7/25/2019 caso clinico camama

1/26

INSTITUTO MEXICANO DEL SEGURO SOCIALHOSPITAL GENERAL REGIONAL NO. 36

GINECOLOGA Y OBSTETRICIA

CASO CLINICOJUEVES 15 DE MAYO DE 2014

DR. OSCAR CRU R4GODR. RODOL!O GONALE ANDERICA R3GO

DRA. AYERIM ROJAS LAARO R2GO

7/25/2019 caso clinico camama

2/26

!ICHA DE IDENTI!ICACION

7/25/2019 caso clinico camama

3/26

ANTECEDENTES

HEREDO!AMILIARES C"#$%&'( )*+*$*",-%'(/ N*+,)'(

O$&'#+%&'(/ C$&*" "*$, '" ",, ,-*"$,

A-*",&%'$*( C"''(#%&,(/ N*+,),(

7/25/2019 caso clinico camama

4/26

ANTECEDENTES

PRESONALES PATOLGICOS N%*+, *$*"*),)*( &"#$%&' )*+*$*",-%,(

A*"+%,(/ 78

C%"9+:,(/ 78T",9,-%('(/ 78

T",$(9(%'$*(/ 78

7/25/2019 caso clinico camama

5/26

ANTECEDENTES

GINECOOBSTETRICOS M*$,"&,/ 13 ,;'(

C%&'(/ 2,;'( P,"*?,( (*=9,*(/ 1

G*(-,/ 0

M@-')' )* ,$%&,&%#$ ,%%,"/ N%$+9$'

!*&, )* -%, *$(-"9,&%#$/ J9$%' 12 D*-*&&%#$ ''"-9$, )* &$&*" &*"%&'9-*"%$'/ N9$&,

D*-*&&%#$ ''"-9$, )* &$&*" )* ,,/ M,(-'+",:, ,&* 6,;'( $' )'&9*$-,),.

7/25/2019 caso clinico camama

6/26

PADECIMIENTO ACTUAL

D''" ,)'%$, -%' %&' '&,(%'$,

P*")%), '$)*", 5 + *$ 9$ *( )* *'9&%#$F

,&',;,)' )* ,(-*$%,F ,)%$,%, * %'"*=%, A9*$-' )* '9*$ )* *":*-"' ,)'%$,

USG ,"-%&9," J9$%' 20128/ I,+*$ )**$)%*$-* )*,$*=' )*"*&' &'$ 6 & )%*-"'F -*"' %""*+9," )* < =10 &

7/25/2019 caso clinico camama

7/26

G*$*",/ P,&%*$-* &'$(%*$-*F '"%*$-,),F %)",-,),F &'$ ,)*&9,),

&''",&%#$ )* -*+9*$-'(.

C,*,/ N'"'&*,'F &,", (%@-"%&,F :, ,@"*, $'

&'"'*-%),F (%$ ,)*$'*+,%,(F '"',":$+* $'",.

C9*'/T"9*, &*$-", ,,*F &'$ &'$+'*",)' +,$+%'$,"

*$ -"%$+9' '(-*"%'" %9%*")'F $' (* ,9(&9-,$(''(F -%"'%)*( $' ,,*.

EXPLORACIN !SICA

7/25/2019 caso clinico camama

8/26

T#",=/ S%@-"%&'F (%$ ,-*",&%'$*( *$ *&$%&, *$-%,-'"%,F

&,'( 9'$,"*( %*$ *$-%,)'(F "*&'")%' (%$

,-*",&%'$*(F ,,( (%@-"%&,(F &'$ &'"'%(' )*&'*?' %*F ,"*',F *#$. ,, )*"*&, ?, ,,"*) -'"&%&, &'$ &9-$%)*(F ,=%, )*"*&, &'$ +,$+%'*$ :$*, ,=%," )* 2& ?' , ,$'( "'9$)'(F ,,%9%*"), &'$ -9'" )* 11 = 10 = 5 & (9(-%-9*$)'

'( &9,)",$-*( (9*"%'"*( &,(% *$ (9 -'-,%),)F #%F 2+,$+%'( *$ ,=%, %9%*"), @-"*'( #%*( )* 1.5&.

A)'*$/ G''(' , *=*$(,( )* :9%)' )* ,(&%-%(F (%$ -*$(%#$F

(%$ ),-'( )* %""%-,&%#$ *"%-'$*,F *"%(-,(%(

EXPLORACIN !SICA

7/25/2019 caso clinico camama

9/26

T,&-' ,+%$,/ V,+%$, *(-%&,F ,",@-"%'( %"*(F (* *$&9*$-", '$)' )*

(,&' -*$('F ,$ 78F &@"%= '(-*"%'"F 9$-%'"* &'$ *(%#$

*=':-%&, )* ,"'=%,),*$-* 2=2&F $' (* )*%%-, *?**)%' )* -*"'F ,$*='( $' ,,*(F +9,$-* *='",)'" &'$,$&,)' *-%&' K8.

T,&-' "*&-,/ T9'" *=':-%&' )* 5& 9* %$,)* 2K3 )* ,+%$,F -,%9*(

,$-*"%'" '(-*"%'" -',)'(F ,",@-"%'( %"*(. E=-"*%),)*(/

S%$ *)*,F "**?'( )* *(-%",%*$-' 9(&9," $'",*(F 9('()%(-,*( (%@-"%&'(F ,)*&9,)'( *$ ,%-9)F "*&9*$&%, (%*-":,.

EXPLORACIN !SICA

7/25/2019 caso clinico camama

10/26

PREGUNTAS

7/25/2019 caso clinico camama

11/26

LABORATORIOS

TELE DE TORAX

US PELVICO

US ABDOMINAL

US MAMA

BIOPSIA

GAMMA GRAMA SEO

7/25/2019 caso clinico camama

12/26

LABORATORIOS

H*'+'%$,/ 15.< +K)

H*,-'&"%-'/ 46.>

P,9*-,(/ 33

7/25/2019 caso clinico camama

13/26

TELE DE TORAX AP

7/25/2019 caso clinico camama

14/26

TELE DE TRAX OBLICUA

7/25/2019 caso clinico camama

15/26

ULTRASONIDO PQLVICO

C'$&9(%'$*(/

-*"' )* ,"*)*( %""*+9,"*( )* 20=1

7/25/2019 caso clinico camama

16/26

US ABDOMINAL

C'$&9(%'$*(/ N' (* )*-*&-,$ *(%'$*( *-,(-(%&,( , :+,)' A(&%-%(

7/25/2019 caso clinico camama

17/26

US MAMA

M,, %9%*"),/ I,+*$%*"*&'%&, )* 110 = 2 = 50

G,$+%'( ,=%,"*( )* 11F>F 4

M,, )*"*&,/ G,$+%'( *$"*+%#$ ,=%," )* 16 15

7/25/2019 caso clinico camama

18/26

GAMMA GRAMA SEO

P*$)%*$-* *$ , ,&%*$-* , '*$-' )* %$+"*('F'(-*"%'"*$-*

7/25/2019 caso clinico camama

19/26

BIOPSIAS

M,, %9%*"),/

C,"&%$', '9%,"%$-",$-*F +",)' III SBR.

R. E(-"#+*$'(..0 R.

P"'+*(-*"'$,..0 HER2 NEU.......78 E7C,)*"%$,...78

M,, )*"*&,/ I$-",&%#$ '"

&,"&%$', '9%,"

C@"%= (,&,'&,)'8/ I$-",&%#$ '"

&,"&%$', '9%,"

PAP/ N*+,-%' , *(%#$*(&,'(, %$-",*%-*%,.

C%-''+:, )* ,(&%-%(/N*+,-%,

7/25/2019 caso clinico camama

20/26

ETAPA CLNICA

7/25/2019 caso clinico camama

21/26

ETAPA CLNICA

C9-$%)*(

M*-(-,(%( , &@"%=

T9'" *$,,)*"*&,

EC IV

7/25/2019 caso clinico camama

22/26

PRONSTICO

7/25/2019 caso clinico camama

23/26

CIRUGA

UIMIOTERAPIA

NEOADYUVANTE

ADYUVANTE

RADIOTERAPIA

TRATAMIENTO

7/25/2019 caso clinico camama

24/26

7/25/2019 caso clinico camama

25/26

SEGUIMIENTO UIMIOTERAPIA/

6 &%&'( DOCETAXEL 110 +K):,

EPIRRUBICINA >5 +K):, CICLO!OS!AMIDA >50+K):,

ULTIMO CICLO 22 !*"*"' 2013

R*(9*(-, -'-, *$ ,, )*"*&,F "*(9*(-, ,"&%, *$ ,, %9%*"),F (*"'+",, ,", %'(%, %$&%(%'$, %,-*", %'(%, *=&%(%'$, )* &@"%= *$ A"%

)* 2013. RHP &'$ *(%'$*( &'$ "+*$*( %"*(

S* "'+",, R,)%'-*"%, *$ A"% )* 2013

P*"%')' %"* )* *$*"*),) )* 11 *(*( ,", M,' 2014

7/25/2019 caso clinico camama

26/26GRACIAS

N'", !,(* $')*-*&-,*

!,(* C:$%&,

T1/

I$%&%'B%'#+%&'

T2/

T9'"D*-*&-,*M,(-'+",:,

T/

M'*$-' )*D*-*&&%#$M,(-'+",:,

T3/

T9'"D*-*&-,)'

!,(* "* &:$%&,

C9",&%#$

LATENCIA

T%*'