tumor del glomus carotideo (quemodectoma)
DESCRIPTION
revision del diagnostico y manejo de los tumores del cuerpo carotideoTRANSCRIPT
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Tumor del Glomus CarotídeoDr. Wagner RomeroR3 Cirugia GeneralUniversidad Central del EcuadorHospital de Especialidades Eugenio Espejo
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Mide 3 x 6 mmPeso: 2mg
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Tumor del Glomus Carotideo Historia
Guild, 1941: Cuerpo yugular,12
Mulligan, 1950: Propuso el nombre de quemodectoma
Lattes, 1950: Paraganglioma (basandose en la ubicación anatomica y origen embrionario)
Guild, SR. A hitherto unrecognized structure, the glomus jugularis. Man. Anat. Rec. (Suppl. 2), 79: 28, 1941.Mulligan, RM. Chemodectoma in the Dog. Am. J. Path. 1950. 26: 680.
Lattes, R. Nonchromaffin paraganglioma of ganglion nodosum, carotid body, and aortic-arch bodies. Cancer, 1950; 3: 667.
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Epidemiologia Paragangliomas
0,8/100.000/año 30 – 50 años H:M Benignos Tumor del Glomus: 65% de todos los
paragangliomas de cabeza y cuello 10% Malignidad 10% Bilaterales 10% antecedente familiar
Derrick Lin, MD; Sally E Carty, MD, FACS; William F Young, Jr, MD, MscParagangliomas: Epidemiology, Clinical Presentation, Diagnosis, And Histology. Uptodate, Sept 9 th 2013
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Factores de Riesgo Sindromes hereditarios
Mutaciones en los genes codificadores de la succinato deshirogenasa
MEN2A y 2B Von Recklinghausen Von Hippel Lundau Carney-Stratakis
Derrick Lin, MD; Sally E Carty, MD, FACS; William F Young, Jr, MD, MScParagangliomas: Epidemiology, clinical presentation, diagnosis, and histology. UpToDate, Sept 9th 2013
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Factores de Riesgo Asociación hipoxia – paraganglioma
Grandes alturas Prevalencia: 1 de cada 10, 1 de cada 2
bovinos 86 a 96% en mujeres
EPOC
High altitude hypoxia and chemodectomas. Saldana MJ, Salem LE, Travezan R. Hum Pathol. 1973 Jun;4(2):251-63
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Patología Crecimiento lento Vascularizados Benignos Histología: Pequeños nidos de células
cromafínicas poligonales uniformes (“Zellballen")
Inmunohistoquimica: S-100 positivos
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Patología Criterios de malignidad
Invasión local con el desarrollo de parálisis de los nervios craneales, la invasión de la carótida, o infiltración de los tejidos blandos en el espacio parafaríngeo; o la destrucción ósea en la base del cráneo
MTS linfática MTS a distancia
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Clasificacion
CLASIFICACION
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Cuadro Clínico Hallazgo casual Al examen físico
Parte alta del cuello Pulsátiles Parálisis de los pares craneales inferiores
Tumores en espacio parafaringeo Masa en pared faríngea lateral Desplazamiento medial de la amigdala y
paladar
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Diagnostico TC
Desplazamiento de la grasa del espacio parafaringeo y de la ACI hacia adelante
Muy vascularizados Realce al contraste
RMN Aumento de intensidad y vacíos de flujo
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Tratamiento Selección de pacientes
Tamaño del tumor Ubicación Edad Profesion del paciente Riesgo de lesión neurológica
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Manejo no Quirurgico Observación
Debe ser considerada la primera opción Control imagenológico seriado RMN anual Cirugía
Aparición rápida de síntomas Crecimiento del tumor desproporcionado
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Radioterapia No erradica el tumor
Tecnica convencional Radiocirugía estereotáctica Radiocirugía con bisturí gamma
Indicaciones Ancianos Shamblin III > 5cm Mal estado general
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14Mohamad Chaaban, MD; Chief Editor: Arlen D Meyers, MD, MBA. Carotid Body Tumors
Treatment & Management. Jan 14, 2014
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Embolizacion Indicado en tumores mayores a 4cm
Ayuda a delinear el controno La infiltracion vascular Detecta tumores bilaterales
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14Mohamad Chaaban, MD; Chief Editor: Arlen D Meyers, MD, MBA. Carotid Body Tumors
Treatment & Management. Jan 14, 2014
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Tratramiento Médico Util en paragangiomas funcionantes Inhibidores del análogo de la
somatostatina Disminucion del tamaño tumoral en el
15% de los casos. No tiene mucha utilidad en tumores del
glomus carotideo
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Tratamiento Quirúrgico Indicaciones
Factores del tumor Malignidad confirmada Crecimiento rápido Compresión local
Factores del paciente Paciente joven Lesión unilateral Riesgo minimo de lesión neurológica
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Preparacion Prequirúrgica Si la lesión es grande y muy vascularizada se
debe realizar angiografía Embolización preoperatoria: 24 horas
previos a la cirugía Estimar el potencial sangrado transquirurgico En tumores grandes: estudios de oclusion
para demostrar buena circulación del flujo carotideo contralateral
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Técnica: Tumores Benignos Anestesia general Electrocauterio bipolar Instrumental vascular (clamps, loops,
Fogarty) Posicion: decubito supino, cuello
extendido y lateralizado en sentido contralateral
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Técnica: Tumores Malignos Informar al paciente de la posible lesión
cerebrovascular Estar preparado para resecar y
reconstruir la ACI Team debe contar con cirujano vascular Anestesia: general
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14
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Complicaciones Lesión vascular (Shamblin III) Lesión neurológica (X – XII, laringeo
superior) Incapacidad de crear sonidos agudos Paralisis de cuerdas vocales Problemas para la deglucion Dolor en el hombro y debilidad Sindrome del primer bocado
Mohamad Chaaban, MD; Chief Editor: Arlen D Meyers, MD, MBA. Carotid Body Tumors Treatment & Management. Jan 14, 2014
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Cuidado Postoperatorio Supervision de neuropatias craneales Evaluar habla y deglucion En caso de lesiones permanentes:
Protesis de aumento palatino Paralisis de cuerdas vocales:
medialización Terapia del habla y deglucion*
Jatin Shah’s. Head And Neck. Surgery And Oncology. Fourth Edition (2012) Chapter 14