Dermatologia Pediátrica Clínica Acesso livre

Abstrato

Pediatria Clínica 2020: Tumor do Saco Vitelino Testicular num Doente de Dezassete Anos - Leya Imanuelle Martin - Hospital do Centro Médico Menino Jesus

Leya Imanuelle Martin

Apresentação do caso:

Doente de dezassete anos com história de seis meses de extensão contínua de massa escrotal esquerda fácil, sem efeitos secundários. Catorze dias antes da confirmação, apresentou febre moderada, sem arrepios ao anoitecer, acompanhada de ataques não lucrativos. Várias semanas depois, teve perda de peso com diminuição da fome e o tratamento foi concluído. A avaliação física revelou uma massa escrotal esquerda forte, firme, versátil e não delicada, com linfadenopatias inguinais. A Alfa fetoproteína, o Beta HCG e o LDH estavam totalmente elevados. O filtro de TC notou numerosos centros aumentados nos pulmões, zonas mediastinais, fígado e pâncreas. Tolerante, experiente orquiectomia extrema esquerda com exames histopatológicos revelando tumor do saco vitelino. Iniciou-se o silêncio sobre a quimioterapia de rotina BEP (bleomicina, etoposídeo e cisplatina). A sua última confirmação para o quarto padrão de quimioterapia demonstrou uma redução notável dos níveis de marcadores tumorais. Os filtros de tomografia computorizada revelaram libertação de botões aspiratórios e diminuição do tamanho das massas da cauda do fígado e do pâncreas.

Conclusão:

O tumor do saco vitelino é uma ameaça incomum para os jovens, com uma frequência de desenvolvimento observada nas décadas anteriores. Os avanços tanto no diagnóstico como na imagiologia, bem como nos procedimentos médicos e na quimioterapia à base de cisplatina, transformaram esta doença numa doença com uma elevada taxa de resistência.

Introdução:

Testicular tumors are uncommon in adolescence with larger part analyzed to be dangerous. Germ cell tumors (GCT), remarkably the most widely recognized of threatening gonadal tumor involves just 3% of pediatric malignant growths. Yolk sac tumor has been reported to have the most elevated rate among harmful GCT in kids. A yolk sac tumor is an uncommon, dangerous tumor of cells that line the yolk sac of the incipient organism. These cells ordinarily become ovaries or testicles; be that as it may, the reason for a yolk sac tumor is obscure. It is regularly found in kids before the ages of 1 to 2, however can happen all through life. The term yolk sac tumors envelops numerous sorts of tumors including germ cell tumors, teratomas, embryonal carcinoma, aysgermenomas, semenoma, and so forth. These tumors can happen in the testicles, ovaries, chest, mind and different pieces of the body. Testicular yolk sac tumors (otherwise called endodermal sinus tumor of the testis) is the most well-known youth testicular tumor (80%), with most cases happening before the age of two years. In grown-ups, unadulterated yolk sac tumor is incredibly uncommon, anyway blended germ cell tumor are usually observed. Totipotent cells, which later structure extraembryonic fetal films, offer ascent to yolk sac tumors. Perivascular structures called Schiller-Duval bodies can be found in half of tumors and are pathognomonic. AFP (alpha fetoprotein) is raised in >90% instances of yolk sac tumor. Perceptibly, the testis is supplanted by a coagulated mass. Minutely, a positive response for AFP is found in tumor cells. Planned radiologic portrayal of yolk sac tumor is troublesome, anyway a heterogeneous testicular mass favors non-seminomatous germ cell tumor (NSGCT), and at age <2 years, yolk sac tumor is the supported determination. Heterogeneous testicular mass sore with post-differentiate heterogeneous upgrade, with zones of drain/rot. In the event that the tumor is confined to the testis, and if the serum AFP isn't raised, orchiectomy is the favored treatment, with close development. In the event that backslide happens, chemotherapy is the treatment of decision. The lungs are the most well-known site of recurrence. Testicular tumors are exceptional in kids, involving around 1% to 2% of every single pediatric harm. Be that as it may, the rate of testicular tumors in youngsters is expanding, and related bleakness has multiplied during the most recent 40 years. Testicular yolk sac tumors represent 70% to 80% of prepubertal harmful testicular tumors and are the most widely recognized youth testicular disease. The anticipation of testicular yolk sac tumors is subject to early discovery and treatment. Pediatric patients with testicular yolk sac tumors generally present with an asymptomatic scrotal mass beginning phase (I) in the infection procedure. Assessment of the strong scrotal mass incorporates: scrotal ultrasound; chest, stomach, and pelvic registered tomography (CT); and assurance of serum tumor marker levels, for example, alpha-fetoprotein (AFP) and beta-human chorionic gonadotropin (β-hCG). A raised serum AFP level is firmly connected with yolk sac tumors in over 90% of patients. The treatment of testicular yolk sac tumors is subject to tumor stage and patient age. Resection and chemotherapy with or without retroperitoneal lymph hub dismemberment (RPLND) is frequently utilized for kids with raised or rising AFP levels as well as retroperitoneal lymphadenopathy.