Coexistent primary lymphoma of the thyroid and cerebral aneurysm / Linfoma primário de tiróide coexistente com aneurisma cerebral

Relata-se um raro caso de linfoma primário de tiroide em uma mulher de 52 anos com hipotiroidismo associado à tiroidite crônica de Hashimoto. Houve rápido crescimento de um tumor cervical antero-medial, com sintomas de compressão nas vias aéreas superiores e no esôfago. Imagens de tomografia computadorizada com contraste e de endoscopia digestiva alta confirmaram os efeitos compressivos. O linfoma de células B CD20+ primário de tiróide foi diagnosticado por punção aspirativa com agulha grossa e exame histológico e imunoistoquímico. Imagens incidentais do pescoço e da cabeça revelaram um aneurisma cerebral. Com base no diagnóstico, a paciente se submeteu com sucesso a quimioterapia e radioterapia e houve controle do linfoma. A paciente continua em acompanhamento nos ambulatórios de Oncologia e de Neurocirugia. Olinfoma primário de tiroide pode apresentar-se como uma massa indolor na região cervical anterior e média, causando dificuldades de diagnóstico. A relação, causal ou casual, entre linfomas e aneurismas cerebrais nãoestá bem definida.

A rare case of primary lymphoma of the thyroid is reported in a 52-year-old woman with a previous history of hypothyroidism due to Hashimoto?sthyroiditis, and rapid development of an anteromedial cervical tumor with symptoms of extrinsic compression over the upper airways and the esophagus. Contrasted computed tomography images and upper digestive endoscopy confirmed the compressive mass effects. The primary B-cellCD20+ lymphoma of the thyroid was diagnosed by thick-needle biopsy with histological and immunohistochemical evaluation. Incidental images of the head and neck revealed a cerebral aneurysm. Based on the diagnosis, the patient successfully underwent chemotherapy and radiation therapy with control of the lymphoma and is under surveillance in the Oncology andNeurosurgery outpatient care center. Primary lymphoma of the thyroid can present as a painless anterior and medial mass on the neck, leading to diagnosis challenges. The casual or causal relationship between lymphomas and cerebral aneurysms remains unclear.

Mucormycosis in a patient with acute myeloid leukemia successfully treated with liposomal amphotericin B associated with deferasirox and hyperbaric oxygen.

We report a 38-year-old woman presenting with febrile neutropenia, acute myeloid leukemia (AML) and invasive mucormycosis. Bone marrow aspirate was characteristic of AML minimally differentiated (WHO classification 2008). Flow cytometric immunophenotyping analysis showed blasts positive for CD7, CD33, CD34, CD71, CD117, HLA-DR, MPO, and TdT, with normal karyotype (46, XX), and the absence of the FLT3-ITD and NPM1 mutations. The patient's management included chemotherapy with cytarabine and idarubicin, and treatment with liposomal amphotericin B, deferasirox, hyperbaric oxygen therapy, and antibiotics. Nowadays, she is in complete hematological remission, and CT images of control are normal. Invasive mucormycosis is an uncommon and severe condition, which involves diagnosis and treatment challenges. Clinical features and predisposing factors should be highlighted in order to enhance the suspicion index, contributing to early diagnosis and disease control. Our aim is to report classical features of this uncommon condition and to emphasize usual management challenges.

Plaquetopenia grave em paciente etilista com infecção por vírus da imunodeficiência humana / Severe thrombocytopenia in an alcoholic patient with human immunodeficiency virus infection

A infecção por vírus da imunodeficiência humana e síndrome da imunodeficiência adquirida constituem importantes problemas de saúde pública em todo o mundo e a plaquetopenia tem sido um achado frequente nesse grupo populacional. Os mecanismos da citopenia são multifatoriais e ainda não estão completamente esclarecidos. Fatores que agravam a plaquetopenia incluem coinfecção por hepatite C e cirrose hepática. O objetivo desse relato é exemplificar o caso de um paciente com o vírus, cirrose alcoólica e plaquetopenia grave, abaixo de 5.000/mm3, corrigida com a administração de corticosteroide.

Infection with human immunodeficiency virus infection and acquired immunodeficiency syndrome is a serious public health issue worldwide, and thrombocytopenia has been a frequent finding among this group of patients. The mechanisms of this cytopenia are multifactorial and have not been completely understood. Factors that worsen thrombocytopenia include hepatitis C coinfection and hepatic cirrhosis. The aim of this report is to describe the case of an human immunodeficiency virus infection patient with alcoholic cirrhosis and severe thrombocytopenia, above 5,000/mm3, which was treated with corticosteroid use.