Resumen de Enfoque multidisciplinar para el diagnóstico del mesotelioma

Marta Capilla Díez, Paula Bayo Juanas, María Lorena Navas Gómez, Manuel Baladrón Segura, María Miguel Lucero Salaverry, Sara Anabel Díaz Villarreal

• español

  El mesotelioma constituye uno de los tumores más frecuentes, dentro de los de origen pulmonar y mamario, siendo la prevalencia de derrame pleural secundario elevada.

  Se presenta un caso de una mujer de mediana edad que requiere toracocentesis diagnostica tras la situación de empeoramiento general y disnea ante pequeños esfuerzos que presenta desde hace más de 1 mes. Al realizar el análisis del líquido pleural destaca el hallazgo de cluster celulares de mediano-gran tamaño, multinucleares, vacuolados que forman acúmulos. Este hallazgo favorece la ampliación de diferentes estudios anatomopatológicos y radiológicos realizados a la paciente orientando a una sospecha de neoplasia renal y pleural izquierda.

  Al mes siguiente se realiza otra toracocentesis tras la presencia de derrame pleural derecho, observándose de nuevo al microscopio el mismo componente celular previo. Se realiza un estudio inmunohistoquímico que se complementa con una biopsia a la que se realiza bloque celular.

  Finalmente se logra gracias un trabajo multidisciplinar, diagnosticar a la paciente de mesotelioma pleural maligno de morfología epitelioide.

• English

  Pleural mesothelioma is a rare tumor, representing less than 2% of all malignant neoplasms. One of its main clinical manifestations is secondary pleural effusion, which raises the differential diagnosis with other more frequent tumors, such as those of pulmonary or breast origin.

  We present the case of a middle-aged woman who required diagnostic thoracentesis after the general worsening and dyspnea with slight exertion that she had been experiencing for more than 1 month. When analyzing the pleural fluid, the finding of medium-large, multinuclear, vacuolated cell clusters that form accumulations was notable. This finding favors the extension of different anatomopathological and radiological studies performed on the patient, leading to a suspicion of renal and left pleural neoplasia.

  The following month, another thoracentesis was performed after the presence of right pleural effusion, and the same previous cellular component was observed again under the microscope. An immunohistochemical study is performed, which is complemented by a biopsy from which a cell block is performed.

  Finally, thanks to multidisciplinary work, the patient is diagnosed with malignant pleural mesothelioma of epithelioid morphology.