RESUMO
Biliary drainage was performed in a 71-year-old man with obstructive jaundice of unknown origin; however, he died due to acute pulmonary failure. At autopsy, proliferation of adenocarcinoma cells was observed in the gallbladder mucosa transitioning from isolated signet-ring cell carcinoma (SRCC) to the subserosa and bile ducts without growth toward the gallbladder lumen. Furthermore, fibrocellular intimal proliferation, tumor emboli and organized thrombi were observed in the small pulmonary arteries. The final diagnosis was gallbladder carcinoma complicated by SRCC associated pulmonary tumor thrombotic microangiopathy (PTTM). PTTM may present as rapidly progressive dyspnea, and a high level of clinical suspicion is required to make the differential diagnosis.
Assuntos
Carcinoma de Células em Anel de Sinete/complicações , Artéria Pulmonar/patologia , Neoplasias Gástricas/complicações , Microangiopatias Trombóticas/etiologia , Idoso , Autopsia , Ductos Biliares/patologia , Neoplasias da Vesícula Biliar/patologia , Humanos , Icterícia Obstrutiva/complicações , Pulmão/patologia , Masculino , Células Neoplásicas CirculantesRESUMO
A 65-year-old woman was admitted with sudden-onset abdominal pain. Abdominal computed tomography revealed hepatic portal venous gas. Physical and laboratory examination suggested that a conservative approach was appropriate; however, 4 days later, the pain recurred and severe ischemic enteritis was diagnosed. A stenosis was identified 60 cm distal to the start of the ileum, and partial resection of the small intestine was performed. The diagnosis of ischemic enteritis was confirmed. Ischemic enteritis affecting the small intestine is uncommon, and enteritis causing intestinal stenosis with hepatic portal vein gas is even rarer.
Assuntos
Embolia Aérea/etiologia , Ileíte/complicações , Íleo/irrigação sanguínea , Isquemia/complicações , Veia Porta , Idoso , Constrição Patológica , Procedimentos Cirúrgicos do Sistema Digestório , Embolia Aérea/diagnóstico , Feminino , Humanos , Ileíte/patologia , Ileíte/cirurgia , Íleo/patologia , Íleo/cirurgia , Isquemia/patologia , Isquemia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
A 44-year-old woman presented with high-grade fever. Chest radiography showed a 30 mm solitary pulmonary mass in the left lower lobe. Chest CT revealed a well-defined solid mass in the left lower lobe. On contrast-enhanced CT, the mass showed homogeneity and mild enhancement. There was an emphysematous portion in the surrounding lung parenchyma. The patient underwent partial lobectomy of the left lower lobe. The final diagnosis of sclerosing hemangioma with abundant vasculature was confirmed pathologically. Pulmonary sclerosing hemangioma is a rare benign neoplasm. Some cases have been reported in which sclerosing hemangioma is surrounded by air spaces. We suggest that the air spaces around the tumor were formed by not only peritumoral bleeding but also a check-valve effect of the compressed bronchus.