Transformación anaplásica tard ía de bocio multinodular

• Main Author: Lidia Martínez Ramos
• Format: Article
• Language: English
• Published: Universidad de Ciencias Médicas de La Habana 2012-03-01
• Series: Revista Habanera de Ciencias Médicas
• Online Access: http://www.revhabanera.sld.cu/index.php/rhab/article/view/1953

<div style="left: 138.222px; top: 759.163px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.42509);" data-canvas-width="123.98259507745033">Introducción:</div><div style="left: 262.212px; top: 759.163px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.16852);" data-canvas-width="229.02993883942068">el Cáncer tiroideo se caract</div><div style="left: 490.99px; top: 759.163px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18867);" data-canvas-width="235.35579738584045">eriza por su baja incidencia,</div><div style="left: 138.222px; top: 778.951px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.20303);" data-canvas-width="342.8644633614462">comportamiento maligno infrecuente y ba</div><div style="left: 480.949px; top: 778.951px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.20253);" data-canvas-width="285.0006013205201">ja mortalidad. La mayoría de ellos</div><div style="left: 138.222px; top: 798.642px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17382);" data-canvas-width="336.8853386982964">procede de bocios multinodulares de larg</div><div style="left: 474.905px; top: 798.642px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.21255);" data-canvas-width="340.72545715197737">a duración por lo que es muy importante</div><div style="left: 138.222px; top: 818.43px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.21156);" data-canvas-width="325.9103159705655">tener en cuenta factores que constituye</div><div style="left: 463.891px; top: 818.43px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17851);" data-canvas-width="321.73323078525596">n riesgos potenciales como: tiempo de</div><div style="left: 138.222px; top: 838.121px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19187);" data-canvas-width="362.3271408655622">establecimiento de la enfermedad, tamaño,</div><div style="left: 500.347px; top: 838.121px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.1759);" data-canvas-width="330.42762360471755">así como las características particulares</div><div style="left: 138.222px; top: 857.909px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19643);" data-canvas-width="349.35636348577003">personales y la evolución de la entidad en</div><div style="left: 487.187px; top: 857.909px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18312);" data-canvas-width="338.37320146500446">cada caso. Si tenemos en cuenta el gran</div><div style="left: 138.222px; top: 877.697px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17095);" data-canvas-width="244.72900724438023">avance tecnológico que consti</div><div style="left: 382.791px; top: 877.697px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17144);" data-canvas-width="443.9740171533216">tuye la Biopsia Aspirativa con Aguja Fina (BAAF), que</div><div style="left: 138.222px; top: 897.388px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.21502);" data-canvas-width="343.84931781862156">nos permite no solamente evitar su transf</div><div style="left: 481.925px; top: 897.388px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.15482);" data-canvas-width="172.0679104667182">ormación neoplásica</div><div style="left: 653.874px; top: 897.388px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19772);" data-canvas-width="150.9122600114243">maligna, sino que</div><div style="left: 138.223px; top: 917.176px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18732);" data-canvas-width="344.32139681462326">también podemos prolongar la vida con la</div><div style="left: 482.315px; top: 917.176px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.1884);" data-canvas-width="325.620557138537">calidad que humanamente se requiere</div><div style="left: 138.223px; top: 936.867px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18641);" data-canvas-width="546.9328183226369">que es en definitiva la meta principal de la Salud Pública Cubana.</div><div style="left: 138.223px; top: 956.655px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.37469);" data-canvas-width="83.85588041732468">Objetivo:</div><div style="left: 221.956px; top: 956.655px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17898);" data-canvas-width="581.2350548872686">destacar la importancia del adecuado seguimiento evolutivo del Bocio</div><div style="left: 138.223px; top: 976.345px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.20286);" data-canvas-width="661.5747607136855">multinodular como elemento significativo en la prevención de su transformación</div><div style="left: 138.223px; top: 996.134px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.2259);" data-canvas-width="82.13523386982965">maligna.</div><div style="left: 138.223px; top: 1015.82px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.29401);" data-canvas-width="210.92326755485365">Presentación del caso:</div><div style="left: 349.163px; top: 1015.82px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17806);" data-canvas-width="460.62049926749773">paciente femenina de 80 años de edad con aumento de</div><div style="left: 138.223px; top: 1035.61px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.21249);" data-canvas-width="331.0103969859883">volumen de la región anterior del cuello</div><div style="left: 469.156px; top: 1035.61px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18759);" data-canvas-width="180.5132409193239">y antecedentes patoló</div><div style="left: 649.584px; top: 1035.61px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.14621);" data-canvas-width="166.20110804744462">gicos personales de</div><div style="left: 138.222px; top: 1055.4px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19649);" data-canvas-width="635.3353078290377">Bocio Multinodular (BMN) con tratamiento inconstante e irregular de años de</div><div style="left: 138.222px; top: 1075.09px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.20023);" data-canvas-width="369.6720388999025">evolución, quien no solamente pudo haber m</div><div style="left: 507.755px; top: 1075.09px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.16576);" data-canvas-width="170.200756644602">ejorado la calidad de</div><div style="left: 677.754px; top: 1075.09px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.20512);" data-canvas-width="144.61407506132184">su vida sino que</div><div style="left: 138.222px; top: 1094.88px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19513);" data-canvas-width="339.4166588320286">no la hubiera truncado, considerando las</div><div style="left: 477.44px; top: 1094.88px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18796);" data-canvas-width="321.9383409697255">condiciones atenuantes en la forma de</div><div style="left: 138.222px; top: 1114.57px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18555);" data-canvas-width="248.9646953395383">presentación que tuvo su caso</div><div style="left: 386.981px; top: 1114.57px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.21124);" data-canvas-width="439.68135400692194">. Al examen físico: Aumento de la región anterior del</div><div style="left: 138.222px; top: 1134.36px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18371);" data-canvas-width="662.8786754578138">cuello, palpándose masa de superficie irregular, consistencia firme, dolorosa, de</div><div style="left: 138.222px; top: 1154.05px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19873);" data-canvas-width="368.0116231208628">aproximadamente 6x5 cm que había aument</div><div style="left: 506.098px; top: 1154.05px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18416);" data-canvas-width="314.9857568596485">ado considerablemente en los últimos</div><div style="left: 138.222px; top: 1173.84px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.16499);" data-canvas-width="356.48638418399906">meses sin fecha precisada. La paciente fue</div><div style="left: 494.4px; top: 1173.84px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17704);" data-canvas-width="340.1638459325962">ingresada por el gran agobio respiratorio</div><div style="left: 138.222px; top: 1193.53px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19159);" data-canvas-width="344.36860471422324">y la toma del estado general, pudiéndose</div><div style="left: 482.314px; top: 1193.53px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.1771);" data-canvas-width="337.82786883169246">realizar únicamente la Biopsia Aspirativa</div><div style="left: 138.222px; top: 1213.32px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17052);" data-canvas-width="599.3059132824837">con Aguja Fina (BAAF). Desde su ingreso presenta evolución tórpida con<div style="left: 138.222px; top: 115.038px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18951);" data-canvas-width="681.5876544269345">incremento del compromiso respiratorio requiriendo la práctica de la traqueotomía</div><div style="left: 138.222px; top: 134.729px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17197);" data-canvas-width="351.59141335304594">que sólo ayuda como medida de soporte al</div><div style="left: 489.624px; top: 134.729px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.1897);" data-canvas-width="312.892330691173">estadio terminal de esta enfermedad</div><div style="left: 138.222px; top: 154.517px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.16152);" data-canvas-width="261.34293218641847">neoplásica maligna. (Carcinoma</div><div style="left: 399.459px; top: 154.517px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17334);" data-canvas-width="432.9631815362386">Anaplásico del Tiroides). A pesar de ello la paciente</div><div style="left: 138.222px; top: 174.305px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.1982);" data-canvas-width="378.6301448136822">fallece y los familiares autorizan la necropsia.</div><div style="left: 138.222px; top: 193.996px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.27086);" data-canvas-width="119.46040386747755">Conclusiones</div><div style="left: 257.728px; top: 193.996px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19014);" data-canvas-width="293.9652186687275">: los BMN deben tener seguimiento</div><div style="left: 551.522px; top: 193.996px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.20349);" data-canvas-width="255.13916303551628">evolutivo que permita precisar</div><div style="left: 138.222px; top: 213.784px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19457);" data-canvas-width="332.0896672423641">una tiroidectomía a tiempo como preven</div><div style="left: 470.227px; top: 213.784px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17061);" data-canvas-width="294.9940253082893">ción en enfermedades benignas del</div><div style="left: 138.222px; top: 233.474px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17791);" data-canvas-width="664.3404924868115">Tiroides, por los cambios malignos que pueden producirse cuando la glándula es</div><div style="left: 138.222px; top: 253.263px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18882);" data-canvas-width="351.89093933671575">irradiada. La tiroidectomía a tiempo permit</div><div style="left: 489.917px; top: 253.263px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.21049);" data-canvas-width="332.88406224253225">e evitar no solamente la transformación</div><div style="left: 138.222px; top: 272.953px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18689);" data-canvas-width="671.778178461745">maligna que puede producirse, sino también previene las metástasis que ocurren</div><div style="left: 138.222px; top: 292.741px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.15212);" data-canvas-width="253.4657243876213">en los Carcinoma Anaplásicos.</div><div style="left: 138.222px; top: 335.237px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.2978);" data-canvas-width="144.05571955915457">Palabras clave:</div><div style="left: 282.292px; top: 335.237px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.18855);" data-canvas-width="267.4229840831961">bocio multinodular (BMN), calida</div><div style="left: 549.767px; top: 335.237px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.16908);" data-canvas-width="267.71925434965226">d de vida, carcinoma anaplásico</div><div style="left: 138.222px; top: 354.928px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.16768);" data-canvas-width="291.92062825845903">del tiroides (CAT), necropsia, biopsi</div><div style="left: 430.066px; top: 354.928px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.17708);" data-canvas-width="155.37422045294173">a aspirativa con ag</div><div style="left: 585.248px; top: 354.928px; font-size: 16.2786px; font-family: sans-serif; transform: scaleX(1.19705);" data-canvas-width="136.4633870165653">uja fina (BAAF).</div></div>