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Carcinoma epidermoide de pared torácica en una toracostomía abierta
Squamous Cell Carcinoma of the Chest Wall in Open Thoracostomy
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(24). As the immune response is less effective due to HIV-infection, energy or dysfunctional responses (e.g. Th2 or neutrophil response) immune control of the pathogen is less effective, and TB bacilli are more easily detected by microbiologic diagnostics. As a more effective Th1immune response occurs, less viable TB bacilli exist and diagnosis by traditional techniques becomes more challenging. In the extreme, such as in paradoxical immune reconstitution inflammatory syndrome, immunopathology can occur in the absence of viable or detectable organisms. Mortality is highest in those with the most attenuated or exuberant inflammatory responses.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Emilio Letang, Jayne Ellis, Kogieleum Naidoo, Esther C. Casas, Paquita Sánchez, Razia Hassan-Moosa, Fiona Cresswell, Jose M. Miró, Alberto L. 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B) Gran crecimiento del tumor que ya ocupa todo el orificio días después. C y D) Cortes axiales de la TAC donde se aprecia la toracostomía y el tumor.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Varón de 56 años que consultó por la aparición de una masa en el orificio de una toracostomía abierta permanente secundaria a un empiema tuberculoso desde hacía 15 años. El paciente presentaba un síndrome general muy marcado y una caquexia importante. En la exploración física se apreciaba dicha masa en el orificio de la toracostomía (<a class="elsevierStyleCrossRef" href="#fig0005">fig. 1</a>). En la TAC torácica se objetivó una gran tumoración heterogénea extrapulmonar de 13<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>7<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>cm. La biopsia con aguja gruesa confirmó que se trataba de un carcinoma escamoso infiltrante bien diferenciado.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">El tumor presentó un crecimiento muy rápido y agresivo ocupando todo el orificio de la toracostomía en apenas unos días. El paciente presentó graves complicaciones y un dolor difícil de controlar que le condujeron a un mayor deterioro clínico, precisando cada vez más medidas paliativas hasta que finalmente falleció.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Los tumores de pared torácica sobre una toracostomía son extremadamente infrecuentes. Apenas hay descritos casos en la literatura<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>. En todos habían transcurrido años desde la cirugía hasta la aparición de la lesión<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a>, de ahí la importancia del seguimiento a los pacientes portadores de toracostomías. Suelen ser de estirpe escamosa<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">1,2</span></a> y difícilmente tratables por el inusual escenario en el que se desarrollan.</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" => 1000 "Ancho" => 1148 "Tamanyo" => 169841 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A) Tumoración que aflora por el orificio de la toracostomía abierta permanente. B) Gran crecimiento del tumor que ya ocupa todo el orificio días después. C y D) Cortes axiales de la TAC donde se aprecia la toracostomía y el tumor.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "Bibliografía" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:2 [ 0 => array:3 [ "identificador" => "bib0015" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Treatment of Invasive Squamous Cell Carcinomas in an Open Clagett Window" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "N. Atanaskova Mesinkovska" 1 => "R.Z. Conic" 2 => "E.A. Kiracofe" 3 => "A.T. Vidimos" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/DSS. 0000000000000236" "Revista" => array:6 [ "tituloSerie" => "Dermatol Surg" "fecha" => "2015" "volumen" => "41" "paginaInicial" => "170" "paginaFinal" => "172" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/25551329" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0020" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Tumor recurrence in an open window thoracostomy space" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "L. Alpay" 1 => "T. Lacin" 2 => "A.K. Misirlioglu" 3 => "I. Yalcinkaya" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.ejcts.2011.01.026" "Revista" => array:5 [ "tituloSerie" => "Eur J Cardiothorac Surg" "fecha" => "2011" "volumen" => "40" "paginaInicial" => "527" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21345695" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "es" "url" => "/03002896/0000005600000007/v2_202007230732/S0300289619302820/v2_202007230732/es/main.assets" "Apartado" => array:4 [ "identificador" => "21422" "tipo" => "SECCION" "es" => array:2 [ "titulo" => "Clinical Images / Imágenes clínicas" "idiomaDefecto" => true ] "idiomaDefecto" => "es" ] "PDF" => "https://static.elsevier.es/multimedia/03002896/0000005600000007/v2_202007230732/S0300289619302820/v2_202007230732/es/main.pdf?idApp=UINPBA00003Z&text.app=https://archbronconeumol.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0300289619302820?idApp=UINPBA00003Z" ]
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