Caso Clínico del mes: CA Urotelial Papilar de Alto Grado

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Se trata de paciente femenina de 77 años de edad, natural y procedente de la ciudad de Caracas, quien consultó en Junio de 2011, por presentar disuria. Hábitos tabáquicos acentuados desde la adolescencia hasta los 30 años de edad, perteneciente a la religión Testigos de Jehová. Se realiza ecosonograma pélvico en el que se evidencia LOE de vejiga de 2-3 cm y cistoscopia que revela la presencia de 2 lesiones, en techo-cuello y región retrotrigonal de 2 cm cada una. Se realiza RTUV con resección completa de ambas lesiones e instilación inmediata de Quimioterapia intravesical a base de Mitomicina C: 40 mg diluidos en 40 ml de solución salina estéril. La Biopsia número 1632-2011, de fecha 18/07/11 reportó: Ca urotelial papilar de alto grado sin infiltración a la capa muscular (se anexa informe).

casoclinico1

Hallazgos cistoscópicos

Lesión en Techo-Cuello

casoclinico2
Lesión en región Retrotrigonal

casoclinico3

Preguntas:

1. ¿Está Ud. de acuerdo en haber usado quimioterapia intravesical inmediata con Mitomicina C?

2. ¿Qué otras alternativas o modalidades de tratamiento aplicaría usted?
a.- Re-resección transuretral de vejiga
b.- Inmunoterapia intravesical
c.- Quimioterapia intravesical
d.- Cistectomía radical

Consulte aquí la SEGUNDA PARTE del Caso Clínico

392 thoughts on “Caso Clínico del mes: CA Urotelial Papilar de Alto Grado

  1. Matias Guevara dice:

    De acuerdo con Mitomicina, re rtu-V antes de las 3 semanas.

  2. Antonio dice:

    Estoy de acuerdo con Mitomicina y con la re Rtu a las 6 semanas

  3. Francisco García Belandria dice:

    Totalmente de acuerdo con ReRTU-V a 3 semanas y posterior a ello, Inmunoterapia intravesical. Seria bueno saber que se hizo y los controles. Saludos.

  4. Sarai Palomo dice:

    De acuerdo con la aplicación de mitomicina c inicialmente antes de Dx patológico. No estoy de acuerdo con Re – resección si ya la lesión fue totalmente resecada y tenemos musculo en la muestra no veo sentido volver a resecar. Yo planificaría inmunoterapia intravesical bajo esquema de Lamm a las 4 semanas post resección para garantizar que haya cicatrizado totalmente la lesión y evitar complicaciones y fracaso.

  5. Con Buenos niveles de evidencia y alto grado de recomendacion, se apoya el uso de mitomicina C en la primera reseccion, , la re reseccion ha demostrado ser la mejor conducta y mas con el grado histologico

  6. Jhon Jimenez dice:

    ese procedimiento es el correcto al paciente hay que brindarle lo mejor.

  7. Estoy deacuerdo con mit c y nueva resección a las 2 semanas de la cicatriz

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    Hola, tuve hace unos af1os un pastor aleme1n, y lo qumtiaos por motivos totalmente ajenos a alergias, af1os despue9s me dio alergia a los perros y las verdad esque me enamoran son mi gran pasif3n, mi madre no me deja tener perros en casa por mis alergias, no se como convencerla, ni que hacer, seria posible con todos esos consejos que no me de alergia?.

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