RESUMO
POEMS syndrome is a rare multi-system disease with typical features of polyneuropathy, organomegaly, endocrinopathy, monoclonal plasmaproliferative disorder and skin changes. We describe a 44-year-old woman with polyneuropathy, hepatomegaly, IgA lambda-plasmacytoma, thrombocytosis, papilledema with elevated protein levels in cerebrospinal fluid and multiple cutaneous hemangiomas who was diagnosed with three intracranial lesions. Histology revealed capillary hemangiomas, one of them displaying partially glomeruloid features.
Assuntos
Neoplasias Encefálicas/etiologia , Neoplasias Encefálicas/patologia , Encéfalo/patologia , Hemangioma Cavernoso do Sistema Nervoso Central/etiologia , Hemangioma Cavernoso do Sistema Nervoso Central/patologia , Síndrome POEMS/complicações , Biomarcadores/sangue , Encéfalo/irrigação sanguínea , Encéfalo/fisiopatologia , Neoplasias Encefálicas/diagnóstico por imagem , Diplopia/imunologia , Diplopia/fisiopatologia , Feminino , Hemangioma Cavernoso do Sistema Nervoso Central/diagnóstico por imagem , Humanos , Imunoglobulina A/sangue , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos , Doenças do Sistema Nervoso Periférico/imunologia , Doenças do Sistema Nervoso Periférico/fisiopatologia , Plasmocitoma/complicações , Plasmocitoma/imunologia , Radiografia , Resultado do Tratamento , Regulação para Cima/fisiologia , Fator A de Crescimento do Endotélio Vascular/sangue , Baixa Visão/imunologia , Baixa Visão/fisiopatologiaRESUMO
Methotrexate (MTX)-associated myelopathy is a rare but serious subacute complication of MTX-based chemotherapy. We report the case of a woman with breast cancer and meningeal carcinomatosis who developed severe progressive myelopathy after four cycles of intrathecal MTX administration. We substituted high doses of the key metabolites of the methyl-transfer pathway: S-adenosylmethionine (SAM), 200 mg three times daily i.v.; folinate, 20 mg four times daily i.v.; cyanocobalamin, 100 microg once daily i.v.; and methionine, 5 g daily p.o. The patient's paraparesis improved rapidly thereafter, and magnetic resonance (MR) imaging showed resolution of the intramedullary lesions. Genetic analyses revealed homozygosity for the A allele of methylenetetrahydrofolate reductase (MTHFR) c.1298A>C (p.E429A), whereas other genetic variants of folate/methionine metabolism associated with MTX neurotoxicity were not present. Substitution with multiple folate metabolites may be a promising strategy for the treatment of MTX-induced neurotoxicity.
Assuntos
Antimetabólitos Antineoplásicos/efeitos adversos , Metionina/administração & dosagem , Metotrexato/efeitos adversos , Doenças da Medula Espinal/induzido quimicamente , Doenças da Medula Espinal/terapia , Complexo Vitamínico B/administração & dosagem , Neoplasias da Mama/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Carcinomatose Meníngea/tratamento farmacológico , Carcinomatose Meníngea/secundário , Pessoa de Meia-IdadeRESUMO
Lamellar keratectomy was performed in dogs to induce capillary endothelial proliferation at the limbus of the eye and the radiation response of endothelial cells was evaluated in terms of the dose required to prevent neovascularization in 50% of irradiated eyes (NVD50).Single- and split-dose experiments were carried out before and after induction of proliferation to determine the response of slowly and rapidly proliferating endothelial cells. the NVD-50-S prior to induction were about 400 rads greater than those following induction,indicating increased resistance of slowly proliferating cells. Split-dose studies indicatedthat the radiation repair capability was about 350 rads, either before or after induction.
