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Metástasis de melanoma maligno en forma de nódulos no sólidos: diagnóstico mediante biopsia pulmonar percutánea
Malignant melanoma metastasis in the form of non-solid nodules: Diagnosis by percutaneous lung biopsy
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=> "<span class="elsevierStyleTextfn">Imagen clínica</span>" "titulo" => "Metástasis de melanoma maligno en forma de nódulos no sólidos: diagnóstico mediante biopsia pulmonar percutánea" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "433" "paginaFinal" => "434" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Ivan Vollmer, José Ramírez, Marcelo Sánchez" "autores" => array:3 [ 0 => array:4 [ "nombre" => "Ivan" "apellidos" => "Vollmer" "email" => array:1 [ 0 => "vollmer@clinic.ub.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "José" "apellidos" => "Ramírez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 2 => array:3 [ "nombre" => 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true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 725 "Ancho" => 1500 "Tamanyo" => 297357 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen de TC (A) que muestra múltiples nódulos no sólidos (flechas) en el pulmón derecho. Enmarcado por una circunferencia, puede observarse el nódulo no sólido que se biopsió. Imágenes microscópicas a ×250 de la biopsia pulmonar (B y C) en las que se observa infiltración de células neoplásicas por el intersticio en la tinción de hematoxilina-eosina (B), y se aprecia la diferenciación melanocítica mediante positividad para proteína S-100 (C).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Se trata de una paciente de 20 años diagnosticada de un melanoma maligno de localización preesternal (clasificación de Clark III y Breslow: 3,56), tratada mediante biopsia excisional, y posterior ampliación de márgenes con detección de ganglio centinela.</p><p id="par0010" class="elsevierStylePara elsevierViewall">La paciente siguió controles mediante tomografía computarizada (TC), que evidenció, 15 meses después de la cirugía, múltiples nódulos no sólidos en ambos pulmones. Se recomendó control mediante TC torácica en 3 meses, que demostró la persistencia de las lesiones nodulares que, incluso, mostraban crecimiento de tamaño y de densidad (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>A). Dada la sospecha clínica de enfermedad metastásica pulmonar, se realizó biopsia percutánea guiada por TC que confirmó el diagnóstico.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Si bien la mayoría de nódulos no sólidos persistentes corresponden a lesiones del espectro del adenocarcinoma pulmonar, dentro del diagnóstico diferencial deben incluirse las metástasis de neoplasias gastrointestinales, melanoma y carcinoma renal.</p><p id="par0020" class="elsevierStylePara elsevierViewall">En la literatura existen tan solo 2 casos reportados de metástasis pulmonares de melanoma en forma de nódulos no sólidos, que precisaron biopsia quirúrgica para su confirmación<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>. En nuestro caso, la biopsia percutánea demostró el típico crecimiento de las células de melanoma infiltrando los septos alveolares y preservando los espacios aéreos (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>B y C), que confiere el aspecto de nódulo no sólido en la TC.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figura 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 725 "Ancho" => 1500 "Tamanyo" => 297357 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Imagen de TC (A) que muestra múltiples nódulos no sólidos (flechas) en el pulmón derecho. Enmarcado por una circunferencia, puede observarse el nódulo no sólido que se biopsió. Imágenes microscópicas a ×250 de la biopsia pulmonar (B y C) en las que se observa infiltración de células neoplásicas por el intersticio en la tinción de hematoxilina-eosina (B), y se aprecia la diferenciación melanocítica mediante positividad para proteína S-100 (C).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Multiple ground-glass opacity in metastasis of malignant melanoma diagnosed by lung biopsy" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Okita" 1 => "M. Yamashita" 2 => "M. Nakata" 3 => "N. Teramoto" 4 => "A. Bessho" 5 => "H. Mogami" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2003.12.104" "Revista" => array:4 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2005" "volumen" => "79" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/15854988" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ground-glass nodules found in two patients with malignant melanomas: Different growth rate and different histology" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "M.J. Kang" 1 => "M.A. Kim" 2 => "C.M. Park" 3 => "C.H. Lee" 4 => "J.M. Goo" 5 => "H.J. Lee" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.clinimag.2009.10.036" "Revista" => array:6 [ "tituloSerie" => "Clin Imaging" "fecha" => "2010" "volumen" => "34" "paginaInicial" => "396" "paginaFinal" => "399" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20813308" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005200000008/v1_201607230338/S030028961500304X/v1_201607230338/es/main.assets" "Apartado" => array:4 [ "identificador" => "45361" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Imagen clínica" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005200000008/v1_201607230338/S030028961500304X/v1_201607230338/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S030028961500304X?idApp=UINPBA00003Z" ]
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