Tratamiento del carcinoma primario de la vesícula seminal

Favaretto, R.L.; Ercolani, M.C.; Sánchez-Salas, R.; Validire, P.; Barret, E.; Cathelineau, X.
doi:10.1016/j.acuro.2011.06.011
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El adenocarcinoma&#44; la histolog&#237;a m&#225;s com&#250;n encontrada en tumores malignos primarios de la ves&#237;cula seminal &#40;VS&#41;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; normalmente se presenta como una enfermedad localmente avanzada debido a la escasez de s&#237;ntomas y signos en las primeras etapas&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Recientemente tratamos a un hombre de 62 a&#241;os con un historial de tres meses de hematospermia y un PSA de 1&#44;92 ng&#47;ml&#46; En el examen rectal digital se observ&#243; una anomal&#237;a y se confirm&#243; con ultrasonido una VS derecha dilatada&#46; La RNM mostr&#243; una VS derecha de 10<span class="elsevierStyleHsp" style=""></span>cm con un componente hemorr&#225;gico que comprim&#237;a la pr&#243;stata y la vejiga&#46; No se observ&#243; dilataci&#243;n de ganglios linf&#225;ticos&#46; La biopsia transrectal guiada por ultrasonido de la VS fue histopatol&#243;gicamente compatible con un adenocarcinoma mucinoso&#46; La biopsia de pr&#243;stata demostr&#243; las mismas caracter&#237;sticas patol&#243;gicas y sugiri&#243; una invasi&#243;n secundaria&#46; Se pretend&#237;a una prostatovesiculectom&#237;a rob&#243;tica con linfadenectom&#237;a p&#233;lvica bilateral&#46; Debido al tama&#241;o del tumor&#44; y a la dificultad del procedimiento&#44; la operaci&#243;n se convirti&#243; a un abordaje abierto y se complet&#243; con &#233;xito&#46; No hubo complicaciones perioperatorias&#46; La patolog&#237;a final confirm&#243; un tumor primario de 7<span class="elsevierStyleHsp" style=""></span>cm &#40;172<span class="elsevierStyleHsp" style=""></span>g&#41; de la VS con un diagn&#243;stico histol&#243;gico de adenocarcinoma mucinoso con arquitectura papilar &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 y 2</a>&#41;&#46; Inmunohistoqu&#237;micamente&#44; el tumor fue positivo para CA 125 y CK 7&#44; y negativo para PSA y PAP&#46; El tumor estaba invadiendo los l&#243;bulos prost&#225;ticos derecho e izquierdo&#44; y se identificaron los m&#225;rgenes quir&#250;rgicos positivos&#46; Un total de 23 ganglios linf&#225;ticos p&#233;lvicos extirpados fueron negativos para met&#225;stasis&#46; En la &#250;ltima visita de seguimiento el paciente se encontraba bien&#44; con un PSA de 0&#44;01 ng&#47;ml&#44; y no mostraba signos de progresi&#243;n de la enfermedad&#46; Se propuso un tratamiento adyuvante &#40;terapia hormonal y radioterapia&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">El carcinoma primario de la VS es dif&#237;cil de diagnosticar y diferenciar de los tumores de pr&#243;stata&#44; vejiga y recto que invaden la VS&#46; Incluso con los avances en formaci&#243;n de im&#225;genes&#44; que permiten una mayor sensibilidad para la detecci&#243;n de anomal&#237;as de la VS y el uso de estudios inmunohistoqu&#237;micos&#44; el carcinoma de ves&#237;cula seminal a menudo se diagnostica en una etapa avanzada y los resultados de supervivencia son pobres<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#46; Como el tumor no tiene caracter&#237;sticas patognom&#243;nicas&#44; el diagn&#243;stico se realiza a trav&#233;s de una combinaci&#243;n de an&#225;lisis de muestras brutas&#44; una evaluaci&#243;n de formaci&#243;n de im&#225;genes antes de la operaci&#243;n &#40;sin anomal&#237;as de la vejiga&#44; el colon&#44; la pr&#243;stata o el recto en TAC o RNM&#41; y ensayos inmunohistoqu&#237;micos<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">El diagn&#243;stico precoz y un tratamiento quir&#250;rgico agresivo parecen ser la &#250;nica forma de mejorar la supervivencia<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Sin embargo&#44; debido a la rareza de la enfermedad&#44; no hay directrices disponibles sobre la mejor manera de tratar esta entidad agresiva cl&#237;nicamente&#46; Las estrategias de tratamiento se han concentrado en la extirpaci&#243;n quir&#250;rgica del tumor<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; Tambi&#233;n se recomienda la disecci&#243;n exhaustiva<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> de los ganglios linf&#225;ticos p&#233;lvicos&#46; S&#243;lo los tumores sin implicaci&#243;n prost&#225;tica se pueden tratar con extirpaci&#243;n local o vesiculectom&#237;a&#44; una situaci&#243;n cl&#237;nica que rara vez ocurre<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> muestra los casos divulgados en los &#250;ltimos 10 a&#241;os enfatizando el tratamiento utilizado<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#8211;9</span></a>&#46; En los pacientes con m&#225;rgenes quir&#250;rgicos positivos la radioterapia adyuvante podr&#237;a desempe&#241;ar un papel en el control de la enfermedad a nivel local<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#8211;8</span></a>&#46; Tambi&#233;n se ha utilizado la terapia hormonal adyuvante<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4&#44;7&#44;8</span></a>&#46; Se ha empleado la quimioterapia&#44; pero los resultados han sido decepcionantes<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#46; Teniendo en cuenta la vigilancia despu&#233;s del tratamiento de la enfermedad primaria&#44; CA-125 parece tener importancia en el diagn&#243;stico y se puede utilizar como un marcador serol&#243;gico para controlar la respuesta al tratamiento<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3&#44;10</span></a>&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">Confirmamos que el carcinoma primario de la VS es una enfermedad poco com&#250;n&#44; con diagn&#243;stico t&#237;picamente tard&#237;o&#46; Se necesitan biomarcadores y la vigilancia cl&#237;nica para cambiar el pron&#243;stico hist&#243;ricamente pobre de esta enfermedad&#46; Las directrices para tratar la enfermedad a&#250;n no est&#225;n disponibles&#44; pero en funci&#243;n de la escasa informaci&#243;n publicada creemos firmemente que el tratamiento quir&#250;rgico agresivo&#44; con la extirpaci&#243;n amplia del tumor&#44; parece proporcionar el mayor provecho de supervivencia&#46;</p></span>"
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostatovesiculectom&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thiel et al&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2002&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extirpaci&#243;n de la ves&#237;cula seminal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Egevad et al&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">RT neoadyuvante &#43; cistoprostatectom&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lee et al&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Extirpaci&#243;n de la ves&#237;cula seminal y cistectom&#237;a parcial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Thyavihally et al&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2007&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Quimioterapia &#43; bloqueo hormonal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mohring et al&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2008&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostatovesiculectom&#237;a&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Angulo et al&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2011&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Vesiculectom&#237;a y prostatectom&#237;a parcial&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presente&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2012&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Prostatovesiculectom&#237;a &#43; bloqueo hormonal &#43; RT&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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          "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Tratamiento de carcinomas de la ves&#237;cula seminal primaria descritos en los &#250;ltimos 10 a&#241;os</p>"
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                0 => array:2 [
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                    0 => array:2 [
                      "titulo" => "Vesiculectom&#237;a con prostatectom&#237;a parcial laparosc&#243;pica en el tratamiento del adenocarcinoma primario de ves&#237;cula seminal con transformaci&#243;n carcinomatosa del conducto eyaculador"
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                            2 => "P&#46; Cabrera"
                            3 => "J&#46; Gonz&#225;lez"
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                        "volumen" => "35"
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