A urticária e o angioedema fazem habitualmente parte de uma síndrome benigna, porém, podem por vezes estar associados a síndromes paraneoplásicos. Uma doente do sexo feminino, com 46 anos, foi enviada a consulta de Imunoalergologia no contexto de urticária, angioedema e fadiga progressiva, de causa desconhecida. A urticária cedia aos anti-histaminicos, porém o angioedema não respondia a estes fármacos e tinha um ritmo circadiano. A urticária era ligeira, enquanto os episódios de angioedema eram mais severos. Foi requisitado estudo analítico, que demonstrou contagem de eritrócitos e leucócitos normais, assim como função renal, hepática e tiroideia sem alterações. Foram também requisitados a velocidade de sedimentação, estudo das proteínas do complemento (C1, C3, C4 e C1q) e o doseamento de C1-esterase inibidor, que se encontravam dentro dos limites da normalidade. Uma TC demonstrou um quisto com cerca de 4,8 cm de diâmetro no rim direito, que foi considerado como um provável carcinoma de células renais numa Uro-TC realizada posteriormente. Foi realizada uma nefro-ureterectomia radical. O estudo anatomopatológico revelou um carcinoma de células renais cromófobo, com estadiamento pTNM pT1b Nx R0. Durante o primeiro mês após a cirurgia, verificou-se uma rápida melhoria dos episódios de angioedema. Após o primeiro mês não ocorreram novos episódios de angioedema, com nenhuma recorrência após um ano de seguimento. A avaliação de doentes com urticária e angioedema não requer, habitualmente, a requisição de múltiplos exames complementares de diagnóstico. Porém, deve ser considerado um estudo complementar mais alargado nos doentes em que estes sintomas se manifestam de forma atípica.

Urticaria and angioedema are part of a benign syndrome in the majority of cases. However, they can occur as paraneoplastic syndromes. A 46 year old woman was observed with urticaria, angioedema and progressive fatigue and adynamia of unknown cause. The urticaria responded to anti-histamines, but the angioedema did not and had a circadian evolution. The urticaria was mild, but the angioedema caused severe episodes. Blood tests revealed normal red and white blood cell counts as, normal renal, liver and thyroid function. Sedimentation rate, complement serum proteins (C1, C3, C4 and C1q) and C1-esterase inhibitor concentrations were within normal ranges. A CT-scan Demonstrated a 4.8 cm diameter cyst in the right kidney, deemed as a probable renal cells carcinoma on a posterior Uro-CT-scan. A radical nefro-ureterectomy was successfully performed and tumor histology established a cromophobe renal cells carcinoma (RCC) diagnosis at a pTNM pT1b Nx R0. A few days after surgery, a fast improvement of facial angioedema was observed and one month later its complete disappearance was ascertained, without any recurrence during a subsequent one-year follow-up. The evaluation of patients with urticaria and angioedema does not usually require a lot of complementary tests. However, further study should be considered when these symptoms are present with atypical characteristics.

PURPOSE: Prostate cancer (PCa) is one of the most commonly diagnosed malignancies in the world. Although PSA utilization as a serum marker has improved prostate cancer detection it still presents some limitations, mainly regarding its specificity. The expression of this marker, along with the detection of PCA3 mRNA in urine samples, has been suggested as a new approach for PCa detection. The goal of this work was to evaluate the efficacy of the urinary detection of PCA3 mRNA and PSA mRNA without performing the somewhat embarrassing prostate massage. It was also intended to optimize and implement a methodological protocol for this kind of sampling. MATERIALS AND METHODS: Urine samples from 57 patients with suspected prostate disease were collected, without undergoing prostate massage. Increased serum PSA levels were confirmed by medical records review. RNA was extracted by different methods and a preamplification step was included in order to improve gene detection by Real-Time PCR. RESULTS: An increase in RNA concentration with the use of TriPure Isolation Reagent. Despite this optimization, only 15.8% of the cases showed expression of PSA mRNA and only 3.8% of prostate cancer patients presented detectable levels of PCA3 mRNA. The use of a preamplification step revealed no improvement in the results obtained. CONCLUSION: This work confirms that prostate massage is important before urine collection for gene expression analysis. Since PSA and PCA3 are prostate specific, it is necessary to promote the passage of cells from prostate to urinary tract, in order to detect these genetic markers in urine samples.

Os autores apresentam o caso de um homem de 43 anos, com dor abdominal e sintomas constitucionais com 3 semanas de evolução, a quem se diagnosticou tumor solido do fígado e infecção crónica a Virus da Hepatite C (VHC). O tumor era um Linfoma não Hodgkin ( LNH) tipo B, primário. O doente foi submetido a quimioterapia e a tratamento para a hepatite crónica C, com boa resposta. Os autores discutem o caso e apresentam uma revisão da litera-tura sobre a associação VHC e LNH, em particular o LNH primário do fígado, e o eventual papel do virus na génese de linfomas.

The authors present the case of a 43 year old man, with abdominal pain and constitutional symptoms during 3 weeks, in whom was diagnosed a solid liver tumor and chronic hepatitis C. The tumor was a primary cell B non-Hodgkin Lymphoma (LNH). The patient was submitted to chemotherapy and treatment for hepatitis C with a favourable response. The authors discuss the case and present a review on the VHC and LNH association, the primary hepatic lymphoma in particular, and the possible role of the virus in lymphomagenesis.