Syringomatous tumor of the nipple: a case report.

Syringomatous tumor of the nipple is a benign, locally infiltrative tumor. There are reports in the literature of tumor recurrence in cases of incomplete excision. Clinical and mammographic findings in syringomatous tumors are like those of breast carcinoma and the pathologist has a fundamental role in final tumor diagnosis. Therefore, the aim of this study was to report a case of syringoma located in the areolar region. A 33-year-old woman reported that she had noticed a nodule in her left areolar region 4 years previously (February 2019). A breast ultrasound was performed, detecting intraparenchymatous breast cysts. Surgical resection of the nodule was indicated although it was not performed. Two years later, in August 2021, the patient underwent a mastopexy with prosthesis inclusion. Histopathology study of the surgical specimen revealed a syringomatous tumor with positive margins. Thirteen (13) months after diagnosis (September 3, 2021 - October 16, 2022), the patient is doing well and receives clinical follow-up.

Inherited bone marrow failure syndromes: phenotype as a tool for early diagnostic suspicion at a major reference center in Mexico.

Introduction: The inherited bone marrow failure syndromes (IBMFSs) are a group of rare disorders characterized by bone marrow failure (BMF), physical abnormalities, and an increased risk of neoplasia. The National Institute of Pediatrics (INP) is a major medical institution in Mexico, where patients with BMF receive a complete approach that includes paraclinical tests. Readily recognizable features, such as the hematological and distinctive physical phenotypes, identified by clinical dysmorphologists, remain crucial for the diagnosis and management of these patients, particularly in circumstances where next-generation sequencing (NGS) is not easily available. Here, we describe a group of Mexican patients with a high clinical suspicion of an IBMFS. Methods: We performed a systematic retrospective analysis of the medical records of patients who had a high IBMFS suspicion at our institution from January 2018 to July 2021. An initial assessment included first ruling out acquired causes of BMF by the Hematology Department and referral of the patient to the Department of Human Genetics for physical examination to search for specific phenotypes suggesting an IBMFS. Patients with high suspicion of having an IBMFS were classified into two main groups: 1) specific IBMFS, including dyskeratosis congenita (DC), Diamond-Blackfan anemia (DBA), Shwachman-Diamond syndrome (SDS), thrombocytopenia with absent radii (TAR), and severe congenital neutropenia (SCN); 2) undefined IBMFS (UI). Results: We established a high suspicion of having an IBMFS in 48 patients. At initial evaluation, the most common hematologic features were bicytopenia (20%) and aplastic anemia (16%); three patients received hematopoietic stem cell transplantation. Among patients with a suspicion of an IBMFS, the most common physical abnormality was minor craniofacial features in 83% of patients and neurodevelopmental disorders in 52%. The specific suspicions that we built were DBA (31%), SDS (18%), DC (14%), TAR (4%), and SCN (4%), whereas 27% of cases remained as undefined IBMFS. SDS, TAR, and SCN were more commonly suspected at an earlier age (<1 year), followed by DBA (2 years) and DC (5 years). Conclusions: Thorough examination of reported clinical data allowed us to highly suspect a specific IBMFS in approximately 70% of patients; however, an important number of patients remained with suspicion of an undefined IBMFS. Implementation of NGS and telomere length measurement are forthcoming measures to improve IBMFS diagnosis in Mexico.

Differential Incidence of Tongue Base Cancer in Male and Female HPV16-Transgenic Mice: Role of Female Sex Hormone Receptors.

A growing proportion of oropharyngeal squamous cell carcinomas (OPSCC) are associated with infection by high-risk human papillomavirus (HPV). For reasons that remain largely unknown, HPV+OPSCC is significantly more common in men than in women. This study aims to determine the incidence of OPSCC in male and female HPV16-transgenic mice and to explore the role of female sex hormone receptors in the sexual predisposition for HPV+ OPSCC. The tongues of 30-weeks-old HPV16-transgenic male (n = 80) and female (n = 90) and matched wild-type male (n = 10) and female (n = 10) FVB/n mice were screened histologically for intraepithelial and invasive lesions in 2017 at the Centre for the Research and Technology of Agro-Environmental and Biological Sciences (CITAB), Portugal. Expression of estrogen receptors alpha (ERα) and beta (ERß), progesterone receptors (PR) and matrix metalloproteinase 2 (MMP2) was studied immunohistochemically. Collagen remodeling was studied using picrosirius red. Female mice showed robust ERα and ERß expression in intraepithelial and invasive lesions, which was accompanied by strong MMP2 expression and marked collagen remodeling. Male mice showed minimal ERα, ERß and MMP2 expression and unaltered collagen patterns. These results confirm the association of HPV16 with tongue base cancer in both sexes. The higher cancer incidence in female versus male mice contrasts with data from OPSCC patients and is associated with enhanced ER expression via MMP2 upregulation.

Women with Polycystic Ovarian Syndrome Exhibit Reduced Baroreflex Sensitivity That May Be Associated with Increased Body Fat / Mulheres com Síndrome do Ovário Policístico Apresentam menor Sensibilidade Barorreflexa, a Qual Pode Estar Associada ao Aumento da Gordura Corporal

Abstract Background: Polycystic ovarian syndrome (PCOS) women have a high prevalence of obesity and alterations in cardiovascular autonomic control, mainly modifications in heart rate variability (HRV) autonomic modulation. However, there are few studies about other autonomic control parameters, such as blood pressure variability (BPV) and baroreflex sensitivity (BRS). In addition, there are still doubts about the obesity real contribution in altering autonomic control in these women. Objective: To investigate BPV and BRS autonomic modulation alterations in PCOS women, as well as, to evaluate whether these alterations are due PCOS or increased body fat. Methods: We studied 30 eutrophic volunteers [body mass index (BMI) < 25 kg/m2] without PCOS (control group) and 60 volunteers with PCOS divided into: eutrophic (BMI < 25 kg/m2, N = 30) and obese women (BMI > 30 kg/m2, N = 30). All volunteers were submitted to anthropometric evaluation, hemodynamic and cardiorespiratory parameters record at rest and during physical exercise, analysis of HRV, BPV and spontaneous BRS. The differences in p less than 5% (p < 0.05) were considered statistically significant. Results: Related to eutrophics groups, there were no differences in autonomic parameters evaluated. The comparison between the PCOS groups showed that both PCOS groups did not differ in the BPV analysis. Although, the obese PCOS group presented lower values of spontaneous BRS and HRV, in low frequency and high frequency oscillations in absolute units. Conclusion: Our results suggest that obesity did little to alter HRV in women with PCOS, but it may influence the spontaneous BRS.

Resumo Fundamento: As mulheres com síndrome do ovário policístico (SOP) apresentam alta prevalência de obesidade e alterações no controle autonômico cardiovascular, principalmente modificações na modulação autonômica da variabilidade da frequência cardíaca (VFC). No entanto, existem poucos estudos sobre outros parâmetros de controle autonômico, como a variabilidade da pressão arterial (VPA) e a sensibilidade barorreflexa (SBR). Além disso, ainda há dúvidas sobre a real contribuição da obesidade na alteração do controle autonômico dessas mulheres. Objetivo: Investigar as alterações da modulação autonômica da VPA e SBR em mulheres com SOP, bem como avaliar se essas alterações se devem à SOP ou ao aumento da gordura corporal. Métodos: Foram estudadas 30 voluntárias com peso normal [índice de massa corporal (IMC) < 25 kg/m2] sem SOP (grupo controle) e 60 voluntárias com SOP, divididas em: mulheres com peso normal (IMC < 25 kg/m2, N = 30) e mulheres obesas (IMC > 30 kg/m2, N = 30). Todas as voluntárias foram submetidas à avaliação antropométrica, com registro de parâmetros hemodinâmicos e cardiorrespiratórios em repouso e durante exercício físico, e análise da VFC, VPA e SBR espontânea. As diferenças de p < 5% (p < 0,05) foram consideradas estatisticamente significantes. Resultados: Em relação aos grupos com peso normal, não houve diferenças nos parâmetros autonômicos avaliados. A comparação entre os grupos SOP mostrou que ambos os grupos não diferiram na análise da VPA. No entanto, o grupo SOP obeso apresentou menores valores de SBR espontânea e VFC nas oscilações de baixa e alta frequências, em unidades absolutas. Conclusão: Nossos resultados sugerem que a obesidade pouco influenciou a VFC em mulheres com SOP, mas pode afetar a SBR espontânea.

Early ovarian hormone deprivation increases cardiac contractility in old female rats-Role of physical training.

OBJECTIVES: We investigated the effects of early ovarian hormones deprivation on morphology and cardiac function and the effects of aerobic training on these parameters, in old rats. METHODS: Female Wistar rats (N = 48) were divided into two groups, at 10 weeks of life: early ovarian hormones deprivation by ovariectomy (OVX; N = 24) and sham (SHAM; N = 24). Between weeks 62 and 82, 12 animals of each group underwent aerobic training (OVX-T and SHAM-T, N = 12). At the end of week 82, all were evaluated by echocardiography, cardiac function (Langendorff technique) and cardiac ß-adrenergic receptor expression quantification. RESULTS: Echocardiography showed slight changes in morphology between OVX and SHAM groups. OVX group (Δ = 101 ±â€¯4.7 mmHg) showed higher values for maximal left intraventricular pressure in response to dobutamine, when compared to SHAM group (Δ = 55 ±â€¯11.8 mmHg). Both OVX-T (Δ = 70 ±â€¯4.0 mmHg) and SHAM-T (Δ = 22 ±â€¯6.6 mmHg) groups showed a reduction in this response. While, ß-adrenergic receptor expression was not different between the untrained groups, SHAM-T (0.23 ±â€¯0.02 AU) and OVX-T (0.29 ±â€¯0.01 AU), showed decreased expression of these receptors. CONCLUSION: Early ovarian hormones deprivation associated with aging, promotes discrete changes in cardiac morphology and increasing cardiac contractility. Aerobic training decreases ß-adrenergic receptors expression, influencing the cardiac contractility.

Women with Polycystic Ovarian Syndrome Exhibit Reduced Baroreflex Sensitivity That May Be Associated with Increased Body Fat.

BACKGROUND: Polycystic ovarian syndrome (PCOS) women have a high prevalence of obesity and alterations in cardiovascular autonomic control, mainly modifications in heart rate variability (HRV) autonomic modulation. However, there are few studies about other autonomic control parameters, such as blood pressure variability (BPV) and baroreflex sensitivity (BRS). In addition, there are still doubts about the obesity real contribution in altering autonomic control in these women. OBJECTIVE: To investigate BPV and BRS autonomic modulation alterations in PCOS women, as well as, to evaluate whether these alterations are due PCOS or increased body fat. METHODS: We studied 30 eutrophic volunteers [body mass index (BMI) < 25 kg/m2] without PCOS (control group) and 60 volunteers with PCOS divided into: eutrophic (BMI < 25 kg/m2, N = 30) and obese women (BMI > 30 kg/m2, N = 30). All volunteers were submitted to anthropometric evaluation, hemodynamic and cardiorespiratory parameters record at rest and during physical exercise, analysis of HRV, BPV and spontaneous BRS. The differences in p less than 5% (p < 0.05) were considered statistically significant. RESULTS: Related to eutrophics groups, there were no differences in autonomic parameters evaluated. The comparison between the PCOS groups showed that both PCOS groups did not differ in the BPV analysis. Although, the obese PCOS group presented lower values of spontaneous BRS and HRV, in low frequency and high frequency oscillations in absolute units. CONCLUSION: Our results suggest that obesity did little to alter HRV in women with PCOS, but it may influence the spontaneous BRS.

The blood pressure variability and baroreflex sensitivity in healthy participants are not determined by sex or cardiorespiratory fitness.

BACKGROUND: Heart rate (HR) and blood pressure (BP) autonomic modulation and baroreflex sensitivity (BRS) are important indexes of cardiovascular homeostasis. However, methodological errors are often observed, such as joint analysis of men and women. Another important aspect is that we still do not know whether cardiorespiratory fitness influences these autonomic parameters in healthy individuals. OBJECTIVES: This study aimed to investigate whether sex can affect BRS, autonomic modulation of HR and BP variabilities (HRV and BPV, respectively), as well as the influence of cardiorespiratory fitness on these autonomic parameters. METHODS: Healthy men and women (N=120) were assigned to groups according to the peak oxygen consumption (VO2 peak) obtained in the cardiorespiratory test: low cardiorespiratory fitness (VO2 peak: 22-38 ml/kg/min), moderate cardiorespiratory fitness (VO2 peak: 38-48 ml/kg/min), and high cardiorespiratory fitness (VO2 peak>48 ml/kg/min). HRV and BPV evaluations were performed for all groups in the frequency domain by spectral analysis. Spontaneous BRS was assessed using the sequence method. RESULTS: Women presented lower BP values compared with men. HR did not differ between sexes, but showed an inverse relationship with cardiorespiratory performance. The HRV analysis showed greater sympathetic modulation for men and greater vagal modulation for women. Men and women presented similar results for systolic BPV and BRS, and cardiorespiratory performance did not influence any of the autonomic parameters evaluated. CONCLUSION: Cardiorespiratory fitness does not interfere with HRV and BPV autonomic modulation or BRS. However, the cardiac modulatory balance differs between sexes, with a greater influence of the autonomic vagal component in women and the sympathetic component in men.

Physical training promotes similar effects to the blockade of angiotensin-converting enzyme on the cardiac morphology and function in old female rats subjected to premature ovarian failure.

We investigated the effects of angiotensin-converting enzyme (ACE) inhibition and aerobic physical training on the heart of old female rats (82-wk-old) submitted to premature ovarian failure (10-wk.-old). We used different approaches: morphology and function by echocardiography, reactivity of the coronary bed and left ventricular contractibility (Langendorff Technique). Female Wistar ovariectomized (OVX) rats (n=42) were assigned to one of four groups: OVX, vehicle treated only; OVX-EM, Enalapril Maleate only (EM, 10mg·kg-1·d-1); OVX-T, aerobic trained only; and OVX-EMT, treated with Enalapril Maleate and aerobic trained. Both Enalapril Maleate treatment and aerobic training were done in the last 20weeks of the experimental protocol. When compared to the OVX group, the OVX-EM group showed lower values of wall thickness and left ventricular (LV) mass, lower values of coronary bed reactivity and reduced maximum response of LV contractility to dobutamine, while the OVX-T group showed lower values of LV wall thickness, increase in end-systolic volume, reduced maximum response of LV contractility to dobutamine, and left intraventricular pressure due to increased flow. The combination of treatments (EM and aerobic physical training) did not promote additional important effects on the parameters evaluated. Our results suggest similar beneficial effects of physical training and EM treatment on the morphology and cardiac function in old female rats submitted to premature ovarian failure. Although the causes of these benefits are still unknown, both treatments have promoted a decrease in cardiac contractility, and the reduced ß1-adrenergic sensitivity suggests that both treatments may attenuate the sympathetic effect on the heart.

Chronic treatment with angiotensin-converting enzyme inhibitor increases cardiac fibrosis in young rats submitted to early ovarian failure.

BACKGROUND: We investigated whether the treatment with enalapril maleate, combined with aerobic physical training, promotes positive effects on the autonomic balance, the morphology and the cardiac function in female rats submitted to early ovarian failure. METHODS: Thirty-five female Wistar rats, ovariectomized at 10weeks of age, were assigned into Ovariectomized rats (OVX) and Ovariectomized rats treated with enalapril maleate (OVX-EM, 10mg-1·kg-1·d-1) Each group was subdivided into sedentary and trained (aerobic swimming training for 10weeks). All animals were submitted to a) double pharmacological autonomic blockade, b) study of morphology and cardiac function by echocardiography, and c) analysis of cardiac fibrosis. RESULTS: The OVX-EM sedentary group showed a significant increase in cardiac fibrosis, relative heart weight, interventricular septum thickness and increased sympathetic participation and reduced participation of the vagal tone in the determination of the basal heart rate when compared to the OVX sedentary group. Physical training reduced cardiac fibrosis in both groups, however, with less intensity in the OVX-EM group. It also increased the absolute and relative heart weight and the end-systolic volume. Finally, the OVX-EM trained group showed higher values for left ventricular end-systolic volume and lower values for ejection fraction and shortening fraction than the sedentary OVX-EM group. CONCLUSION: Enalapril maleate exacerbated cardiac fibrosis and increased sympathetic participation in the basal heart rate determination, without significantly affecting the cardiac function. Aerobic physical training did not change the cardiac autonomic control, but reduced cardiac fibrosis and had little effect on the cardiac function.

Time trends of human papillomavirus types in invasive cervical cancer, from 1940 to 2007.

Contribution over time of human papillomavirus (HPV) types in human cancers has been poorly documented. Such data is fundamental to measure current HPV vaccines impact in the years to come. We estimated the HPV type-specific distribution in a large international series of invasive cervical cancer (ICC) over 70 years prior to vaccination. Paraffin embedded ICC cases diagnosed between 1940 and 2007 were retrieved from eleven countries in Central-South America, Asia and Europe. Included countries reported to have low-medium cervical cancer screening uptake. Information on age at and year of diagnosis was collected from medical records. After histological confirmation, HPV DNA detection was performed by SPF-10/DEIA/LiPA25 (version1). Logistic regression models were used for estimating the adjusted relative contributions (RC) of HPV16 and of HPV18 over time. Among 4,771 HPV DNA positive ICC cases, HPV16 and HPV18 were the two most common HPVs in all the decades with no statistically significant variations of their adjusted-RC from 1940-59 to 2000-07 (HPV16-from 61.5 to 62.1%, and HPV18-from 6.9 to 7.2%). As well, the RC of other HPV types did not varied over time. In the stratified analysis by histology, HPV16 adjusted-RC significantly increased across decades in adenocarcinomas. Regarding age, cases associated to either HPV16, 18 or 45 were younger than those with other HPV types in all the evaluated decades. The observed stability on the HPV type distribution predicts a high and stable impact of HPV vaccination in reducing the cervical cancer burden in future vaccinated generations.

Variabilidade da frequência cardíaca e carga máxima atingida no teste de esforço físico dinâmico em homens idosos / Heart rate variability and maximum workload reached in the dynamic physical exertion test in elderly men

INTRODUÇÃO: Um dos benefícios promovidos pelo exercício físico parece ser a melhora da modulação do sistema nervoso autônomo sobre o coração. No entanto, o papel da atividade física como um fator determinante da variabilidade da frequência cardíaca (VFC) não está bem estabelecido. Desta forma, o objetivo do estudo foi verificar se há correlação entre a frequência cardíaca de repouso e a carga máxima atingida no teste de esforço físico com os índices de VFC em homens idosos. MÉTODOS: Foram estudados 18 homens idosos com idades entre 60 e 70 anos. Foram feitas as seguintes avaliações: a) teste de esforço máximo em cicloergômetro utilizando-se o protocolo de Balke para avaliação da capacidade aeróbia; b) registro da frequência cardíaca (FC) e dos intervalos R-R durante 15 minutos na condição de repouso em decúbito dorsal. Após a coleta, os dados foram analisados no domínio do tempo, calculando-se o índice RMSSD, e no domínio da frequência, calculando-se os índices de baixa frequência (BF), alta frequência (AF) e razão BF/AF. Para verificar se existe associação entre a carga máxima atingida no teste de esforço e os índices de VFC foi aplicado o teste de correlação de Pearson (p < 0,05). RESULTADOS: Características demográficas, antropométricas, fisiológicas e carga máxima atingida no teste ergométrico: idade = 63 ± 3,0 anos; IMC = 24 ± 2kg/m²; FC = 63 ± 9bpm; PAS = 123 ± 19mmHg; PAD = 83 ± 8mmHg; carga máxima = 152 ± 29 watts. Não houve correlação entre os índices de VFC com os valores de FC de repouso e carga máxima atingida no teste ergométrico (p > 0,05). CONCLUSÃO: Os índices de variabilidade da frequência cardíaca temporal e espectrais estudados não são indicadores do nível de capacidade aeróbia de homens idosos avaliados em cicloergômetro.

INTRODUCTION: One of the benefits provided by regular physical activities seems to be the improvement of cardiac autonomic nervous system modulation. However, the role of physical activity as a determinant factor of the heart rate variability (HRV) is not well-established. Therefore, the aim of this study was to verify whether there was a correlation between resting heart rate and maximum workload reached in an exercise test with HRV indices in elderly men. METHODS: A study was carried out with 18 elderly men between the ages of 60 and 70 years. The following evaluations were made: a) Maximal exercise test on a cycle ergometer using Balke treadmill protocol to evaluate the aerobic capacity; b) Heart Rate (HR) and RR Intervals (RRi) registered for 15 minutes at rest, in the supine position. After collection, data were analyzed by time domain (RMSSD index) and by the frequency domain (low (LF) and high (HF) frequency indices and LF/HF ratio). Pearson correlation test was used to verify whether there was a correlation between the maximum workload reached during the exercise test and the HRV indices (p < 0.05). RESULTS: Demographic, physiological, and anthropometric characteristics and the maximum load achieved during exercise test: Age = 63 ± 3.0 years; BMI = 24 ± 2 kg/m2; HR = 63 ± 9 bpm; SBP = 123 ± 19 mmHg; DBP = 83 ± 8 mmHg; maximum workload = 152 ± 29 watts. No correlation was found between the HRV indices with the values of the resting heart rate and the maximum workload reached in the exercise test (p > 0.05). CONCLUSION: Temporal and spectral indices of heart rate variability are not indicators of aerobic capacity of elderly men evaluated on a cycle ergometer.

Frequência cardíaca máxima prevista e a obtida em teste de esforço máximo em homens idosos / Predicted maximum heart rate and the one got in maximum effort test in old men

Objetivo: Verificar se há diferença entre a frequência cardíaca (FC) máxima obtida durante o teste de esforço máximo e a prevista pela proposta por Karvonen (220-idade). Métodos: Foram estudados 11 homens saudáveis, fisicamente ativos e com idade compreendida entre 60 e 65 anos. Foram submetidos a um Teste de Ergométrico máximo, utilizando-se o protocolo de Balke. A FC obtida na maior carga atingida durante o teste e a FC máxima prevista pela fórmula de Karvonen, em batimentos por minuto (bpm) foram utilizadas para análise. Foi aplicado o teste t pareado para verificar se existe associação entre a FC obtida e a prevista (p<0,05). Resultado: Idade: 62,36+-1.55 anos; a FC média de repouso foi: 58,75+- 8,12bpm; média da FC máxima obtida: 141,83+-9,29 bpm; FC máxima prevista: 144,5+- 1,55 bpm. Conclusão; Os resultados dessa pesquisa confirmam o valor preditivo da equação proposta por Karvonen (220-idade) para idosos saudáveis e ativos.

Objective: To determine whether there are diferences between heart rate (HR) obtained during maximal exercise testing and provided the maximum proposed by Karvonen(220-age). Methods: We studied 11 healthy men, physically active and aged between 60 and 65 years who underwent a maximum Stress Test using the Balke protocol. The HR from the highest load reached during the test and predicted maximum HR by Karvonen formula in beats per minute (bpm) was used for analysis, We applied the paired t test to investigate the association between HR obtained and the predicted (p<0.05). Results: Age 62.36+-1.55 years; resting HR obtained:141.83+-9,29 bpm; predicted maximum HR: 144.5+-1.55 bpm. Conclusion. he results of this study confirmed the predictive value of the equation proposed by Karvonen (220-age) for healthy and active sênior.

Capacitação de cuidadores de pacientes em alta hospitalar / Caregivers' qualification of discharged patients

Um projeto foi desenvolvido para cuidador de pacientes com sequelas neurológicas, com a finalidade de capacitá-los ao cuidado no domicílio em neurologia clínica e cirúrgica de hospital universitário. A capacitação foi conduzida por enfermeiros, nutricionistas e fisioterapeuta. A metodologia foi identificação do paciente e do cuidador, avaliação da equipe; diário, avaliação e relato de caso. O artigo descreve essas fases, com 12 pacientes ao longo do ano de 2004, analisa o andamento e aponta caminhos que implementem o projeto. Dentre as potencialidades do projeto destacam-se acesso aos pacientes e prontuários; segurança dos familiares e pacientes para lata; colaboração nas unidades; acesso à bibliografia, materiais e equipamentos. Dentre as limitações são citadas: sobrecarga de trabalho; organização da equipe e disponibilidade do cuidador. Percebeu-se no projeto o exercício da autonomia profissional, embora se reconheça que entrosamento entre a equipe e condições de trabalho sejam complexos e requeiram esforço para organizar, implantar e avaliar ações educativas.

Thyroid paraganglioma: case report

Los paragangliomas de la glándula tiroides son tumores poco frecuentes. Se presenta un caso clínico de una mujer de 32 años de edad, con una masa en el lóbulo derecho de la glándula tiroides, sin otros síntomas. El diagnóstico inicial, al que se llegó por citopunción, fue de carcinoma medular de tiroides. La opción terapéutica fue de hemitiroidectomía. Los estudios anatomopatológicos de la pieza operatoria y la histoquímica fueron compatibles con un paraganglioma. Se pone de manifiesto las dificultades del diagnóstico y la importancia de la