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ResumoO tumor de Buschke-Löwenstein (TBL) é uma variante rara de condiloma acuminatum que possui comportamento maligno pelo crescimento local, mas não apresenta potencial metastático. Afeta primariamente a área genital e, menos frequentemente a região perianal. Os fatores de risco para o seu desenvolvimento incluem a terapêutica imunossupressora e a infeção VIH. Possui elevada taxa de recorrência e de transformação maligna, sendo a cirurgia o tratamento inicial recomendado. Apresenta-se um caso de TBL perianal e anal num doente com infeção VIH cuja histologia não revelou transformação maligna e para o qual a terapêutica cirúrgica isolada foi eficaz. Revê-se o conhecimento atual sobre esta entidade tendo em atenção a história natural nos indivíduos infetados pelo VIH.AbstractThe Buschke-Löwenstein tumor (TLB) is a rare variant of condyloma acuminatum that presents local malignant behavior but no metastatic potential. It affects primarily the genital area and less frequently the perianal region. Risk factors for its development include immunosuppressive therapy and HIV infection. This tumor has a high rate of malignant transformation and the recommended initial treatment is surgery. We present a case of perianal and anal TBL in a HIV patient whose histology revealed no malignant transformation and that was treated successfully with surgery alone. We review the current knowledge about this entity taking into account its natural history in individuals infected with HIV.

ResumoO vírus da hepatite D (VHD) é um vírus satélite, que necessita do vírus da hepatite B (VHB) para a sua replicação. Na maioria dos casos, o VHD suprime a replicação do VHB e, nestas circunstâncias, está recomendado o tratamento com Interferão. Nos doentes em que não se observa resposta virológica após o 1.° ano de terapêutica, o seu prolongamento pode aumentar a taxa de resposta virológica sustentada.Caso clínicoHomem, 42 anos, com hepatite crónica B, anti-HBe positivo e baixa carga viral. Apresentava aminotransferases aumentadas que persistiram, mesmo após negativação do ADN-VHB. A positividade da fração IgM do AcVHD conduziu ao diagnóstico de co-infecção VHB-VHD. Foi tratado com PegInterfeão α-2a durante 102 semanas. Observou-se normalização das aminotransferases à 33.ª semana, negativação da IgM do AcVHD à 88.ª semana e resposta virológica sustentada com perda do AgHB.ComentáriosEste caso ilustra a importância de se manter o tratamento nos doentes com infecção VHD até resposta virológica, uma vez que a cura do VHD pode acompanhar-se da cura da infecção VHB.AbstractHepatitis D virus (HDV) is a satellite virus which needs hepatitis B virus (HBV) for its replication. In most cases, HDV suppresses HBV replication and in these circumstances the treatment should be with Interferon. In patients that have no virological response after the 1th year of therapy, continuing it will possible increase the virological response and the loss of the HBs antigen.Case report42 years old man with chronic HBV, anti-HBe positive and low HBV viral load. He had increased transaminases which had persisted even after HBV-DNA negativation. We performed antibody anti-HDV that came positive and treated the patient with PegInterferon α-2a during 102 weeks. We assist to normalization of the transaminases at week 33 and negativation of IgM-HVD at week 88. At the end of the treatment RNA-HDV was negative and the patient lost HBs antigen that persisted over the next sixth months.CommentsThis case illustrates the importance of maintaining treatment until HDV virological response since the cure of the HDV may be accompanied by the cure of HBV infection.

A 74-year-old man attended our gastroenterology outpatient clinic with hipogastric aching pain for the past 5 years associated with recent worsening of chronic constipation. Physical examination as well as abdomino-pelvic ultrasound and colonoscopy was unremarkable. Anti-antispasmodics and dietary measures did not improve the clinical condition. For this reason, we performed an abdomino-pelvic computed tomography (CT) scan which showed thickening of the terminal ileum. The patient repeated colonoscopy with ileoscopy and regular hogback in the terminal ileum was observed that could not be overcome, lined by normal mucosa. It was biopsed, but histologic examination was normal. The entero-resonance was suggestive of nonspecific mesenteritis, but did not reveal changes in small bowel. Serologies to Crohn’s disease and celiac disease were negative. A video capsule enteroscopy was performed which revealed diffuse pattern of linfagiectasia and segmental pseudopolypoid whitish areas in jejunum and ileum (Fig. 1). Through push enteroscopy (Fig. 2) with a pediatric colonoscope, biopsies of proximal jejunum were taken. Microscopic examination demonstrated neoplastic proliferation of lymphoid tissue with follicular pattern (Fig. 3). The tumor cells were positive for CD20, CD10, BCL2, BCL6 and negative for CD3, CD5, CD23, and 5 blasts per high power field were observed. Based on these findings, a diagnosis of follicular lymphoma grade 1 was established.