INTRODUÇÃOAs primeiras descrições sobre a relação entre as formas pulmonares e extrapulmonares da tuberculose foram feitas por Laennec, em 1804. No início do sé-culo XX, era a principal causa de estenose e obstrução intestinal 1 . Depois de uma importante diminuição de sua incidência a partir da década de 40, a nível mundial, se notou, na década de 80, um incremento paulatino desta enfermidade, dentre outras causas, pela epidemia do ví-rus HIV 2,3 . Estima-se que metade da população mundial esteja infectada e a cada ano pelo menos 8 milhões de novos casos são diagnosticados. No Brasil a prevalência deve atingir os 50 milhões 4 . Ocorre com maior freqüência em países tropicais e subdesenvolvidos, mas há relatos de aumento do número de casos inclusive nos países desenvolvidos 2,5,6 . A tuberculose intestinal geralmente é uma complicação da doença pulmonar 5 . A obstrução intestinal é uma complicação rara, mas comum no curso da tuberculose intestinal, com ou sem tratamento 7 . O diagnóstico pré-operatório é muito difícil, seja pela baixa incidência da doença no trato gastrintestinal, como pela simulação de diversas enfermidades abdominais, notadamente a doença de Crohn 1,3,5,8 . Deste modo, deve estar presente esta possibilidade, pois sem um elevado grau de suspeição, o diagnóstico é difícil de estabelecer, resultando num aumento substancial da morbimortalidade 3,6,8 .
like HCC is a very rare form, which have been described only twice before in literature. We present the case of a 72 years-old man, otherwise in good health, known for a nonactive HCV infection. On routine follow-up, two hepatic lesions were found, in segment 8 (S8) and segment 2 (S2). A 4 cm lymph node was found in the coeliac region, retrospectively present since 3 years on previous imaging. Biopsy of the S8 lesion showed a classical trabecular HCC; while in the coeliac lymph node showed carcinoma cells. PET scan showed an important captation of lymph node and S2 lesion, while no captation was found in the S8 lesion. Considering the patient's good health, the presence of two different lesions, a possible low morbidity approach, a non-completely evidence-based minimally invasive treatment was decided, with chemoembolization of the S8 HCC lesion while the S2 lesion was resected laparoscopically with left lobectomy and complete lymphadenectomy of the hepatic pedicle and coeliac trunk. Final pathologic analysis revealed a medullary-like HCC pT1, pN1. A B-cell lymphoma of the marginal zone was found in hepatic pedicle and coeliac trunk nodes. In this patient we found three different tumours, of which one was a medullary-like HCC. This is the third case described in literature to our knowledge. Because of its unknown biological behaviour, a surgical approach seems reasonably justified in this particular case.
Introduction: Hepatoid carcinoma (HC) is a rare and aggressive tumor, defined as a primary extrahepatic tumor with morphology similar to hepatocellular carcinoma (HCC). The diagnosis is usually difficult only by the clinical basis and histological examination, but the association with immunohistochemistry may facilitate the diagnosis. Methods: We present an unusual case of primary peritoneal hepatoid carcinoma (PPHC). He is 61 years-old patient with multiple mesenteric and peritoneal tumor nodules. He received neoadjuvant treatment with 9 cycles of GEMOX and sorafenib with partial respose and 90% reduction in alpha-fetoprotein level (AFP) followed by optimal cytoreductive surgery (CRS) and intraperitoneal chemotherapy (HIPEC) with cisplatin. During the 5 month follow-up, there was an increasing in AFP and the investigation showed small peritoneal nodules on the CT Scan. He resumed 5 cycles of same regimen with tumor stabilization followed by second CRS and HIPEC with mitomycin C. He has been followed up, with a 14-month and until now, there is no evidence of recurrence disease. Conclusion: CRS and HIPEC showed be feasible and safe in the treatment of PPHC.
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