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Patología Revista Latinoamericana

2011, Número S1

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Patol Rev Latinoam 2011; 49 (S1)


Linfoma primario bilateral de adrenales: reporte de caso y revisión de criterios inmunohistoquímicos

Sierra AJA, Núñez PHL, Bonilla TLJ, Puentes MCA, García AE

Idioma: Español
Referencias bibliográficas: 44
Paginas: s18-s25
Archivo PDF: 536.50 Kb.


RESUMEN

El linfoma adrenal bilateral es una afección clínico-patológica linfoproliferativa extranodal rara, con menos de 100 casos reportados, que se correlaciona con un pronóstico malo. La insuficiencia suprarrenal es un hallazgo frecuente, se establece de acuerdo con el grado de infiltración. Los criterios inmunohistoquímicos son importantes para develar el adecuado diagnóstico, pronóstico y manejo terapéutico. Se comunica el caso de una paciente de 74 años de edad, con antecedente de diabetes mellitus tipo 2, enfermedad neurodegenerativa e hipertensión arterial, quien consultó al servicio de urgencias por síncope. Desarrolló un cuadro neumónico nosocomial, encefalopatía metabólica, insuficiencia multisistémica y falleció. En la autopsia médico-científica se encontraron: masas adrenales bilaterales aumentadas de tamaño y peso, edema generalizado, microtrombos en la circulación sistémica e infartos hipóxicos-isquémicos difusamente distribuidos en el encéfalo. Se realizaron ensayos de inmunohistoquímica con los marcadores CD3, CD10, CD20, MUM-1, Bcl-2, Bcl-6, Ki67 y ciclina D1, que revelaron un linfoma no Hodgkin B difuso de célula grande con un fenotipo centrogerminal, una tasa de proliferación de 40% y microtrombos tumorales multiorgánicos distribuidos sistémicamente. El linfoma B difuso de célula grande afecta frecuentemente órganos del sistema retículo endotelial y la médula ósea, hallazgos ausentes en este caso, al igual que los criterios clínicos de insuficiencia suprarrenal a pesar del amplio daño del órgano. Los hallazgos difieren de los de trabajos anteriores en los cuales se ha reportado una elevada frecuencia de los fenotipos no centrogerminales. Se ratifica el uso de ocho marcadores inmunohistoquímicos para la orientación clínico-terapéutica y aproximación al pronóstico en los casos de linfoma extranodal.


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