OBJETIVO: Comparar o grau evolutivo da apendicite determinada pela inspeção trans-operatória com o resultado anatomopatológico, e identificar alguma relação entre a idade, grau evolutivo da apendicite aguda e o tempo de internação hospitalar. MÉTODO: Análise retrospectiva dos prontuários de 199 pacientes submetidos a apendicectomia entre o período de outubro de 2003 a agosto de 2004, quanto à idade, sexo, tempo de internação e a fase do processo inflamatório segundo anatomopatológico das peças. RESULTADOS: A análise foi possível em 182 casos. Nestes pacientes, a distribuição quanto ao sexo mostrou maior incidência em homens, com 54,4% casos; a mediana da idade foi de 20 anos, sendo a faixa etária mais prevalente entre os 11-20 anos com 36,22% dos casos. A mediana do tempo de internação foi de três dias. Houve uma diferença significativa do tempo de internação de acordo com a faixa etária dos pacientes, sendo que os pacientes acima de 60 anos tiveram maior tempo de internação. O anatomopatológico evidenciou 73,62% casos de apendicite supurada, 13,73% apendicite branca, 7,14% gangrenosa, 4,49% catarral e 0,54% neoplásico, confirmando o diagnóstico de apendicite em 86,24%. O tempo de internação e a idade não foram significativamente diferentes entre os graus evolutivos da apendicite aguda. CONCLUSÕES: A apendicite aguda ocorre com maior freqüência nos pacientes jovens e do sexo masculino. Os pacientes idosos permanecem mais tempo internados, porém não houve diferença na idade nem tempo de internação em relação aos vários graus evolutivos da apendicite.
Introduction: Lymphocytic mastopathy is a rare condition, responsible for 1% of all benign breast lesions, commonly associated to autoimmune disorders and diabetes (especially insulin-requiring diabetes). The differential diagnosis may be difficult, since the clinical and imaging aspects can mimic malignant disease. Some authors suggest that lymphocytic mastitis could be a precursor of primary breast lymphoma. However, other studies disagree with such correlation, presenting the mastopathy as a distinct diagnosis, but one of difficult differentiation from lymphoma. To avoid misdiagnosis, an appropriate study of the specimen is recommended, through image-guided or surgical biopsy and immunohistochemical markers. Due to its unique presentation and scarce reports in global literature, we present a case of a patient with lymphocytic mastopathy that preceded the diagnosis of primary bilateral lymphoma. Case report: A healthy 46-year-old, nulliparous, premenopausal female patient, with a negative family history of breast cancer, presented palpable masses in the inferior medial quadrants (IMQ) of the right and left breasts, measuring 5 cm and 1.2 cm, respectively, both classified as Category 4 in the BIRADS lexicon. She was referred for excisional surgical biopsy, with anatomopathological diagnosis compatible with nonspecific chronic mastitis in both specimens. Immunohistochemistry (IHC) revealed lymphocytic mastitis, without signs of malignancy. The patient maintained regular control with a mastologist and after two years of follow-up, two new category 4 masses were identified: one in the IMQ of the right breast, and another in the retro-areolar (RRA) region of the left one. Core biopsy of the masses revealed lymphoproliferative disease, with IHC showing non-Hodgkins’ diffuse large B-cell lymphoma, (Ki67 60%, CD20+, BCL6+). A magnetic resonance imaging of the breasts identified bilateral breast masses in the RRA region, with extension to the medial quadrants and no cleavage plane with the nipple, the largest measuring 4.5 cm, in the left breast, with heterogeneous internal enhancement and type III kinetic pattern, in addition to an atypical lymph node in level I of the right axilla. Positron emission tomography–computed tomography (PET-CT) ruled out distant disease, and confirmed it was restricted to the breasts. The patient received six cycles of chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone, presenting a complete metabolic response on PET-CT. Subsequently, radiotherapy was performed on both breasts at a dose of 30 Grays in 15 fractions each and, after a clinical follow-up of two months, no new abnormalities have been noted.
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