Diagnóstico diferencial de las gammapatías monoclonales / Monoclonal gammopathies differential diagnosis

Las aparición de un pico monoclonal en sangre o en orina, es un hallazgo que aparece con bastante frecuencia en la práctica clínica habitual. Son múltiples las patologías que pueden ser responsables de tal dato, y conseguir llegar al diagnóstico definitivo determinará que el tratamiento sea el adecuado y que se modifique el pronóstico del paciente. Asimismo, el descartar una etiología maligna de la gammapatía monoclonal, permitirá evitar pruebas cruentas innecesarias a este grupo de pacientes. En el siguiente manuscrito, se ofrece una descripción de las principales patologías asociadas a picos monoclonales, así como datos que orientarán al diagnóstico definitivo

The presence of a monoclonal pike in blood is very habitual in our daily medical activity. There are a lot of causes of that. If we know which kind of pathology had originated the monoclonal pike, we could be able to bring a suitable treatment and to change the prognosis of the patient. If we are able to exclude a malignant disease, the patient will not suffer unnecessary aggressive tests. In this report, we describe the main diseases which are associated to monoclonal pike and the clues to get a definitive diagnosis

[Fever of unknown origin as first manifestation of two cases of cervix carcinoma]. / Fiebre de origen desconocido como presentación inicial de dos casos de carcinoma epidermoide de cérvix.

We present the case of two women with FUO as first manifestation of a cervical carcinoma. In both cases, wide spectrum antibiotic treatment (and tuberculostatic medication in the first woman) were not useful to stop fever. Autoimmune diseases tests were normal. Just image techniques let us detect a suspicious lesion (specially, abdomino-pelvic magnetic resonance) and biopsy gave the definitive diagnosis. A radical surgery caused the fever resolution. These are two cases of cervical cancer as cause of fever of unknown origin and, at the moment, we have not found another cases in the literature. We should consider this kind of tumor as a possible origin of fever.

Fiebre de origen desconocido como presentación inicial de dos casos de carcinoma epidermoide de cérvix / Fever of unknown origin as first manifestation of two cases of cervix carcinoma

Presentamos dos casos de mujeres con FOD como primera manifestación de un cáncer de cérvix. En ambos casos, se hizo un despistaje exhaustivo de causas de fiebre. Los tratamientos antibióticos de amplio espectro (junto con tuberculostáticos, en la primera de las pacientes), no consiguieron erradicar la fiebre; los distintos tests de enfermedad autoinmune fueron negativos . Sólo las pruebas de imagen, en especial, la resonancia magnética nuclear, desvelaron que existía una lesión sospechosa, y fue la anatomía patológica la que corroboró la etiología de ambos procesos. El tratamiento del tumor (en ambos casos consistió en una cirugía radical) permitió la resolución de la fiebre. Se trata de dos casos representativos de fiebre etiquetados inicialmente como de origen desconocido, en los que un estudio exhaustivo reveló que esta era secundaria a cáncer epidermoide de cérvix, de los que no se dispone de literatura previa

We present the case of two women with FUO as first manifestation of a cervical carcinoma. In both cases, wide spectrum antibiotic treatment (and tuberculostatic medication in the first woman) were not useful to stop fever. Autoimmune diseases tests were normal. Just image thecniques let us detect a suspicious lesion (specially, abdomino-pelvic magnetic resonance) and biopsy gave the definitive diagnosis. A radical surgery caused the fever resolution. These are two cases of cervical cancer as cause of fever of unknown origin and, at the moment, we have not found another cases in the literature. We should consider this kind of tumor as a possible origin of fever

Dysphagia and dysphonia in a woman with a previous breast cancer.

Metastasis to the thyroid occur infrequently. The overall incidence in autopsy series vary from 0-5% in unselected cases to 24% in patients with a known malignancy. They usually occur when there are another metastases, sometimes many years after diagnosis of the original primary tumour. We present the case of a woman with dysphagia and dysphonia due to a thyroid mass as first manifestation of a metastatic breast cancer.

Cutaneous metastases of lung cancer.

It is uncommon for a cancer to be diagnosed because of skin metastases. Cutaneous metastases as initial manifestation of internal neoplasias, represent only 0.8% of total cases and implies, in general, a very advanced grade of the disease and short survival. When skin metastases of an unknown primary site appear, lung cancer is the first option to be discarded in case of men, and breast cancer in case of women. Lung cancer spreads to the skin in 2.8-8.7% of the cases, in advanced phases of the disease, although just in 7-23.8% of the cases, cutaneous metastases appear as first manifestation of the primary tumor. Sometimes, a complete examination to discover the tumor reveals no metastases elsewhere.

[Monoclonal gammopathies differential diagnosis]. / Diagnóstico diferencial de las gammapatías monoclonales.

The presence of a monoclonal pike in blood is very habitual in our daily medical activity. There are a lot of causes of that. If we know which kind of pathology had originated the monoclonal pike, we could be able to bring a suitable treatment and to change the prognosis of the patient. If we are able to exclude a malignant disease, the patient will not suffer unnecessary aggressive tests. In this report, we describe the main diseases which are associated to monoclonal pike and the clues to get a definitive diagnosis.