Ecografía aplicada al manejo de tumores cutáneos benignos

$FWDV'HUPRVLÀOLRJU6XSO 

www.actasdermo.org

Ecografía aplicada al manejo de tumores cutáneos benignos R. Ruiz-Villaverdea,*, S. Arias-Santiagoa y J.B. Repiso-Jiménezb Unidad de Gestión Clínica (UGC) de Dermatología, Hospital Universitario Virgen de las Nieves, Granada, España

a

Área Integrada de Gestión (AIG) de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España

b

PALABRAS CLAVE (FRJUDItDFXWiQHD 'RSSOHUFRORU 7XPRUFXWiQHR EHQLJQR

Resumen /DHFRJUDItDFXWiQHDSUDFWLFDGDSRUGHUPDWyORJRVHVXQDWpFQLFDGLDJQyVWLFDHPHUJHQWHTXHSHUPLWHFRPSOHPHQWDUHOGLDJQyVWLFRFOtQLFRGHWXPRUHVEHQLJQRVGHODSLHODSRUWDQGRLQIRUPDFLyQLPSRUWDQWHVREUHODHVWUXFWXUDGHORVPLVPRVVXUHODFLyQFRQHVWUXFWXUDVYHFLQDV\HOJUDGRGHYDVFXODUL]DFLyQ8QRGHORVSULQFLSDOHVSXQWRVFODYHHQVXGHVDUUROORGHFDUDDO DERUGDMHGHHVWHWLSRGHWXPRUHVTXHVHFRPHQWDUiQGHIRUPDSRUPHQRUL]DGDHVXQDDGHFXDGDSODQLÀFDFLyQTXLU~UJLFDDVtFRPRODPRQLWRUL]DFLyQGHGHWHUPLQDGDVWpFQLFDVGHFLUXJtDPHQRUDPEXODWRULDGUHQDMHVRLQÀOWUDFLRQHV$VLPLVPRHVLPSRUWDQWHSRQHUHQYDORUODHFRJUDItD FXWiQHDHQHOGLDJQyVWLFRGHORVQyGXORVVXEFXWiQHRVVLQWUDGXFFLyQFOtQLFDGHUPRVFySLFD\VX GLDJQyVWLFRGLIHUHQFLDOFRQWXPRUHVPDOLJQRV ‹(OVHYLHU(VSDxD6/8\$('97RGRVORVGHUHFKRVUHVHUYDGRV

Ultrasound in the management of benign cutaneous tumours KEYWORDS &XWDQHRXVXOWUDVRXQG &RORXU'RSSOHU %HQLJQFXWDQHRXV WXPRXU

Abstract  &XWDQHRXVXOWUDVRXQGFDUULHGRXWE\GHUPDWRORJLVWVLVDQHPHUJLQJGLDJQRVWLFWHFKQLTXHWKDWFRPSOHPHQWVWKHFOLQLFDOGLDJQRVLVRIEHQLJQFXWDQHRXVWXPRXUVE\SURYLGLQJLPSRUWDQWLQIRUPDWLRQRQWKHLUVWUXFWXUHWKHLUUHODWLRQWRQHLJKERXULQJVWUXFWXUHVDQGWKHGHJUHHRI YDVFXODULVDWLRQ2QHRIWKHPDLQNH\SRLQWVLQWKHGHYHORSPHQWRIWKLVWHFKQLTXHIRUXVHLQFXWDQHRXVWXPRXUVZKLFKZLOOEHGLVFXVVHGLQGHWDLOLVDGHTXDWHVXUJLFDOSODQQLQJDQGPRQLWRULQJ RIVRPHPLQRUDPEXODWRU\VXUJHU\WHFKQLTXHVVXFKDVGUDLQDJHRULQÀOWUDWLRQV/LNHZLVHFXWDQHRXVXOWUDVRXQGLVDOVRXVHIXOLQWKHGLDJQRVLVRIVXEFXWDQHRXVQRGXOHVZLWKRXWFOLQLFDOGHUPRVFRSLFPDQLIHVWDWLRQVDQGLQWKHLUGLIIHUHQWLDOGLDJQRVLVZLWKPDOLJQDQWWXPRXUV ‹(OVHYLHU(VSDxD6/8DQG$('9$OOULJKWVUHVHUYHG

$XWRUSDUDFRUUHVSRQGHQFLD Correo electrónico: LVPHQLRV#KRWPDLOFRP 55XL]9LOODYHUGH  0001-7310/© 2015 Elsevier España, S.L.U. y AEDV. Todos los derechos reservados.



55XL]9LOODYHUGHHWDO

Introducción 'HVGHHOSXQWRGHYLVWDFOtQLFRORVWXPRUHVFXWiQHRVEHQLJQRVQRVXHOHQSODQWHDUSUREOHPDHQVXGLDJQyVWLFR1RREVWDQWHODLQWURGXFFLyQGHQXHYDVWpFQLFDVGLDJQyVWLFDVFRPR ODHFRJUDItDFXWiQHDHQPRGR%\HO'RSSOHUFRORUKDPHMRUDGRWDQWRODVHQVLELOLGDGFRPRODHVSHFLÀFLGDGGHOGLDJQyVWLFRLQFUHPHQWDQGRVXSUHFLVLyQHQKDVWDFDVLXQ(VXQD WpFQLFDTXHQRVD\XGDDVXPHMRUFDUDFWHUL]DFLyQORFDOL]DFLyQ\WDPDxR VXUHODFLyQFRQHVWUXFWXUDVDG\DFHQWHV JUDGRGHYDVFXODUL]DFLyQ\DGHFXDGDSODQLÀFDFLyQTXLU~UJLFDHQORVFDVRVGRQGHVHDSUHFLVR(VXQDWpFQLFDLQRFXDSDUD HOSDFLHQWH\SHUPLWHUHDOL]DUXQFXLGDGRVRGLDJQyVWLFRGLIHUHQFLDOHQFDVRVFOtQLFDPHQWHGXGRVRVSHUPLWLHQGRUHDOL]DUWpFQLFDVGHFLUXJtDPHQRUDPEXODWRULDFRPRELRSVLDV HFRJXLDGDVGUHQDMHVLQÀOWUDFLRQHV\H[WLUSDFLRQHVGHFXHUSRVH[WUDxRV$FRQWLQXDFLyQVHGHVFULEHQODVSULQFLSDOHV FDUDFWHUtVWLFDVHFRJUiÀFDV\VXFRUUHODFLyQFRQODFOtQLFDGH ORVWXPRUHVFXWiQHRVPiVIUHFXHQWHVHQODSUiFWLFDFOtQLFD GLDULD\VHKDFHHVSHFLDOKLQFDSLpHQHOGLDJQyVWLFRGHQyGXORVVXEFXWiQHRVGRQGHODFOtQLFD\ODGHUPRVFRSLDQR OOHJDQPiVDOOi

Tumores foliculares Quiste infundibular o epidérmico (OTXLVWHLQIXQGLEXODUHSLGpUPLFRRHSLGHUPRLGHHVXQDOHVLyQVXSHUÀFLDOQRUPDOPHQWHUHGRQGHDGDHQIRUPDGHF~SXODGHSRFRVPLOtPHWURVDYDULRVFHQWtPHWURVGHGLiPHWUR FXELHUWDSRUSLHOQRUPDOTXHVXHOHSUHVHQWDUXQSRURHQVX VXSHUÀFLH6HORFDOL]DSULQFLSDOPHQWHHQODFDUDFXHOOR\ SRUFLyQVXSHULRUGHOWURQFRDXQTXHWDPELpQVRQIUHFXHQWHV HQODELRVPD\RUHV\HVFURWRÀJ$ (QODHFRJUDItDFXWiQHD GHDOWDIUHFXHQFLDHQPRGR%SRGHPRVKDOODUHQODPD\RUtD GHODVRFDVLRQHVXQDLPDJHQUHGRQGHDGDELHQGHOLPLWDGD GHFRQWHQLGRDQHFRJpQLFRRKLSRHFRJpQLFRORFDOL]DGDHQ GHUPLVRWHMLGRFHOXODUVXEFXWiQHRÀJ% (OUDVJRPiV GLVWLQWLYRGHOTXLVWHHSLGpUPLFRHVODSUHVHQFLDGHXQWUD\HF-

A

WRGHUPRHSLGpUPLFRGHOFRQGXFWRGHVDOLGDGHQRPLQDGR punctum,TXHVHDSUHFLDFRPRXQWUD\HFWRKLSRHFRLFRTXH HVGLItFLOGHORFDOL]DU\TXHGHSHQGHUiGHODREOLFXLGDGFRQ ODTXHDSR\HPRVODVRQGDHQODOHVLyQ'RVGHODVFDUDFWHUtVWLFDVHFRJUiÀFDVPiVUHFRQRFLEOHVVRQODSUHVHQFLDGH UHIXHU]RSRVWHULRUDUWHIDFWRTXHHQPXFKDVOHVLRQHVVXEFXWiQHDVGHQRWDEHQLJQLGDG \VRPEUDVDF~VWLFDVODWHUDOHV 6LSURIXQGL]DPRVHQHODVSHFWRHFRJUiÀFRGHOTXLVWHVHKDQ OOHJDGRDGLVWLQJXLUKDVWDVXEWLSRVGLIHUHQWHVGHOHVLRQHV VHJ~QHOFRQWHQLGRGHOPLVPR\WDO\FRPRVHPXHVWUDHQOD HVFDODGHJULVHVÀJ  ‡ 7LSR,DQLOORVFRQFpQWULFRVKLSRHKLSHUHFRLFRVOiPLQDV FRQFpQWULFDVGHTXHUDWLQD  ‡ 7LSR,,FRQWHQLGRSUHGRPLQDQWHPHQWHKLSRHFRJpQLFRFRQ XQIRFRKLSHUHFRJpQLFRFHQWUDO ‡ 7LSR,,,KLSRHFRLFRFRQIRFRVSXQWLIRUPHVKLSHUHFRJpQLFRV VXHOHFRUUHVSRQGHUDGHSyVLWRVGHTXHUDWLQDPiVFRPSDFWRVRLQFOXVRDODSUHVHQFLDGHFULVWDOHVGHFROHVWHURO  ‡ 7LSR,9KLSRHFRJHQLFLGDGKRPRJpQHD ‡ 7LSR9iUHDVGHGLIHUHQWHQLYHOGHHFRJHQLFLGDG 'HWRGRVHVWRVSDWURQHVORVWLSRV,,,\,9VRQORVTXHVH SUHVHQWDQHQODSUiFWLFDFOtQLFDKDELWXDOFRQPD\RUIUHFXHQcia &XDQGRHQVXHYROXFLyQHOTXLVWHVXIUHSURFHVRVGHLQÁDPDFLyQ\RLQIHFFLyQHVWDVFDUDFWHUtVWLFDVVRQRJUiÀFDVSXHGHQYDULDU3/RVTXLVWHVHSLGpUPLFRVQRIUDJPHQWDGRVVXHOHQ WHQHUXQFRQWRUQRRYDODGRELHQGHOLPLWDGRXQKDORJULVTXH GHOLPLWDODSDUHGTXtVWLFD\DXVHQFLDGHÁXMRFHQWUDO\SHULIpULFRHQODH[SORUDFLyQFRQPRGR'RSSOHU(QFRQWUDVWHORV TXLVWHVHSLGpUPLFRVIUDJPHQWDGRVSULQFLSDOPHQWHSRUSURFHVRVLQÁDPDWRULRVPXHVWUDQXQSDWUyQSULQFLSDOPHQWHOREXODGRQRHVH[WUDxRWDPSRFRODSUHVHQFLDGHSURWUXVLRQHV SDWUyQ9RLQFOXVRODIRUPDFLyQGHDEVFHVRV DXVHQFLDGH KDORJULViFHR\SUHVHQFLDGHÁXMRFHQWUDORSHULIpULFRHQHO PRGR'RSSOHU

Quiste triquilemal (VXQTXLVWHFXWiQHRPHQRVIUHFXHQWHTXHHOLQIXQGLEXODU\ UHSURGXFHHQVXSDUHGHOHSLWHOLRGHODYDLQDH[WHUQDGHOSHOR HQVXSRUFLyQGHOLVWPRIROLFXODU(VHVSHFLDOPHQWHIUHFXHQWH HQHOFXHURFDEHOOXGR FRQXQDFODUDSUHGLOHFFLyQSRU HOVH[RIHPHQLQR(QHFRJUDItDFXWiQHDODYDULDQWHFRQFpQWULFDWLSR, HVODPiVIUHFXHQWH\DGLIHUHQFLDGHOTXLVWH HSLGpUPLFRQRSUHVHQWDSRURGHVDOLGDFRQORTXHHFRJUiÀ-

B

Sombra acústica lateral

Refuerzo posterior

Figura 1 $ 4XLVWHHSLGpUPLFRHQPHMLOODL]TXLHUGD% (FRJUDItD FXWiQHD PRGR %  0+] (VDRWH®  OHVLyQ UHGRQGHDGD KLSRHFRJpQLFDPD\RULWDULDPHQWHFRQFRQWHQLGRKLSHUHFRJpQLFR LQWHULRUUHIXHU]RSRVWHULRU\VRPEUDVDF~VWLFDVODWHUDOHV

Tipo I

Tipo II

Tipo III

Tipo IV

Tipo V

Figura 2 3DWURQHVHFRJUiÀFRVGHSUHVHQWDFLyQGHOTXLVWHHSLGpUPLFR

(FRJUDItDDSOLFDGDDOPDQHMRGHWXPRUHVFXWiQHRVEHQLJQRV FDPHQWHVHGLIHUHQFLDUiGHOTXLVWHHSLGpUPLFRSRUODDXVHQFLD GHpunctum4/DSUHVHQFLDGHHVWUXFWXUDVOLQHDOHVKLSHUHFRJpQLFDVHQHOLQWHULRUTXHFRUUHVSRQGHQDUHVWRVIROLFXODUHV RFDOFLÀFDFLRQHVQRHVLQIUHFXHQWH

Tumores de la unidad pilosebácea Pilomatrixoma (OSLORPDWUL[RPDHVXQWXPRUVXEFXWiQHRGLItFLOGHGLDJQRVWLFDUFOtQLFDPHQWH1RHVUDURGLDJQRVWLFDUORFRPRTXLVWH HSLGpUPLFRRFRPRSHTXHxDDGHQRSDWtD6RQOHVLRQHVSUHIHUHQWHPHQWH~QLFDVFRQPRUIRORJtDGHSiSXODRQyGXORÀUPH DODSDOSDFLyQGHELGRDODSUHVHQFLDGHFDOFLÀFDFLyQVHFXQGDULD/DSLHOVXSUD\DFHQWHRVFLODHQFRORUGHVGHHOFRORUGH ODSLHOQRUPDOKDVWDFRORUHVPiVJULViFHRVRD]XODGRVTXHD YHFHVSUHFLVDQXQFXLGDGRVRGLDJQyVWLFRGLIHUHQFLDOFRQQHYXVD]XORPHODQRPDÀJ$ /DLQFLGHQFLDDFWXDO se estima HQWUHFDVRVDODxR&XHURFDEHOOXGRFDUD\FXHOORVRQORFDOL]DFLRQHVHOHFWLYDV+D\YDULHGDGHVFOtQLFDVHVSHFtILFDV FRPR HO SLORPDWUL[RPD SHUIRUDQWH \ HO DQHWRGpUPLFRFX\DVFDUDFWHUtVWLFDVFOtQLFDVKLVWROyJLFDV\ HFRJUiÀFDVSXHGHQYDULDUGHODYDULDQWHFOiVLFD/DPDOLJQL]DFLyQODSUHVHQFLDGHPHWiVWDVLVDGLVWDQFLD\ODVUHFXUUHQFLDVORFDOHVVRQH[WUDRUGLQDULDPHQWHUDUDV/DSURSRUFLyQGH FDVRVFRUUHFWDPHQWHGLDJQRVWLFDGRVHQODFOtQLFDYDUtDVHJ~Q ODVHULHFRQVXOWDGDSHURVXHOHVHUUHODWLYDPHQWHEDMD\ RVFLODUHQWUHXQ\XQ 'HVGHHOSXQWRGHYLVWDJHQpULFRHQHFRJUDItDFXWiQHDHO SLORPDWUL[RPDHVXQWXPRUVXEFXWiQHRRYDODGRELHQGHÀQLGRKLSHUHFRLFRDXQTXHKHWHURJpQHRHQVXFRQWHQLGR ÀJ% $UWHIDFWXDOPHQWHHQPXFKRVFDVRVKD\SUHVHQFLD GHVRPEUDSRVWHULRU$SUR[LPDGDPHQWHHOGHORVSLORPDWUL[RPDVPXHVWUDQFDOFLÀFDFLyQ\HQWUHXQ\XQPXHVWUDQIRFRVGHRVLILFDFLyQ/DLQWHQVLGDGFDQWLGDG\ HVWUXFWXUDGHGLVFRVGHSyVLWRVYDUtDGHXQFDVRDRWUR

A

 (OXVRGHO'RSSOHUFRORUPXHVWUDÁXMRFHQWUDO\SHULIpULFR VRORHQHOGHORVFDVRVGHVFULWRVPLHQWUDVTXHORKDFH GHIRUPDSHULIpULFDSUHGRPLQDQWHHQHOORTXHUHIXHU]D HOFRQFHSWRGHEHQLJQLGDGGHODOHVLyQ/DSUHVHQFLDGHÁXMR YHQRVRRshuntsDUWHULRYHQRVRVQRHVXQKDOOD]JRFRP~Q DGLIHUHQFLDGHORVKHPDQJLRPDV6XSUHVHQFLDSXHGHVHU LQGLFDWLYDGHWUDQVIRUPDFLyQPDOLJQD 'HPDQHUDDQiORJDDOTXLVWHHSLGpUPLFRUHFLHQWHPHQWH VHKDQGHVFULWRSRU6ROLYHWWLHWDOKDVWDSDWURQHVGLIHUHQWHVGHSLORPDWUL[RPDHQHFRJUDItDFXWiQHDÀJ  ‡ 7LSR,ORSUHVHQWDHOGHORVSDFLHQWHVGHVXVHULH 1yGXORFRPSOHWDPHQWHFDOFLÀFDGRVHPLVXSHUÀFLDOHVUDUR HOKDORKLSRHFRLFRSHULIpULFR\VXWDPDxRHVFP ‡ 7LSR,,ORSUHVHQWDHOGHORVSDFLHQWHVGHVXVHULH 1yGXORSDUFLDOPHQWHFDOFLÀFDGRFRQSXQWRVFDOFLÀFDGRVHQ VXVHQRGHWDPDxRYDULDEOHFP FRQKDORSHULIpULFR KLSRHFRJpQLFRDYDVFXODU ‡ 7LSR,,,ORSUHVHQWDHOGHORVSDFLHQWHVGHVXVHULH (VWUXFWXUDGHIRUPDFLyQFRPSOHMD

Tipo I

Tipo II

Tipo III

Tipo IV

Tipo V

Color azul oscuro: calcificación; negro: contenido líquido; blanco: contenido hiperecogénico psudotumoral no calificado

Figura 4 3DWURQHV HFRJUiÀFRV GH SUHVHQWDFLyQ GHO SLORPDWUL[RPD(QD]XORVFXURFDOFLÀFDFLyQHQQHJURFRQWHQLGROtTXLGR HQ EODQFR FRQWHQLGR KLSHUHFRJpQLFR VHXGRWXPRUDO QR FDOFLÀFDGR

B

Figura 3 $ 3LORPDWUL[RPDOHVLyQPiVSDOSDEOHTXHYLVLEOHVXEFXWiQHDHQSDFLHQWHDGROHVFHQWHHQFDUDYRODUGHDQWHEUD]RFRQ VXSHUÀFLHYLROiFHD% (FRJUDItDFXWiQHD0+](VDRWH® WXPRUKLSRGpUPLFRELHQGHOLPLWDGRKLSRHFRJpQLFRVLQKDORSHULIpULFRFRQYDVFXODUL]DFLyQSHULIpULFDHQPRGR'RSSOHU&RUWHVtDGHO'U$OIDJHPH

 ‡ 7LSR,9ORSUHVHQWDHOGHORVSDFLHQWHVGHVXVHULH 1yGXORGHWLSRVHXGRTXtVWLFRVLQUHIXHU]RSRVWHULRU\VHSWRVRWDELTXHVGHJURVRUYDULDEOH ‡ 7LSR9ORSUHVHQWDHOGHORVSDFLHQWHVGHVXVHULH1yGXORGHWLSRVHXGRQHRSOiVLFRFRQSDWUyQYDVFXODUGHWHFWDEOHGHFDUDFWHUtVWLFDVYDULDEOHV

Tumores Àbrohistiocitarios DermatoÀbroma (OGHUPDWRÀEURPDWDPELpQFRQRFLGRFRPRKLVWLRFLWRPDÀEURVREHQLJQRHVXQWXPRUTXHFOtQLFDPHQWHVHSUHVHQWD FRPRSiSXODRQyGXORGpUPLFRGHSHTXHxRWDPDxR~QLFR RP~OWLSOH\FRQXQDFRORUDFLyQVXSHUÀFLDOYDULDEOHHQWUH PDUUyQ\YLROiFHDÀJ$ 'HVGHHOSXQWRGHYLVWDHFRJUiÀFRHQPRGR%VXHOHQDSDUHFHUFRPROHVLRQHVGHUPRKLSRGpUPLFDV PDO GHILQLGDV QRUPDOPHQWH GH DVSHFWR KHWHURJpQHRÀJ% (VIUHFXHQWHTXHVHSURGX]FDXQD GLVWRUVLyQGHORVIROtFXORVSLORVRVTXHH[LVWHQHQHOiUHDDIHFWDGD&RPRVLJQRGLIHUHQFLDOODSUHVHQFLDGHOtQHDVKLSRHFRLFDVHQSHULIHULDSXHGHD\XGDUQRVDHVWDEOHFHUXQFRUUHFWR GLDJQyVWLFR(OH[DPHQPHGLDQWHPRGR'RSSOHUHVDPHQXGR QHJDWLYR\QRVHREVHUYDYDVFXODUL]DFLyQVLELHQSXQWXDOPHQWHVHREVHUYDÁXMRDUWHULDORYHQRVRHQODSHULIHULDGHODOHVLyQ(QRFDVLRQHVVLODOHVLyQKDWHQLGRXQSURFHVR LQÁDPDWRULRHOtQGLFHGH%UHVORZHFRJUiÀFRtQGLFHGHSURIXQGLGDG FRPSDUDGRFRQHOtQGLFHGH%UHVORZKLVWROyJLFR SXHGHVHUPD\RUORTXHHVH[SUHVLyQGHODH[LVWHQFLDGHXQ LQÀOWUDGRLQÁDPDWRULRSHULWXPRUDO

Cicatriz hipertróÀcaqueloide /DSpUGLGDGHODVROXFLyQGHFRQWLQXLGDGFXWiQHDGDOXJDUD XQDKHULGDTXHGHVDIRUWXQDGDPHQWHSXHGHSURGXFLUXQD

A

55XL]9LOODYHUGHHWDO UHSDUDFLyQÀEURVDH[FHVLYDGDQGROXJDUDXQDFLFDWUL]KLSHUWUyÀFDRXQTXHORLGH (QODHFRJUDItDFXWiQHDVHPXHVWUDQFRPRSODFDVLUUHJXODUHVKLSRHFRJpQLFDVGHDVSHFWRKHWHURJpQHR3XHGHQIRUPDU VHXGRQyGXORV\IRUPDUXQSDWUyQÀEULODUKLSHUHFRJpQLFR (VWDVOtQHDVKLSHUHFRLFDVWUDGXFHQSRUWDQWRODSUHVHQFLD GHKDFHVGHÀEUDVGHFROiJHQR(VWDVOtQHDVQRUPDOPHQWH QRVXHOHQHVWDUSUHVHQWHVHQODVFLFDWULFHVKLSHUWUyÀFDVDGLIHUHQFLDGHORVTXHORLGHVÀJ$' 1RHVUDURHQFRQWUDUOD SUHVHQFLDGHWUDFWRVÀVWXORVRVKLSRHFRJpQLFRVFRQODVXSHUÀFLHRHQWUHGLIHUHQWHVOHVLRQHV(QPRGR'RSSOHUHOJUDGR GHYDVFXODUL]DFLyQHVYDULDEOH/DH[LVWHQFLDGHÁXMRSRQHGH PDQLÀHVWRODDFWLYLGDGGHOTXHORLGH &OiVLFDPHQWHODHFRJUDItD\DVHKDEtDXWLOL]DGRHQOD~OWLPDGpFDGDGHOVLJORXXSDUDPRQLWRUL]DUODUHVSXHVWDDGLIHUHQWHVPHGLGDVGHWUDWDPLHQWRPLGLHQGRSULQFLSDOPHQWHOD SURIXQGLGDGRHVSHVRUGHHVWH\VXDSOLFDFLyQHQTXHORLGHV SURGXFLGRVSRUTXHPDGXUDV\WUDWDGRVPHGLDQWHPHGLGDVGH SUHVRWHUDSLD\DVHKDEtDHVWXGLDGR3RUWDQWRODHFRJUDItD GHDOWDIUHFXHQFLDHVHVSHFLDOPHQWH~WLOHQODPHGLGDGHO JURVRUGHOTXHORLGHHQFRPSDUDFLyQFRQODSLHOQRUPDO\FRQ ODViUHDVFRQSURFHVRGHPHMRUtDDYDQ]DGR

Tumores epidérmicos Queratosis seborreicas /DVTXHUDWRVLVVHERUUHLFDVVRQWXPRUHVHSLWHOLDOHVPX\IUHFXHQWHVFRQLQFUHPHQWRGHODLQFLGHQFLDDSDUWLUGHORV DxRVÀJ$ DXQTXHVHKDQSXEOLFDGRFDVRVHQQLxRV 6HKDGHVFULWRXQDUHODFLyQHWLRSDWRJpQLFDFRQHOYLUXVGHO SDSLORPDKXPDQRVREUHWRGRHQODVGHORFDOL]DFLyQJHQLWDO 0XHVWUDQXQDVFDUDFWHUtVWLFDVFOtQLFDV\GHUPDWRVFySLFDV PX\ELHQGHÀQLGDVDXQTXHDYHFHVVHUHTXLHUHUHDOL]DUXQ GLDJQyVWLFRGLIHUHQFLDOFRQRWURVWXPRUHVSLJPHQWDGRVFRPR

B

Figura 5 $ 'HUPDWRÀEURPDWXPRUGLVFUHWDPHQWHH[FUHFHQWHFRPSDFWRGHFRORUYLROiFHR\GXURDOWDFWR% (FRJUDItDFXWiQHD PRGR%0+](VDRWH® OHVLyQGpUPLFDUHODWLYDPHQWHELHQGHOLPLWDGDKLSRHFRJpQLFDFRQGLVFUHWRUHIXHU]RSRVWHULRU

(FRJUDItDDSOLFDGDDOPDQHMRGHWXPRUHVFXWiQHRVEHQLJQRV

33

A

B

C

D

Figura 6 $ 4XHORLGHHQKRPEURGHUHFKR% (FRJUDItDFXWiQHDPRGR%0+](VDRWH® OHVLyQGHUPRKLSRGpUPLFDLVRHFRJpQLFD PDOGHOLPLWDGDFRQOtQHDVFRQFpQWULFDVKLSHUHFRJpQLFDV\'RSSOHUQHJDWLYR& &LFDWUL]KLSHUWUyÀFDSRVWDIHLWDGRGHQHYXVHQDQWHEUD]R' (FRJUDItDFXWiQHDPRGR%0+](VDRWH® WXPRUVXEFXWiQHRELHQGHOLPLWDGRKLSRHFRJpQLFRFRQHVFDVDYDVFXODUL]DFLyQLQIHULRUHQPRGR'RSSOHU

HOPHODQRPDRHOQHYXVLQWUDGpUPLFR(FRJUiÀFDPHQWHVH FDUDFWHUL]DQSRUSUHVHQWDUXQHQJURVDPLHQWRGHODHSLGHUPLVOtQHDKLSHUHFRJpQLFDTXHVHORFDOL]DHQODSDUWHPiV H[WHUQD ÀJ% ELHQGHOLPLWDGRTXHWtSLFDPHQWHGHMD XQDVRPEUDDF~VWLFDSRVWHULRUFRPRFRQVHFXHQFLDGHOD SUHVHQFLDGHTXHUDWLQDHQODVXSHUILFLHFXWiQHD\VLQ DXPHQWRGHODYDVFXODUL]DFLyQFRQHOHVWXGLR'RSSOHUFRORU ÀJ&\' 

Verruga plantar /DVYHUUXJDVSODQWDUHVVRQOHVLRQHVPX\IUHFXHQWHVSURGXFLGDVSRUHOYLUXVGHOSDSLORPDKXPDQRTXHVHPDQLÀHVWDQ FOtQLFDPHQWHFRPROHVLRQHVKLSHUTXHUDWyVLFDVFRQWHQGHQFLD DODLQYDJLQDFLyQÀJ$ \GRORURVDVDODSUHVLyQPXHVWUDQ XQRVSXQWRVQHJURVRURMRVDODH[SORUDFLyQGHUPDWRVFySLFD TXHUHSUHVHQWDQORVFDSLODUHVWURPERVDGRV(FRJUiÀFDPHQWHVHFDUDFWHUL]DQSRUVHUOHVLRQHVKLSRHFRJpQLFDVHQGRItWLFDVIXVLIRUPHVORFDOL]DGDVHQODHSLGHUPLV\GHUPLV VXSHUÀFLDOFRQXQGHVFHQVRIRFDOGHODHFRJHQLFLGDGGHO

WHMLGRFHOXODUVXEFXWiQHRÀJ% /DPD\RUtDGHODVOHVLRQHVPXHVWUDQDXPHQWRGHOÁXMRYDVFXODUDUWHULDOEDMRHVWD VREUHWRGRHQODVGHPD\RUWDPDxRÀJ& $XQTXHHQOD PD\RUtDGHORVFDVRVHOGLDJQyVWLFRGHYHUUXJDSODQWDUHV FOtQLFRODHFRJUDItDSXHGHDSRUWDULQIRUPDFLyQHQFDVRVTXH KDQVLGRWUDWDGRVSDUFLDOPHQWH\VHKDQPRGLÀFDGRODVFDUDFWHUtVWLFDVFOtQLFDVSDUDORFDOL]DUH[DFWDPHQWHODOHVLyQ RKDFHUXQVHJXLPLHQWRFOtQLFRWUDVODUHDOL]DFLyQGHXQWUDWDPLHQWR$GHPiVVHSXHGHGHWHFWDULQÁDPDFLyQGHORV WHMLGRVEODQGRVSHULOHVLRQDOHVFRPRXQDEXUVLWLVSODQWDU HQPiVGHODPLWDGGHORVSDFLHQWHV

Tumores melanocíticos Nevus melanocíticos adquiridos y congénitos /RVQHYXVPHODQRFtWLFRVDGTXLULGRVTXHSXHGHQVHUFRPXQHV RDWtSLFRVVHFODVLÀFDQHQJUXSRVHQIXQFLyQGHODORFDOL]DFLyQKLVWROyJLFDGHODVFpOXODVQpYLFDVMXQWXUDOHVHQOD

34

55XL]9LOODYHUGHHWDO

A

B B

C

D

A

C

Figura 7 $ 4XHUDWRVLVVHERUUHLFDHQVLHQGHUHFKD% (FRJUDItDFXWiQHDPRGR%0+](VDRWH® DXPHQWRGHOJURVRUHSLGpUPLFRFRQOHYHVRPEUDDF~VWLFDSRVWHULRU& 1HYXVLQWUDGpUPLFRHQ]RQDPHQWRQLDQD' (FRJUDItDFXWiQHDPRGR%0+] Esaote® OHVLyQKLSRHFRJpQLFDKRPRJpQHDRYDODGDGHORFDOL]DFLyQLQWUDGpUPLFD

Figura 8 $  9HUUXJD SODQWDU %  (FRJUDItD FXWiQHD PRGR % 0+](VDRWH® OHVLyQKLSRHFRJpQLFDHQGRItWLFDIXVLIRUPH ORFDOL]DGD HQ OD HSLGHUPLV \ GHUPLV VXSHUÀFLDO &  (FRJUDItD FXWiQHDPRGR'RSSOHUDXPHQWRGHYDVFXODUL]DFLyQHQODEDVH HLQWHULRUGHODOHVLyQ

XQLyQGHUPRHSLGpUPLFD FRPSXHVWRVHQODXQLyQGHUPRHSLGpUPLFD\HQODGHUPLV HLQWUDGpUPLFRVHQODGHUPLV (FRJUiÀFDPHQWHVHSXHGHQLGHQWLÀFDUIiFLOPHQWHORVQHYXV LQWUDGpUPLFRVFRPROHVLRQHVGpUPLFDVELHQGHÀQLGDVKRPRJpQHDVKLSRHFRJpQLFDVVLQVHxDO'RSSOHUFRORUÀJ&\'  $OJXQRVHVWXGLRVPXHVWUDQXQDEXHQDFRUUHODFLyQHQWUHHO JURVRUHFRJUiÀFRGHODOHVLyQ\HOJURVRUKLVWRPpWULFRVREUH WRGRHQODVGHHVSHVRU!PP /RVQHYXVPHODQRFtWLFRVFRQJpQLWRVVHGHÀQHQFRPRORV TXHHVWiQSUHVHQWHVGHVGHHOQDFLPLHQWRDXQTXHSXHGHQVHU VXWLOHVLQLFLDOPHQWH\QRPDQLIHVWDUVHKDVWDPHVHVPiVWDUGH&OtQLFDPHQWHVHPDQLÀHVWDQFRPRPiFXODVRPDQFKDV KLSHUSLJPHQWDGDVTXHVHSXHGHQHOHYDUDGTXLULHQGRXQD VXSHUÀFLHYHUUXJRVD6HSXHGHQGHVDUUROODUSiSXODVRQyGXORV HQHOLQWHULRUGHODVOHVLRQHV(FRJUiÀFDPHQWHPXHVWUDQXQDV FDUDFWHUtVWLFDVVLPLODUHVDORVQHYXVLQWUDGpUPLFRVDXQTXH GHSHQGHGHODIDVHHQODTXHVHHQFXHQWUHQ/DSUHVHQFLDGH QyGXORVKLSHUHFRJpQLFRVHQVXLQWHULRUFRQDXPHQWRGHOD

YDVFXODUL]DFLyQSHULIpULFDSXHGHVHUVXJHUHQWHGHQyGXORV SUROLIHUDWLYRVRGHWUDQVIRUPDFLyQDPHODQRPD

Nevus azules /RVQHYXVD]XOHVVRQVHFXQGDULRVDODSUROLIHUDFLyQGHODV FpOXODVQpYLFDVHQODGHUPLVFRQSUHGLOHFFLyQSRUODFDEH]D FXHOORGRUVRGHODVPDQRV\SLHV\]RQDVDFUDÀJ$ (FRJUiÀFDPHQWHVHPDQLÀHVWDQFRPROHVLRQHVKRPRJpQHDV KLSRHFRJpQLFDVIXVLIRUPHVORFDOL]DGDVHQODGHUPLVVXSHUÀFLDOÀJ% 8QRGHORVGLDJQyVWLFRVGLIHUHQFLDOHVGHORV QHYXVD]XOHVPiVLPSRUWDQWHHVODPHWiVWDVLVGHPHODQRPD TXHHFRJUiÀFDPHQWHVHSUHVHQWDFRPROHVLRQHVLUUHJXODUHV KHWHURJpQHDVKLSRHFRJpQLFDVFRQDXPHQWRGHODHFRJHQLFLGDGSRVWHULRU\ORFDOL]DGRVSUHIHUHQWHPHQWHHQODKLSRGHUPLV8QHVWXGLRUHFLHQWHKDPRVWUDGRTXHODHFRJUDItD

A

B

C

Figura 9 $ 1HYXVD]XOHQGRUVRGHPDQRGHUHFKD% 'HUPDWRVFRSLDGHQHYXVD]XOHQODTXHVHREVHUYDHOSDWUyQD]XOKRPRJpQHR& (FRJUDItDFXWiQHDPRGR%0+](VDRWH® WXPRUDFLyQRYDODGDKRPRJpQHDLQWUDGpUPLFDORFDOL]DGDHQOD GHUPLV

Figura 10 (FRJUDItDFXWiQHDPRGR%0+](VDRWH® OHVLyQ SXQWLIRUPH GH  FP KLSHUHFRJpQLFD FRQ OHYH UHYHUEHUDFLyQSRVWHULRUFRPSDWLEOHFRQFXHUSRH[WUDxRFULVWDO 

(FRJUDItDDSOLFDGDDOPDQHMRGHWXPRUHVFXWiQHRVEHQLJQRV WLHQHPD\RUHVSHFLÀFLGDG TXHODH[SORUDFLyQFOtQLFD  \ODGHUPDWRVFRSLD SDUDGLIHUHQFLDUORVQHYXV D]XOHVGHODVPHWiVWDVLVGHPHODQRPD

Cuerpos extraños 1XPHURVRVFXHUSRVH[WUDxRVSXHGHQHQWUDUHQFRQWDFWRFRQ ODSLHOKDELWXDOPHQWHGHIRUPDLQYROXQWDULD\DVRFLDGRVD XQWUDXPDWLVPRFRQVROXFLyQGHFRQWLQXLGDGFXWiQHD6HSXHGHQFODVLÀFDUHQYLYRVRLQHUWHV\FOtQLFDPHQWHVHPDQLÀHVWDQ FRPROHVLRQHVLQGXUDGDVLQÁDPDGDV\HQDOJXQRVFDVRVFRQ SUHVHQFLDGHXQDFLFDWUL]HQODVXSHUÀFLH(OGLDJQyVWLFRFOtQLFRSXHGHVHUFRPSOHMRVREUHWRGRFXDQGRQRVHUHFXHUGD HODQWHFHGHQWHWUDXPiWLFR(OHVWXGLRFRQUDGLRORJtDFRQYHQFLRQDOUDGLRJUDItDRWRPRJUDItDFRPSXWDUL]DGD SXHGHVHU ~WLOSDUDGHWHFWDUPXFKRVFXHUSRVH[WUDxRVSHURODHFRJUDItDDGHPiVSHUPLWHORFDOL]DUORVUDGLRO~FLGRV6HKDHVWDEOHFLGRXQDVHQVLELOLGDGGHOSDUDGHWHFWDUFXHUSRV H[WUDxRVGHPDGHUDGHPP\GHOSDUDORVGH PP(FRJUiÀFDPHQWHVHFDUDFWHUL]DQSRUPRVWUDUXQD

A

C

 HVWUXFWXUDHQEDQGDROLQHDOKLSHUHFRJpQLFDFRQSUHVHQFLD GHXQDUHYHUEHUDFLyQSRVWHULRUHQHOFDVRGHTXHVHDQGH FULVWDORPHWDOÀJ /DOHVLyQLQÁDPDWRULDJUDQXORPDWRVDSHULOHVLRQDOVHPDQLÀHVWDFRPRXQKDORKLSRHFRJpQLFR DOUHGHGRUGHOFXHUSRH[WUDxR(QFDVRGHTXHVHKD\DSURGXFLGRXQDEVFHVRRKHPRUUDJLDVHFXQGDULDDODLQIHFFLyQWDPELpQSXHGHVHUGHWHFWDGRHFRJUiILFDPHQWHFRPRXQD FROHFFLyQÁXLGDKLSRRDQHFRJpQLFD3RUWDQWRODHFRJUDItD FXWiQHDDGHPiVGHIDFLOLWDUHOGLDJQyVWLFRGHXQFXHUSR H[WUDxRSHUPLWHGHWHUPLQDUVXWDPDxRORFDOL]DFLyQRULHQWDFLyQ\ODUHODFLyQFRQHVWUXFWXUDVDQDWyPLFDVDG\DFHQWHV SDUDIDFLOLWDUVXH[WUDFFLyQ$GHPiVHQDOJXQRVFDVRVFRPSOHMRV\XWLOL]DQGRXQJHOHVWpULOVHSRGUiQUHDOL]DUH[WUDFFLRQHVJXLDGDVSRUHFRJUDItD

Lipomas (OOLSRPDHVHOWXPRUEHQLJQRPiVIUHFXHQWHGHSDUWHVEODQGDV(VWiFRPSXHVWRSRUDGLSRFLWRVPDGXURV\VHHQFXHQWUD HQHOWHMLGRFHOXODUVXEFXWiQHRDXQTXHHQRFDVLRQHVDSDUH-

B

D

Figura 11 $ /HVLyQRYDODGDKLSRHFRLFDPX\ELHQGHOLPLWDGDHQFRQWDFWRFRQHOSODQRPXVFXODUTXHDERPEDODGHUPLV\TXH SUHVHQWDHFRVLQWHUQRVDOLQHDGRVHQHOKRPEUROLSRPD0+](VDRWH® % (FRJUDItDGHOLSRPDDEGRPLQDO0+](VDRWH®  & /LSRPDHQQDOJDFRQGLItFLOGLDJQyVWLFRGLIHUHQFLDOGHWHMLGRFHOXODUVXEFXWiQHR0+](VDRWH® ' /LSRPDIURQWDOVRQOODPDWLYDVODVOtQHDVKLSHUHFRLFDVTXHGLVFXUUHQSDUDOHODVDODVXSHUÀFLHFXWiQHD0+](VDRWH® 



55XL]9LOODYHUGHHWDO

FHEDMRODIDVFLDPXVFXODUGHQWURGHOP~VFXORRHQHVWUXFWXUDVPiVSURIXQGDV(FRJUiILFDPHQWHORVOLSRPDVVH PXHVWUDQFRPROHVLRQHVKLSHUHFRLFDVLVRHFRLFDVRKLSRHFRLFDVFRQUHVSHFWRDOWHMLGRDGLSRVRFHUFDQR\HQRFDVLRQHV VRQGLItFLOHVGHGHÀQLUSRUHOREVHUYDGRUÀJ$\% /RV OLSRPDVSXURVPX\FHOXODUHVVHPXHVWUDQKLSRHFRLFRVSHUR ORQRUPDOHVTXHWHQJDQXQDFHOXODULGDGPL[WDORTXH DXPHQWDVXHFRJHQLFLGDG/RVDQJLROLSRPDVVHPXHVWUDQSRU ORJHQHUDOKLSHUHFRLFRV\PiVKHWHURJpQHRV\WLHQHQYDVFXODUL]DFLyQHQPRGR'RSSOHUFRORU(QORVOLSRPDVHVFDUDFWHUtVWLFDODSUHVHQFLDGHHVWUXFWXUDVOLQHDOHVKLSHUHFRLFDV TXHVLJXHQHOHMHORQJLWXGLQDOGHOWXPRU\TXHQRVXHOHQ LGHQWLÀFDUVHHQODVOHVLRQHVFPÀJ& *HQHUDOPHQWH HQORVOLSRPDVVXSHUÀFLDOHVQRVHSURGXFHXQDLPDJHQGH UHIXHU]RSRVWHULRUSHURHQORVSURIXQGRVHQFRQWDFWRFRQHO P~VFXORVtVXHOHREVHUYDUVH(QHOFXHURFDEHOOXGRGRQGHQR H[LVWHDSHQDVWHMLGRFHOXODUVXEFXWiQHRORVOLSRPDVVHGLVSRQHQEDMRHOP~VFXORRJDOHDDSRQHXUyWLFD\VHPXHVWUDQ FRPROHVLRQHVKLSRHFRLFDVVREUHHOSHULRVWLRyVHRTXHDERPEDQHOSODQRPXVFXODURODIDVFLD\FXDQGRVRQGHPD\RUWDPDxRWDPELpQODSLHOTXHDGRSWDQXQDLPDJHQVHPLHVIpULFD \HQODVTXHHOGLDJQyVWLFRVHDSUR[LPDSRUODSUHVHQFLDGH OtQHDVILQDVHFRJpQLFDVSDUDOHODVDODFDORWD\DODSLHO ÀJ' 33

A

Tumores vasculares benignos /RVWXPRUHVYDVFXODUHVEHQLJQRVGHODSLHOGHODGXOWRVHPDQLÀHVWDQJHQHUDOPHQWHFRPRLPiJHQHVQRGXODUHVKLSRHFRLFDV\ELHQGHOLPLWDGDVHQODGHUPLVRGHUPRKLSRGpUPLFDV TXHHQHOHVWXGLR'RSSOHUSUHVHQWDQYDVFXODUL]DFLyQGHEDMR ÁXMRDXQTXHIRFDOPHQWHVHSXHGHQLGHQWLÀFDUYDVRVGHPD\RUFDOLEUH\ÁXMRVDUWHULROL]DGRVHQDOJXQRVGHHOORV (ODQJLRPDVHQLOHVHOWXPRUYDVFXODUEHQLJQRDGTXLULGR PiVIUHFXHQWH34(FRJUiÀFDPHQWHORVDQJLRPDVDSDUHFHQ FRPROHVLRQHVKLSRHFRLFDVRYDODGDVHQGHUPRHSLGHUPLVTXH VREUHVDOHQVREUHODVXSHUÀFLHFXWiQHDÀJ$  (OWXPRUDUWHULRYHQRVRDFUDODSDUHFHJHQHUDOPHQWHHQHO iUHDIDFLDOGHORVDGXOWRV(QODHFRJUDItDHVWRVWXPRUHVDSDUHFHQFRPRHVWUXFWXUDVRYDODGDVKHWHURJpQHDVGpUPLFDVHQ ODVTXHVHSXHGHQLGHQWLÀFDUiUHDVQRGXODUHVKLSRHFRLFDVFRQ YDVFXODUL]DFLyQHQHOHVWXGLR'RSSOHUTXHHQRFDVLRQHVSXHGH VHUXQÁXMRDUWHULROL]DGRSRUODSUHVHQFLDGHshuntÀJ%  (OJUDQXORPDSLyJHQRRKHPDQJLRPDFDSLODUOREXODUHVXQ WXPRUGHUiSLGRFUHFLPLHQWRQRGXODURVpVLOTXHVDQJUDFRQ IDFLOLGDG\TXHHVWiFRPSXHVWRSRUOyEXORVGHFDSLODUHVSUROLIHUDWLYRV(FRJUiÀFDPHQWHÀJ& WLHQHXQDHVWUXFWXUD RYDODGDKLSRHFRLFD\KRPRJpQHDFRQPDUJHQELHQGHÀQLGR HQGHUPLV\HQHOWHMLGRVXEFXWiQHR(QHOHVWXGLR'RSSOHU

B

C

D

Figura 12 $ $QJLRPD VHQLO HQ WURQFR  0+] (VDRWH  % 7XPRU DUWHULRYHQRVR DFUDO HQ SLHUQD GHUHFKD  0+] (VDRWH®  & *UDQXORPDSLyJHQRHQSDEHOOyQDXULFXODU0+](VDRWH® ' 9DVFXODUL]DFLyQPX\HYLGHQWHHQHOHVWXGLR'RSSOHUGHODOHVLyQ DQWHULRU0+](VDRWH®  ®

(FRJUDItDDSOLFDGDDOPDQHMRGHWXPRUHVFXWiQHRVEHQLJQRV



SUHVHQWDYDVFXODUL]DFLyQFHQWUDO\SHULIpULFDGHEDMRÁXMR\ RFDVLRQDOPHQWHVHSXHGHHYLGHQFLDUODDUWHULRODTXHORVQXWUH(QORVWXPRUHVHYROXFLRQDGRVODDSDULFLyQGHÀEURVLV KDFHDXPHQWDUODHFRJHQLFLGDGGHOWXPRU (OWXPRUJOyPLFRHVXQDQHRSODVLDEHQLJQDGHWHMLGRVEODQGRVTXHVHPDQLÀHVWDFRPRXQDSiSXODRQyGXORD]XOURML]R H[WUHPDGDPHQWHGRORURVRDODSUHVLyQ\FRQHOIUtR/RVDYDQFHVHQODHFRJUDItDKDQSHUPLWLGRTXHHVWDVHSRVLFLRQHFRPR ODSULQFLSDOWpFQLFDGLDJQyVWLFDSUHRSHUDWRULDGHVSOD]DQGRD ODUHVRQDQFLDPDJQpWLFD(QODHFRJUDItDORVWXPRUHVJOyPLFRVVHPXHVWUDQFRPRHVWUXFWXUDVRYDODGDVKLSRHFRLFDVD YHFHVKHWHURJpQHDVPX\ELHQGHOLPLWDGDVDQLYHOGHODGHUPLV\TXHSXHGHQHURVLRQDUHOKXHVRDQLYHOVXEXQJXHDO ÀJ$& (QHOHVWXGLR'RSSOHUSUHVHQWDQXQDYDVFXODUL]DFLyQLQWHQVDSHURGHEDMRÁXMRTXHHQRFDVLRQHVVHPXHVWUDIRFDOPHQWHDUWHULDOL]DGD&DUDFWHUtVWLFDPHQWHORV WXPRUHVJOyPLFRVSUHVHQWDQXQDSURORQJDFLyQKLSRHFRLFDTXH VHDVLPLODDXQWDOOR$HVWHQLYHODOJXQRVDXWRUHVKDQGHPRVWUDGRXQÁXMRPD\RUHQHOHVWXGLR'RSSOHU(VWDHVWUXF-

WXUDSRGUtDFRUUHVSRQGHUDXQDDUWHULRODDIHUHQWHTXHKHPRV SRGLGRFRPSUREDUHQODKLVWRORJtDGHDOJXQRVFDVRVÀJ' 

A

D

B

Tumores neurales benignos /DQHXURÀEURPDWRVLVGHWLSRHVXQDHQIHUPHGDGJHQpWLFD DXWRVyPLFDGRPLQDQWHTXHVHPDQLÀHVWDHQODLQIDQFLD\HQ ODTXHODSUHVHQFLDGHQHXURÀEURPDVFXWiQHRVVXEFXWiQHRV RSOH[LIRUPHVHVXQRGHVXVFULWHULRVGLDJQyVWLFRVPD\RUHV ÀJ$ /DHFRJUDItDHVXQDWpFQLFDQRLQYDVLYDGHJUDQ D\XGDHQHOGLDJQyVWLFRGHORVQHXURÀEURPDV(OQHXURÀEURPDFXWiQHRDSDUHFHHQODHFRJUDItDFRPRXQDHVWUXFWXUD UHGRQGHDGDRYDODGDRIXVLIRUPHKLSRHFRLFD\DYHFHVKHWHURJpQHDDQLYHOGHUPRKLSRGpUPLFRÀJ%' 3XHGHWHQHU XQGLVFUHWRUHIXHU]RSRVWHULRU\HQODPD\RUtDGHODVRFDVLRQHVDXVHQFLDGHYDVFXODUL]DFLyQHQHOHVWXGLR'RSSOHU/RV QHXURILEURPDVSOH[LIRUPHVVLJXHQWUD\HFWRVQHUYLRVRV\ HFRJUiILFDPHQWHVHPDQLILHVWDQFRPRWUDFWRVWRUWXRVRV

C

E

Figura 13 $ 1yGXORVGH/\VFK% (VWUXFWXUDRYDODGDGpUPLFDKLSRHFRLFDHQHODQWHEUD]RGHODPLVPDSDFLHQWH0+](VDRWH®  & (FRJUDItDPRGR%QHXURÀEURPD0+](VDRWH® ' ,PDJHQHFRJUiÀFDGHXQQHXURÀEURPDGRORURVRGHFPHQODSLHUQD GHUHFKDGHODPLVPDSDFLHQWHHVWUXFWXUDVXEFXWiQHDPX\ELHQGHOLPLWDGDKHWHURJpQHDFRQiUHDVQRGXODUHVKLSRHFRLFDV0+] 7RVKLED® ( (VWXGLR'RSSOHUFRQYDVFXODUL]DFLyQSURIXVDFHQWUDO\HVWUXFWXUDYDVFXODUVXE\DFHQWHTXHFRUUHVSRQGtDDXQDYHQD GHPHGLDQRFDOLEUH0+]7RVKLED® 



55XL]9LOODYHUGHHWDO

A

B

C

D

Figura 14 $ (FRJUDItDPRGR%LPDJHQRYDODGDKLSRHFRLFDDQLYHOGHUPRKLSRGpUPLFRWXPRUJOyPLFR0+]7RVKLED® % (QHO HVWXGLR'RSSOHUVHHYLGHQFLyXQYDVRHQOD]RQDVXSHULRU\TXHFRUUHVSRQGtDFRQXQDLPDJHQHQWDOORTXHVHLQWXtDHQHOPRGR%& 7XPRUDFLyQEDVyÀODHQODTXHVHDSUHFLDXQDHVWUXFWXUDYDVFXODUHQVX]RQDVXSHULRU+(ù ' 'HWDOOHGHODVFpOXODVJOyPLFDVTXH HQJOREDQHVSDFLRVYDVFXODUHVUHYHVWLGRVSRUXQDFDSDGHFpOXODVHQGRWHOLDOHV\ODDUWHULRODTXHVHGHPRVWUDEDHQHOHVWXGLR'RSSOHU

 LSRHFRLFRVVLQYDVFXODUL]DFLyQHQHOHVWXGLR'RSSOHU  K /RVQHXURÀEURPDVGLIXVRVHQODHFRJUDItDDSDUHFHQFRPR PDVDVKLSHUHFRLFDVH[WHQVDVPDOGHÀQLGDVHQODVTXHDSDUHFHQHVWUXFWXUDVQRGXODUHV\WXEXODUHVKLSRHFRLFDV(QRFDVLRQHVVHPXHVWUDQLPiJHQHVGXFWDOHVDQHFRLFDVTXHHQHO HVWXGLR'RSSOHUVHFRUUHVSRQGHQFRQYDVRVGLODWDGRV ÀJ( 

Tumores benignos en relación con el aparato locomotor (OTXLVWHVLQRYLDORJDQJOLyQHVXQWXPRUEHQLJQRTXtVWLFRTXH GHULYDGHODFiSVXODDUWLFXODU\TXHFRQWLHQHPDWHULDOPXFRVR RPL[RLGHVLQRYLDO(VHOWXPRUEHQLJQRGHWHMLGRVEODQGRVPiV IUHFXHQWHGHODPDQR(QODHFRJUDItDVHPXHVWUDFRPRXQD PDVDUHGRQGHDGDXRYDODQHFRLFDPX\ELHQGHÀQLGD\HQOD

TXHHQRFDVLRQHVVHSXHGHHYLGHQFLDUXQDFRPXQLFDFLyQFRQ HOHVSDFLRDUWLFXODUÀJ$& &DUDFWHUtVWLFDPHQWHHQHO HVWXGLR'RSSOHUQRVHGHPXHVWUDYDVFXODUL]DFLyQDOJXQD$QLYHOVXEXQJXHDOSXHGHFRPSULPLU\DGHOJD]DUODPDWUL]XQJXHDO/RVVHXGRTXLVWHVPL[RLGHVVHSURGXFHQSRUGHJHQHUDFLyQGHOFROiJHQR\WLHQHQLPiJHQHVHFRJUiÀFDVVLPLODUHV SHURQRVHHQFXHQWUDQHQUHODFLyQFRQORVHVSDFLRVDUWLFXODUHV (OWXPRUGHFpOXODVJLJDQWHVGHODYDLQDWHQGLQRVDHVHO VHJXQGRWXPRUEHQLJQRPiVIUHFXHQWHQRFXWiQHRGHOD PDQR(VXQWXPRUÀEURKLVWLRFLWDULRTXHGHULYDGHODYDLQD WHQGLQRVDGHOWHQGyQDODTXHVHHQFXHQWUDDGKHULGR(FRJUiÀFDPHQWHHVWDVQHRIRUPDFLRQHVDSDUHFHQFRPRPDVDV VyOLGDVKLSRHFRLFDVELHQGHOLPLWDGDVPiVRPHQRVKHWHURJpQHDV\DG\DFHQWHVDOWHQGyQTXHPXHVWUDQXQDHFRHVWUXFWXUDQRUPDO\HQRFDVLRQHVHURVLRQDQHOKXHVRÀJ'  6XHOHQWHQHUYDVFXODUL]DFLyQLQWUDOHVLRQDOHQHOHVWXGLR 'RSSOHUODPD\RUtDGHODVYHFHVSURIXVDÀJ( 

(FRJUDItDDSOLFDGDDOPDQHMRGHWXPRUHVFXWiQHRVEHQLJQRV



A

B

C

D

E

F

Figura 15 $ *DQJOLyQOHVLyQRYDODGDDQHFRLFDHQHOGRUVRGHODDUWLFXODFLyQGHPXxHFDL]TXLHUGD0+]7RVKLED® % *DQJOLyQHQODVXSHUÀFLHYRODUGHODPXxHFDGHXQYDUyQGHDxRV0+]7RVKLED® & (FRJUDItDPRGR%OHVLyQDQHFRLFDVLQ YDVFXODUL]DFLyQHQHOHVWXGLR'RSSOHUHQXQGHGRGHODPDQRVHXGRTXLVWHPL[RLGH0+](VDRWH® ' 7XPRUGHFpOXODVJLJDQWHVORFDOL]DGRHQHOVHJXQGRGHGRGHODPDQRGHUHFKDFRQLPSRUWDQWHHURVLyQGHODIDODQJH0+]7RVKLED® ( (VWXGLR'RSSOHU FRORUGHWXPRUGHYDLQDWHQGLQRVDGHFDUDFWHUtVWLFDSROLOREXODU0+]7RVKLED® ) %XUVLWLVHQFRGRWtSLFDLPDJHQKLSRHFRLFD VHSWDGD0+]7RVKLED® 

/DEXUVLWLVHVXQDLQÁDPDFLyQGHODEXUVDRDOPRKDGLOODTXH HQYXHOYHORVWHQGRQHV\TXHHYLWDODIULFFLyQFRQHOKXHVR /DEXUVDVHHQFXHQWUDHQODSUR[LPLGDGGHODVDUWLFXODFLRQHV \FRQWLHQHOtTXLGRVLQRYLDO(QODHFRJUDItDODVEXUVLWLVSUHVHQWDQLPiJHQHVKLSRHFRLFDVTXHRFDVLRQDOPHQWHWLHQHQ VHSWRVKLSHUHFRLFRVHQVXLQWHULRU\UHIXHU]RSRVWHULRU ÀJ) 

Conclusión +HPRVSUHVHQWDGRODVSULQFLSDOHVFDUDFWHUtVWLFDVHFRJUiÀFDV GHORVWXPRUHVEHQLJQRVGHODSLHO\KHPRVHVWDEOHFLGRVX FRUUHODFLyQFRQODFOtQLFDVLHPSUHTXHKD\DVLGRSRVLEOH /DHFRJUDItDFXWiQHDHVXQDWpFQLFDTXHHPHUJHFRPRLQGLVSHQVDEOHHQODSUiFWLFDFOtQLFDGLDULDGHOGHUPDWyORJR\VRQ

 SUHFLVDVQXHYDVDSRUWDFLRQHVSDUDVHJXLUGHVFULELHQGRORV QXHYRVSDWURQHVHFRJUiÀFRVGHORVWXPRUHVEHQLJQRVGH ODSLHOQRFRPXQLFDGRVKDVWDHOPRPHQWR

ConÁicto de intereses /RVDXWRUHVGHFODUDQQRWHQHUQLQJ~QFRQÁLFWRGHLQWHUHVHV

Bibliografía $ULDV6DQWLDJR6*LUyQ3ULHWR06&DVWHOORWH&DEDOOHUR/&DUDFWHUtVWLFDVHFRJUiÀFDVGHODSDWRORJtDWXPRUDOEHQLJQDFXWiQHD PiVIUHFXHQWH$FWXDO0HG6XSO /HH+6-RR.%6RQJ+7.LP<63DUN':3DUN&.HWDO5HODWLRQVKLSEHWZHHQVRQRJUDSKLFDQGSDWKRORJLFÀQGLQJVLQHSLGHUPDOLQFOXVLRQF\VWV-&OLQ8OWUDVRXQG 
55XL]9LOODYHUGHHWDO %HVVRQDUW010DFHGR1&DUPRQD&+LJKUHVROXWLRQ%VFDQ XOWUDVRXQGRIK\SHUWURSKLFVFDUV6NLQ5HV7HFKQRO  6DOHUQL*$ORQVR&*RURVLWR0)HUQiQGH]%XVV\56HERUUKHLF NHUDWRVLVOLNHPHODQRPD-$P$FDG'HUPDWRO6 5XL]&DUUDVFRVD-&5XL]9LOODYHUGH5&DUDFWHUtVWLFDVHFRJUiÀFDVGHODSLHOQRUPDO$FWXDO0HG (O=DZDKU\0%$EGHO(O+DPHHG(O&KHZHLNK+0$EG(O5DKPDQ5DPDGDQ6$KPHG%DVVLRXQ\'0RKDPHG)DZ]\08OWUDVRXQG ELRPLFURVFRS\ LQ WKH GLDJQRVLV RI VNLQ GLVHDVHV (XU -'HUPDWRO :RUWVPDQ;6D]XQLF,-HPHF*%6RQRJUDSK\RISODQWDUZDUWV UROHLQGLDJQRVLVDQGWUHDWPHQW-8OWUDVRXQG0HG :RUWVPDQ;-HPHF*%6D]XQLF,$QDWRPLFDOGHWHFWLRQRILQÁDPPDWRU\FKDQJHVDVVRFLDWHGZLWKSODQWDUZDUWVE\XOWUDVRXQG'HUPDWRORJ\ .XĆLQVNLHQǣ96DPXOǣQLHQǣ'*LQHLNLHQǣ$5DLåXWLV5.Dç\V 5 9DOLXNHYLĆLHQǣ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ÀFDWLRQDQGUHPRYDORIFXWDQHRXVIRUHLJQERGLHVDFDVHVHULHV -(PHUJ0HGH -DFREVRQ-$3RZHOO$&UDLJ-*%RXIIDUG-$9DQ+ROVEHHFN 07:RRGHQIRUHLJQERGLHVLQVRIWWLVVXHGHWHFWLRQDW865DGLRORJ\ :RUWVPDQ;&RPPRQDSSOLFDWLRQVRIGHUPDWRORJLFVRQRJUDSK\ -8OWUDVRXQG0HG :DJQHU-0/HH.65RVDV+.OLHZHU0$$FFXUDF\RIVRQRJUDSKLFGLDJQRVLVRIVXSHUÀFLDOPDVVHV-8OWUDVRXQG0HG  &KRRQJ..6RQRJUDSKLFDSSHDUDQFHRIVXEFXWDQHRXVDQJLROLSRPDV-8OWUDVRXQG0HG :KLWWOH&&RUWpV0%DOGDVVDUH*&DVWUR$&DEUHUD5/LSRPD VXEJDOHDO'HVFULSFLyQHFRJUiÀFD5HY0HG&KLOH  5HTXHQD/6DQJXH]D23&XWDQHRXVYDVFXODUSUROLIHUDWLRQ3DUW ,,+\SHUSODVLDVDQGEHQLJQQHRSODVPV-$P$FDG'HUPDWRO  /HH*.6XK.-/HH-+/HH-<