Hematoma mamario enmascarando un sarcoma / Breast hematoma masking a sarcoma

Los sarcomas suponen menos del 1% de los tumores malignos de la mama. Presentamos un caso de sarcoma (histiocitoma fibroso maligno) de mama que debuta en forma de tumoración, que la paciente relaciona con un traumatismo, y que mostró un aspecto clínico, ecográfico y citológico sugestivo de un hematoma. La tumoración creció rápidamente, y en la ecografía de control realizada al mes tenía claros polos sólidos hipervasculares. Es una presentación atípica, que permite revisar el manejo de lesiones sugestivas de hematomas, y que, en su evolución, a menudo se asocian a imágenes inespecíficas, en ocasiones sospechosas de malignidad. La aparición de lo que parece un hematoma mamario, incluso acompañado de un antecedente traumático o tendencia al sangrado, obliga a ser prudentes, por lo que se recomienda un seguimiento a muy corto plazo, y biopsia, incluso excisional, si los hallazgos evolutivos no son concordantes

Sarcomas account for less than 1% of malignant breast tumors. We present the case of a sarcoma (malignant fibrous histiocytoma) of the breast that debuted as a lump. The patient associated the lump with trauma, and the clinical, sonographic, and cytological findings were suggestive of a hematoma. The lump grew rapidly, and the follow-up sonogram one month later clearly revealed hypervascular solid poles. This atypical presentation is useful for reviewing the management of lesions suggestive of hematomas, which are often associated with nonspecific findings and occasionally with signs that raise suspicion of malignancy. The emergence of what appears to be a hematoma in the breast, even when accompanied by a history of trauma or a tendency toward bleeding, calls for prudence: very short-term follow-up and biopsy, even excisional biopsy, are recommended if the lesion does not evolve like a hematoma

[Breast hematoma masking a sarcoma]. / Hematoma mamario enmascarando un sarcoma.

Sarcomas account for less than 1% of malignant breast tumors. We present the case of a sarcoma (malignant fibrous histiocytoma) of the breast that debuted as a lump. The patient associated the lump with trauma, and the clinical, sonographic, and cytological findings were suggestive of a hematoma. The lump grew rapidly, and the follow-up sonogram one month later clearly revealed hypervascular solid poles. This atypical presentation is useful for reviewing the management of lesions suggestive of hematomas, which are often associated with nonspecific findings and occasionally with signs that raise suspicion of malignancy. The emergence of what appears to be a hematoma in the breast, even when accompanied by a history of trauma or a tendency toward bleeding, calls for prudence: very short-term follow-up and biopsy, even excisional biopsy, are recommended if the lesion does not evolve like a hematoma.

Anemia hemolítica microangiopática y carcinoma lobulillar de mama / No disponible

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Varón de 69 años con afectación del estado general, hiperpigmentación, lesión cutánea y respuesta deficiente al tratamiento / 69 years old male patient, with impairment of physical condition, hyperpigmentation, cutaneos lesion and a deficient response to treatment

Presentamos el caso de un varón con insuficiencia suprarrenal primaria de etiología tuberculosa, con una lesión dérmica en la que se comprobaron granulomas necrotizantes y en cuyo cultivo creció micobacterium bovis. Dados los hallazgos clínicos, y a la espera de recibir el cultivo de la lesión, se inició tratamiento tuberculostático triple, que hubo de suspenderse por toxicidad hepática. Tras conocer el cultivo de M. bovis en la biopsia cutánea, se reinstauró el tratamiento con estreptomicina, rifampicina y etambutol. Tres semanas después, y a pesar de aumentar a 40 mg diarios la dosis de hidrocortisona, reapareció la insuficiencia suprarrenal. Ante esta situación, se optó por mantener la rifampicina y duplicar la dosis de hidrocortisona, con lo que desparecieron totalmente las alteraciones clínicas y analíticas. El interés del caso radica en la confluencia de tres procesos infrecuentes en la actualidad: la insuficiencia suprarrenal de etiología tuberculosa, la tuberculosis cutánea por micobacterium bovis y la insuficiencia suprarrenal primaria desencadenada por el uso de rifampicina, y resuelta con el incremento de dosis de hidrocortisona (AU)

We submit the case of a male patient, suffering from a tuberculous ethiology ad renal primary insufficiency, showing a dermal lesion, in which necrotizing granulomas were found, and from which bacterial culture growth yielded mycobacterium bovis. Given the clinical findings, and a waiting for the bacterial culture result, a triple treatment with tuberculo statics was started, but had to be discontinued because of hepatic toxicity. After culture of cutaneous biopsy yielded micobaterium tuberculosis, treatment with streptomycin, rifampicin and etambutol was restarted. Three weeks later, in spite of increasing hydrocortisone dose to 40 mg, adrenal insufficiency reappeared. Under the circumstances, we chose to continue rifampicin and double hydrocortisone dose. The case is of concern because of the concurrency of three nowadays infrequent disorders: tuberculous ethology adrenal insufficiency, cutaneous tuberculosis due to mycobacterium bovis and primary adrenal insufficiency due to rifampicin treatment, the latter resolved after increasing hydrocortisone dose (AU)

[69 years old male patient, with impairment of physical condition, hyperpigmentation, cutaneous lesion and a deficient response to treatment]. / Varón de 69 años con afectación del estado general, hiperpigmentación, lesión cutánea y respuesta deficiente al tratamiento.

We submit the case of a male patient, suffering from a tuberculous ethiology adrenal primary insufficiency, showing a dermal lesion, in which necrotizing granulomas were found, and from which bacterial culture growth yielded mycobacterium bovis. Given the clinical findings, and awaiting for the bacterial culture result, a triple treatment with tuberculostatics was started, but had to be discontinued because of hepatic toxicity. After culture of cutaneous biopsy yielded micobaterium tuberculosis, treatment with streptomycin, rifampicin and etambutol was restarted. Three weeks later, in spite of increasing hydrocortisone dose to 40 mg, adrenal insufficiency reappeared. Under the circumstances, we chose to continue rifampicin and double hydrocortisone dose. The case is of concern because of the concurrency of three nowadays infrequent disorders: tuberculous ethiology adrenal insufficiency, cutaneous tuberculosis due to mycobacterium bovis and primary adrenal insufficiency due to rifampicin treatment, the latter resolved after increasing hydrocortisone dose.

[Echogenic material in fetal gallbladder: prenatal diagnosis and postnatal follow-up]. / Material ecogénico en vesícula biliar fetal: diagnóstico prenatal y seguimiento posnatal.

OBJECTIVE: To study the prevalence of echogenic material in fetal gallbladder and to analyze its pathological relevance, the perinatal factors involved and the postnatal outcome of detected cases. PATIENTS AND METHODS: We performed a prospective study of ultrasonographic examination of 9235 fetuses in the third trimester of gestation. Perinatal data were collected. Postnatal ultrasonography was performed in identified cases. RESULTS: Fetal biliary echogenic material was found in 0.45 % of all pregnancies, with 42 identified fetuses. A single echogenic image was found in four fetuses (9 %), two or more echogenic images were found in seven fetuses (17 %) and biliary sludge was found in 31 fetuses (74 %). All diagnoses were made between weeks 29 and 38 of gestation. No link was found with maternal factors or perinatal abnormalities. Postnatal follow-up was carried out in 39 neonates; of these, five neonates (13 %) showed biliary sludge, although all five were asymptomatic. In further follow-up examinations, ultrasound studies were normal. CONCLUSIONS: Fetal biliary echogenic material was found in one out of every 200 fetuses. No relationship was found with perinatal abnormalities. The prognosis of fetal gallstones and biliary sludge is favorable.

Material ecogénico en vesícula biliar fetal: diagnóstico prenatal y seguimiento posnatal / Echogenic material in fetal gallbladder: prenatal diagnosis and postnatal follow-up

Objetivo: Estudiar la prevalencia de la detección de material ecogénico biliar fetal, y analizar su significado patológico, factores perinatales relacionados y evolución posnatal de los casos detectados. Pacientes y métodos: Se realizó un estudio prospectivo ecográfico en 9.235 fetos durante el tercer trimestre de gestación. Se recogieron diversos datos perinatales en los casos detectados, y se realizó ecografía posnatal. Resultados: Se encontró material ecogénico biliar fetal en el 0,45 por ciento de todas las gestaciones, con 42 fetos identificados. Una imagen ecogénica única se detectó en 4 casos (9 por ciento); dos o más imágenes ecogénicas se encontraron en 7 pacientes (17 por ciento) y se halló barro biliar en 31 casos (74 por ciento). Todos los diagnósticos se realizaron entre las semanas 29 y 38 de gestación. No se mostró relación con los factores maternos o la patología perinatal. Se sometieron a seguimiento posnatal 39 recién nacidos. En cinco de ellos (13 por ciento) se encontró barro biliar, aunque todos se mostraban asintomáticos. Este hallazgo desapareció en controles posteriores. Conclusiones: Uno de cada 200 fetos muestra material ecogénico biliar fetal. No parece haber relación con enfermedades perinatales. El pronóstico de esta entidad es favorable (AU)

[Idiopathic thrombosis of the renal vein. Report of a new case]. / Trombosis idiopática de la vena renal. Aportación de un nuevo caso.

Thrombosis of the renal vein in adult patients is a rare entity, commonly associated to tumoral masses or hypercoagulability states. Contribution of one case of thrombosis of the renal vein in an 83-year old male patient, and review of current literature.

[Multilocular cystic nephroma. Preoperative diagnosis with CAT]. / Nefroma quístico multilocular: Diagnóstico preoperatorio mediante TAC.

We report a case of multilocular cystic nephroma in a 45-year-old female patient who had been referred for urological evaluation on detecting a mass in the left lumbar region. Patient work up included CT evaluation, which proved to be the most useful in making the diagnosis. The literature is reviewed with special reference to the nature of this lesion and the existing controversy on whether it is an embryonary tumor or a congenital malformation.