Objective: To report a case of a multiple paraganglioma with 5 concurrent locations and also describe a complication not found in the literature, spontaneous tumor bleeding. Introduction: The paragangliomas are mostly...Objective: To report a case of a multiple paraganglioma with 5 concurrent locations and also describe a complication not found in the literature, spontaneous tumor bleeding. Introduction: The paragangliomas are mostly benign and more frequent in women. Can be multiple, and these are considered as the most likely source of familial origin (30%-35%). The multicentric lesions can occur at different life stages not being necessarily simultaneous, a fact that prevents image exam research to be conclusive for tumor presence or absence. In this way the examination of the family members of patients, specially young ones, diagnosed with multicentric tumors may lead to negative results which doesn’t meant that the disease can be developed at a later time period. Therefore routine examination is not justifiable when symptoms relative to tumor presence are not present. Case report: A female patient of 32 years old complaining of tinnitus and diagnosed with five paragangliomas (jugulo-timpanic, bilateral carotid body and bilateral brachiocephalic trunk) through imaging studies. She reported suffering relatives of paragangliomas. Conclusion: The paper reports a rare case and perhaps unique in the literature, multiple paraganglioma with five locations and discusses difficult choice of treatment and complications.展开更多
Introduction: One of the most common causes of hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized by the loss of visual function that doesn’t adequately respond to vario...Introduction: One of the most common causes of hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized by the loss of visual function that doesn’t adequately respond to various forms of treatment, requiring, in most cases, surgical correction. Objective: We report a case of conjunctival edema and protrusion of the eyeball in patients secondary to Graves’ disease, characterizing malignant ophthalmopathy and discuss their surgical treatment. Case Report: A 73-year-old male patient presenting bilateral conjunctive hyperaemia, decreased visual acuity, exophtalmos with progressive deterioration. Pulse therapy was performed without improvement and then underwent bilateral ethmoidectomy. Discussion: Late diagnosis is harmful due to the fact that malignant disease is extremely aggressive and fast, as reported in this case. Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses. In extreme cases acute orbital decompression is indicated complementing appropriate medical treatment, which will allow herniation of orbital contents. Many orbital decompression techniques have been used in the treatment of Graves’ ophthalmopathy. The most common of these is the endoscopic sinus surgery which potentiated act in decompression of the medial wall safely and minimally invasive. In our case, open bilateral ethmoidectomy was used, due to the fact that surgeons are most experienced in this technique. Although the post-operative has been successfully submitted, no signs of recurrence were observed after fifteen days due to the evolution of Graves’ disease. Even with outpatient treatment, he walked to the total visual loss. Conclusion: We observed that the malignant ophthalmopathy is rare and aggressive;however, in spite of therapeutic resources used, it can progress to total visual loss.展开更多
文摘Objective: To report a case of a multiple paraganglioma with 5 concurrent locations and also describe a complication not found in the literature, spontaneous tumor bleeding. Introduction: The paragangliomas are mostly benign and more frequent in women. Can be multiple, and these are considered as the most likely source of familial origin (30%-35%). The multicentric lesions can occur at different life stages not being necessarily simultaneous, a fact that prevents image exam research to be conclusive for tumor presence or absence. In this way the examination of the family members of patients, specially young ones, diagnosed with multicentric tumors may lead to negative results which doesn’t meant that the disease can be developed at a later time period. Therefore routine examination is not justifiable when symptoms relative to tumor presence are not present. Case report: A female patient of 32 years old complaining of tinnitus and diagnosed with five paragangliomas (jugulo-timpanic, bilateral carotid body and bilateral brachiocephalic trunk) through imaging studies. She reported suffering relatives of paragangliomas. Conclusion: The paper reports a rare case and perhaps unique in the literature, multiple paraganglioma with five locations and discusses difficult choice of treatment and complications.
文摘Introduction: One of the most common causes of hyperthyroidism is Graves’ disease. The malignant exophthalmos is a rare condition characterized by the loss of visual function that doesn’t adequately respond to various forms of treatment, requiring, in most cases, surgical correction. Objective: We report a case of conjunctival edema and protrusion of the eyeball in patients secondary to Graves’ disease, characterizing malignant ophthalmopathy and discuss their surgical treatment. Case Report: A 73-year-old male patient presenting bilateral conjunctive hyperaemia, decreased visual acuity, exophtalmos with progressive deterioration. Pulse therapy was performed without improvement and then underwent bilateral ethmoidectomy. Discussion: Late diagnosis is harmful due to the fact that malignant disease is extremely aggressive and fast, as reported in this case. Most often, the ophthalmopathy follows a relatively mild and self-limiting course, making a proper diagnosis difficult if the disease progresses. In extreme cases acute orbital decompression is indicated complementing appropriate medical treatment, which will allow herniation of orbital contents. Many orbital decompression techniques have been used in the treatment of Graves’ ophthalmopathy. The most common of these is the endoscopic sinus surgery which potentiated act in decompression of the medial wall safely and minimally invasive. In our case, open bilateral ethmoidectomy was used, due to the fact that surgeons are most experienced in this technique. Although the post-operative has been successfully submitted, no signs of recurrence were observed after fifteen days due to the evolution of Graves’ disease. Even with outpatient treatment, he walked to the total visual loss. Conclusion: We observed that the malignant ophthalmopathy is rare and aggressive;however, in spite of therapeutic resources used, it can progress to total visual loss.
