{"id":14843,"date":"2010-04-30T22:51:21","date_gmt":"2010-05-01T02:51:21","guid":{"rendered":"http:\/\/piel-l.org\/blog\/?p=14843"},"modified":"2010-05-01T17:50:48","modified_gmt":"2010-05-01T21:50:48","slug":"consulta-a-un-colega-n%c2%ba1-edicion-268-numerosos-nodulos-sub-cutaneos-generalizados","status":"publish","type":"post","link":"https:\/\/piel-l.org\/blog\/14843","title":{"rendered":"Consulta a un Colega N\u00ba1 Edici\u00f3n 268: Numerosos n\u00f3dulos sub-cut\u00e1neos generalizados"},"content":{"rendered":"<p><em><strong>Presentado por <br \/>\nRolando Hern\u00e1ndez P\u00e9rez <span style=\"font-size: xx-small;\">( m\u00e9dico dermat\u00f3logo)<\/span><br \/>\nNelly Torrealba <span style=\"font-size: xx-small;\">(m\u00e9dico internista)<\/span><br \/>\nZulema Le\u00f3n <span style=\"font-size: xx-small;\">(m\u00e9dico anatomopat\u00f3logo)<\/span><br \/>\n<span style=\"font-size: xx-small;\">Cl\u00ednica Ntra. Se\u00f1ora del Pilar. Barinas \/Venezuela<\/span><\/strong><\/em><\/p>\n<p>Paciente femenina de 65 a\u00f1os de edad, docente jubilada,\u00a0 quien cursa desde hace mes y medio con dolor en base de hemi -t\u00f3rax derecho (8\u00b0-9\u00b0-10\u00b0 arco costal derecho) el cual remite parcialmente con AINEX, exacerbado con los movimientos; presenta adem\u00e1s debilidad generalizada,\u00a0 adinamia, insomnio, edema de miembros inferiores y malestar general.<\/p>\n<p><!--more--><\/p>\n<p>Numerosos n\u00f3dulos sub-cut\u00e1neos generalizados en cuero cabelludo, cuello (principalmente), tronco, miembros superiores , piel de los genitales y muslos, redondeados, eritematosos, cubiertos por piel lisa de diferentes tama\u00f1os desde 1-2 hasta 2 cm de di\u00e1metro; hay uno particularmente grande en piel de abdomen izquierdo de 3 cm de di\u00e1metro, cuya piel es purp\u00farica. P\u00e9rdida de peso importante no cuantificada.<\/p>\n<table style=\"width: 132px; height: 64px;\" border=\"0\">\n<tbody>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000378.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14866\" title=\"268-[P1000378]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000378-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000377.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14865\" title=\"268-[P1000377]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000377-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000376.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14864\" title=\"268-[P1000376]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000376-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000375.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14863\" title=\"268-[P1000375]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000375-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000374.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14862\" title=\"268-[P1000374]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000374-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000373.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14861\" title=\"268-[P1000373]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000373-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000372.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14860\" title=\"268-[P1000372]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000372-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000371.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14859\" title=\"268-[P1000371]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000371-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Para el momento del examen dermatol\u00f3gico presenta Hb: 8.3 G%; Hto 29% Calcio elevado: 12 .7 mg\/dl; Reticulocitos 1%;Plaquetas:370.000: Leucocitos: 14.000 (Seg: 65%-Lin.:35%)<\/p>\n<p>Descripci\u00f3n del fr\u00f6tis:<\/p>\n<p>a)\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0serie roja: anisocitosis, Hipocrom\u00eda, Reticulocitosis.<\/p>\n<p>b)\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0Serie blanca: leucocitosis con neutrofilia<\/p>\n<p>c)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Serie plaquetaria: morfol\u00f3gica y cuantitativamente normal.<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p>Antecedente de intervenci\u00f3n quir\u00fargica tiroides : n\u00f3dulos\/ Bocio (hace 2 a\u00f1os), aparentemente no hubo c\u00e1ncer de tiroides<\/p>\n<p>Antecedente de importancia: Hipertensi\u00f3n arterial moderada de larga data, controlada con un antagonista de los receptores de la angiotensina II (Olmesartan medoxomil\/ Benicar de 20 mg; \u00bd\u00a0 tableta VO\/OD; no refiere\u00a0 alergia medicamentosa.<\/p>\n<p>Al examen f\u00edsico: TA 125\/63 mm Hg FC: 70 latidos por minutos; pacientes en regulares condiciones generales, palidez cut\u00e1neo mucosa generalizada; numerosos n\u00f3dulos sub-cut\u00e1neos con las caracter\u00edsticas antes descritas.<\/p>\n<p>ID: Linfoma cut\u00e1neo<\/p>\n<p>MT cut\u00e1nea (Tiroide \u00bf; mama?, pulm\u00f3n?)<\/p>\n<p>Enfermedad monoclonal<\/p>\n<p>Anemia severa<\/p>\n<p>Insuficiencia renal aguda<\/p>\n<p>Deshidrataci\u00f3n moderada<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p>Evaluada por Medicina interna, Hematolog\u00eda,\u00a0 Mastolog\u00eda, Gastroenterolog\u00eda, Neumonolog\u00eda y Ginecolog\u00eda.<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p>Se solicita ECO abdomino p\u00e9lvico (report\u00f3 normal)<\/p>\n<p>RX: S\u00edndrome intersticial pulmonar cr\u00f3nico; Angiesclerosis, cardiomegalia grado IV. Signos ICC. Derramen Pleural izquierdo.<\/p>\n<p>TAC DE T\u00d3RAX: S\u00edndrome intersticial pulmonar cr\u00f3nico, con predominio en base con tendencia a la consolidaci\u00f3n basal izquierda: Angioesclerosis, cardiomegalia. Derramen pleural bilateral\u00a0 de moderada cantidad: resto normal.<\/p>\n<p>TAC ABDOMINAL-P\u00e9lvico: : numerosos n\u00f3dulos y ganglios linf\u00e1ticos de mediano tama\u00f1o, retroperitoneales, para a\u00f3rticos y alrededor de la\u00a0 cava. Derramen pleural bilateral. Cardiomegalia con signos de pericarditia. Lesiones osteol\u00edticas de tipo apolillado en columna: Mieloma M\u00faltiple \u00bf?; Escasa ascitis. Signo de hernia unbilical<\/p>\n<p>Mamografia: Mama de densidad baja, usual para la edad de la paciente. Sim\u00e9tricas. Degeneraci\u00f3n grasa. Finas modularidades bilaterales y difusas sin densidad de aspecto nodular: Se sugiere ECO mamario complementario. Ganglios axilares: Calcificaciones de aspecto benigno en mama derecha. Estudio BI-RAD III<\/p>\n<p>ECO MAMARIO: Ganglio axilares : Resto de la exploraci\u00f3n mamaria normal para la edad.<\/p>\n<p>TAC COLUMNA DORSO LUMBAR: m\u00faltiples lesiones osteol\u00edticas . Fractura arco costal izquierdo posterior en D10<\/p>\n<p>Evaluaci\u00f3n por el Mast\u00f3logo: En espera de resultado de anatom\u00eda patol\u00f3gica: Sugiere un CA oculto en mama.<\/p>\n<p>Gastroscopia y colononoscopia: gastritis moderada .No im\u00e1genes tumorales.<\/p>\n<p>M\u00e9dula \u00f3sea: Realizado en espina il\u00edaca posterior superior derecha; aspirado y biopsia de m\u00e9dulas\u00a0 \u00f3sea y ev\u00edo material para anatom\u00eda patol\u00f3gica y citometr\u00eda d eflujo- marcadores monoclonales . Se espera resultados<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>LEUC<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>13.4<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>ERI<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>2.62<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>HB<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>8.5 g%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>HTC<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>27.7 %<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Plaquetas<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>103\/mm3<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>PTC<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>239%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>LINFO<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>17%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>MON<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>13.8%<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>GRA<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>69.1 %<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><br class=\"spacer_\" \/><\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Glicemia<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>112 mg\/dl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>TGO\/AST<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>92 UL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>TGP\/ALT<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>36\u00a0 UL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Fosfatasas alcalinas<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>114 U\/L<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Sodio<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>140,3 mEq\/dl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Cloro<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>98,7 mmol\/dl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Potasio<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>3,08 mEq\/DL<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"299\" valign=\"top\">\n<p>Magnesio<\/p>\n<\/td>\n<td width=\"299\" valign=\"top\">\n<p>2,20 mg\/dl<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><br class=\"spacer_\" \/><\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>UREA\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 85\u00a0 mg\/dl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>CREATININA\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0   1,70 mg\/dl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>CALCIO\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a010,7 mg\/dl<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\"><\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\"><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><br class=\"spacer_\" \/><\/p>\n<p>CITOQU\u00cdMICA LIQUIDO PLEURAL:<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<table border=\"1\" cellspacing=\"0\" cellpadding=\"0\">\n<tbody>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>EXAMEN MACROSCOPICO: Color   amarillo claro; Aspecto: turbio; pH: 9; Cantidad: 4,4cc; Presencia de   coagulo: si<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>EXAMEN MICROSC\u00d3PICO: 0,1 X   10 3 cel.\/mm3<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>EXAMEN QU\u00cdMICO: Glicemia: 172   mg\/dl- Prote\u00ednas: 2,2 mg\/dl- LDH: 241 U\/L<\/p>\n<\/td>\n<\/tr>\n<tr>\n<td width=\"599\" valign=\"top\">\n<p>En la muestra no se observaron ni   cocos ni bacilos.<\/p>\n<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><br class=\"spacer_\" \/><\/p>\n<p>EXAMEN DEL L\u00cdQUIDO PLEURAL ANATOM\u00cdA PATOL\u00d3GICA:<\/p>\n<p>Presencia de numerosas c\u00e9lulas tumorales (L\u00edqu\u00eddo pleural positivo)<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p>MARCADORES TUMORALES:<br \/>\n CEA:\u00a0 2,2\u00a0\u00a0\u00a0 ng\/ml\u00a0\u00a0\u00a0 (VR: 0-5,8 )<\/p>\n<p>AFP: 2,5 ng\/ml\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 ( 0-9,5)<\/p>\n<p>CA 19-9\u00a0 UL\/ml\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 (0-37)<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p>Se tom\u00f3 muestra para estudio histopatol\u00f3gico e inmunohistoqu\u00edmica:<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<table style=\"width: 335px; height: 124px;\" border=\"0\">\n<tbody>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image305.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14845\" title=\"268-[image305]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image305-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image306.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14846\" title=\"268-[image306]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image306-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image307.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14847\" title=\"268-[image307]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image307-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image308.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14848\" title=\"268-[image308]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image308-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image309.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14849\" title=\"268-[image309]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image309-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image310.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14850\" title=\"268-[image310]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image310-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image311.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14851\" title=\"268-[image311]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image311-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image312.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14852\" title=\"268-[image312]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image312-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image313.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14853\" title=\"268-[image313]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image313-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image314.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14854\" title=\"268-[image314]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image314-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image315.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14855\" title=\"268-[image315]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image315-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image316.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14856\" title=\"268-[image316]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image316-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image317.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14857\" title=\"268-[image317]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image317-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image318.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14858\" title=\"268-[image318]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-image318-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><\/td>\n<td><\/td>\n<td><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000422.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14867\" title=\"268-[P1000422]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000422-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000423.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14868\" title=\"268-[P1000423]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000423-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000424.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14869\" title=\"268-[P1000424]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000424-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000425.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14870\" title=\"268-[P1000425]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000425-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000426.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14871\" title=\"268-[P1000426]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000426-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000427.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14872\" title=\"268-[P1000427]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000427-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000428.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14873\" title=\"268-[P1000428]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000428-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000429.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14874\" title=\"268-[P1000429]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000429-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000430.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14875\" title=\"268-[P1000430]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000430-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<tr>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000431.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14876\" title=\"268-[P1000431]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000431-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000432.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14877\" title=\"268-[P1000432]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000432-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<td><a href=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000433.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-thumbnail wp-image-14878\" title=\"268-[P1000433]\" src=\"http:\/\/piel-l.org\/blog\/wp-content\/uploads\/\/2010\/04\/268-P1000433-150x150.jpg\" alt=\"\" width=\"150\" height=\"150\" \/><\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p><br class=\"spacer_\" \/><\/p>\n<p><strong><em><span style=\"text-decoration: underline;\">INFORME DE INMUNOHISTOQU\u00cdMICA<\/span><\/em><\/strong><\/p>\n<p><strong><em><span style=\"text-decoration: underline;\"> <\/span><\/em><\/strong><\/p>\n<p>Mediante la t\u00e9cnica de Avidina-Biotina Estreptavidina, y utilizando m\u00e9todos de recuperaci\u00f3n antig\u00e9nica, se practic\u00f3 la investigaci\u00f3n de los siguientes ant\u00edgenos. Se utilizaron controles positivos adecuados.<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p><strong>ANTICUERPOS\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 RESULTADOS<\/strong><\/p>\n<p>CITOQUERATINA 7\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 POSITIVIDAD INTENSA Y DIFUSA EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p>CITOQUERATINA 20\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 POSITIVIDAD D\u00c9BIL Y FOCAL EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p>CEA (ANTIGENO CARCINOEMBRIONARIO)\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 POSITIVIDAD D\u00c9BIL Y FOCAL EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p>TTF1 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 NEGATIVO EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p>RECEPTORES DE ESTR\u00d3GENOS\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 \u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 POSITIVIDAD INTENSA Y DIFUSA EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p>RECEPTORES DE PROGESTERONA\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 NEGATIVO EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p><em>c-erb<\/em>B-2\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 NEGATIVO EN C\u00c9LULAS NEOPL\u00c1SICAS.<\/p>\n<p><strong> <\/strong><\/p>\n<p><strong>DIAGN\u00d3STICO: <\/strong><\/p>\n<p><strong>PIEL, L\u00c1MINAS Y BLOQUES DE REVISI\u00d3N (# 891-10\/893-10):<\/strong><\/p>\n<ul>\n<li>HALLAZGOS      HISTOL\u00d3GICOS E INMUNOHISTOQU\u00cdMICOS COMPATIBLES CON ADENOCARCINOMA      METAST\u00c1SICO, PROBABLE PRIMARIO EN GL\u00c1NDULA MAMARIA (VER COMENTARIO).<\/li>\n<\/ul>\n<p><br class=\"spacer_\" \/><\/p>\n<p><span style=\"text-decoration: underline;\">Comentario:<\/span> La morfolog\u00eda y el patr\u00f3n de inmunomarcaje observado sugieren tumor primario en gl\u00e1ndula mamaria, sin embargo debe explorarse adem\u00e1s el tracto genital femenino (ovarios &#8211; endometrio) y el est\u00f3mago, ya que los tumores originados en dichos \u00f3rganos pueden presentar un patr\u00f3n inmunohistoqu\u00edmico similar.<\/p>\n<p><br class=\"spacer_\" \/><\/p>\n<p><strong>Cu\u00e1l es su comentario<\/strong><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Presentado por Rolando Hern\u00e1ndez P\u00e9rez ( m\u00e9dico dermat\u00f3logo) Nelly Torrealba (m\u00e9dico internista) Zulema Le\u00f3n (m\u00e9dico anatomopat\u00f3logo) Cl\u00ednica Ntra. Se\u00f1ora del Pilar. Barinas \/Venezuela Paciente femenina de 65 a\u00f1os de edad, docente jubilada,\u00a0 quien cursa desde hace mes y medio con dolor en base de hemi -t\u00f3rax derecho (8\u00b0-9\u00b0-10\u00b0 arco costal derecho) el cual remite parcialmente &hellip;<\/p>\n","protected":false},"author":16,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[25],"tags":[],"class_list":["post-14843","post","type-post","status-publish","format-standard","","category-consulte-a-un-colega"],"_links":{"self":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/14843","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/users\/16"}],"replies":[{"embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/comments?post=14843"}],"version-history":[{"count":0,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/posts\/14843\/revisions"}],"wp:attachment":[{"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/media?parent=14843"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/categories?post=14843"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/piel-l.org\/blog\/wp-json\/wp\/v2\/tags?post=14843"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}