Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus,and must be considered in the differential diagnosis of intra-abdominal tumors in endemic areas.We report a rare case of paracoccidioidomycos...Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus,and must be considered in the differential diagnosis of intra-abdominal tumors in endemic areas.We report a rare case of paracoccidioidomycosis in the pancreas.A 45-year-old man was referred to our institution with a 2-mo history of epigastric abdominal pain that was not diet-related,with night sweating,inappetence,weight loss,jaundice,pruritus,choluria,and acholic feces,without signs of sepsis or palpable tumors.Abdominal ultrasonography(US)showed a solid mass of approximately 7 cm×5.5 cm on the pancreas head.Abdominal computerized tomography showed dilation of the biliary tract,an enlarged pancreas(up to 4.5 in the head region),with dilation of the major pancreatic duct.The patient underwent exploratory laparotomy,and the surgical description consisted of a tumor,measuring 7 to 8 cm with a poorly-defined margin,adhering to posterior planes and mesenteric vessels,showing an enlarged bile duct.External drainage of the biliary tract,Rouxen-Y gastroenteroanastomosis,lymph node excision,and biopsies were performed,but malignant neoplasia was not found.Microscopic analysis showed chronic pancreatitis and a granulomatous chronic inflammatory process in the choledochal lymph node.Acid-alcohol resistant bacillus and fungus screening were negative.Fine-needle aspiration of the pancreas was performed under US guidance.The smear was compatible with infection by Paracoccidioides brasiliensis.We report a rare case of paracoccidioidomycosis simulating a malignant neoplasia in the pancreas head.展开更多
Approximately 10% of patients with gastrointestinal stromal tumors (GIST) develop other neoplasms, either synchronously or metachronously. In this report we describe coexistence of a gastrointestinal stromal tumor and...Approximately 10% of patients with gastrointestinal stromal tumors (GIST) develop other neoplasms, either synchronously or metachronously. In this report we describe coexistence of a gastrointestinal stromal tumor and a hepatic perivascular epithelioid cell tumor (PEComa) in a 51-year-old woman with no evidence of tuberous sclerosis. A subcapsular hepatic nodule (0.8 cm in diameter) was found during surgery for symptomatic gastric neoplasm (15 cm in diameter) arising from the lesser curvature. Both tumors revealed histomorphological and immunohistochemical features confirming a diagnosis of a small incidental hepatic PEComa and a high risky extramural gastric GIST, respectively. The patient remained disease-free 25 mo after surgery with no evidence of tumor recurrence or new neoplasms. To our knowledge, this is the first report of PEComa in a patient with GIST. Hepatic lesions detected synchronously or metachronously in patients with GISTs may represent histogenetically distinct lesions and should be sampled to confirm or exclude metastatic GISTs.展开更多
文摘Paracoccidioidomycosis is a systemic granulomatous disease caused by fungus,and must be considered in the differential diagnosis of intra-abdominal tumors in endemic areas.We report a rare case of paracoccidioidomycosis in the pancreas.A 45-year-old man was referred to our institution with a 2-mo history of epigastric abdominal pain that was not diet-related,with night sweating,inappetence,weight loss,jaundice,pruritus,choluria,and acholic feces,without signs of sepsis or palpable tumors.Abdominal ultrasonography(US)showed a solid mass of approximately 7 cm×5.5 cm on the pancreas head.Abdominal computerized tomography showed dilation of the biliary tract,an enlarged pancreas(up to 4.5 in the head region),with dilation of the major pancreatic duct.The patient underwent exploratory laparotomy,and the surgical description consisted of a tumor,measuring 7 to 8 cm with a poorly-defined margin,adhering to posterior planes and mesenteric vessels,showing an enlarged bile duct.External drainage of the biliary tract,Rouxen-Y gastroenteroanastomosis,lymph node excision,and biopsies were performed,but malignant neoplasia was not found.Microscopic analysis showed chronic pancreatitis and a granulomatous chronic inflammatory process in the choledochal lymph node.Acid-alcohol resistant bacillus and fungus screening were negative.Fine-needle aspiration of the pancreas was performed under US guidance.The smear was compatible with infection by Paracoccidioides brasiliensis.We report a rare case of paracoccidioidomycosis simulating a malignant neoplasia in the pancreas head.
基金Fundao para o Desenvolvimento da UNESP-FUNDUNESP, So Paulo, Brazil
文摘Approximately 10% of patients with gastrointestinal stromal tumors (GIST) develop other neoplasms, either synchronously or metachronously. In this report we describe coexistence of a gastrointestinal stromal tumor and a hepatic perivascular epithelioid cell tumor (PEComa) in a 51-year-old woman with no evidence of tuberous sclerosis. A subcapsular hepatic nodule (0.8 cm in diameter) was found during surgery for symptomatic gastric neoplasm (15 cm in diameter) arising from the lesser curvature. Both tumors revealed histomorphological and immunohistochemical features confirming a diagnosis of a small incidental hepatic PEComa and a high risky extramural gastric GIST, respectively. The patient remained disease-free 25 mo after surgery with no evidence of tumor recurrence or new neoplasms. To our knowledge, this is the first report of PEComa in a patient with GIST. Hepatic lesions detected synchronously or metachronously in patients with GISTs may represent histogenetically distinct lesions and should be sampled to confirm or exclude metastatic GISTs.
