Cáncer de piel: melanoma. Revisión de la literatura

Skin cancer is usually classified into melanoma (SCM) and non-melanoma (SCNM), with different cell origins; being the SCM responsible for the highest mortality. In Chile, an incidence (2008) of 434 new cases is estimated, obtaining a standardized rate of 2.2 cases per 100,000 habitants. There are multiple associated risk factors, the main ones being exposure to UV radiation and sunburn. The strategies to prevent this pathology fall on these same factors. The clinical evaluation of the lesions with ABCD mnemonics added to the use of dermoscopy increases the diagnostic sensitivity and specificity; however, the definitive confirmation is through biopsy, which must include the necessary parameters to define prognosis of disease. The definitive treatment is Surgical. There are alternatives such as the use of the sentinel lymph node to define lymph node dissections. Regarding systemic therapies, the use of immunotherapy has shown results that improve survival in these patients

Infecciones profundas del cuello

Deep neck infections (DNIs) are special entities among infectious diseases for their versatility and potential for severe complications. Complex head and neck anatomy often makes early recognition of DNIs challenging, and a high index of suspicion is necessary to avoid any delay in treatment. The diagnosis is made by clinical history, physical examination findings and imaging studies. The treatment consists in securing the airway, intravenous antibiotics and surgical drainage, when needed. To make decisions the surgeon must understand the anatomy of the region, the etiology of infection, appropriate diagnostic tools, and medical and surgical management. This article provides a review of these pertinent topics

Enfrentamiento a una masa cervical no tiroidea en Atención Primaria

The clinical approach to non-thyroid cervical masses in primary care has always been considered a diagnostic challenge. In the absence of specific diagnostic methods, the general practitioner must rely on clinic and general tests in order to achieve a suspected diagnosis and timely referral. On initial approach to cervical masses, one must first analyze each case according to patient age, associating an exhaustive anamnesis focused on the growth pattern and aggregate symptoms, along with a physical examination focused on signs of malignancy. Once completed, the etiology of the mass can be classified as probable congenital, inflammatory or tumoral origin. And also try to determine localization, temporality and discriminate between benign and malignant causes. Once the clinical interrogation has been completed, basic complementary tests and/or directed test according to suspicion can be requested. The foregoing allows the primary care physician a proper referral to specialist and/or initiation of appropriate treatment

Caracterización epidemiológica y clínica de pacientes operados con diagnóstico de quiste branquial

Introduction: Branchial Cysts are uncommon anomalies in regular clinical practice. However, among congenital cervical cysts, they represent about 30% from total. Objective: Characterize patients diagnosed with operated branquial cyst in our clinical center, and correlate clinic, imaging and final diagnose. Material and methods: Retrospective descriptive study of discharged patients diagnosed as cervical cysts, between January 2005 and July 2011, at Hospital Clinico Universidad de Chile. Selection of Clinical records with final diagnose of branchial cyst were selected. Age, sex, clinical story, imaging exams, pre-operative and post-operative diagnoses, and biopsy report were registered. Results: from a total of 149 cervical cysts, 31 (20,8%) were branchial cysts. Man 45% and women 55%. By age, 9 (29%) were 15 years (average: 33,7 years). Lateral cervical mass was the most common clinical manifestation. Regarding Imaging study, 15 cervical ultrasounds (sensibility 0,86 and specificity 0,98) and 13 cervical CTA scans (sensibility 0,92 and specificity 0,94) were conducted. In 9 patients, imaging studies weren’t conducted for the clinical diagnose (sensibility 0,77 and specificity 0,98). Correlation of pre-operative and post-operative diagnose was 87%. Discussion: According to literature, presentation age is generally during childhood; however, in our statistics it presented during adult age, which could be explained due to the main focus our medical center has for adult population. Most common clinical presentation was lateral neck mass, which had a good clinical correlation, however improves with imaging studies

Tumores de glándulas salivales: enfrentamiento diagnóstico inicial

It is described that salivary gland tumors account for up to 3-6% of head and neck tumors, 80% of these being located in the parotid gland. Broadly speaking, the smaller the gland, the greater the probability of malignancy. The most common clinical manifestation in tumor pathology is the appearance of a painless mass. Indicators of malignancy should be considered: chronic volume increase or rapid growth, facial paralysis, cranial nerve involvement, ulceration, and cervical lymphadenopathy. Ultrasonography should be the first imaging study, however, it provides limited information. MRI is the exam of choice for salivary gland tumors, whereas CT and PET-CT allow the study of local and remote invasion. FNA is controversial, it is not indicated for all patients, in parotid tumors a cytological examination is usually not necessary prior to surgery. Excisional biopsy is not recommended due to the risk of tumor seeding, neural damage, and salivary fistula. The goal of treatment in gland tumors is the removal of the glands, associated with lymph node dissection and adjuvant radiation therapy in indicated cases. The general practitioner must comprehensively address these pathologies to achieve a timely referral to the specialist

Paratirotoxicosis y tumor cervical palpable: caso clínico de cáncer de paratiroides

ResumenIntroducciónEl cáncer de paratiroides es poco frecuente. Suele presentarse como hiperparatiroidismo primario, en ocasiones como crisis hipercalcémica, con malestar general, náuseas, vómitos, alteraciones del ánimo y pérdida de peso. En algunos casos se presenta como osteítis fibrosa quística, osteopenia difusa, osteoporosis y fracturas patológicas. El diagnóstico suele estar dado por biopsia quirúrgica que muestra invasión a estructuras adyacentes, o metástasis locales y distantes. El tratamiento es la resección quirúrgica del tumor, sin uso de terapias adyuvantes. Su tasa de recurrencia es alta, de 25 a 100%. Algunos factores de mal pronóstico son metástasis a linfonodos en la presentación inicial, metástasis distantes y carcinomas no funcionantes.Caso clínicoPaciente masculino de 64 años que consultó por compromiso del estado general, bradipsiquia, poliuria, cefalea y masa cervical. Además presentaba hipercalcemia y gran elevación de PTH. Se realizó resección quirúrgica de la masa cervical, con biopsia rápida con atipias y mitosis 1/10, y de un nódulo hiperplásico tiroideo. Tras esto, sus niveles de PTH disminuyeron, así como también descendieron sus niveles de calcio.DiscusiónLos pacientes que presentan cáncer de paratiroides suelen tener valores más elevados de calcemia y PTH. Para su diagnóstico, no se recomienda usar biopsia por punción, por riesgo de diseminación y por el bajo rendimiento de esta técnica.ConclusiónPese a ser poco frecuente, se debe pensar en cáncer de paratiroides en el contexto de un paciente con hipercalcemia, especialmente si presenta PTH muy elevada. La sospecha clínica de este diagnóstico tiene directa relación con la posibilidad de tratamiento y pronóstico de la enfermedad.AbstractIntroductionParathyroid cancer is rare. Usually presented as primary hyperparathyroidism, sometimes as hypercalcemic crisis, with general malaise, nausea, vomiting, mood disturbances and low weight. In some cases it occurs as osteitis fibrosa cystica, diffuse osteopenia, osteoporosis and pathological fractures. The diagnosis is usually made by surgical biopsy shows invasion of adjacent structures, or local and distant metastases. The treatment is surgical resection of the tumor, without the use of adjuvant therapies. Their recurrence rate is high, 25 to 100%. Poor prognostic factors are lymph node metastases at initial presentation, distant metastases and nonfunctional carcinomas.Case reportMale patient consulted for 64 years in general conditions, bradypsychia, polyuria, headache and neck mass. He also had hypercalcemia and high elevation of PTH. Surgical resection of the cervical mass was performed, with rapid biopsy atypia and mitosis 1/10, and hyperplastic thyroid nodule. After this, PTH decreased levels as well as levels of calcium.DiscussionPatients with parathyroid cancer tend to have higher serum calcium and PTH of values. For diagnosis, it is not recommended to use needle biopsy, risk of spread and the poor performance of this technique.ConclusionDespite being rare, you should think parathyroid cancer in the context of a patient with hypercalcemia, especially if you have very high PTH. The clinical suspicion of this diagnosis is directly related to the possibility of treatment and prognosis of the disease