{"id":11383,"date":"2022-04-22T12:45:31","date_gmt":"2022-04-22T12:45:31","guid":{"rendered":"https:\/\/endoscopiaterapeutica.net\/pt\/?p=11383"},"modified":"2022-07-11T07:45:04","modified_gmt":"2022-07-11T07:45:04","slug":"caso-clinico-achado-incidental-no-pet-tc-de-lesao-de-colon","status":"publish","type":"post","link":"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-achado-incidental-no-pet-tc-de-lesao-de-colon\/","title":{"rendered":"CASO CL\u00cdNICO – Achado incidental no PET\/TC de les\u00e3o de c\u00f3lon"},"content":{"rendered":"

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 <\/strong>Paciente masculino, 69 anos, hipertenso, diab\u00e9tico, dislipid\u00eamico, cardiopata (arritmia card\u00edaca), al\u00e9m de antecedente de S\u00edndrome de Erdheim Chester (histiocitose de c\u00e9lulas n\u00e3o-Langerhans) com uso de interferon e prednisona h\u00e1 cerca de um ano.<\/p>\n

Paciente vinha bem em acompanhamento ambulatorial e realizou PET\/CT de seguimento oncol\u00f3gico que evidenciou aumento da atividade metab\u00f3lica (SUV: 5,8) no \u00e2ngulo espl\u00eanico do c\u00f3lon com suspeita de c\u00e2ncer colorretal avan\u00e7ado (Figura 1), sendo sugerido realiza\u00e7\u00e3o de colonoscopia para bi\u00f3psias e tatuagens pr\u00e9-operat\u00f3rias (em planejamento de colectomia).<\/p>\n

\"\"

PET-CT de abdomen<\/p><\/div>\n

A colonoscopia revelou p\u00f3lipo s\u00e9ssil de 3 cm (Paris 0-Is) no c\u00f3lon descendente proximal, junto ao \u00e2ngulo espl\u00eanico, que \u00e0 cromoscopia com NBI\/ \u00edndigo carmin e uso da magnifica\u00e7\u00e3o (near focus, <\/em>CF-HQ190L, EVIS EXERA III, Olympus) apresentava superf\u00edcie com leve irregularidade de criptas e vascular (tipo Vi de Kudo e JNET IIB low), cuja as bi\u00f3psias mostraram adenoma tubular com displasia de alto grau.<\/p>\n

Ap\u00f3s discuss\u00e3o multidisciplinar com equipe da oncologia e cirurgia, foi optado por ressec\u00e7\u00e3o endosc\u00f3pica por dissec\u00e7\u00e3o da submucosa (endoscopic submucosal dissection \u2013 ESD). A ESD foi realizada com Knife tipo Flush, inje\u00e7\u00e3o submucosa de voluven (6%), em cerca de 90 minutos, sem intercorr\u00eancias. Paciente evoluiu bem e recebeu alta no dia seguinte com dieta leve. Anatomopatol\u00f3gico da pe\u00e7a mostrou adenoma tubular com displasia de alto grau (com atipias intensas), margens profundas e laterais livres, e aus\u00eancia de invas\u00e3o linfovascular. O procedimento foi ent\u00e3o considerado curativo.<\/p>\n

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 <\/p>\n

 <\/p>\n

CONCLUS\u00d5ES<\/strong><\/p>\n

O caso relatado mostra o aumento do acesso e melhora da capacidade diagn\u00f3stica dos m\u00e9todos de imagem, que incidentalmente podem revelar neoplasias colorretais mesmo que em est\u00e1gios precoces ainda. E, fundamentalmente, demonstra a import\u00e2ncia da avalia\u00e7\u00e3o com cromoendoscopia com magnifica\u00e7\u00e3o para defini\u00e7\u00e3o de condutas nos les\u00f5es colorretais.<\/p>\n","protected":false},"excerpt":{"rendered":"

\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Paciente masculino, 69 anos, hipertenso, diab\u00e9tico, dislipid\u00eamico, cardiopata (arritmia card\u00edaca), al\u00e9m de antecedente…<\/p>\n","protected":false},"author":3495,"featured_media":11387,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[150],"tags":[365,368,366,364,367],"ano":[309],"tipo":[156],"volume":[263],"class_list":["post-11383","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-casosclinicos","tag-cancer-colorretal","tag-cromoendoscopia","tag-pet","tag-polipo","tag-tc-de-abdomen","ano-309","tipo-colonoscopia","volume-volume-i"],"yoast_head":"\nCASO CL\u00cdNICO - Achado incidental no PET\/TC de les\u00e3o de c\u00f3lon • Endoscopia Terapeutica<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/endoscopiaterapeutica.net\/pt\/casosclinicos\/caso-clinico-achado-incidental-no-pet-tc-de-lesao-de-colon\/\" \/>\n<meta property=\"og:locale\" content=\"pt_BR\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"CASO CL\u00cdNICO - 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