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Neoplasia oculta : revisão da literatura e análise de pequena série de quatro casos clínicos
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Introdução: Neoplasia oculta ou neoplasia de localização primária não identificada engloba um grupo heterogéneo de situações clínicas definidas pela presença de metástases de crescimento agressivo sem tumor primário definido após uma investigação completa e exaustiva, ou pela presença de manifestações sistémicas relacionadas com a presença de síndromes paraneoplásicos, constituindo 3 a 5% de todos os diagnósticos de neoplasia. A neoplasia oculta é a terceira/quarta causa de morte por neoplasia, apresentando na maioria dos casos (80 a 85%) prognóstico desfavorável, com sobrevida média de 6 a 10 meses. A terapêutica da neoplasia oculta deve ser ponderada a nível individual, de acordo com as bases clinico-patológicas e subgrupo de prognóstico em que o doente se insere. Casos Clínicos: Neste trabalho apresentam-se quatro casos clínicos de doentes internados no serviço de Medicina 1C do Hospital de Santa Maria que constituem exemplos ilustrativos de neoplasia oculta, nomeadamente na gravidade da forma de apresentação, progressão rápida e dificuldade de estabelecer diagnóstico histológico. Conclusão: Nos casos apresentados evidenciou-se o rápido carácter evolutivo de mau prognóstico da neoplasia oculta, culminando invariavelmente em morte. Apesar de nos casos em questão se considerar o diagnóstico de neoplasia oculta pela apresentação de metástases sem tumor primário definido, os exames que seriam necessários para a obtenção de diagnóstico final não foram realizados por rápida evolução da doença, tendo a abordagem diagnóstica sido limitada, principalmente no que diz respeito à obtenção de biópsia. Para além disso, permaneceu a dúvida quanto ao regime terapêutico adequado bem como quanto à aplicabilidade das guidelines atuais.
Introduction: Occult neoplasia or cancer of unknown primary is a diverse group of cancers that is defined by the presence of metastasis of aggressive growth without an identifiable primary tumor after a complete and exhaustive evaluation, or by the presence of systemic manifestations related to paraneoplastic syndromes, which accounts for 3 to 5% of all cancer cases. Occult neoplasia is the third/forth cause of death by neoplasia, and has a poor prognosis, with a life expectancy of 6 to 10 months, in the majority of cases (80 to 85%). Treatment must be settled individually, according to clinical and pathological findings and the prognostic subgroup in which the patient is in. Case Report: Here are described four clinical cases of patients admitted to Hospital de Santa Maria Internal Medicine IC care which are illustrative examples of occult neoplasia, in its aggressive presentation, rapid progression and difficulty in establishing histological diagnosis. Conclusion: In the cases presented, the aggressive evolution and poor prognosis of occult neoplasia are evident, since all the patients died. Even though the diagnosis of occult neoplasia was considered because of the presence of metastasis without an identifiable primary tumor, the necessary investigation to reach the final diagnosis was not completed due to the aggressive progression of the disease and the diagnostic approach was limited, especially when a biopsy was needed. In addition, the doubt remained as to the adequate therapeutic regimen to apply as well as the applicability of the current guidelines.
Introduction: Occult neoplasia or cancer of unknown primary is a diverse group of cancers that is defined by the presence of metastasis of aggressive growth without an identifiable primary tumor after a complete and exhaustive evaluation, or by the presence of systemic manifestations related to paraneoplastic syndromes, which accounts for 3 to 5% of all cancer cases. Occult neoplasia is the third/forth cause of death by neoplasia, and has a poor prognosis, with a life expectancy of 6 to 10 months, in the majority of cases (80 to 85%). Treatment must be settled individually, according to clinical and pathological findings and the prognostic subgroup in which the patient is in. Case Report: Here are described four clinical cases of patients admitted to Hospital de Santa Maria Internal Medicine IC care which are illustrative examples of occult neoplasia, in its aggressive presentation, rapid progression and difficulty in establishing histological diagnosis. Conclusion: In the cases presented, the aggressive evolution and poor prognosis of occult neoplasia are evident, since all the patients died. Even though the diagnosis of occult neoplasia was considered because of the presence of metastasis without an identifiable primary tumor, the necessary investigation to reach the final diagnosis was not completed due to the aggressive progression of the disease and the diagnostic approach was limited, especially when a biopsy was needed. In addition, the doubt remained as to the adequate therapeutic regimen to apply as well as the applicability of the current guidelines.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2018
Palavras-chave
Neoplasia oculta Síndrome paraneoplásico