Dermatología Clínica Pediátrica Acceso abierto

Abstracto

Pediatría clínica 2020: Tumor del saco vitelino testicular en un paciente de diecisiete años - Leya Imanuelle Martin - Hospital del Centro Médico Infante Jesús

Leya Imanuelle Martín

Presentación del caso:

Paciente de diecisiete años con antecedentes de seis meses de una masa escrotal izquierda blanda y persistente sin efectos secundarios. Catorce días antes de la confirmación, desarrolló fiebre de segundo grado sin escalofríos por la noche acompañada de tos no lucrativa. Una semana después, tuvo pérdida de peso con disminución del apetito, tras lo cual se completó la consulta. La evaluación física reveló una masa escrotal izquierda firme, flexible y no blanda con linfadenopatías inguinales. La alfa fetoproteína, la beta HCG y la LDH estaban completamente elevadas. La tomografía computarizada detectó numerosos centros agrandados en los pulmones, las zonas del mediastino, el hígado y el páncreas. El paciente se sometió a una orquiectomía extrema izquierda con estudios histopatológicos que revelaron un tumor del saco vitelino. Se inició la quimioterapia del régimen BEP (bleomicina, etopósido y cisplatino). Su reciente confirmación para el cuarto ciclo de quimioterapia ha demostrado una reducción significativa en los niveles de marcadores tumorales. Los filtros de TC descubrieron la liberación de los nódulos aspiratorios y la disminución del tamaño de las masas de la cola del hígado y del páncreas.

Conclusión:

El tumor del saco vitelino es una amenaza poco común en la juventud y su frecuencia ha aumentado en las últimas décadas. Los avances en el diagnóstico y la imagenología, así como la cirugía y la quimioterapia basada en cisplatino, han convertido a esta enfermedad en una de las que tienen una alta tasa de supervivencia.

Introducción:

Testicular tumors are uncommon in adolescence with larger part analyzed to be dangerous. Germ cell tumors (GCT), remarkably the most widely recognized of threatening gonadal tumor involves just 3% of pediatric malignant growths. Yolk sac tumor has been reported to have the most elevated rate among harmful GCT in kids. A yolk sac tumor is an uncommon, dangerous tumor of cells that line the yolk sac of the incipient organism. These cells ordinarily become ovaries or testicles; be that as it may, the reason for a yolk sac tumor is obscure. It is regularly found in kids before the ages of 1 to 2, however can happen all through life. The term yolk sac tumors envelops numerous sorts of tumors including germ cell tumors, teratomas, embryonal carcinoma, aysgermenomas, semenoma, and so forth. These tumors can happen in the testicles, ovaries, chest, mind and different pieces of the body. Testicular yolk sac tumors (otherwise called endodermal sinus tumor of the testis) is the most well-known youth testicular tumor (80%), with most cases happening before the age of two years. In grown-ups, unadulterated yolk sac tumor is incredibly uncommon, anyway blended germ cell tumor are usually observed. Totipotent cells, which later structure extraembryonic fetal films, offer ascent to yolk sac tumors. Perivascular structures called Schiller-Duval bodies can be found in half of tumors and are pathognomonic. AFP (alpha fetoprotein) is raised in >90% instances of yolk sac tumor. Perceptibly, the testis is supplanted by a coagulated mass. Minutely, a positive response for AFP is found in tumor cells. Planned radiologic portrayal of yolk sac tumor is troublesome, anyway a heterogeneous testicular mass favors non-seminomatous germ cell tumor (NSGCT), and at age <2 years, yolk sac tumor is the supported determination. Heterogeneous testicular mass sore with post-differentiate heterogeneous upgrade, with zones of drain/rot. In the event that the tumor is confined to the testis, and if the serum AFP isn't raised, orchiectomy is the favored treatment, with close development. In the event that backslide happens, chemotherapy is the treatment of decision. The lungs are the most well-known site of recurrence. Testicular tumors are exceptional in kids, involving around 1% to 2% of every single pediatric harm. Be that as it may, the rate of testicular tumors in youngsters is expanding, and related bleakness has multiplied during the most recent 40 years. Testicular yolk sac tumors represent 70% to 80% of prepubertal harmful testicular tumors and are the most widely recognized youth testicular disease. The anticipation of testicular yolk sac tumors is subject to early discovery and treatment. Pediatric patients with testicular yolk sac tumors generally present with an asymptomatic scrotal mass beginning phase (I) in the infection procedure. Assessment of the strong scrotal mass incorporates: scrotal ultrasound; chest, stomach, and pelvic registered tomography (CT); and assurance of serum tumor marker levels, for example, alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG). A raised serum AFP level is firmly connected with yolk sac tumors in over 90% of patients. The treatment of testicular yolk sac tumors is subject to tumor stage and patient age. Resection and chemotherapy with or without retroperitoneal lymph hub dismemberment (RPLND) is frequently utilized for kids with raised or rising AFP levels as well as retroperitoneal lymphadenopathy.