Esophageal malignancy encompasses a group of diseases that are mostly represented by the squamous cell carcinoma and the adenocarcinoma. Quite frequently, these neoplasms present aggressive behavior; therefore, the diagnosis is often made when the condition is in advanced stages. Dysphagia is the typical clinical complaint, although it is present only when most of the lumen is obstructed. Therefore, quite often, the metastatic disease is first diagnosed, which contributes to the patient's poor survival expectancy. The authors report the case of a 58-year-old man who looked for medical care complaining of a long-term history of scapular pain. The diagnostic work-up disclosed a cervical spine lytic lesion surrounded by a tumoral mass shown by computed tomography. The cervical tumor was sampled by fine needle aspiration, revealing an undifferentiated carcinoma. The outcome was unfavorable and the patient died. The autopsy findings revealed metastatic disease to the spine and central nervous system, and the primary tumor was found to be an esophageal squamous cell carcinoma, which had progressed without typical dysphagia.
Small-cell neuroendocrine carcinoma is a well-known aggressive neoplasia, which is usually associated with a poor prognosis. The lung is the most common primary site, but other organs may be involved, especially those of the digestive tract. The authors report the case of a 71-year-old Caucasian, male patient who was admitted because of congestive heart failure and loss of vision accompanied by right proptosis. Skull and sinuses computed tomography showed a tumoral mass involving the posterior region of the right eye, local bones, and paranasal sinuses. Because of severe hemodynamic instability, the patient died and no diagnostic investigation could be performed. Autopsy findings revealed small-cell neuroendocrine carcinoma of the esophagus and metastases to the posterior region of the right ocular globe, which affected the sinuses, the muscles of the ocular region, the orbit bones, the skull, the meninges and the brain, plus the liver, adrenal glands, and the pericardium. This case called the author’s attention to the extent of the metastatic disease in a patient who was firstly interpreted as presenting solely with congestive heart failure. The autopsy findings substantially aid the understanding of the immediate cause of death.
LISTA DE ABREVIATURAS % Esp Art: porcentagem de espessura da parede das artérias pulmonares % Esp Veias: porcentagem de espessura da parede das veias pulmonares Ap Diast: pressão diastólica da artéria pulmonar Ap Média: pressão média da artéria pulmonar Ap Sist: pressão sistólica da artéria pulmonar CP: pressão do capilar pulmonar DPD: diferença pressórica diastólica ET-1 CM: marcador da endotelina 1 presente na camada média das artérias pulmonares ET-1 com lesão CM: marcador da endotelina 1 presente na camada média das artérias pulmonares com lesão intimal ET-1 com lesão End: marcador da endotelina 1 presente no endotélio das artérias pulmonares com lesão intimal ET-1 End: marcador da endotelina 1 presente no endotélio das artérias pulmonares ET-1 intra CM: marcador da endotelina 1 presente na camada média das artérias pulmonares intra-acinares ET-1 intra End: marcador da endotelina 1 presente no endotélio das artérias pulmonares intra-acinares ET-1 pré CM: marcador da endotelina 1 presente na camada média das artérias pulmonares intra-acinares ET-1 pré End: marcador da endotelina 1 presente no endotélio das artérias pulmonares pré-acinares ET-1 sem lesão CM: marcador da endotelina 1 presente na camada média das artérias pulmonares sem lesão intimal ET-1 sem lesão End: marcador da endotelina 1 presente no endotélio das artérias pulmonares sem lesão intimal ET-1 Veias CM: marcador da endotelina 1 presente na camada média das veias pulmonares ABSTRACT Campos PTR. Morphologic and immunohistochemistry characterization of the pulmonary vasculature in patients with pulmonary hypertension associated with left heart disease: hemodynamic and clinical correlations [Thesis]. São Paulo: "Faculdade de Medicina, Universidade de São Paulo"; 2017.BACKGROUND: patients with heart failure may develop, especially in the end stage of the disease, "passive" pulmonary hypertension (PH). Even with the recognition that PH in such patients is associated with poor prognosis, data from literature about its incidence, physiopathology and treatment are lacking. OBJECTIVES: in pulmonary tissue from patients with passive PH: 1characterize and quantify the morphologic alterations of pulmonary vessels; 2correlate the hemodynamic data with the degree of pulmonary vasculature lesions; 3-evaluate the endothelin-1, and its receptors A and B, and phosphodiesterase-5 expression in the vascular wall, correlating them with the morphologic alterations and the hemodynamic data; 4-as a secondary goal, evaluate comparatively all the objectives above mentioned among all cardiopathy etiologies. METHODOLOGY: from the autopsy archives of the
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