Gastric cancer during pregnancy is a rare event and difficult to diagnose, as the symptoms can be confused with those of an ordinary pregnancy. We report a case of a 25-year-old patient with a 29-week gestation, with asthenia complaint, vomiting and weight loss. During the investigation of wasting syndrome endoscopy was performed with infiltrative ulcerative lesions in pre-pyloric region with biopsy revealing carcinoma with signet ring, undifferentiated type. It was held on a strict control of fetal vitality, and pregnancy was interrupted via the abdominal delivery at 34 weeks. Soon after the cesarean section was performed, exploratory laparotomy was performed to perform inventory of the abdominal cavity, being observed the presence of carcinomatous implants in the peritoneum. In the face of irresectability clinical conduct was adopted and the patient was sent to chemotherapy, ensuring nutrition via a jejunostomy. The article reviews the gastric carcinoma association with pregnancy, discussing the initiation of treatment and continuity of pregnancy.
Biliary atresia (BA) is classically described at the neonatal age. However, rare
cases of BA in older infants have also been reported. We report four cases of
late-onset BA in infants older than 4 weeks (3 males, 1 female), and describe the
diagnostic and management difficulties. One of the cases had a late-onset (29 weeks)
presentation with a successful surgical procedure. We highlight the importance of
this unusual differential diagnosis in infants with cholestatic syndrome, who may
benefit from Kasai surgery, regardless of age.
Paget’s disease of bone (PDB) is a common skeleton disorder in which the diagnosis is suggested by radiological analyses. Congenital generalized lipodystrophy (CGL) is a rare, but a radiologic differential diagnosis of Paget’s disease. Patients present total or almost total lack of subcutaneous adipose tissue, leptin deficiency, and precocious ectopic lipid accumulation, which lead to intense insulin resistance, poorly controlled diabetes mellitus, and hypertriglyceridemia. CGL subtypes 1 and 2 present sclerosis and osteolytic lesions that can resemble “pagetic” lesions. The clinical correlation is, therefore, essential. We report a CGL patient with bone lesions in which the radiographic findings led to a misdiagnosis of PDB. This case report brings awareness to CGL, a life-threating condition. Its early recognition is essential to avoid clinical complications and premature death. Therefore, it is important to consider CGL as PDB’s differential diagnosis, especially in countries with high prevalence of this rare disease, such as Brazil.
ResumoNeurotecomas, também conhecidos como mixomas da bainha neural, são tumores benignos raros da bainha neural afetando mais comumente a cabeça, braços e ombros de mulheres entre 20 e 40 anos de idade. Devido à baixa prevalência e quadro clínico mal definido, essas lesões são raramente consideradas no diagnóstico diferencial de tumores cutâneos. Relatamos o caso de uma mulher de 24 anos de idade que procurou atendimento em 2016 relatando dor moderada por mais de um ano e limitação dos movimentos do ombro esquerdo. Ao exame, foi constatada restrição da mobilidade dessa articulação e uma ressonância magnética revelou imagem multilobular com aumento de sinal em T2 na região quadrilateral, aparentando invasão da região cortical do úmero subjacente. A histopatologia de uma biópsia incisional mostrou lesão composta por tecido conjuntivo frouxo, sem sinais de invasão, figuras de mitose ou atipias. Foi realizada excisão completa da lesão e o diagnóstico de neurotecoma foi confirmado após análise histopatológica que incluiu painel imunohistoquímico. À revisão de 18 meses, a paciente estava assintomática com recuperação completa do movimento e sem evidência de recidiva da lesão.
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