RESUMO
Defective apoptotic program due to the overexpression of the anti-apoptotic Bcl-2 protein of the outer mitochondrial membrane may be a cause of the poor response of malignant pheochromocytoma to 131I-MIBG therapy. We report a case of malignant pheochromocytoma which showed early intense uptake and immediate rapid washout of 99mTc-tetrofosmin characterizing the overexpression of anti-apoptotic Bcl-2 and which was refractory to 131I-MIBG therapy.
Assuntos
Neoplasias das Glândulas Suprarrenais/diagnóstico por imagem , Neoplasias das Glândulas Suprarrenais/metabolismo , Proteínas Reguladoras de Apoptose/metabolismo , Compostos Organofosforados/farmacocinética , Compostos de Organotecnécio/farmacocinética , Feocromocitoma/diagnóstico por imagem , Feocromocitoma/metabolismo , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Idoso , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Taxa de Depuração Metabólica , Cintilografia , Compostos Radiofarmacêuticos/farmacocinéticaRESUMO
We experienced a very rare case of intracystic papilloma in a 57-year-old man who came to our hospital complaining of a left subareolar mass and nipple discharge. The patient had a history of chronic schizophrenia, necessitating long-term treatment with phenothiazines. His serum prolactin levels were elevated. Mammography demonstrated a well defined mass with microcalcifications. Ultrasonography revealed a cyst with an intracystic component. The inner lesion of the mass enhanced on contrast-enhanced computed tomography. The carcinoembryonic antigen concentration of the cyst fluid was 400 ng/mL and no malignant cells were found by aspiration biopsy cytology. Excisional biopsy was performed under local anesthesia. Pathological examination revealed the intracystic component to be intracystic papilloma. There are ten reports of male intracystic papilloma including ours. We report the second case of a patient given long-term phenothiazine therapy, which is known to increase serum prolactin levels.
