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Caso Clínico / Clinical Case
Massas pulmonares bilaterais. Mesma etiologia?
Bilateral lung masses: The same aetiology?
C. Damas1,*, S. Saleiro2, V.P. Hespanhol2,3
1 Interna Complementar de Pneumologia, Serviço de Pneumologia, Hospital de São João – Porto (Portugal)
2 Assistente Hospitalar Graduado de Pneumologia, Serviço de Pneumologia, Hospital de São João – Porto (Portugal)
3 Professor Agregado da Faculdade de Medicina da Universidade do Porto, Serviço de Pneumologia, Hospital de São João – Porto (Portugal)
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        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall">Os autores descrevem o caso de uma mulher de 50 anos&#44; fumadora&#46; Assintom&#225;tica at&#233; Setembro de 2003&#44; altura em que refere o aparecimento de tosse seca&#44; cansa&#231;o e perda de peso&#46; Na radiografia do t&#243;rax eram evidentes duas massas&#44; uma no lobo superior direito e outra no lobo lingular&#46; A doente foi submetida a bi&#243;psia aspirativa transtor&#225;cica e a citologia obtida foi compat&#237;vel com carcinoma de pulm&#227;o do tipo pequenas c&#233;lulas&#46; No estadiamento da doen&#231;a foram identificadas les&#245;es hep&#225;ticas secund&#225;rias&#44; motivo porque a doen&#231;a foi considerada como disseminada&#44; dada a exist&#234;ncia de les&#245;es hep&#225;ticas e pulmonares contra-laterais&#46; Foi&#44; nesta fase&#44; iniciada quimioterapia com <span class="elsevierStyleItalic">carboplatinum</span> e etopos&#237;deo&#46; Seis meses mais tarde&#44; a les&#227;o direita inha diminu&#237;do&#44; mas a les&#227;o esquerda apresentava aumento das suas dimens&#245;es&#46; A bi&#243;psia desta les&#227;o mos-trou uma citologia compat&#237;vel com adenocarcinoma do pulm&#227;o&#44; motivo porque inicia novo ciclo de quimioterapia com vinorelbina e gencitabina&#46; Aos quatro ciclos e por n&#227;o se evidenciar nenhuma resposta ao tratamento&#44; foi realizada radioterapia da les&#227;o esquerda&#46; Durante este per&#237;odo &#40;28 meses&#41; mant&#233;m-se assintom&#225;tica&#44; mantendo a sua actividade di&#225;ria habitual&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall">De acordo com o momento do diagn&#243;stico as neo-plasias do pulm&#227;o podem ser consideradas s&#237;ncronas ou met&#225;cronas&#46; Estas &#250;ltimas s&#227;o mais frequentes&#44; re-presentando cerca de 50-70&#37; dos casos&#44; sendo o pa-dr&#227;o histol&#243;gico mais frequente o adenocarcinoma&#46;</p><p id="sp0010" class="elsevierStyleSimplePara elsevierViewall">No caso apresentado&#44; a situa&#231;&#227;o parecia ser uma doen&#231;a disseminada&#44; o que afastou a hip&#243;tese de tumores s&#237;ncronos&#46; Apesar de a doen&#231;a se apresentar num est&#225;dio avan&#231;ado aquando do diagn&#243;stico e do mau progn&#243;sti-co associado&#44; a evolu&#231;&#227;o dos dois tipos de tumor n&#227;o pareceu comprometer a actividade di&#225;ria da doente&#46;</p><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007&#59; XIII &#40;2&#41;&#58; 287-291</span></p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall">The authors describe the case of a 50 year old woman&#44; smoker&#44; healthy until September 2003 when she presented persistent dry cough&#44; fatigue and weight loss&#46; Chest x-ray showed two lung masses&#44; one in the superior right lobe and the other in the lingula lobe of the left lung&#46;</p><p id="sp0135" class="elsevierStyleSimplePara elsevierViewall">The patient underwent TFNA &#40;transthoracic fine needle aspiration&#41; and the cytological result was compatible with small cell lung cancer&#46; Staging procedures identified hepatic lesions&#44; probably secondary&#46; Presence of hepatic metastasis and contralateral lung lesions defined the stage of the disease as disseminate&#46; Chemotherapy with carboplatin and etoposide was started&#46; Six months later the right lesion had decreased but the left lesion had increased&#46; TFNA of this lesion revealed adenocarci-noma&#46; A new treatment was started with vinorel-bine and gemcitabine&#46; After four cycles of chemotherapy without any response patient underwent radio-therapy of the left lesion&#46;</p><p id="sp0030" class="elsevierStyleSimplePara elsevierViewall">After 28 months of follow up the patient was asymptomatic and able to manage her normal daily routine&#46; Multiple lung cancers can be considered as synchronous or metachronous&#44; depending on the time of diagnosis&#46; Metachronous lesions are the most frequent &#40;50-70&#37; of all cases&#41; and adenocarcinoma the more frequent histological pattern&#46;</p><p id="sp0035" class="elsevierStyleSimplePara elsevierViewall">In this case the disease was at a disseminate stage&#44; which did not suggest a synchronous lung tumour&#46; While the disease was at an advanced stage with poor prognosis at diagnosis&#44; the evolution of the two different lung tumours did not seem to compromise patient&#8217;s daily routine&#46;</p><p id="sp0040" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2007&#59; XIII &#40;2&#41;&#58; 287-291</span></p></span>"
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Article information
ISSN: 08732159
Original language: Portuguese
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