Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J,...
Transcript of Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J,...
![Page 1: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/1.jpg)
SESIÓN DE RESIDENTES Cinthya Báez Leal
![Page 2: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/2.jpg)
Hombre de 45 años
Antecedentes: Tumor Fibroso Solitario
tentorial izquierdo(2003, 2004, 2005,
2011)
Enfermedad actual: Lumbalgia intensa
e intolerancia a la bipedestación
![Page 3: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/3.jpg)
RNM Cervical
![Page 4: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/4.jpg)
RNM Lumbar
![Page 5: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/5.jpg)
TAC Toracoabdominal
![Page 6: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/6.jpg)
PAAF guiada por ECO
![Page 7: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/7.jpg)
![Page 8: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/8.jpg)
![Page 9: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/9.jpg)
![Page 10: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/10.jpg)
![Page 11: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/11.jpg)
![Page 12: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/12.jpg)
DIAGNÓSTICO DIFERENCIAL
Tumor Fibroso Solitario
Hemangioendotelioma Epitelioide
Schwanomma
Fibrosarcoma
HCC Sarcomatoide
Fibromatosis
Tumor miofibroblástico inflamatorio
Leiomioma
Carcinoma sarcomatoide
Mioepitelioma
Tumor del estroma gastrointestinal
Sarcoma sinovial
Sarcoma epitelioide
Meningioma
Leiomiosarcoma
![Page 13: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/13.jpg)
CD34 BCL-2
RETICULINA CD99
![Page 14: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/14.jpg)
NEGATIVOS CK AE1-AE3 EMA S100 CD31
![Page 15: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/15.jpg)
DIAGNÓSTICO DIFERENCIAL TFS
HEMANGIOENDOTELIOMA
EPITELIOIDE SCHWANOMMA FIBROSARCOMA HCC SARCOMATOIDE
Cd34
Cd99
S100
Bcl2
Vimentina
Actina
Factor VIII
Cd31
+
+
-
+
+
-
-
-
+
-
-
-
+
-
+
+
-
+/-
+
-
+
-
-
+/-
-
-
-
-
+
-
-
-
-
-
-
-
+
-
-
-
![Page 16: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/16.jpg)
PAAF Y BAG DE MASA HEPÁTICA:
TUMOR FIBROSO SOLITARIO
METASTÁSICO
DIAGNÓSTICO
![Page 17: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/17.jpg)
![Page 18: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/18.jpg)
![Page 19: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/19.jpg)
CD34 BCL-2
RETICULINA EMA
![Page 20: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/20.jpg)
TUMOR FIBROSO SOLITARIO
CITOLOGÍA INMUNOHISTOQUÍMICA
Grupos cohesivos
Células fusiformes
Citoplasma mal definidos
Núcleos desnudo
Matriz mixoide ó colagenizada
Vasos ramificados (bloque celular)
Positividad
CD34 (90%)
CD99 (70%)
BCL-2 (30%)
Negatividad
S100
Citoqueratinas
Desmina
EMA
![Page 21: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/21.jpg)
TUMOR FIBROSO SOLITARIO
Tumor mesenquimal 4ª y 5ª década de vida Hombres=Mujeres
Poco sintomático
![Page 22: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/22.jpg)
50% partes blandas, 25% abdomen y
retroperitoneo, cabeza, cuello,
extremidades superiores y meninges
Menos del 1% de los tumores del SNC
(parasagital, fosa posterior y tienda del
cerebelo)
TUMOR FIBROSO SOLITARIO
![Page 23: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/23.jpg)
TUMOR FIBROSO SOLITARIO
2007
Tumor fibroso solitario
Hemangiopericitoma
![Page 24: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/24.jpg)
WHO 2013. PARTES BLANDAS Y HUESO:
TUMOR FIBROSO SOLITARIO TÍPICO
TUMOR FIBROSO SOLITARIO MALIGNO
Hipercelularidad
Número de mitosis (≥4 mitosis/10 cga)
Necrosis
Pleomorfismo nuclear
Márgenes infiltrativos
TUMOR FIBROSO SOLITARIO
2013
![Page 25: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/25.jpg)
TUMOR FIBROSO SOLITARIO
Recidivas locales: 45%-90%
Metástasis: Hígado, pulmones,
hueso, riñón y páncreas
![Page 26: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/26.jpg)
TUMOR FIBROSO SOLITARIO
EXTRAMENINGEO* MENINGEO**
>15 cm
≥ 4 mitosis/ 10 cga
>55 años
Hipercelularidad
>5 mitosis/10 cga
Extensión quirúrgica
FACTORES DE MAL PRONÓSTICO
*Demicco E, Park M, Araujo D, Fox PS, Bassett RL, Pollock RE, et al. Solitary fibrous tumor: a clinico- pathological study of 110 cases and proposed risk assessment model. Modern
Pathology. 2012;25: 1298-306.
tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping pathological features and
common prog-nostic factors suggest the same spectrum of tumors. Brain Pathol. 2012;22(4):511-21.
Otros: p53 y Ki67
![Page 27: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/27.jpg)
TRATAMIENTO
Cirugía: Tratamiento de elección
Radioterapia / Quimioterapia
Expresión ALDH1 (marcador diagnóstico/ diana terapeutica) Bouvier C. ALDH1 is an immunohistochemical diagnostic marker
for solitary fibrous tumours and haemangiopericytomas of the meninges emerging from gene profiling study. Acta Neuropathol Commun. 2013 May 9;1(1):10. doi: 10.1186/2051-5960-1-10.
TUMOR FIBROSO SOLITARIO
![Page 28: Sesión de residentes · 2014. 2. 15. · tellus P, de Paula VM, Vasiljevic A, Jouvet A, Guyotat J, et al. Solitary fibrous tumors and hemangiopericytomas of the meninges: over- lapping](https://reader031.fdocuments.co/reader031/viewer/2022012003/60a7536b51e5f85d1267ca6d/html5/thumbnails/28.jpg)
CONCLUSIÓN
TUMOR FIBROSO SOLITARIO
TFS neoplasia poco frecuente que puede ocurrir en cualquier localización En el SNC es uno de los pocos tumores primarios que pueden metastatizar El diagnóstico por PAAF es difícil. Orientar diagnóstico Pronóstico incierto Seguimiento prolongado