SILVIA MOULIN RIBEIRO FONSECA

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Instituto do Câncer do Estado de São Paulo, Hospital das Clínicas, Faculdade de Medicina - Médico

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  • article
    Acute coronary syndrome due to an invasive thymoma with blood supply by circumflex artery-a case report
    (2020) FIGUEIREDO, Clara Salles; COSTA, Isabela Bispo Santos da Silva; BITTAR, Cristina Salvadori; PAIVA, Antonio Fernando Lins de; LIMA, Ivanhoe Stuart; DIVINO, Paulo Henrique do Amor; SILVA, Carolina Maria P. D. de C.; FONSECA, Silvia Moulin Ribeiro; KALIL FILHO, Roberto; HAJJAR, Ludhmila Abrahao
    Thymomas are usually tumors with a good prognosis but with potential to invade nearby structures. We report a case of a 56-year-old woman previously diagnosed with an invasive thymoma that came to the emergence room with symptoms of acute coronary syndrome. After a coronary computed tomography angiography, it was seen that the tumor was invading the myocardial and it was irrigated by the left circumflex coronary and its branches. Considering her poor prognosis, it was decided not to make further interventions. This case highlights a unique and rare case of an unresectable thymoma that was invading the myocardium and it was irrigated by the left circumflex coronary and its branches, causing typical angina due to compromised coronary blood flow by the mass causing ischemia.
  • article 9 Citação(ões) na Scopus
    Brazilian cardio-oncology: the 10-year experience of the Instituto do Cancer do Estado de Sao Paulo
    (2020) COSTA, Isabela B. S. da S.; BITTAR, Cristina S.; FONSECA, Silvia M. R.; SILVA, Carolina M. P. D. e; REHDER, Marilia H. H. dos Santos; RIZK, Stephanie I.; CRUZ, Cecilia B. B. V.; FIGUEIREDO, Clara S.; ANDRADE, Fernanda T. de A.; BARBERINO, Ludmila de A.; COSTA, Fernanda A. de S.; MACHADO, Letticya P.; GONZALEZ, Thalita B.; ALMEIDA, Marcel P. C.; FUKUSHIMA, Julia T.; KALIL FILHO, Roberto; HAJJAR, Ludhmila Abrahao
    BackgroundIn recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes.MethodsA retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity).ResultsFrom a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48-66], 66 [58-74] and 69 [62-76], p <0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p <0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p <0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p <0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p =0.650]).ConclusionThe number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.