched up. In Group 2 (control), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and 2 cc of saline was intraperitoneally administered to each rat. In Group 3 (experimental), after laparotomy was performed, punctate hemorrhage was induced by cecal abrasion in the cecum and each rat was intraperitoneally administered a sterile Allium sativum derivative. The rats in all groups were re-laparotomized on postoperative day 7; samples were obtained from the peritoneal tissue surrounding the cecum Results: In Group 3, there was a statistically significant difference in terms of inflammation, lymph node size, and free oxygen radicals; these parameters tended to increase. In terms of fibrosis evaluated using H&E and MT, there was no significant difference between groups 2 and 3. Conclusions: No positive outcomes indicating that Allium sativum reduces intra-abdominal adhesions were obtained. However, it caused severe inflammation in the tissue. Additionally, in immunohistochemical analyses conducted to detect oxidative stress, allium sativum increased the production of free oxygen radicals in the tissue.


Subject(s)
Animals , Peritoneal Diseases/prevention & control , Garlic/chemistry , Peritoneal Diseases/pathology , Postoperative Complications/pathology , Postoperative Complications/prevention & control , Fibrosis , Immunohistochemistry , Tissue Adhesions/pathology , Tissue Adhesions/prevention & control , Reproducibility of Results , Rats, Sprague-Dawley , Oxidative Stress/drug effects , Free Radicals/analysis , Laparotomy , Lymph Nodes/drug effects , Lymph Nodes/pathology
8.
Braz. j. otorhinolaryngol. (Impr.) ; 85(5): 617-622, Sept.-Oct. 2019. tab, graf
Article in English | LILACS | ID: biblio-1039286

ABSTRACT

Abstract Introduction: The fine-needle cytology is being used as a first line of investigation in the diagnosis of head and neck swellings, as it is simple, cost effective and less invasive as compared to biopsy. Objective: The aims of this study were to evaluate the results of the fine-needle non-aspiration cytology of cervical lymphadenopathy and to study the factors influencing the rate of non-diagnosis results. Methods: This retrospective study was conducted on selected patients with cervical lymphadenopathy that had undergone a fine-needle non-aspiration cytology followed by a histological biopsy. The sensitivity, specificity, positive predictive value and negative predictive value of fine-needle non-aspiration cytology for diagnosing tuberculosis were estimated. The risk factors of non-diagnosis results were evaluated. Results: The sensitivity, specificity, positive predictive value rates of fine-needle non-aspiration cytology for tuberculosis were 83.3%, 83.3%, 78.9% and 86.9% respectively. In total, 47 out of the 131 samples (35.8%) were considered non-diagnosis. Of the non-diagnosis samples, 84.2% (38 out of 47) were benign mostly due to tuberculosis (30 cases). Among the studied factors, only tuberculosis (confirmed by histopathological examination) was significantly associated with non-diagnosis cytology (p = 0.02, Odds-Ratio = 2.35). Conclusion: Tuberculosis is currently the commonest cause of cervical lymphadenopathy in North Africa. Fine-needle non-aspiration cytology is safe and accurate in the diagnosis of cervical tuberculous lymph node that is associated with the risk of non-diagnosis cytology.


Resumo Introdução: A punção não aspirativa com agulha fina tem sido utilizada como primeira linha de investigação no diagnóstico de tumores de cabeça e pescoço, por ser uma técnica simples, custo-efetiva e menos invasiva quando comparada à biópsia. Objetivo: Os objetivos deste estudo foram avaliar os resultados de citologia por punção não-aspirativa com agulha fina de linfadenopatias cervicais e estudar os fatores que influenciam a taxa de falha diagnóstica. Método: Este estudo retrospectivo foi realizado em pacientes selecionados com linfadenopatia cervical submetidos a punção não aspirativa com agulha fina, seguida por biópsia histológica. Foram estimadas a sensibilidade, especificidade, o valor preditivo positivo e valor preditivo negativo da punção não aspirativa com agulha fina para o diagnóstico de tuberculose. Os fatores de risco dos resultados com falha diagnóstica foram avaliados. Resultados: As taxas de sensibilidade, especificidade, valor preditivo positivo e valor preditivo negativo da punção não aspirativa com agulha fina para tuberculose foram de 83,3%, 83,3%, 78,9% e 86,9%, respectivamente. Das 131 amostras, 47 (35,8%) foram consideradas como falha diagnóstica. Das amostras não diagnosticadas, 84,2% (38 de 47) eram benignas, principalmente devido à tuberculose (30 casos). Entre os fatores estudados, apenas a tuberculose (confirmada pelo exame histopatológico) estava significativamente associada à citologia com falha diagnóstica (p = 0,02, odds ratio = 2,35). Conclusão: A tuberculose é atualmente a causa mais comum de linfadenopatia cervical no norte da África. A punção não aspirativa com agulha fina é uma técnica segura e precisa no diagnóstico de linfonodos cervicais associados ao risco de citologia com falha diagnóstica.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Young Adult , Tuberculosis, Lymph Node/diagnosis , Biopsy, Fine-Needle/methods , Lymph Nodes/pathology , Tuberculosis, Lymph Node/pathology , Retrospective Studies
9.
Int. braz. j. urol ; 45(4): 671-678, July-Aug. 2019. tab, graf
Article in English | LILACS | ID: biblio-1019884

ABSTRACT

ABSTRACT Introduction Penile cancer (PC) occurs less frequently in Europe and in the United States than in South America and parts of Africa. Lymph node (LN) involvement is the most important prognostic factor, and inguinal LN (ILN) dissection can be curative; however, ILN dissection has high morbidity. A nomogram was previously developed based on clinicopathological features of PC to predict ILN metastases. Our objective was to conduct an external validation of the previously developed nomogram based on our population. Materials and methods We included men with cN0 ILNs who underwent ILN dissection for penile carcinoma between 2000 and 2014. We performed external validation of the nomogram considering three different external validation methods: k-fold, leave-one-out, and bootstrap. We also analyzed prognostic variables. Performance was quantified in terms of calibration and discrimination (receiver operator characteristic curve). A logistic regression model for positive ILNs was developed based on clinicopathological features of PC. Results We analyzed 65 men who underwent ILN dissection (cN0). The mean age was 56.8 years. Of 65 men, 24 (36.9%) presented with positive LNs. A median 21 ILNs were removed. Considering the three different methods used, we concluded that the previously developed nomogram was not suitable for our sample. Conclusions In our study, the previously developed nomogram that was applied to our population had low accuracy and low precision for correctly identifying patients with PC who have positive ILNs.


Subject(s)
Humans , Male , Adult , Aged , Aged, 80 and over , Penile Neoplasms/pathology , Carcinoma/pathology , Nomograms , Inguinal Canal/pathology , Lymph Nodes/pathology , Lymphatic Metastasis/diagnosis , Reference Values , Logistic Models , Predictive Value of Tests , Reproducibility of Results , Retrospective Studies , Risk Factors , ROC Curve , Tumor Suppressor Protein p53/analysis , Statistics, Nonparametric , Neoplasm Grading , Lymph Node Excision , Middle Aged , Neoplasm Staging
10.
Braz. j. otorhinolaryngol. (Impr.) ; 85(3): 297-302, May-June 2019. tab, graf
Article in English | LILACS | ID: biblio-1011631

ABSTRACT

Abstract Introduction: Ultrasonography is the easiest non-invasive method to diagnose lymph node metastases in patients with head and neck cancer. However, since CT scans are often preferred in the evaluation of primary tumours of these patients, information about lymphatic metastases may also available in these patients. Therefore, ultrasound is not routinely employed in the evaluation of these patients. However, elastography technique, a recent development in ultrasound technology, could make use of ultrasonography in these patients even more widespread, even though it is still not widely used today. Objectives: The aim of this study was to evaluate the role of sonographic elastography in the diagnosis of lymph node metastasis of head and neck cancer. Methods: Twenty-three patients diagnosed with head and neck cancer and scheduled for surgical treatment including neck dissection were included in the study. All patients underwent neck examination by palpation, ultrasound elastography and computerized tomography with contrast. To compare the diagnostic performance of palpation, ultrasound elastography and computerized tomography, the findings of each examination method were compared with the histopathological examination results of neck specimens. Results: 15 (65.2%) patients had a primary tumour in the larynx; 7 (30.4%) in the oral cavity; and 1 (4.3%) in the parotid. 7 (30.4%) out of 23 patients underwent bilateral neck dissection. In total, 30 neck dissections were hereby taken into account during study. Ultrasound elastography showed higher accuracy (83.3%) and higher sensitivity (82.4%) than palpation and computerized tomography, but the specificity of ultrasound elastography was lower (84.6%) than palpation and computerized tomography. Conclusions: Ultrasound elastography is helpful for the diagnosis of lymph node metastases in patients with head and neck cancer. Due to its non-invasive character, it can be used safety in combination with other radiological techniques to support or improve their diagnostic performance.


Resumo Introdução: A ultrassonografia é o método mais fácil e não invasivo para diagnosticar metástases em linfonodos em pacientes com câncer de cabeça e pescoço. No entanto, como as tomografias computadorizadas são frequentemente preferidas na avaliação de tumores primários desses pacientes, as informações sobre metástases linfáticas também se tornam disponíveis. Portanto, a ultrassonografia não faz parte da avaliação de rotina desses pacientes. Entretanto, a técnica de elastografia, um desenvolvimento mais recente na tecnologia de ultrassom, poderia tornar o uso da ultrassonografia mais difundido nesses pacientes, embora atualmente ainda não seja amplamente usado. Objetivo: Avaliar o papel da elastografia ultrassonográfica no diagnóstico de metástases em linfonodos em casos de câncer de cabeça e pescoço. Método: Foram incluídos no estudo 23 pacientes diagnosticados com câncer de cabeça e pescoço e com tratamento cirúrgico programado, inclusive esvaziamento cervical. Todos os pacientes foram submetidos a exame cervical por palpação, elastografia ultrassonográfica e tomografia computadorizada com contraste. Para comparar o desempenho diagnóstico da palpação, elastografia ultrassonográfica e tomografia computadorizada, os achados de cada método de exame foram comparados com os resultados do exame histopatológico de amostras obtidas do pescoço. Resultados: Dos pacientes, 15 (65,2%) apresentaram tumor primário na laringe; sete (30,4%) na cavidade oral; e um (4,3%) na parótida. Sete (30,4%) dos 23 pacientes foram submetidos a esvaziamento cervical bilateral. Foram considerados durante o estudo 30 pescoços. A elastografia ultrassonográfica mostrou maior acurácia (83,3%) e maior sensibilidade (82,4%) do que a palpação e a tomografia computadorizada, mas a especificidade da elastografia ultrassonográfica foi menor (84,6%) do que a palpação e a tomografia computadorizada. Conclusões: A elastografia ultrassonográfica é útil para o diagnóstico de metástases de linfonodos em pacientes com câncer de cabeça e pescoço. Graças ao seu caráter não invasivo, pode ser usada com segurança em combinação com outras técnicas radiológicas para apoiar ou melhorar o desempenho diagnóstico.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Head and Neck Neoplasms/diagnostic imaging , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis/diagnostic imaging , Cross-Sectional Studies , Predictive Value of Tests , Sensitivity and Specificity , Elasticity Imaging Techniques , Head and Neck Neoplasms/pathology , Lymph Nodes/pathology , Lymphatic Metastasis/pathology , Neoplasm Staging
11.
Autops. Case Rep ; 9(1): e2018053, Jan.-Mar. 2019. ilus
Article in English | LILACS | ID: biblio-987077

ABSTRACT

ABSTRACT: Metastatic spread of cancer via the thoracic duct may lead to an enlargement of the left supraclavicular node, known as the Virchow node (VN), leading to an appreciable mass that can be recognized clinically ­ a Troisier sign. The VN is of profound clinical importance; however, there have been few studies of its regional anatomical relationships. Our report presents a case of a Troisier sign/VN discovered during cadaveric dissection in an individual whose cause of death was, reportedly, chronic obstructive pulmonary disease. The VN was found to arise from an antecedent pulmonary adenocarcinoma. Our report includes a regional study of the anatomy as well as relevant gross pathology and histopathology. Our anatomical findings suggest that the VN may contribute to vascular thoracic outlet syndrome as well as the brachial plexopathy of neurogenic thoracic outlet syndrome. Further, the VN has the potential to cause compression of the phrenic nerve, contributing to unilateral phrenic neuropathy and subsequent dyspnea. Recognition of the Troisier sign/VN is of great clinical importance. Similarly, an appreciation of the anatomy surrounding the VN, and the potential for the enlarged node to encroach on neurovascular structures, is also important in the study of a patient. The presence of a Troisier sign/VN should be assessed when thoracic outlet syndrome and phrenic neuropathy are suspected. Conversely, when a VN is identified, the possibility of concomitant or subsequent thoracic outlet syndrome and phrenic neuropathy should be considered.


Subject(s)
Humans , Female , Aged , Phrenic Nerve , Thoracic Outlet Syndrome/etiology , Adenocarcinoma , Peripheral Nervous System Diseases/etiology , Lung Neoplasms , Lymph Nodes/pathology , Autopsy , Thoracic Outlet Syndrome/pathology , Fatal Outcome , Peripheral Nervous System Diseases/pathology
13.
Rev. Soc. Bras. Med. Trop ; 52: e20180188, 2019. graf
Article in English | LILACS | ID: biblio-1041591

ABSTRACT

Abstract Reports of simultaneous infections and neoplasms in patients with acquired immune deficiency syndrome (AIDS) are occasionally seen in the literature. However, coexistent lymphoma with tuberculosis, and Kaposi sarcoma (KS) with tuberculosis occurring in the same lymph node is rare. Coexistent lesions pose diagnostic difficulties. In this article, we report two HIV-positive patients from Zimbabwe who displayed KS and tuberculosis; KS and diffuse large B-cell lymphoma in the same lymph node. We found only one similar case presentation in the literature, which was reported in India.


Subject(s)
Humans , Male , Female , Adult , Sarcoma, Kaposi/complications , Tuberculosis/complications , HIV Infections/complications , Lymphoma, Large B-Cell, Diffuse/complications , Lymph Nodes/pathology , Sarcoma, Kaposi/pathology , Tuberculosis/pathology , Zimbabwe , HIV Infections/pathology , Lymphoma, Large B-Cell, Diffuse/pathology
14.
ABCD arq. bras. cir. dig ; 32(2): e1441, 2019. tab, graf
Article in English | LILACS | ID: biblio-1019242

ABSTRACT

ABSTRACT Background: The identification of prognostic factors of gastric cancer (GC) has allowed to predict the evolution of patients. Aim: Assess the reliability of the lymphoparietal index in the prediction of long-term survival in GC treated with curative intent. Method: Prospective study of the Universidad de Chile Clinical Hospital, between May 2004 and May 2012. Included all gastric cancer surgeries with curative intent. Exclusion criteria were: gastrectomies due to benign lesions, stage 4 cancers, R1 resections, palliative procedures, complete esophagogastrectomies and emergency surgeries. Results: A total of 284 patients were included; of the sample 65.4% were male,mean age of 64.5 years,75% were advanced cancers, 72.5% required a total gastrectomy, 30 lymph nodes harvest. Surgical morbidity and mortality were 17.2% and 1.7%. 5-year survival was 56.9%. The N+/T index could predict long-term survival in all de subgrups (p<0.0001), although had a reliable prediction in early GC (p=0.005), advanced GC (p<0.0001), signet ring cell GC (p<0.0001), proximal GC (p<0.0001) and distal GC (p<0.0001). The ROC curves N+/T index, LNR and T classification presented areas below the curve of 0.789, 0.786 and 0,790 respectively, without a significant statistical difference (p=0.96). Conclusion: The N+/T index is a reliable quotient in the prognostic evaluation of gastric adenocarcinoma patients who have been resected with curative intent.


RESUMO Racional: A identificação de fatores prognósticos do câncer gástrico (GC) permitiu predizer a evolução dos pacientes. Objetivo: Avaliar a confiabilidade do índice linfoparietal na predição de sobrevida em longo prazo em pacientes tratados com intenção curativa. Método: Estudo prospectivo do Hospital das Clínicas da Universidade de Chile, entre maio de 2004 e maio de 2012. Todas as operações de câncer gástrico foram com intenção curativa. Os critérios de exclusão foram: gastrectomia por lesões benignas, cânceres estágio 4, ressecções R1, procedimentos paliativos, esofagogastrectomias completas e operações de emergência. Resultados: Foi incluído um total de 284 pacientes; da amostra 65,4% eram homens, com média de idade de 64,5 anos, 75% eram cânceres avançados, 72,5% necessitaram de gastrectomia total e 30 coletas de linfonodos. A morbimortalidade cirúrgica foi de 17,2% e 1,7%. Sobrevida em cinco anos foi de 56,9%. O índice N +/T pôde predizer a sobrevida em longo prazo em todos os subgrupos (p<0,0001), embora tivesse previsão confiável em GC precoce (p=0,005), GC avançado (p<0,0001), célula GC de anel de sinete (p< 0,0001), GC proximal (p<0,0001) e GC distal (p<0,0001). As curvas ROC N +/T, LNR e T apresentaram áreas abaixo da curva de 0,789, 0,786 e 0,790, respectivamente, sem diferença estatística significativa (p=0,96 ). Conclusão: O índice N +/T é um quociente confiável no prognóstico na avaliação de pacientes com adenocarcinoma gástrico que foram ressecados com intenção curativa.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Stomach Neoplasms/mortality , Lymph Nodes/pathology , Prognosis , Stomach Neoplasms/surgery , Stomach Neoplasms/pathology , Prospective Studies , Reproducibility of Results , Disease-Free Survival , Gastrectomy , Neoplasm Staging
15.
Prensa méd. argent ; 104(10): 500-504, dic 2018.
Article in Spanish | LILACS, BINACIS | ID: biblio-1046992

ABSTRACT

La presencia de adenopatías periféricas con rango adenomegálico es un hallazgo clínico frecuente, tanto en los pacientes con serología reactiva como en los no infectados por el VIH. En este estudio retrospectivo se analizaron 132 muestras de biopsias quirúrgicas ganglionares obtenidas de pacientes internados en un hospital de referencia en Enfermedades Infecciosas del GCABA, Argentina, en el período comprendido entre enero de 2011 y diciembre de 2015. La mayoría de los pacientes (100/132, 75,8%) tuvieron serología reactiva para VIH; en este subgrupok de sujetos, la mediana del recuento de linfocitos T CD-4 positivos fue de 141 cél/µL. El diagnóstico histopatológico más frecuente resultó la infiltración ganglionar por neoplasias linfoides primarias (linfomas) o metástasis de carcinomas (41%). Entre las patologías infecciosas predominaron las micobacteriosis, en especial la tuberculosis. Solo en 3 de 132 (2,3%) muestras de biopsias los hallazgos histológicos fueron normales. En conclusión, la biopsia quirúrgica de adenopatías periféricas resulta un método muy valioso y mínimamente invasivo para el diagnóstico de patologías infecciosas y tumorales. Una alta incidencia de enfermedades neoplásicas se detectaron en este estudio realizado en un hospital de Enfermedades Infecciosas.


Peripheral lymphadenopathy is a common clinical condition in both HIV-infected and non-HIV patients and has a wide spectrum of differential diagnoses. In this retrospective study, we carried out a cross-sectional study of peripheral lymph node biopsies performed from January 2011 to December 2015 in a reference hospital of Infectious Diseases in Argentina. We include a 132 patients underwent excisional lymph node biopsies during the time of study. The majority of patients were HIV-seropositive (100/132; 75,8%); the median of CD4 T-cell count was 141 cell/µL. The most common histopathological diagnosis was primitive or secondary neoplasms (54/132; 40,9%). In 51/132 biopsies the diagnosis corresponded to infectious pathologies, especially mycobacterial diseases, including tuberculosis. Only 3 of 132 biopsies (2,3%) included in the evaluation had only with normal findings. Peripheral lymph node biopsy is a simple and useful tool to diagnose opportunistic diseases and neoplasms in HIV and non-HIV infected patients. A high incidence of neoplasm diseases (41%) were obtained in this retrospective study


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Aged , Aged, 80 and over , Epidemiology, Descriptive , Communicable Diseases/diagnosis , Retrospective Studies , Biopsy, Fine-Needle , Lymphadenopathy/pathology , Lymph Nodes/pathology , Neoplasms/physiopathology
16.
Arch. endocrinol. metab. (Online) ; 62(5): 495-500, Oct. 2018. tab
Article in English | LILACS | ID: biblio-983800

ABSTRACT

ABSTRACT Objective: Our aim was to present our experiences related to performing neck surgery using the guided intraoperative scintigraphic tumor targeting (GOSTT) procedure for patients who had locally recurrent or persistent differentiated thyroid cancer (DTC) and who had undergone previous thyroid surgery. Subjects and methods: We retrospectively evaluated 11 patients who had locally recurrent or persistent DTC, who had undergone previous surgery, and for whom reoperation was planned for metastatic cervical lymph nodes (LNs). We performed the neck surgery using the GOSTT procedure on all patients and at a single academic institution. Results: The 11 patients had a total of 26 LNs, as marked with a radiotracer, and those LNs' mean size was 14.7 ± 8.2 mm (range: 5-34 mm). Histopathological examinations revealed DTC metastasis in all 26 of the preoperatively marked LNs. Of the 11 patients, only one needed a reoperation in the neck; she had another successful surgery (also using the GOSTT procedure). In the evaluation of the patients' final status, all were disease-free in their necks. There also were no GOSTT-associated postoperative complications. Conclusion: The GOSTT procedure is a useful, successful, inexpensive, and comfortable procedure for marking and mapping metastatic LNs, especially in DTC patients who have undergone previous surgery.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Thyroid Neoplasms/pathology , Carcinoma, Papillary/surgery , Carcinoma, Papillary/secondary , Lymph Node Excision/methods , Lymph Nodes/surgery , Neck/surgery , Carcinoma, Papillary/diagnostic imaging , Radionuclide Imaging/methods , Radiography, Interventional , Reproducibility of Results , Retrospective Studies , Treatment Outcome , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Lymphatic Metastasis , Neck/pathology , Neck/diagnostic imaging , Neoplasm Recurrence, Local
18.
Autops. Case Rep ; 8(3): e2018033, July-Sept. 2018. ilus
Article in English | LILACS | ID: biblio-911974

ABSTRACT

Simultaneous calcified fibrous pseudotumor (CFT) and Castleman disease (CD) is an extremely rare association. CD is an uncommon lymphoproliferative disease that can arise in various sites of the body, while CFT is a rare type of benign fibrous lesion that frequently affects children and young adults, occurring as solitary or multiple lesions throughout the human body. Both entities are rare and exhibit typical and diverse histomorphological features. We report the case of a 15-year-old female patient, who, at the age of 13 had a biopsy performed at an external medical center; however, after 4 months the lesion had regrown. This lesion was removed with a surgical operation; however, it regrew 2 years later and was removed a third time. The results of the latter two biopsies were the same: CFT accompanying CD. The histologic examination of the excised lymph node and the surrounding tissue showed hyalinized fibrous tissue containing dystrophic and psammomatous calcification. In this case, the hyaline vascular type of CD was found to be intertwined with a CFT, which hampered the differentiation of whether both entities emerged within the lymph node or if the CFT developed from the soft tissue and then involved the lymph node. Future studies involving larger case series will provide a more precise insight, which should serve to resolve the current uncertainty.


Subject(s)
Humans , Female , Adolescent , Castleman Disease/diagnosis , Clavicle/pathology , Lymph Nodes/pathology
19.
Int. braz. j. urol ; 44(4): 688-696, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-954075

ABSTRACT

ABSTRACT Objectives: To evaluate the diagnostic performance of preoperative multiparametric magnetic resonance imaging (mp-MRI) as a predictor of extracapsular extension (ECE) and unfavorable Gleason score (GS) in patients with intermediate and high-risk prostate cancer (PCa). Materials and Methods: Patients with clinically localized PCa who underwent radical prostatectomy (RP) and had preoperative mp-MRI between May-2011 and December-2013. Mp-MRI was evaluated according to the European Society of Urogenital Radiology MRI prostate guidelines by two different readers. Histopathological RP results were the standard reference. Results: 79 patients were included; mean age was 61 and median preoperative prostate-specific antigen (PSA) 7.0. On MRI, 28% patients had ECE evidenced in the mp-MRI, 5% seminal vesicle invasion (SVI) and 4% lymph node involvement (LNI). At RP, 39.2% had ECE, 26.6% SVI and 12.8% LNI. Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) of mp-MRI for ECE were 54.9%, 90.9%, 76%, 81% and 74.1% respectively; for SVI values were 19.1%, 100%, 77.3%, 100% and 76.1% respectively and for LNI 20%, 98.4%, 86.7%, 66.7% and 88.7%. Conclusions: Major surgical decisions are made with digital rectal exam (DRE) and ultrasound studies before the use of Mp-MRI. This imaging study contributes to rule out gross extraprostatic extension (ECE, SVI, LNI) without competing with pathological studies. The specificity and NPV are reasonable to decide surgical approach. A highly experienced radiology team is needed to provide accurate estimations of tumor extension and aggressiveness.


Subject(s)
Humans , Male , Adult , Aged , Prostatic Neoplasms/pathology , Prostatic Neoplasms/diagnostic imaging , Magnetic Resonance Imaging/methods , Prostatectomy/methods , Prostatic Neoplasms/surgery , Seminal Vesicles/pathology , Seminal Vesicles/diagnostic imaging , Biopsy , Reproducibility of Results , Sensitivity and Specificity , Prostate-Specific Antigen/blood , Risk Assessment/methods , Neoplasm Grading , Lymph Nodes/pathology , Lymph Nodes/diagnostic imaging , Middle Aged , Neoplasm Invasiveness/pathology , Neoplasm Staging
20.
Säo Paulo med. j ; 136(4): 368-371, July-Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-962739

ABSTRACT

ABSTRACT CONTEXT: Histiocytic necrotizing lymphadenitis (HNL) is a rare disorder that is often benign and self-limiting. There have been reports of co-occurrence of HNL with other diseases, including systemic lupus erythematosus, hemophagocytic syndrome and antiphospholipid syndrome. CASE REPORT: Here, we report a case in which a patient experienced unexplained fever, swelling of the cervical lymph node and bilateral pleural effusion and was ultimately diagnosed with HNL based on results from a lymph node biopsy. After treatment with glucocorticoid, the patient regained normal body temperature, the swelling of the lymph nodes disappeared and the pleural effusion was reabsorbed. CONCLUSIONS: The pathogenesis of HNL remains unclear, and pleural effusion is rarely reported in HNL patients. We presented this case to improve diagnostic awareness of this condition among clinicians and help reduce the likelihood of misdiagnosis.


Subject(s)
Humans , Female , Adult , Pleural Effusion/etiology , Histiocytic Necrotizing Lymphadenitis/complications , Histiocytic Necrotizing Lymphadenitis/pathology , Lymph Nodes/pathology , Pleural Effusion/diagnostic imaging , Biopsy , Neck
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