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2.
Can Assoc Radiol J ; 72(4): 767-774, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33461324

RESUMO

PURPOSE: Sclerosing lymphocytic lobulitis (SLL) is a rare benign breast condition usually associated with diabetes mellitus and whose imaging features have been assessed in few studies, limiting the adoption of diagnostic guidelines. We aimed to identify the main morphological features associated with SLL on imaging examinations (mainly ultrasound and mammography) and to retrospectively evaluate the role that each method played in the diagnostic workup (detection and indication for biopsy). METHODS: A retrospective study was conducted in a high-volume single center, encompassing 51 consecutive patients (100% female; 26-78 y; 43.7 ± 15.5 y) with histopathologically proven SLL (59 lesions; 0.5-6.1 cm). RESULTS: Most lesions (31/59; 53%) were found in asymptomatic individuals. Ultrasound detected 91.1% (51 out of 56 lesions assessed by this modality), of which 94.1% were non-circumscribed masses (BI-RADS® 4). Mammography detected 41.6% (15 out of 36 lesions assessed by this modality), with a predominance (80%) of non-calcified ones (masses, asymmetries and distortion). Two-year follow-up was achieved in 29 lesions (49%), showing complete remission (45%) or stability (41%) in most cases. CONCLUSIONS: Most lesions in this retrospective sample have been detected by means of ultrasound and had their need for biopsy indicated by this modality. Female diabetic patients younger than 40 years presenting with a palpable lesion and a non-circumscribed mass on ultrasound could be submitted to core biopsy; histopathologic findings suggestive of SLL should be considered concordant in this scenario, with subsequent conservative treatment.


Assuntos
Doenças Mamárias/diagnóstico por imagem , Linfocitose/diagnóstico por imagem , Esclerose/diagnóstico por imagem , Ultrassonografia Mamária/métodos , Adulto , Idoso , Mama/diagnóstico por imagem , Estudos de Coortes , Feminino , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
J Child Neurol ; 34(3): 161-167, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30514135

RESUMO

Headache and Neurologic Deficits with cerebrospinal fluid Lymphocytosis (HaNDL) syndrome is a rare stroke mimicker characterized by moderate to severe headache temporally associated with transient neurologic deficits, typically hemiparesis, hemisensory disturbance, and/or aphasia. Cerebrospinal fluid studies reveal a lymphocytosis and elevated protein. Episodes recur over a period no longer than 3 months. Here we describe the case of a 16-year-old boy who presented with 3 episodes of self-resolving neurologic deficits, papilledema on fundoscopic examination, and leptomeningeal enhancement on magnetic resonance imaging (MRI). We additionally review the 30 previously reported pediatric cases of HaNDL syndrome, with a focus on possible etiologic and pathophysiologic mechanisms of disease. The reported case and literature review highlight the benign episodic nature of this likely underrecognized syndrome as well as the higher than expected frequency of abnormal neuroimaging findings.


Assuntos
Cefaleia/diagnóstico por imagem , Linfocitose/líquido cefalorraquidiano , Linfocitose/diagnóstico por imagem , Doenças do Sistema Nervoso/diagnóstico por imagem , Adolescente , Cefaleia/fisiopatologia , Cefaleia/terapia , Humanos , Linfocitose/terapia , Masculino , Doenças do Sistema Nervoso/fisiopatologia , Doenças do Sistema Nervoso/terapia , Síndrome
9.
Vet Clin Pathol ; 46(1): 64-71, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28001311

RESUMO

An 11-year-old, 443-kg Haflinger mare was presented to the North Carolina State University Veterinary Teaching Hospital with a 2-week history of lethargy and a 3-day duration of anorexia, pyrexia, tachycardia, and ventral edema. Severe pitting edema, peripheral lymphadenopathy, and a caudal abdominal mass were noted on physical examination. An extreme leukocytosis (154.3 × 103 /µL) and microscopic hematologic findings suggestive of myelomonocytic leukemia were observed. Serum protein electrophoresis revealed a monoclonal gammopathy and urine protein electrophoresis revealed a monoclonal light chain proteinuria. Necropsy and histopathology confirmed widespread neoplastic infiltration in many organs with a heterogenous population of cells; there was no apparent evidence of bone marrow involvement. Immunohistochemistry confirmed presence of a majority of B cells with a limited antigen expression, admixed with a lower number of T cells. Molecular clonality analysis of IgH2, IgH3, and kappa-deleting element (KDE, B cell) on whole blood and KDE on infiltrated tissues revealed clonal rearrangements, and the KDE intron clones that amplified in blood and in infiltrated tissue were identical. In contrast, the clonality analysis of T-cell receptor γ revealed no clonality on blood cells and infiltrated tissues. In conjunction with the histopathologic changes, the lesion was interpreted to be composed of neoplastic B cells with a reactive T-cell population. Polymerase chain reaction testing for equine herpes virus 5 was negative. The final diagnosis was diffuse large B-cell lymphoma with a marked hematogenous component.


Assuntos
Doenças dos Cavalos/diagnóstico por imagem , Linfocitose/veterinária , Linfoma de Células B/veterinária , Animais , Feminino , Doenças dos Cavalos/patologia , Cavalos , Imuno-Histoquímica/veterinária , Linfocitose/diagnóstico por imagem , Linfocitose/patologia , Linfoma de Células B/diagnóstico por imagem , Linfoma de Células B/patologia , Microscopia Eletrônica de Transmissão/veterinária , Linfócitos T/patologia
10.
Headache ; 57(1): 129-134, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-27774587

RESUMO

BACKGROUND: The etiology of HaNDL is not known. Recent neuroimaging studies have suggested that there may be altered cerebrovascular blood flow during acute episodes. However, what exactly these vascular changes represent and how they may relate to the overall pathogenesis of HaNDL is uncertain. CASE: A 42-year-old, right-handed male, presented with acute aphasia and right arm weakness. Urgent CT/CT-angiogram were normal except for an incidental hypoplastic right anterior cerebral artery (ACA) A1 segment. However, CT perfusion revealed global left hemisphere hypoperfusion in the range of oligemia. Also, the right ACA territory, supplied by the dominant left A1, shared the same pattern of hypoperfusion. Further investigations and clinical course were consistent with HaNDL. DISCUSSION/CONCLUSIONS: The pattern of global left hemispheric hypoperfusion seen in this case of HaNDL supports a hypothesis of secondary oligemia induced by a hemispheric wave of cortical spreading depression (CSD). However, the extension of hypoperfusion to the right ACA territory represents a phenomenon not previously reported in this field. We speculate that the direct spread of CSD-induced vasomotor changes across the anomalous vasculature could account for this finding. This case provides a valuable contribution toward understanding HaNDL pathophysiology and in doing so may also yield broader implications regarding neurophysiological principles of CSD.


Assuntos
Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Cefaleia/diagnóstico por imagem , Cefaleia/fisiopatologia , Linfocitose/diagnóstico por imagem , Linfocitose/fisiopatologia , Adulto , Angiografia Cerebral , Depressão Alastrante da Atividade Elétrica Cortical/fisiologia , Cefaleia/terapia , Humanos , Linfocitose/terapia , Masculino , Síndrome , Tomografia Computadorizada por Raios X
12.
Colomb Med (Cali) ; 47(1): 59-62, 2016 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-27226666

RESUMO

CASE DESCRIPTION: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. CLINICAL FINDINGS: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. TREATMENT AND OUTCOME: Patient was treated with Rituximab monotherapy with improvement on her platelet count. CLINICAL RELEVANCE: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.


DESCRIPCIÓN DE CASO: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. HALLAZGOS CLÍNICOS: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. TRATAMIENTO Y RESULTADO: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. RELEVANCIA CLÍNICA: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.


Assuntos
Linfócitos B/patologia , Medula Óssea/patologia , Linfocitose/patologia , Linfoma/patologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Parotídeas/patologia , Trombocitopenia/patologia , Idoso de 80 Anos ou mais , Medula Óssea/diagnóstico por imagem , Células Clonais/patologia , Feminino , Humanos , Linfocitose/diagnóstico por imagem , Linfoma/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Trombocitopenia/diagnóstico por imagem
14.
Eur J Neurol ; 23(7): 1235-40, 2016 07.
Artigo em Inglês | MEDLINE | ID: mdl-27105768

RESUMO

BACKGROUND AND PURPOSE: The syndrome of transient headache and neurological deficits with cerebrospinal fluid lymphocytosis (HaNDL) can present as sudden onset of focal neurological deficits which are clinically and radiologically indistinguishable from an ischaemic stroke. Its diagnosis requires a lumbar puncture (LP), which contraindicates intravenous thrombolytic therapy (IV-tPA). METHODS: All patients referred to our stroke centre as a stroke code resulting in a final diagnosis of HaNDL syndrome from June 2005 to June 2015 were retrospectively analysed. RESULTS: Nine cases were identified: seven women and two men (mean age 27.6 years, range 15-51). Clinical onset consisted of isolated aphasia (two) and aphasia with right hemiparesis/hemiparaesthesia (seven). All patients had headache in the acute setting, lasting 2-12 h. Cranial computed tomography (CT) and CT angiography (CTA) were normal in all patients. Perfusion CT was performed in seven patients, showing left hemispheric focal hypoperfusion in five cases; the remaining two were normal. Five patients were initially diagnosed as stroke and treated uneventfully with IV-tPA. Cranial magnetic resonance imaging within 48 h was normal in all cases. LP performed in all patients showed pleocytosis (range 17-351 cells/mm(3) ), high protein levels (range 0.4-1.6 g/l) and normal glucose levels. All cases recovered within 12 h and suffered a second episode within 72 h. Patients were asymptomatic between episodes and after remission. CONCLUSIONS: The decision to thrombolyse or perform an LP in HaNDL patients mimicking a stroke is difficult in the acute setting. Perfusion CT can provide misleading results and CTA may be useful in ruling out occlusion of a cerebral vessel.


Assuntos
Afasia/diagnóstico , Cefaleia/diagnóstico , Linfocitose/diagnóstico , Acidente Vascular Cerebral/diagnóstico , Adolescente , Adulto , Afasia/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Fibrinolíticos/uso terapêutico , Cefaleia/diagnóstico por imagem , Humanos , Linfocitose/diagnóstico por imagem , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/diagnóstico por imagem , Acidente Vascular Cerebral/tratamento farmacológico , Síndrome , Terapia Trombolítica , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Colomb. med ; 47(1): 59-62, Jan.-Mar. 2016. ilus
Artigo em Inglês | LILACS | ID: lil-783540

RESUMO

Case Description: An 82-years old Hispanic woman with a past medical history significant for pulmonary thromboembolism on oral anticoagulation, rheumatoid arthritis, and hypertension developed a new onset thrombocytopenia. Clinical Findings: Small clonal B-cells populations (SCBP) also known as monoclonal B-cell lymphocytosis was found as part of the workup for an idiopathic thrombocytopenia and lead ultimately to the diagnosis of parotid primary follicular lymphoma coexisting with Warthin tumor involving the bone marrow in a small extent and oncocytic papilloma located in the maxillary sinus. Treatment and Outcome: Patient was treated with Rituximab monotherapy with improvement on her platelet count. Clinical relevance: Although it is unclear the role of this clonal cells, they may work as a possible diagnostic tool for occult lymphomas. Further prospective studies are needed to confirm this possible association.


Descripción de caso: Mujer hispana de 82 años con una historia médica significativa de tromboembolismo pulmonar en anticoagulación, artritis reumatoide e hipertensión, la cual desarrolló recientemente una trombocitopenia. Hallazgos clínicos: Una pequeña población de células B monoclonales también conocida como linfocitosis monoclonal de células B fue encontrado dentro del estudio de una trombocitopenia idiopática que conllevó al diagnóstico de un linfoma folicular primario de parótida coexistiendo con un tumor de Warthin y un papiloma oncocítico localizado en el seno maxilar. Tratamiento y resultado: La paciente fue tratada con monoterapia de Rituximab con una mejoría en su conteo de plaquetas. Relevancia clínica: Aunque el rol de las pequeñas poblaciones B monoclonales no está completamente dilucidado, podrían tener una aplicación como herramienta diagnóstica. Futuros estudios prospectivos son necesarios para confirmar esta posible asociación.


Assuntos
Idoso de 80 Anos ou mais , Feminino , Humanos , Trombocitopenia/patologia , Medula Óssea/patologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Parotídeas/patologia , Linfócitos B/patologia , Linfocitose/patologia , Linfoma/patologia , Trombocitopenia/diagnóstico por imagem , Medula Óssea/diagnóstico por imagem , Neoplasias Primárias Desconhecidas/diagnóstico por imagem , Neoplasias Parotídeas/diagnóstico por imagem , Células Clonais/patologia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Linfocitose/diagnóstico por imagem , Linfoma/diagnóstico por imagem
19.
Am J Hematol ; 88(7): 539-44, 2013 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-23553682

RESUMO

Total body computed tomography (TB-CT) scan is not mandatory in the diagnostic/staging algorithm of chronic lymphocytic leukemia (CLL). The aim of this study was to determine the value and prognostic significance of TB-CT scan in early stage CLL patients. Baseline TB-CT scan was performed in 240 Binet stage A CLL patients (179 Rai low- and 61 Rai intermediate-risk) included in a prospective multicenter observational study (clinicaltrial.gov ID:NCT00917549). The cohort included 69 clinical monoclonal B lymphocytosis (cMBLs). Patients were restaged considering only radiological data. Following TB-CT scans, 20% of cases reclassified as radiologic Binet (r-Binet) stage B. r-Binet B patients showed a higher incidence of unfavorable cytogenetic abnormalities (P = 0.027), as well as a shorter PFS (P = 0.001). At multivariate analysis, r-Binet stage [HR = 2.48; P = 0.004] and IGHV mutational status [HR = 3.01; P = 0.002] retained an independent predictive value for PFS. Among 179 Rai low-risk cases, 100 were redefined as r-Rai intermediate-risk based upon TB-CT scan data, showing a higher rate of cases with higher ZAP-70 (P = 0.033) and CD38 expression (P = 0.029) and ß2-microglobulin levels (P < 0.0001), as well as a shorter PFS than those with r-Rai low-risk (P = 0.008). r-Rai stage [HR = 2.78; P = 0.046] and IGHV mutational status [HR = 4.25; P = 0.009] retained a significant predictive value for PFS at multivariate analysis. Forty-two percent of cMBL patients were reclassified as r-small lymphocytic lymphomas (r-SLLs) by TB-CT scan. TB-CT scan appears to provide relevant information in early stage CLL related to the potential and the timing of patients to progress towards the more advanced disease stages.


Assuntos
Leucemia Linfocítica Crônica de Células B/diagnóstico , Linfocitose/diagnóstico , ADP-Ribosil Ciclase 1/genética , Adulto , Idoso , Linfócitos B/metabolismo , Linfócitos B/patologia , Aberrações Cromossômicas , Progressão da Doença , Feminino , Expressão Gênica , Humanos , Leucemia Linfocítica Crônica de Células B/diagnóstico por imagem , Leucemia Linfocítica Crônica de Células B/genética , Leucemia Linfocítica Crônica de Células B/patologia , Linfocitose/diagnóstico por imagem , Linfocitose/genética , Linfocitose/patologia , Masculino , Glicoproteínas de Membrana/genética , Pessoa de Meia-Idade , Análise Multivariada , Estadiamento de Neoplasias , Estudos Prospectivos , Fatores de Risco , Análise de Sobrevida , Tomografia Computadorizada por Raios X , Proteína-Tirosina Quinase ZAP-70/genética , Microglobulina beta-2/genética
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