Metástasis óseas, primera manifestación clínica de un carcinoma productor de calcitonina / Bone metastases as the first clinical manifestation of a thyroid medullar carcinoma

Introducción: el carcinoma medular de tiroides comprende entre el 5%-10% de todos los carcinomastiroideos. La presentación clínica más frecuente es una masa tiroidea. Caso clínico: varón de 32 años, con dolores debidos a múltiples metástasis óseas. Una biopsia de médulaósea mostró un carcinoma con positividad inmunohistoquímica a calcitonina y antígeno carcinoembrionario.Los niveles séricos de calcitonina y antígeno carcinoembrionario estaban muy altos. El paciente murió a los 12 meses del diagnóstico a pesar de ser sometido a quimio y radioterapia. Discusión: las metástasis a distancia son una manifestación inicial infrecuente en el carcinoma medularde tiroides. Pacientes con menos de 45 años tienen mejor supervivencia, pero la existencia de metástasis óseasse correlaciona con mal pronóstico. Las determinaciones inmunohistoquímicas y séricas de calcitonina y antígenocarcinoembrionario son importantes instrumentos diagnósticos. Conclusión: mostramos lo que creemos es un carcinoma medular de tiroides en un varón joven, con una presentación inicial atípica debido a múltiples metástasis óseas y curso fatal. La inmunohistoquimia es fundamentalpara diagnosticar el tumor primario en estas metástasis. En el caso de calcitonina y/o antígeno carcinoembrionarioplasmático elevado y no explicado, es imprescindible descartar un carcinoma medular de tiroides

Purpose: Thyroid medullary carcinoma comprises between 5 and 10 % of all thyroid cancers. The mostcommon clinical presentation is a thyroid mass. Study of a case with bone metastases. Case report: A 32 year old man with pain due to multiple bone metastases. A bone marrow biopsydisclosed a carcinoma immunologically positive to calcitonin and carcinoembryonic antigen. Serum level ofboth, calcitonin and carcinoembryonic antigen, were very high. The patient was treated with chemotherapy andradiotherapy, and died 12 months later. Discussion: Distant metastases are not a usual presentation of thyroid medullary carcinoma. Patientsyounger than 45 years have a better survival, but bone metastases correlate with a very bad prognosis.Immunohistochemistry and blood determination of carcinoembryonic antigen and calcitonin are importantdiagnostic tools. Conclusion: Atypical presentation of a thyroid medullary carcinoma in a young man with bonemetastases and short survival. Immunohistochemistry is very useful to establish the origin of the primarytumour in these metastases. In the event of an unexplained plasma rise of calcitonin and/or carcinoembryonicantigen, it is mandatory to rule out a thyroid medullary carcinoma

Mesenteric actinomycosis with retroperitoneal involvement.

Mesenteric or retroperitoneal actinomycosis is an extremely rare disease. The international databases have revealed only 10 cases affecting the mesenterium and another 52 cases affecting the retroperitoneum. We report a 78-year-old female who was admitted with complaints of abdominal pain. Laboratory examination revealed anemia and the clinical examination revealed an irregular mass in the abdomen. Ultrasound and computed tomography (CT) scans showed a solid mass in the mesenteric-retroperitoneal region. Biopsy of the nonresectable mass revealed the presence of chronic inflammation in the mesenteric area with Actinomyces colonies. The patient was treated with oral amoxicillin, 500 mg every 6 hours for 6 months. The symptoms disappeared, but the mesenteric-retroperitoneal mass remains, but smaller in size. Based on the review of the literature and the case reported here, we conclude that mesenteric-retroperitoneal actinomycosis is difficult to diagnose by means of noninvasive techniques as it can masquerade as a malignant process. An accurate diagnosis is always obtained in a histological or microbiological examination, often requiring surgical intervention. Treatment with penicillin has proven to be effective.

Mesotelioma maligno en la región inguinal de origen incierto / Malignant mesothelioma of unknown origin in the inguinal region

Se presenta un caso de mesotelioma maligno en una paciente joven, localizado en la región inguinal y sin aparente relación con ningún saco herniario ni cavidad peritoneal. Se revisa la bibliografía existente, sin encontrar ninguna otra forma igual de mesotelioma (AU)