Gabrielle Gurgel Lima

Características clínico-evolutivas de 134 pacientes com histoplasmose disseminada associada a SIDA no Estado do Ceará.

INTRODUCTION: Since the beginning of the HIV epidemic in Ceara, disseminated histoplasmosis (DH) has often been detected among AIDS patients. METHODS: In order to investigate the clinical and laboratory characteristics, evolution and survival of cases of DH/AIDS coinfection, the medical records on 134 cases of DH admitted to a reference hospital in Ceara between 1999 and 2005 were analyzed. RESULTS: Patients with DH presented higher frequency of daily fever, coughing, weight loss, enlarged liver and spleen and acute kidney failure. The diagnosis was made using investigation and/or cultures. At admission, the following were risk factors for death among DH patients: vomiting, dyspnea, respiratory failure, acute kidney failure, hemoglobin 40mg/dl and creatinine >1.5 mg/dl. CONCLUSIONS: Patients with DH characteristically presented higher fever, previous hospitalization due to respiratory infection and more clinical complications. Significant anemia and elevated urea were independent risk factors for death among DH patients.

Orbital metastasis as primary clinical manifestation of thyroid carcinoma: case report and literature review

Capillary thyroid carcinoma (PTC) is the most common neoplasm of thyroid. It usually grows slowly and is clinically indolent; although rare, its aggressive forms with local invasion or distant metastases can occur. Metastatic thyroid carcinoma rarely involves the orbit. We reported an uncommon case of orbital metastasis of PTC. A 66-years-old woman presented proptosis of the right eye. The biopsy of the tumor in orbit revealed metastatic thyroid carcinoma. The ultrasensitive TSH level was 1,34 mUI/L and free T4 level was 1,65 ng/dL. A total thyroidectomy was performed and histopathological analysis of the nodule revealed follicular variant of papillary thyroid carcinoma. Currently, the patient has been receiving palliative chemotherapy with Clodronate Disodium. The importance of the case is due to its unusual presentation, which emerged as a primary clinical manifestation. Although rare, thyroid carcinoma should be suspected in orbit metastasis.

Primary non-Hodgkin lymphoma of bone: an unusual presentation.

Primary lymphoma of bone (PLB) is an extremely rare condition that is usually confused with other primary injuries of the bone. It is characterized by the involvement of one or more bone locations, with or without involvement of regional lymph nodes and viscera. PLB constitutes 3-7% of all malignant bone tumors and approximately 3% of all extranodal lymphomas. It is found at all ages, being most frequently seen in adult life. Any part of the skeleton can be involved, but a trend exists in favor of bones with persistent bone marrow. We report a case of PLB with an unusual presentation: involvement of the proximal phalanx of the thumb. Treatment with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) plus etoposide established complete remission. Consolidation with radiotherapy of the femur and phalanx was performed. There was no evidence of recurrence at the 14 th month follow-up.

Apresentação incomum de sarcoma granulocítico mamário

O termo sarcoma granulocitico (SG) designa um raro tumor solido composto de agregados de precursores granulociticos imaturos em sitios extramedulares. A lesao geralmente ocorre durante o curso natural da leucemia mieloide aguda (LMA) ou apos sua remissao. O SG primario manifesta-se mais comumente na pele e linfonodos, portanto, quando se apresenta na mama, o erro diagnostico de linfoma nao Hodgkin, carcinoma lobular, sarcoma e melanoma maligno e um problema comum. A mama tem sido relatada como um local incomum de SG. Relata-se um caso raro de SG bilateral em mamas concomitante com LMA numa mulher de 47 anos. A paciente foi admitida em nosso hospital devido a manifestacoes neurologicas e descobrimos, durante a investigacao, tumoracoes nas mamas. A histopatologia das lesoes sugeriu linfoma nao Hodgkin, sendo iniciada quimioterapia esquema CHOP. No entanto, o mielograma mostrou hiperplasia das series granulociticas, e a imuno-histoquimica revelou mieloperoxidase e CD68 positivos, confirmando o diagnostico de SG primario em mamas. A citogenetica nao detectou anomalias. A revisao da microscopia e a analise do liquor confirmaram a presenca de infiltracao no parenquima mamario e no sistema nervoso central por leucemia monoblastica aguda (LMA-M5a). O protocolo de inducao da remissao foi iniciado com daunorrubicina, arabinosideo-C e quimioterapia intratecal com metotrexate, arabinosideo-C e dexametasona (MADIT). Um mes depois, a paciente recusou a continuacao do tratamento, depois de ter feito pedido de alta.

Linfoma não Hodgkin primário da coluna vertebral

O linfoma primario do osso (LPO) e uma condicao extremamente rara, habitualmente confundida com outras lesoes osseas primarias. E responsavel por cerca de 3%-5% de todos os tumores malignos no osso e 4%-7% de todos os linfomas naoHodgkin extranodais. Caracteriza-se pelo envolvimento de um ou varios locais osseos, com ou sem comprometimento de linfonodos regionais e visceras. Histopatologicamente, o linfoma non Hodgkin de grandes celulas B representa a maioria dos casos de LPO. Ossos longos sao mais frequentemente comprometidos, e o femur e o sitio mais acometido. Osso iliaco e da coluna vertebral tambem podem ser atingidos. Relatamos um caso raro de linfoma nao Hodgkin da vertebra em mulher de 41 anos. A imuno-histoquimica revelou CD20 e CD45 positivos. Ela foi diagnosticada com linfoma primario difuso de grandes celulas B da coluna vertebral. O estudo histopatologico da medula ossea nao detectou infiltracao por hemopatia linfoide. A paciente foi tratada com quimioterapia CHOP juntamente com etoposide, seguida de radioterapia (dose total = 3600cGy) na regiao toraco-lombar. Nao houve evidencia de recidiva em um periodo de vinte meses de acompanhamento.

Mediastinal nonleukemic granulocytic sarcoma with cardiac infiltration

We report on a case of mediastinal granulocytic sarcoma with cardiac infiltration in a young man with no evidence of leukemia involving the bone marrow or peripheral blood. Diagnosis was accomplished by immuno-histochemistry with expressions of myeloperoxidase and CD99 antigens. The patient achieved clinical remission, but evolved with febrile neutropenia during chemotherapy and died. Although subclinical cardiac infiltrations are commonly found at autopsy in patients with acute non-lymphoblastic leukemia, only one case of involvement of the heart with granulocytic sarcoma in the absence of bone marrow disease has been published in the literature. A diagnosis of granulocytic sarcoma should not be excluded when the biopsy of the bone marrow does not show any evidence of leukemic infiltration.

Acute myeloid leukemia with t(8;21)(q22;q22) preceded by breast granulocytic sarcoma

Granulocytic sarcoma (GS) is a rare extramedullary tumor mass composed of immature cells derived from the hematopoietic myeloid series. It is usually associated with leukemia and other myeloproliferative disorders but can also occur without overt hematologic diseases. The breast has been reported to be an uncommon site of presentation. We report a case of acute myeloid leukemia preceded by GS of the breast. The immunohistochemistry revealed myeloperoxidase, CD68 and CD43 positivity, thus indicating a diagnosis of GS. Conventional cytogenetic analysis of peripheral blood cells showed t(8;21)(q22;22). Complete remission was achieved with Daunorubicin and Cytarabine induction therapy followed by three courses of high-dose Cytarabine consolidation. The patient remains in continuous complete remission at 27 months.