{"id":47176,"date":"2017-11-21T11:30:27","date_gmt":"2017-11-21T10:30:27","guid":{"rendered":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/?p=47176"},"modified":"2017-12-10T20:32:30","modified_gmt":"2017-12-10T19:32:30","slug":"diagnostico-tardio-carcinoma-de-cavum","status":"publish","type":"post","link":"https:\/\/www.revista-portalesmedicos.com\/revista-medica\/diagnostico-tardio-carcinoma-de-cavum\/","title":{"rendered":"Diagn\u00f3stico tard\u00edo de carcinoma de cavum"},"content":{"rendered":"

Diagn\u00f3stico tard\u00edo de carcinoma de cavum <\/strong><\/h2>\n

Caso cl\u00ednico:<\/strong><\/p>\n

Paciente hombre de 61 a\u00f1os, visto en consultas de Atenci\u00f3n Primaria y de SUAP, hasta en 8 ocasiones, de Octubre de 2016 hasta enero de 2017, por cuadro de congesti\u00f3n nasal, otalgia izquierda, Hipoacusia izquierda y mucosidad oral.<\/p>\n

<\/p>\n

AUTORES:<\/strong><\/p>\n

Dr. Jos\u00e9 Manuel Guti\u00e9rrez Pell\u00f3n. M\u00e9dico de familia. Cantabria.<\/p>\n

Dra. M\u00aa \u00c1ngeles Pereda. M\u00e9dico de Familia. Cantabria.<\/p>\n

Dra. M\u00aa Victoria Viota Gonz\u00e1lez. M\u00e9dico de Familia. Cantabria.<\/p>\n

Dra. Yolanda Garc\u00eda Zorrilla. M\u00e9dico de Familia. Cantabria.<\/p>\n

Dra. Ar\u00e1nzazu Rojo. M\u00e9dico de Familia. Cantabria.<\/p>\n

Dra. Patricia L\u00f3pez Tens. Residente Medicina familiar y comunitaria. Cantabria.<\/p>\n

Dra. Isabel Rodr\u00edguez Marcos. M\u00e9dico de familia. Cantabria.<\/p>\n

Gema Viota Gonz\u00e1lez. Diplomada Universitaria en Enfermer\u00eda. HUMV. Cantabria.<\/p>\n

Luz Mar\u00eda Cazorla Cuadrado. Diplomada Universitaria en Enfermer\u00eda. Atenci\u00f3n primaria. Cantabria<\/p>\n

Dra. Adelaida Marcos Mart\u00edn. M\u00e9dicos de Familia. Cantabria<\/p>\n

Palabras clave:<\/strong> Ototubaritis, Hipoacusia<\/p>\n

Tratado como otitis y tubaritis, con corticoides nasales, mucol\u00edticos y antibioterapia oral.<\/p>\n

En enero de 2017, tras episodio de fiebre y p\u00e9rdida de peso, se le deriva a Urgencias Hospitalarias. Se remite a ORL donde se le realiza una fibroscopia, diagnostic\u00e1ndose una masa en cavum.<\/p>\n

Posteriormente, visto en varias ocasiones por epistaxis en centro de salud y hospital.<\/p>\n

Antecedentes Personales: <\/strong><\/p>\n

No alergias farmacol\u00f3gicas, no factores de riesgo cardiovascular.<\/p>\n

Exfumador. Profesi\u00f3n: pintor<\/p>\n

Hipotiroidismo<\/p>\n

IQ: fimosis, hernioplastia umbilical<\/p>\n

Exploraci\u00f3n F\u00edsica: <\/strong><\/p>\n

Faringe roja con mucosidad, otoscopio normal, Auscultaci\u00f3n normal<\/p>\n

Resto anodino<\/p>\n

Otras Pruebas: <\/strong><\/p>\n

– Anal\u00edtica: Septiembre 2016: hemograma normal. Bioqu\u00edmica (glucosa, urea, TFG, PFH, Fe, Perfil lip\u00eddico, PSA): normal. TSH elevado.<\/p>\n

– Diciembre 2016: leucocitosis.<\/p>\n

– Fibroscopia: (Enero 2017): masa que asoma por detr\u00e1s del paladar.<\/p>\n

– Biopsia de Cavum: carcinoma de c\u00e9lulas escamosas, no queratinizante, indiferenciado.<\/p>\n

– TAC cervicotor\u00e1cico (febrero 2017): gran tumoraci\u00f3n nasofaringe 3’6 x6’1×6’2, que alcanza cranealmente suelo de seno esfenoidal, sin infiltraci\u00f3n del mismo, anterosuperiormente protruye a nivel de coanas y tercio posterior de fosas nasales, margen anteroinferior contacta con paladar blando, e inferiormente se insin\u00faa en orofaringe.<\/p>\n

Tumoraci\u00f3n no infiltra musculatura pterigoidea ni infiltra hueso.<\/p>\n

Numerosos ganglios no patol\u00f3gicos.<\/p>\n

Gl\u00e1ndulas par\u00f3tidas, submaxilares y tiroides normales.<\/p>\n

No adenopat\u00edas de aspecto patol\u00f3gico en cadenas axilares, hiliares ni mediast\u00ednicas.<\/p>\n

– RMN de regi\u00f3n craneocervical (febrero 2017): Masa de aspecto neoformativo a nivel de nasofaringe y cavum (30 x 64 x 56 mm). A la altura de C1 y clivus parece traspasar el espacio retrofar\u00edngeo e invadir espacio prevertebral, que sugiere infiltraci\u00f3n tumoral. Anteriormente infiltra paladar blando.<\/p>\n

Por restricci\u00f3n de la difusi\u00f3n no se puede descartar que exista diseminaci\u00f3n ganglionar laterocervical difusa.<\/p>\n

Impresi\u00f3n Diagn\u00f3stica<\/strong><\/p>\n

– Neoformaci\u00f3n de nasofaringe y cavum (30 x 64 x 56 mm), epidermoide cT4N0M0 con infiltraci\u00f3n prevertebral y clivus, mas m\u00faltiples ganglios laterocervicales no definitivos.<\/p>\n

– Actualmente en tratamiento con quimioterapia y radioterapia concomitante radical, m\u00e1s hierro intravenoso y batidos hiperproteicos.<\/p>\n

Comentario<\/strong><\/p>\n

– El carcinoma de cavum es infrecuente en Espa\u00f1a, Se caracteriza por dar una sintomatolog\u00eda enga\u00f1os e inespec\u00edfica por lo que se su diagn\u00f3stico se hace de forma tard\u00eda (tumor palpable en cuello, tubaritis, epistaxis, otalgia, hipoacusia).<\/p>\n

– 2 picos de incidencia 20 y 50 a\u00f1os, m\u00e1s frecuente en hombres.<\/p>\n

– Etiolog\u00eda multifactorial; VEB, factores gen\u00e9ticos, ambientales, tabaco…<\/p>\n

– AP: carcinoma epidermoide queratinizante 25 % de los casos<\/p>\n

Bibliograf\u00eda:<\/strong><\/p>\n

    \n
  1. Decker J, Goldstein JC: Risk factors in head and neck cancer. N Engl J Med 306 (19): 1151-5, 1982.\u00a0[PUBMED Abstract]<\/li>\n
  2. Chen L, Gallicchio L, Boyd-Lindsey K, et al.: Alcohol consumption and the risk of nasopharyngeal carcinoma: a systematic review. Nutr Cancer 61 (1): 1-15, 2009.\u00a0[PUBMED Abstract]<\/li>\n
  3. Feinmesser R, Miyazaki I, Cheung R, et al.: Diagnosis of nasopharyngeal carcinoma by DNA amplification of tissue obtained by fine-needle aspiration. N Engl J Med 326 (1): 17-21, 1992.\u00a0[PUBMED Abstract]<\/li>\n
  4. Cummings CW, Fredrickson JM, Harker LA, et al.: Otolaryngology – Head and Neck Surgery. Saint Louis, Mo: Mosby-Year Book, Inc., 1998.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"

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