Radioterapia definitiva en el carcinoma adenoide quístico de la tráquea. A propósito de un caso / Definitive radiotherapy in adenoid cystic carcinoma of the trachea. A case report

Los carcinomas adenoides quísticos son tumores extremadamente raros, para los cuales la cirugía es el pilar terapéutico; sin embargo, el abordaje quirúrgico puede estar contraindicado en función del tamaño tumoral, el compromiso de estructuras adyacentes o enfermedades concurrentes. En estos casos, la radioterapia externa definitiva puede ofrecer un adecuado control tumoral y alivio de síntomas. El presente reporte de caso describe un paciente con un tumor irregular que rodea la circunferencia de la tráquea, el cual genera disminución de la luz traqueal, en quién se decidió realizar una reducción de volumen de la lesión tumoral con argón plasma, seguido de colocación de un stent en Y (traqueal, bronquial izquierdo y bronquial derecho) y, posteriormente, realizar un tratamiento definitivo con radioterapia externa con técnica de intensidad modulada a dosis de 60 Gy en fraccionamiento de 2 Gy. Tres meses después del tratamiento, el paciente se presenta sin evidencia radiológica de adenopatías en la base del cuello o axila, con un stent endotraqueal permeable, sin estenosis y con una disminución del volumen tumoral, por lo que fue posible el retiro del stent.

Adenoid cystic carcinomas are extremely rare tumors, for which surgery is the mainstay of therapy; however, the surgical approach may be contradictory depending on tumor size, involvement of adjacent structures or concurrent diseases. In these cases, definitive external beam radiation therapy can offer adequate tumor control and symptom relief. The present case report describes a patient with an irregular tumor that surrounds the circumference of the trachea, causing a decrease in the tracheal lumen, in whom it was decided to perform a volume reduction of tumor with argon plasma, followed by placement of a Y-stent (tracheal, left bronchial and right bronchial), and subsequent definitive treatment with external radiotherapy with intensity modulated technique at doses of 60 Gy in 2 Gy fractionation. Three months after treatment, the patient presents without radiological evidence of lymphadenopathy at the base of the neck or axilla, with a patent endotracheal stent, with no stenosis and a decrease in tumor volume, for which the removal of the Stent was feasilble.

Low-grade Leiomyosarcoma of the Cavernous Sinus in an HIV Positive Patient: Case Report.

Primary leiomyosarcomas of the central nervous system are extremely rare tumors, with few cases reported in the literature. In this article we report the case of a patient with an intracranial leiomyosarcoma of the cavernous sinus. This is the case of a 23-year-old man with a history of human immunodeficiency virus (HIV) and Epstein-Barr virus infection, with clinical picture of headache and left palpebral ptosis, who underwent nuclear magnetic resonance imaging that showed a lesion that occupied the cavernous sinus. Excisional biopsy reported fusocellular mesenchymal neoplasm with smooth muscle differentiation by immunohistochemistry compatible with low-grade leiomyosarcoma. The patient was initially taken to a partial resection, without treatment. Subsequently, the patient presented progression of his disease, so the area of neurosurgery considered that the lesion was unresectable due to its location and the risk of sequelae. It was then decided to treat the patient with intensity-modulated radiation therapy technique external radiotherapy. At six months of treatment, the patient continues asymptomatic with a stable disease.