Central nervous system metastases of a pulmonary epitheloid haemangioendothelioma.

The case of a 55-yr-old male with a right pleural effusion and multiple bilateral nodules is reported. A diagnostic thoracothomy was necessary to obtain a definitive histological diagnosis. During the postoperative course, the subject's neurological condition deteriorated and multiple cerebral mass lesions were discovered. The pathological analysis of both lung and cerebral tumours revealed an atypical endothelial cell proliferation; vascular immunohistochemical markers, such as factor VIII and CD34, were strongly positive. His general condition remained poor and the patient died 18 months after the initial diagnosis. The final diagnosis was pulmonary epitheloid haemangioendothelioma with synchronous central nervous system dissemination, the first time the authors believe that association has been reported. Little is known of the prognosis and treatment of these tumours, due to their rarity. Negative prognostic factors appear to be the presence of symptoms, pleural effusion or multifocal presentations. Treatment should include surgical resection if possible; chemotherapy appears to have little effect. Watchful waiting is an acceptable option, especially in asymptomatic patients.

Lethal toxicity after 5-fluorouracil chemotherapy and its possible relationship to dihydropyrimidine dehydrogenase deficiency: a case report and review of the literature.

5-fluorouracil (5-FU) is a chemotherapeutic agent widely used in the treatment of solid malignancies, especially in colorectal cancer. A characteristic note seen with its use is the considerable interindividual variation in the incidence and severity of the toxicities seen among patients. We report the case of a 55-year old woman who presented with severe, lethal toxicity to standard doses of 5-fluorouracil (5-FU) and folinic acid. We discuss the known clinical determinants of toxicity. We also discuss the possible molecular factors implicated in the variable toxicity seen to 5-FU, especially in regards to dihiyropyrimidine dehydrogenase, a pivotal enzyme in the metabolism of 5-FU.

Imágenes pulmonares no neoplásicas, dolor lumbar y debilidad en miembros inferiores. ¿Cómo nos aproximamos al diagnóstico oncológico? / Non neoplastic lungimages, lumbar pain and lower limbs weakness. How can we approach the oncological diagnosis?

- Propósito: Presentamos el caso de una neoplasia cuya primera manifestación es una compresión medular. La presencia de baritomas pulmonares demoró el proceso diagnóstico y terapéutico.- Caso clínico: Varón de 78 años con nódulos pulmonares de densidad metálica que presentó clínica de dolor óseo y posterior alteración motora (paraplejía). Se confirmó la existencia de lesiones líticas vertebrales con anatomía patológica de adenocarcinoma. Las lesiones pulmonares no tenían relación con las lesiones óseas. La evolución del paciente no permitió la confirmación del origen prostático pero ante un PSA elevado era la opción diagnóstica más probable.- Discusión: El 15 por ciento de las neoplasias debutan con clínica secundaria a metástasis. Un 20 por ciento de los casos de compresión medular son la primera manifestación de un tumor. El síntoma inicial suele ser dolor de espalda que precede a los síntomas neurológicos. El método diagnóstico de elección ante una sospecha de CM es la RNM. El tratamiento de la CM es de carácter urgente para evitar la progresión del deterioro neurológico. En caso de histología conocida, debe instaurarse sin demora un régimen de corticoides a altas dosis junto con RT vertebral. La cirugía hay que considerarla como primera maniobra terapéutica y diagnóstica si se desconoce la histología (AU)