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con trastornos visuales y v&#233;rtigos&#44; realiz&#225;ndose resonancia magn&#233;tica nuclear con contraste del cr&#225;neo&#44; encontr&#225;ndose lesi&#243;n tumoral &#250;nica en el l&#243;bulo temporal izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel derecho&#41; a la que se le realiz&#243; metastasectom&#237;a con radioterapia como adyuvancia&#46; Cinco meses despu&#233;s se detecta en un ultrasonido abdominal tumoraci&#243;n de la gl&#225;ndula suprarrenal derecha &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel izquierdo&#41;&#44; confirmada con la TC contrastada y efectu&#225;ndose suprarrenalectom&#237;a&#46; Actualmente en seguimiento 5<span class="elsevierStyleHsp" style=""></span>a&#241;os despu&#233;s del &#250;ltimo proceder&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">El t&#233;rmino oligomet&#225;stasis&#44; propuesto por Hellman y Wechselbaum en 1995 y revisado por Niibe et al&#46; 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Carta al Director
Oligorrecurrencia a partir de un adenocarcinoma del pulmón. Utilidad de la resección
Oligo-Recurrence From a Lung Adenocarcinoma. Usefulness of Resection
Miguel Emilio García Rodrígueza,
Corresponding author
grmiguel@finlay.cmw.sld.cu

Autor para correspondencia.
, Bárbaro Agustín Armas Pérezb, Karina Armas Moredoc
a Facultad de Medicina, Universidad de Ciencias Médicas Carlos J. Finlay, Camagüey, Cuba
b Departamento de Cirugía General, Hospital Universitario Amalia Simoni Argilagos, Camagüey, Cuba
c Departamento de Neumología, Hospital Universitario Amalia Simoni Argilagos, Camagüey, Cuba
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">En el c&#225;ncer pulmonar &#40;CP&#41;&#44; la variedad no microc&#237;tica ocupa el 80-85&#37; y el adenocarcinoma es su tipo histol&#243;gico m&#225;s frecuente<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; El pron&#243;stico ominoso de la enfermedad est&#225; dado por una escasa supervivencia y elevada recurrencia<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Sometemos a su consideraci&#243;n un enfermo&#44; el cual en la historia de su enfermedad present&#243; oligorrecurrencias que fueron tratadas con cirug&#237;a&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Se trata de un hombre de 42 a&#241;os&#44; fumador&#44; estudiado por sombra pulmonar en una radiograf&#237;a de t&#243;rax eventual&#46; La tomograf&#237;a computarizada &#40;TC&#41; mostr&#243; radiodensidad central de 4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>2<span class="elsevierStyleHsp" style=""></span>cm en el l&#243;bulo superior del pulm&#243;n izquierdo&#44; sin adenomegalias&#46; La fibrobroncoscopia y la citolog&#237;a por aspiraci&#243;n facilitaron el diagn&#243;stico de CP de tipo epitelial&#44; confirmado en la biopsia por congelaci&#243;n durante la toracotom&#237;a que se complement&#243; con lobectom&#237;a superior izquierda y linfoadenectom&#237;a mediastinal &#40;estaciones 5&#44; 6&#44; 7 y 10&#41;&#46; El resultado histopatol&#243;gico postoperatorio fue&#58; adenocarcinoma pobremente diferenciado&#44; invasivo&#44; predominantemente s&#243;lido con producci&#243;n de mucina sin rasgos de sobreexpresi&#243;n o mutaci&#243;n del receptor del factor de crecimiento epid&#233;rmico con 2 de los ganglios de la ventana aortopulmonar metast&#225;sicos&#46; Se complement&#243; con quimiorradioterapia secuencial&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A los 9<span class="elsevierStyleHsp" style=""></span>meses comenz&#243; con trastornos visuales y v&#233;rtigos&#44; realiz&#225;ndose resonancia magn&#233;tica nuclear con contraste del cr&#225;neo&#44; encontr&#225;ndose lesi&#243;n tumoral &#250;nica en el l&#243;bulo temporal izquierdo &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel derecho&#41; a la que se le realiz&#243; metastasectom&#237;a con radioterapia como adyuvancia&#46; Cinco meses despu&#233;s se detecta en un ultrasonido abdominal tumoraci&#243;n de la gl&#225;ndula suprarrenal derecha &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#44; panel izquierdo&#41;&#44; confirmada con la TC contrastada y efectu&#225;ndose suprarrenalectom&#237;a&#46; Actualmente en seguimiento 5<span class="elsevierStyleHsp" style=""></span>a&#241;os despu&#233;s del &#250;ltimo proceder&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">El t&#233;rmino oligomet&#225;stasis&#44; propuesto por Hellman y Wechselbaum en 1995 y revisado por Niibe et al&#46; en 2006 como oligorrecurrencia<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a>&#44; son etapas del CP donde las met&#225;stasis o recurrencias &#40;entre 1 y 5<span class="elsevierStyleHsp" style=""></span>lesiones&#41; pueden ser tratadas con terapias locales&#46; Las diferencias estriban en el control del tumor primario y su forma de aparici&#243;n&#59; en la oligorrecurrencia existe control del tumor primario y aparece de forma metacr&#243;nica&#44; mientras que en la oligomet&#225;stasis sucede lo contrario&#46; Resumiendo&#44; la oligorrecurrencia es un estado oligometast&#225;sico de tipo metacr&#243;nico con control del tumor primario<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La tomograf&#237;a con emisi&#243;n de positrones ha disminuido el diagn&#243;stico de oligorrecurrencias&#44; pues muchas de ellas son metast&#225;sicas al diagn&#243;stico inicial&#46; Sin embargo&#44; a pesar de ser parte de los protocolos diagn&#243;sticos&#44; no est&#225; disponible en algunos pa&#237;ses&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">El control del tumor primario&#44; el estado nutricional&#44; el tipo histol&#243;gico y el n&#250;mero de met&#225;stasis&#44; entre otros factores&#44; influyen en el tratamiento de la oligorrecurrencia<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a>&#46; Sin embargo&#44; la presencia o no de afectaci&#243;n ganglionar metast&#225;sica es un factor determinante para la supervivencia &#40;0-35&#37;&#41;<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;5</span></a>&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">A la luz de los avances tecnol&#243;gicos actuales y la aplicaci&#243;n de terapias locales y sist&#233;micas&#44; la cirug&#237;a<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#8211;5</span></a> es v&#225;lida para algunos pacientes con oligorrecurrencias&#46; 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Article information
ISSN: 03002896
Original language: Spanish
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