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una TC toraco-abdominal&#44; apreci&#225;ndose una masa de partes blandas a nivel pleural posterior y en pleura diafragm&#225;tica izquierda de 7&#44;4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&#44;2<span class="elsevierStyleHsp" style=""></span>cm&#44; que se continuaba por la pared costal y por los planos musculares de la pared posterior abdominal izquierda&#44; con infiltraci&#243;n de todos los planos y del tejido celular subcut&#225;neo&#44; acompa&#241;&#225;ndose de un derrame pleural ipsilateral significativo&#46; A nivel abdominal destacaban adenopat&#237;as significativas cavo-portales y retroperitoneales&#46; Dado estos hallazgos se realiz&#243; una biopsia de la lesi&#243;n guiada por TC&#44; con resultado compatible con linfoma no-Hodgkin B difuso de c&#233;lulas grandes&#44; con nivel de proliferaci&#243;n del 70&#37;&#44; sin positividad para VEB ni para <span class="elsevierStyleItalic">c-myc</span>&#46; La biopsia de m&#233;dula &#243;sea fue normocelular y las serolog&#237;as para VIH&#44; VHB&#44; VHC y CMV resultaron negativas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; se realiz&#243; una tomograf&#237;a por emisi&#243;n de positrones &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; visualiz&#225;ndose un extenso foco hipermetab&#243;lico&#44; correspondiente a la masa pleural izquierda&#44; con un SUVm&#225;x de 10&#44;3&#44; compatible con lesi&#243;n neopl&#225;sica primaria&#46; Adem&#225;s&#44; se observaban adenopat&#237;as axilares izquierdas y abdominales en hilio hep&#225;tico&#44; retropancre&#225;ticas y paraa&#243;rticas sugestivas de infiltraci&#243;n tumoral&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tras el diagn&#243;stico de linfoma B difuso de c&#233;lulas grandes&#44; estadio <span class="elsevierStyleSmallCaps">IV</span> AX&#44; IPI 4&#44; se inici&#243; tratamiento quimioter&#225;pico con rituximab&#44; 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Carta científica
Linfoma pulmonar: a propósito de un caso
Pulmonary Lymphoma. A Case Report
María del Carmen Vera Sanchez
Corresponding author
maricarmenvera46@gmail.com

Autor para correspondencia.
, María del Carmen Fernández Aguirre, María Victoria Hidalgo Sanjuan
Servicio de Neumología, Hospital Universitario Virgen de la Victoria, Málaga, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Presentamos el caso de una mujer de 78 a&#241;os&#44; sin h&#225;bitos t&#243;xicos&#44; con antecedentes de hipertensi&#243;n arterial&#44; diabetes mellitus&#44; dislipemia y fibrilaci&#243;n auricular&#44; que consultaba por dolor tor&#225;cico izquierdo&#44; de un mes de evoluci&#243;n&#44; refractario al tratamiento analg&#233;sico habitual&#46; En la exploraci&#243;n f&#237;sica presentaba una hipoventilaci&#243;n en la mitad inferior del hemit&#243;rax izquierdo&#46; En la radiograf&#237;a de t&#243;rax se visualizaba un moderado derrame pleural izquierdo y&#44; en la anal&#237;tica sangu&#237;nea&#44; destacaban valores elevados de LDH y d&#237;mero D&#46; Se practic&#243; una toracocentesis diagn&#243;stica&#44; extray&#233;ndose l&#237;quido pleural compatible con exudado de predominio mononuclear con LDH alta y ADA normal&#46; La citolog&#237;a del l&#237;quido pleural fue negativa&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Para continuar el estudio se realiz&#243; una TC toraco-abdominal&#44; apreci&#225;ndose una masa de partes blandas a nivel pleural posterior y en pleura diafragm&#225;tica izquierda de 7&#44;4<span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>8&#44;2<span class="elsevierStyleHsp" style=""></span>cm&#44; que se continuaba por la pared costal y por los planos musculares de la pared posterior abdominal izquierda&#44; con infiltraci&#243;n de todos los planos y del tejido celular subcut&#225;neo&#44; acompa&#241;&#225;ndose de un derrame pleural ipsilateral significativo&#46; A nivel abdominal destacaban adenopat&#237;as significativas cavo-portales y retroperitoneales&#46; Dado estos hallazgos se realiz&#243; una biopsia de la lesi&#243;n guiada por TC&#44; con resultado compatible con linfoma no-Hodgkin B difuso de c&#233;lulas grandes&#44; con nivel de proliferaci&#243;n del 70&#37;&#44; sin positividad para VEB ni para <span class="elsevierStyleItalic">c-myc</span>&#46; La biopsia de m&#233;dula &#243;sea fue normocelular y las serolog&#237;as para VIH&#44; VHB&#44; VHC y CMV resultaron negativas&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">Por &#250;ltimo&#44; se realiz&#243; una tomograf&#237;a por emisi&#243;n de positrones &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#44; visualiz&#225;ndose un extenso foco hipermetab&#243;lico&#44; correspondiente a la masa pleural izquierda&#44; con un SUVm&#225;x de 10&#44;3&#44; compatible con lesi&#243;n neopl&#225;sica primaria&#46; Adem&#225;s&#44; se observaban adenopat&#237;as axilares izquierdas y abdominales en hilio hep&#225;tico&#44; retropancre&#225;ticas y paraa&#243;rticas sugestivas de infiltraci&#243;n tumoral&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">Tras el diagn&#243;stico de linfoma B difuso de c&#233;lulas grandes&#44; estadio <span class="elsevierStyleSmallCaps">IV</span> AX&#44; IPI 4&#44; se inici&#243; tratamiento quimioter&#225;pico con rituximab&#44; ciclofosfamida&#44; vincristina y prednisona &#40;R-CVP&#41;&#44; previa prevenci&#243;n de lisis tumoral&#46; En la TC de control&#44; tras 4 ciclos de quimioterapia&#44; se aprecia una reducci&#243;n significativa de la lesi&#243;n&#44; quedando un discreto aumento de los planos blandos musculares residual&#44; y un discreto derrame pleural&#44; sin observarse adenopat&#237;as patol&#243;gicas ni engrosamientos pleurales&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">El linfoma pleural primario &#40;LPP&#41; es una entidad poco frecuente &#40;aproximadamente el 7&#37; de los linfomas&#41;&#46; Usualmente afecta a pacientes con VIH o piot&#243;rax cr&#243;nico&#46; El LPP en inmunocompetentes&#44; sin estos antecedentes&#44; es excepcional<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">1</span></a>&#46; La cl&#237;nica predominante es dolor tor&#225;cico y disnea&#44; si se acompa&#241;a de derrame pleural significativo&#46; Radiol&#243;gicamente se presenta como un engrosamiento pleural nodular difuso&#44; acompa&#241;ado de masa pleural&#46; En otras ocasiones&#44; puede aparecer un derrame pleural aislado previo al desarrollo de la masa pleural<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a>&#46; Para el diagn&#243;stico se recomienda realizar una biopsia pleural guiada por ecograf&#237;a o TC&#44; o mediante videotoracoscopia<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">2</span></a>&#46; En cuanto a la histolog&#237;a&#44; cualquier tipo de linfoma puede estar implicado&#46; El que se ha descrito con mayor frecuencia es el linfoma de c&#233;lulas B de c&#233;lulas grandes&#44; seguido del linfoma folicular&#44; con tasas del 60 y 20&#37;&#44; respectivamente<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">3</span></a>&#46; El tratamiento requiere quimioterapia sist&#233;mica basada en combinaciones que incluyen ciclofosfamida&#44; doxorrubicina&#44; vincristina y prednisona&#46;</p></span>"
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ISSN: 03002896
Original language: Spanish
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