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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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Journal Information
Vol. 13. Issue 2.
Pages 287-291 (March - April 2007)
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Vol. 13. Issue 2.
Pages 287-291 (March - April 2007)
Caso Clínico / Clinical Case
Open Access
Massas pulmonares bilaterais. Mesma etiologia?
Bilateral lung masses: The same aetiology?
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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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Resumo

Os autores descrevem o caso de uma mulher de 50 anos, fumadora. Assintomática até Setembro de 2003, altura em que refere o aparecimento de tosse seca, cansaço e perda de peso. Na radiografia do tórax eram evidentes duas massas, uma no lobo superior direito e outra no lobo lingular. A doente foi submetida a biópsia aspirativa transtorácica e a citologia obtida foi compatível com carcinoma de pulmão do tipo pequenas células. No estadiamento da doença foram identificadas lesões hepáticas secundárias, motivo porque a doença foi considerada como disseminada, dada a existência de lesões hepáticas e pulmonares contra-laterais. Foi, nesta fase, iniciada quimioterapia com carboplatinum e etoposídeo. Seis meses mais tarde, a lesão direita inha diminuído, mas a lesão esquerda apresentava aumento das suas dimensões. A biópsia desta lesão mos-trou uma citologia compatível com adenocarcinoma do pulmão, motivo porque inicia novo ciclo de quimioterapia com vinorelbina e gencitabina. Aos quatro ciclos e por não se evidenciar nenhuma resposta ao tratamento, foi realizada radioterapia da lesão esquerda. Durante este período (28 meses) mantém-se assintomática, mantendo a sua actividade diária habitual.

De acordo com o momento do diagnóstico as neo-plasias do pulmão podem ser consideradas síncronas ou metácronas. Estas últimas são mais frequentes, re-presentando cerca de 50-70% dos casos, sendo o pa-drão histológico mais frequente o adenocarcinoma.

No caso apresentado, a situação parecia ser uma doença disseminada, o que afastou a hipótese de tumores síncronos. Apesar de a doença se apresentar num estádio avançado aquando do diagnóstico e do mau prognósti-co associado, a evolução dos dois tipos de tumor não pareceu comprometer a actividade diária da doente.

Rev Port Pneumol 2007; XIII (2): 287-291

Palavras-chave:
Tumor primitivo do pulmão
tumores síncronos do pulmão
tumores metácronos do pulmão
Abstract

The authors describe the case of a 50 year old woman, smoker, healthy until September 2003 when she presented persistent dry cough, fatigue and weight loss. Chest x-ray showed two lung masses, one in the superior right lobe and the other in the lingula lobe of the left lung.

The patient underwent TFNA (transthoracic fine needle aspiration) and the cytological result was compatible with small cell lung cancer. Staging procedures identified hepatic lesions, probably secondary. Presence of hepatic metastasis and contralateral lung lesions defined the stage of the disease as disseminate. Chemotherapy with carboplatin and etoposide was started. Six months later the right lesion had decreased but the left lesion had increased. TFNA of this lesion revealed adenocarci-noma. A new treatment was started with vinorel-bine and gemcitabine. After four cycles of chemotherapy without any response patient underwent radio-therapy of the left lesion.

After 28 months of follow up the patient was asymptomatic and able to manage her normal daily routine. Multiple lung cancers can be considered as synchronous or metachronous, depending on the time of diagnosis. Metachronous lesions are the most frequent (50-70% of all cases) and adenocarcinoma the more frequent histological pattern.

In this case the disease was at a disseminate stage, which did not suggest a synchronous lung tumour. While the disease was at an advanced stage with poor prognosis at diagnosis, the evolution of the two different lung tumours did not seem to compromise patient’s daily routine.

Rev Port Pneumol 2007; XIII (2): 287-291

Key-words:
Primitive lung tumor
synchronous lung tumor
metachronous lung tumour
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Copyright © 2007. Sociedade Portuguesa de Pneumologia/SPP
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