Acanthosis Nigricans associated with clear-cell renal cell carcinoma.

Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC.

Acanthosis Nigricans associated with clear-cell renal cell carcinoma

Acanthosis nigricans (AN), an entity recognized since the 19th century, is a dermatopathy associated with insulin-resistant conditions, endocrinopathies, drugs, chromosome abnormalities and neoplasia. The latter, also known as malignant AN, is mostly related to abdominal neoplasms. Malignant AN occurs frequently among elderly patients. In these cases, the onset is subtle, and spreading involves the flexural regions of the body, particularly the axillae, palms, soles, and mucosa. Gastric adenocarcinoma is the most frequent associated neoplasia, but many others have been reported. Renal cell carcinoma (RCC), although already reported, is rarely associated with malignant AN. The authors report the case of a woman who was being treated for depression but presented a long-standing and marked weight loss, followed by darkening of the neck and the axillary regions. Physical examination disclosed a tumoral mass in the left flank and symmetrical, pigmented, velvety, verrucous plaques on both axillae, which is classical for AN. The diagnostic work-up disclosed a huge renal mass, which was resected and further diagnosed as a RCC. The post-operative period was uneventful and the skin alteration was evanescent at the first follow-up consultation. The authors call attention to the association of AN with RCC

Tratamento cirúrgico do hiperparatireoidismo primário / Surgical management of primary hyperparathyroidism

Introdução: Hiperparatireoidismo é a condição resultantedo aumento na atividade das glândulas paratireoides. Talaumento pode decorrer tanto de uma alteração intrínseca(hiperparatireoidismo primário - HPP), causando produçãoexcessiva do paratormônio (PTH), como por alteração extrínseca,(hiperparatireoidismo secundário) na qual a homeostasiado cálcio é afetada. Objetivo: Avaliar retrospectivamente aexperiência de um serviço de cirurgia de cabeça e pescoço notratamento do hiperparatireoidismo primário. Método: Realizouseum estudo retrospectivo analisando os aspectos clínicos,tratamento e evolução de 48 pacientes com diagnóstico dehiperparatireoidismo primário tratados entre 2002 e 2010 noserviço de Cirurgia de Cabeça e Pescoço do Hospital Ana Costae Santa Casa da Misericórdia de Santos. Resultados: Em nossaamostra, dois pacientes eram do gênero masculino, a idademédia foi de 55,8 anos variando de 26 a 81 anos. Em dois casosnão foi evidenciado aumento de paratireoide através do exame dacintilografia a partir do radioisótopo Technetium (99mTc) sestamibi.No exame anátomo patológico, o diagnóstico foi negativo paraparatireoide em um caso. Foram necessárias 4 reoperações pordoença residual. Em três casos o cálcio iônico no pós-operatóriofoi maior do que no pré-operatório e o PTH pós-cirúrgico foisempre menor do que o pré-operatório.

Introduction: Hyperparathyroidism is a condition resulting fromincreased activity of the parathyroid glands. Such an increase maystem from both a change in intrinsic (primary hyperparathyroidism- HPTP), causing excessive production of parathyroid hormone(PTH), or by altering extrinsic (secondary hyperparathyroidism) inwhich calcium homeostasis is affected. Objectives: To evaluateretrospectively the experience of a service of head and necksurgery in the treatment of primary hyperparathyroidism. Method:We performed a retrospective study analyzing the clinical features,treatment and outcome of 48 patients diagnosed with primaryhyperparathyroidism treated between 2002 and 2010 in theservice of the Head and Neck Surgery, Hospital Ana Costa andSanta Casa da Misericórdia de Santos. Results: In our sample,two patients were male; the mean age was 55.8 years ranging 26-81 years. In two cases it was not evident increase in parathyroidfrom the radioisotope Technetium (99mTc) sestaMIBI scintigraphy.The diagnosis was negative for parathyroid tissue under thepathological evaluation in one case. Four reoperations werenecessary for residual disease. In three cases the ionic calciumin the postoperative period was higher than the pre-operative andpost surgical PTH was always lower than the preoperative.