Introdução: Tumor neuroendócrino (TNE) é uma neoplasia rara que pode surgir em diversos tecidos. Sua origem na via biliar extra-hepática é ainda mais incomum, com poucos casos na literatura. Este relato visa descrever um paciente com carcinoma neuroendócrino de pequenas células em colédoco distal, descrição ainda inexistente na literatura brasileira. Relato do caso: Paciente de 81 anos procura atendimento por icterícia difusa, prurido generalizado, colúria e acolia. Tomografia computadorizada evidenciou formação tecidual no terço distal do colédoco. Havia dilatação das vias biliares intra e extrahepáticas, com dilatação a montante do colédoco acima da lesão. Diante da suspeita de lesão neoplásica, paciente foi submetido à duodenopancreatectomia e linfadenectomia retroperitoneal. Anatomopatológico e exame imuno-histoquímico posteriormente revelaram carcinoma neuroendócrino de pequenas células pouco diferenciado de alto grau removido com margens livres, mas com invasão linfovascular e perineural. Atualmente, paciente encontra-se em bom estado geral e foi submetido a 4 ciclos de quimioterapia adjuvante à ressecção cirúrgica. Conclusão: Poucos casos semelhantes são descritos na literatura mundial e nenhum na literatura brasileira, ratificando seu relato. Palavras-chave: Carcinoma Neuroendócrino. Neoplasias dos Ductos Biliares. Ductos Biliares. Icterícia. Pancreaticoduodenectomia.
Introduction Streptococcus gallolyticus belongs to the Streptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers.
Case Presentation A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma.
Conclusion Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality.
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