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Enfermedades Pleurales Malignas

B. D. García, A. D. P. Gafas, R. L. Hernández, C. García-Gallo
Published 2006 · Medicine

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Mesotelioma pleural maligno (MPM) Etiopatogenia. El MPM es un tumor que se origina en las celulas mesoteliales de la pleura y que esta claramente relacionado con la exposicion al asbesto. Clinica. La disnea progresiva y el dolor toracico son los sintomas mas frecuentes de presentacion. Historia natural. El pronostico es sombrio, siendo la principal causa de muerte la insuficiencia respiratoria. Diagnostico. El analisis del liquido pleural con marcadores inmunohistoquimicos permite realizar el diagnostico en algunas ocasiones, pero el diagnostico de certeza solo se puede establecer con el analisis histopatologico de la biopsia pleural. Tratamiento. No hay un tratamiento curativo para este tumor. La terapia multimodal en pacientes en estadios precoces de la enfermedad y el uso combinado de pemetrexed y cisplatino son las unicas terapias capaces de prolongar la supervivencia de estos pacientes. Derrame pleural maligno (DPM) Concepto. Se entiende como DPM aquel derrame en el que se demuestra la presencia de celulas tumorales en el liquido o tejido pleural. Etiopatogenia. El carcinoma broncogenico es el tumor que mas frecuentemente causa DPM. El tipo histologico predominante es el adenocarcinoma. Diagnostico. Un DPM solo puede ser diagnosticado demostrando la presencia de celulas malignas en el liquido pleural o en el tejido pleural. La tecnica que ofrece mayor rentabilidad en el diagnostico es la biopsia pleural obtenida con toracoscopia. Tratamiento. Va dirigido al alivio sintomatico del paciente y a prevenir la recurrencia del derrame mediante la evacuacion del liquido y posterior pleurodesis quimica.
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