Cordeiro em pele de lobo: um caso clínico

Andreia Soares Teles  Ribeiro; Gonçalo Freire; Ricardo Simões de  Araújo

doi:10.5712/rbmfc15(42)2645

Authors

Andreia Soares Teles Ribeiro USF Descobertas, ACES Lisboa Ocidental e Oeiras, ARS Lisboa e Vale do Tejo, Portugal. https://orcid.org/0000-0002-9134-8584
Gonçalo Freire Serviço de Radiologia, Hospital Beatriz Ângelo, Loures, Portugal. https://orcid.org/0000-0002-5597-3104
Ricardo Simões de Araújo USF Descobertas, ACES Lisboa Ocidental e Oeiras, ARS Lisboa e Vale do Tejo, Portugal. https://orcid.org/0000-0001-6842-609X

DOI:

https://doi.org/10.5712/rbmfc15(42)2645

Keywords:

Leiomyomatosis, Multiple Pulmonary Nodules, Primary Health Care.

Abstract

Introduction: When a patient has a medical appointment, they already have a pre-defined idea of their health problem. This idea is influenced by their previous experience, local culture and family support. Case Description: 48-year-old female, former smoker. She reveals a personal history of uterine leiomyoma excision 18 years ago. She turns to her doctor complaining of cough for the last four months. A chest computed tomography was ordered, in which nodular formations were identified, suggestive of metastasis. An urgent referral was made to a pulmonology consultation, where a biopsy was requested, which the patient refused to perform. After a family assessment, the patient realized that her previous life experience generated her fear. The patient ended up performing the biopsy that revealed a leiomyoma pattern. The diagnosis of benign metastatic leiomyomatosis secondary to uterine fibroid excision was made. Conclusion: The “illness” understood by patients will influence how they will manage their disease and their malaise. In the consultation there is a confrontation between the patient’s fears and the diagnostic uncertainties of the physician. In such cases, the family doctor should not assume a paternalistic position of decision, but should empower patients to make a conscious and informed choice.

Downloads

Download data is not yet available.

Metrics

Metrics Loading ...

Author Biographies

Gonçalo Freire, Serviço de Radiologia, Hospital Beatriz Ângelo, Loures, Portugal.

Interno de 4ºAno de formação específica de Radiologia, Hospital Beatriz Ângelo, Loures

Ricardo Simões de Araújo, USF Descobertas, ACES Lisboa Ocidental e Oeiras, ARS Lisboa e Vale do Tejo, Portugal.

Interno de 4ºAno de formação específica de Medicina Geral e Familiar, USF Descobertas, ACES Lisboa Ocidental e Oeiras, ARS Lisboa e Vale do Tejo;

References

(1) McWhinney I, Freeman T. Textbook of family medicine. 3rd ed. Oxford: Oxford University Press; 2009.

(2) Mendes-Nunes J. Comunicação em contexto clínico. Lisboa: Instituto de Clínica Geral da Zona Sul; 2010.

(3) Caeiro RT. Registos clínicos em medicina familiar. Lisboa: Instituto de Clínica Geral da Zona Sul; 1991.

(4) Graffar M. Une méthode de classification d’achantillon de population. Courrier. 1958;6:455-78.

(5) Rebelo L. Genograma familiar: o bisturi do médico de família. Rev Port Clin Geral. 2007;23(23):309-17.

(6) Thrower SM, Bruce WE, Walton RF. The family circle method for integrating family systems concepts in family medicine. J Fam Pract. 1982 Set;15(3):451-7.

(7) Khan M, Faisal A, Ibrahim H, Barnes T, VanOtteren GM. Pulmonary benign metastasizing leiomyoma: a case report. Respir Med Case Rep [Internet]. 2018 Jan; [citado 2019 Jul 13]; 24:117-21. Disponível em: https://www.sciencedirect.com/science/article/pii/S2213007118300996#bbib2 DOI: https://doi.org/10.1016/j.rmcr.2018.04.017

(8) Bakkensen JB, Samore W, Bortoletto P, Morton CC, Anchan RM. Pelvic and pulmonary benign metastasizing leiomyoma: a case report. Case Rep Womens Health [Internet]. 2018 Mar; [citado 2019 Mai 13]; 18:e00061. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/29785389 DOI: https://doi.org/10.1016/j.crwh.2018.e00061

(9) Pacheco-Rodriguez G, Silva AMT, Moss J. Benign metastasizing leiomyoma. Clin Chest Med [Internet]. 2016 Set; [citado 2019 Mai 13]; 37(3):589-95. Disponível em: https://linkinghub.elsevier.com/retrieve/pii/S0272523116300569 DOI: https://doi.org/10.1016/j.ccm.2016.04.019

(10) Castelli P, Caronno R, Piffaretti G, Tozzi M. Intravenous uterine leiomyomatosis with right heart extension: successful two-stage surgical removal. Ann Vasc Surg [Internet]. 2006 Mai; [citado 2019 Mai 14]; 20(3):405-7. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/16583249 DOI: https://doi.org/10.1007/s10016-006-9024-0

(11) Chen S, Liu RM, Li T. Pulmonary benign metastasizing leiomyoma: a case report and literature review. J Thorac Dis [Internet]. 2014 Jun; [citado 2019 Mai 13]; 6(6):E92-8. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/24977035

(12) Moreira M, Pinto F, Oliveira N, Andrade L, Oliveira M. Benign metastasizing leiomyoma: literature review based on a case report. Acta Obstet Ginecol Port [Internet]. 2013; [citado 2019 Mai 14]; 7(2):131-5. Disponível em: http://www.fspog.com/fotos/editor2/2013-2-caso_clinico_1.pdf

(13) Cardoso AR, Pereira E. Leiomioma benigno metastizante: a propósito de um caso clínico. Rev Soc Port Med Intern. 2005 Out/Dez;12(4):230-3.

(14) Rivera JA, Christopoulos S, Small D, Trifiro M. Hormonal manipulation of benign metastasizing leiomyomas: report of two cases and review of the literature. J Clin Endocrinol Metab [Internet]. 2004 Jul; [citado 2019 Mai 14]; 89(7):3183-8. Disponível em: http://www.ncbi.nlm.nih.gov/pubmed/15240591 DOI: https://doi.org/10.1210/jc.2003-032021

(15) European Academy of Teachers in General Practice (EURACT). WONCA - The European definition of genral practice/family medicine [Internet]. Europa: EURACT: 2011; [acesso em 2020 Set 20]. Disponível em: http://www.woncaeurope.org

(16) Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q. 2005 Set;83(3):457-502. DOI: https://doi.org/10.1111/j.1468-0009.2005.00409.x