{"id":5979,"date":"2023-03-17T08:42:44","date_gmt":"2023-03-17T08:42:44","guid":{"rendered":"https:\/\/www.eurocytology.eu\/course\/carcinoma-papilar\/"},"modified":"2023-04-26T09:26:25","modified_gmt":"2023-04-26T09:26:25","slug":"carcinoma-papilar","status":"publish","type":"course","link":"https:\/\/www.eurocytology.eu\/es\/course\/citologia-de-tiroides\/tumores-malignos\/carcinoma-papilar\/","title":{"rendered":"Carcinoma papilar"},"content":{"rendered":"<div data-object_id=\"5979\" class=\"cbxwpbkmarkwrap cbxwpbkmarkwrap_guest cbxwpbkmarkwrap_user_cat cbxwpbkmarkwrap-course \"><a  data-redirect-url=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5979\/\"  data-display-label=\"1\" data-show-count=\"1\" data-bookmark-label=\"Bookmark\"  data-bookmarked-label=\"Bookmarked\"  data-loggedin=\"0\" data-type=\"course\" data-object_id=\"5979\" class=\"cbxwpbkmarktrig  cbxwpbkmarktrig-button-addto\" title=\"Bookmark This\" href=\"#\"><span class=\"cbxwpbkmarktrig-label\" >Bookmark (<i class=\"cbxwpbkmarktrig-count\">0<\/i>)<\/span><\/a> <div  data-type=\"course\" data-object_id=\"5979\" class=\"cbxwpbkmarkguestwrap\" id=\"cbxwpbkmarkguestwrap-5979\"><div class=\"cbxwpbkmarkguest-message\"><a href=\"#\" class=\"cbxwpbkmarkguesttrig_close\"><\/a><h3 class=\"cbxwpbookmark-title cbxwpbookmark-title-login\">Please login to bookmark<\/h3><form name=\"loginform\" id=\"loginform\" action=\"https:\/\/www.eurocytology.eu\/wp-login.php\" method=\"post\"><p class=\"login-username\">\n\t\t\t\t<label for=\"user_login\">Nombre de usuario o correo electr\u00f3nico<\/label>\n\t\t\t\t<input type=\"text\" name=\"log\" id=\"user_login\" autocomplete=\"username\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-password\">\n\t\t\t\t<label for=\"user_pass\">Contrase\u00f1a<\/label>\n\t\t\t\t<input type=\"password\" name=\"pwd\" id=\"user_pass\" autocomplete=\"current-password\" spellcheck=\"false\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-remember\"><label><input name=\"rememberme\" type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/> Recu\u00e9rdame<\/label><\/p><p class=\"login-submit\">\n\t\t\t\t<input type=\"submit\" name=\"wp-submit\" id=\"wp-submit\" class=\"button button-primary\" value=\"Acceder\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5979\/\" \/>\n\t\t\t<\/p><\/form><p class=\"cbxwpbookmark-guest-register\">No account yet? <a href=\"https:\/\/www.eurocytology.eu\/es\/register\/?redirect_to=https%3A%2F%2Fwww.eurocytology.eu%2Fes%2Fwp-json%2Fwp%2Fv2%2Fcourse%2F5979%2F\">Register<\/a><\/p><\/div><\/div><\/div><p>El carcinoma papilar de tiroides (CPT) es uno de los tumores malignos m\u00e1s comunes de la gl\u00e1ndula tiroides (&gt;80% de los c\u00e1nceres de tiroides). Puede ocurrir a cualquier edad, pero la mayor\u00eda de pacientes est\u00e1n entre los 30 y 50 a\u00f1os, muchos de ellos son mujeres (M:H 3:1). Usualmente se presenta como un n\u00f3dulo solitario, no funcional (\u201cfrio\u201d), algunas veces con linfadenopat\u00eda cervical debido a las met\u00e1stasis. El pron\u00f3stico es usualmente muy bueno.<\/p>\n<p>Muchos de los carcinomas papilares contienen uno de los oncogenes quimericos ret\/PTC, resultantes de re-arreglos que comprometen el oncogen ret en el cromosoma 10.<\/p>\n<h3>Caracter\u00edsticas citol\u00f3gicas diagn\u00f3sticas<\/h3>\n<ul>\n<li>Papilas, s\u00e1banas microfol\u00edculos<\/li>\n<li>Cambios nucleares&nbsp;&nbsp;&nbsp;\n<ul>\n<li>Aumento de tama\u00f1o nuclear<\/li>\n<li>Cromatina \u201cpulverizada\u201d o en vidrio esmerilado<\/li>\n<li>Pseudoinclusiones nucleares y hendiduras<\/li>\n<li>Nucleolo ( peque\u00f1o o grande)<\/li>\n<li>Membrana nuclear irregular<\/li>\n<\/ul>\n<\/li>\n<li>Api\u00f1amiento nuclear y moldeamiento<\/li>\n<li>Citoplasma variable (escaso, escamoide, parecido a Hurtle, vacuolado)<\/li>\n<li>Cuerpos de psammoma<\/li>\n<li>Histiocitos (c\u00e9lulas gigantes multinucleadas)<\/li>\n<\/ul>\n<p>Las caracter\u00edsticas t\u00edpicas de la arquitectura son las papilas (con c\u00e9lulas neopl\u00e1sicas recubriendo un tallo fibrovascular): los microfol\u00edculos se obsevan en la variante folicular del carcinoma papilar. La variante de esclerosis difusa puede ser dif\u00edcil de reconocer. Tambi\u00e9n se pueden encontrar variantes mixtas.<\/p>\n<p align=\"justify\">El reconocimiento de las formaciones papilares es muy \u00fatil pero no es necesario, pues este est\u00e1 ausente en la variante folicular del carcinoma papilar. El diagn\u00f3stico no se basa en las caracter\u00edsticas arquitect\u00f3nicas, se basa en los cambios nucleares caracter\u00edsticos: hendiduras longitudinales, pseudoinclusiones nucleares, un patr\u00f3n de cromatina p\u00e1lida y pulverizada. Un rasgo caracter\u00edstico del carcinoma papilar es el aumento de la densidad citopl\u00e1smica, que est\u00e1 presente en la mayor\u00eda de los casos (66% a 100%) dando lugar a las llamadas \u201cc\u00e9lulas escamoides\u201d<\/p>\n<p align=\"justify\">Se pueden encontrar coloide y en algunas ocasiones es abundante, este puede tener una viscosidad anormal (coloide \u201cchicle\u201d) y puede tener la forma de hilos largos o manchas densas. Los cuerpos de psamoma (que son calcificaciones laminadas) son un rasgo diagn\u00f3stico \u00fatil, pero no se observa frecuentemente en los frotis citol\u00f3gicos. La presencia de degeneraci\u00f3n qu\u00edstica, usualmente con la presencia varios macr\u00f3fagos en el frotis, puede llevar a diagn\u00f3sticos falsos negativos: se requiere siempre de c\u00e9lulas foliculares para considerar el frotis adecuado.<\/p>\n<p>Las variantes agresivas del carcinoma papilar se pueden reconocer por el gran tama\u00f1o de las c\u00e9lulas, las numerosas invaginaciones citoplasm\u00e1ticas, el marcado pleomorfismo nuclear, la cromatina gruesa o el citoplasma abundante, denso y&nbsp; granular.<\/p>\n<p align=\"justify\">Dos variantes inusuales del carcinoma papilar tienen rasgos diagn\u00f3sticos distintivos. La variante de c\u00e9lulas altas (o c\u00e9lulas rosa) se caracteriza por las c\u00e9lulas con abundante citoplasma, con los rasgos nucleares del carcinoma papilar. Debido al citoplasma \u201calto\u201d y muchas veces granular, pueden semejar las c\u00e9lulas Hurthle. El pron\u00f3stico es peor que el de la variante cl\u00e1sica del carcinoma papilar. La variante de c\u00e9lulas columnares est\u00e1 compuesta de c\u00e9lulas api\u00f1adas, altas, columnares, con las caracter\u00edsticas nucleares del carcinoma papilar.<\/p>\n<h3>Diagn\u00f3stico diferencial<\/h3>\n<ul style=\"list-style-type:circle;\">\n<li>N\u00f3dulos benignos de tiroides (p.ej. bocio nodular)<\/li>\n<li>Neoplasia folicular<\/li>\n<li>Adenoma trabecular hialinizante<\/li>\n<li>Cambios por irradiaci\u00f3n<\/li>\n<\/ul>\n<p align=\"justify\">A pesar que las hendiduras nucleares est\u00e1n usualmente presentes, son escasas en un 25% de los casos y pueden estar ausentes en un 10% de casos. Las hendiduras nucleares pueden encontrarse en otras lesiones benignas de tiroides tales como la tiroiditis y el bocio. Las pseudoinclusiones nucleares son los calificativos m\u00e1s importantes del carcinoma papilar y deben estar siempre presentes. Debido a que est\u00e1n siempre rodeadas de membrana nuclear, tienen un margen muy n\u00edtido, que esta frecuentemente demarcado por un anillo de cromatina condensada. A pesar que las pseudoinclusiones pueden estar presentes en otros tumores primarios (tumor de c\u00e9lulas de Hurthle, carcinoma medular, carcinoma insular) o tumores secundarios (melanoma) son excepcionales en condiciones benignas del tiroides. Asi en las biopsias por aspiraci\u00f3n de aguja fina, estas inclusiones representan un argumento fuerte para el diagn\u00f3stico de c\u00e1ncer, usualmente carcinoma papilar, cuando se combina con otras caracter\u00edsticas diagn\u00f3sticas. La variante folicular del carcinoma papilar puede ser dif\u00edcil de distinguir de una lesi\u00f3n folicular; el patr\u00f3n de la cromatina puede ser de ayuda. El adenoma trabecular hialinizante puede tener las caracter\u00edsticas nucleares del carcinoma papilar, y en la mayor\u00eda de casos se diagnostica como sospechoso de o carcinoma papilar mediante la aspiraci\u00f3n por aguja fina. Solo el examen histol\u00f3gico puede hacer la diferenciaci\u00f3n diagn\u00f3stica, mostrando la encapsulaci\u00f3n, arquitectura trabecular y la marcada hialinizaci\u00f3n del estroma. Algunos de los rasgos nucleares (hendiduras y pseudoinclusiones) del carcinoma papilar pueden ser ocasionalmente vistos en los n\u00f3dulos benignos despu\u00e9s de la administraci\u00f3n de yodo, pero en este caso los n\u00facleos son hipercrom\u00e1ticos y de tama\u00f1o variable.<\/p>\n<p>La aspiraci\u00f3n con aguja fina es altamente precisa en el diagn\u00f3stico de CPT y debido a la relativa incidencia de este tipo de tumor tiroideo esta explica la alta sensibilidad del aspirado con aguja fina para lesiones malignas<\/p>\n<h3 align=\"justify\">Grados citol\u00f3gicos del carcinoma papilar&nbsp;<\/h3>\n<table border=\"1\" cellpadding=\"1\" cellspacing=\"1\" style=\"width: 500px;\">\n<tbody>\n<tr>\n<td style=\"width: 89px;\">&nbsp;<\/td>\n<td style=\"width: 78px;\">Score 1<\/td>\n<td>Score 2<\/td>\n<td>Score 3<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 89px;\">Cell size<\/td>\n<td style=\"width: 78px;\">= pmn<\/td>\n<td>= 2 pmn<\/td>\n<td>= 3 pmn<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 89px;\">pseudoincl. x 5 hpf<\/td>\n<td style=\"width: 78px;\">&lt; 5<\/td>\n<td>5-10<\/td>\n<td>&gt; 10<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 89px;\">nuclear pleomorphism<\/td>\n<td style=\"width: 78px;\">mild<\/td>\n<td>moderate<\/td>\n<td>severe<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 89px;\">chromatin<\/td>\n<td style=\"width: 78px;\">fine<\/td>\n<td>granular<\/td>\n<td>coarse<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n<ul>\n<li>Bajo grado (puntaje &lt;= 8) usualmente variante cl\u00e1sica en histolog\u00eda<\/li>\n<li>Intermedio (puntaje 9-11)<\/li>\n<li>Alto grado (puntaje&gt;11) usualmente variantes agresivas en histolog\u00eda<\/li>\n<\/ul>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img fetchpriority=\"high\" decoding=\"async\" alt=\"\" height=\"456\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/styles\/max\/public\/images\/Picture1_10.jpg\" width=\"400\" \/><\/a><figcaption><strong>A large fragment exhibiting a papillary configuration.&nbsp;<\/strong>A rather large papillary fragment with central stroma, with elongated mesenchymal nuclei, lined by crowded epithelial cells, some showing a perpendicular cellular axis to the stroma.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img decoding=\"async\" alt=\"\" height=\"475\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/styles\/max\/public\/images\/Picture4_4.jpg\" width=\"318\" \/><\/a><figcaption><strong>A small cluster of cells with the nuclear feature of PTC.&nbsp;<\/strong>This group maintains a follicular arrangement but the nuclei exhibit grooves and pseudoinclusions, consistent with a PTC. These findings are expression of nuclear membrane irregularity, found in all cases of PTC.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img decoding=\"async\" alt=\"\" height=\"798\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/styles\/max\/public\/images\/Picture5_2.jpg\" width=\"538\" \/><\/a><figcaption><strong>A group of &#8216;squamoid&#8217; cells with the nuclear features of PTC.&nbsp;<\/strong>The cells have a dense, &#8216;squamoid&#8217; looking cytoplasm but the nuclei have groovings and pseudoinclusions. Please note that few cells have a high N\/C ratio.&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"572\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/styles\/max\/public\/images\/Picture6_1.jpg\" width=\"762\" \/><\/a><figcaption><strong>Two groups of normal and atypical cells.&nbsp;<\/strong>The needle will often go through normal areas, therefore a mixed cell population will be idnetified in the smears such as in this case. The larger size, crowding and nuclear atypia of the lower group of cells clashes with the monolayered, follicular aspect of the group at the top.<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"900\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/styles\/max\/public\/images\/404_1425393079.jpg\" width=\"1200\" \/><\/a><figcaption><strong>A large fragment from a PTC. &nbsp;<\/strong>A large papillary fragment (microbiopsy) from a PTC in which there is an obvious perpendicular arrangement of the epithelial cells to the stroma.&nbsp;<\/figcaption><\/figure>\n<figure><a data-toggle=\"modal\" href=\"#modal-container-2\"><img loading=\"lazy\" decoding=\"async\" alt=\"\" height=\"503\" src=\"http:\/\/lnx.eurocytology.eu\/sites\/default\/files\/styles\/max\/public\/images\/Picture28.jpg\" width=\"670\" \/><\/a><figcaption><strong>A group of blander cells from a PTC.&nbsp;<\/strong><\/figcaption><\/figure>\n","protected":false},"excerpt":{"rendered":"<div data-object_id=\"5979\" class=\"cbxwpbkmarkwrap cbxwpbkmarkwrap_guest cbxwpbkmarkwrap_user_cat cbxwpbkmarkwrap-course \"><a  data-redirect-url=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5979\/\"  data-display-label=\"1\" data-show-count=\"1\" data-bookmark-label=\"Bookmark\"  data-bookmarked-label=\"Bookmarked\"  data-loggedin=\"0\" data-type=\"course\" data-object_id=\"5979\" class=\"cbxwpbkmarktrig  cbxwpbkmarktrig-button-addto\" title=\"Bookmark This\" href=\"#\"><span class=\"cbxwpbkmarktrig-label\" >Bookmark (<i class=\"cbxwpbkmarktrig-count\">0<\/i>)<\/span><\/a> <div  data-type=\"course\" data-object_id=\"5979\" class=\"cbxwpbkmarkguestwrap\" id=\"cbxwpbkmarkguestwrap-5979\"><div class=\"cbxwpbkmarkguest-message\"><a href=\"#\" class=\"cbxwpbkmarkguesttrig_close\"><\/a><h3 class=\"cbxwpbookmark-title cbxwpbookmark-title-login\">Please login to bookmark<\/h3><form name=\"loginform\" id=\"loginform\" action=\"https:\/\/www.eurocytology.eu\/wp-login.php\" method=\"post\"><p class=\"login-username\">\n\t\t\t\t<label for=\"user_login\">Nombre de usuario o correo electr\u00f3nico<\/label>\n\t\t\t\t<input type=\"text\" name=\"log\" id=\"user_login\" autocomplete=\"username\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-password\">\n\t\t\t\t<label for=\"user_pass\">Contrase\u00f1a<\/label>\n\t\t\t\t<input type=\"password\" name=\"pwd\" id=\"user_pass\" autocomplete=\"current-password\" spellcheck=\"false\" class=\"input\" value=\"\" size=\"20\" \/>\n\t\t\t<\/p><p class=\"login-remember\"><label><input name=\"rememberme\" type=\"checkbox\" id=\"rememberme\" value=\"forever\" \/> Recu\u00e9rdame<\/label><\/p><p class=\"login-submit\">\n\t\t\t\t<input type=\"submit\" name=\"wp-submit\" id=\"wp-submit\" class=\"button button-primary\" value=\"Acceder\" \/>\n\t\t\t\t<input type=\"hidden\" name=\"redirect_to\" value=\"https:\/\/www.eurocytology.eu\/es\/wp-json\/wp\/v2\/course\/5979\/\" \/>\n\t\t\t<\/p><\/form><p class=\"cbxwpbookmark-guest-register\">No account yet? <a href=\"https:\/\/www.eurocytology.eu\/es\/register\/?redirect_to=https%3A%2F%2Fwww.eurocytology.eu%2Fes%2Fwp-json%2Fwp%2Fv2%2Fcourse%2F5979%2F\">Register<\/a><\/p><\/div><\/div><\/div><p>El carcinoma papilar de tiroides (CPT) es uno de los tumores malignos m\u00e1s comunes de la gl\u00e1ndula tiroides (&gt;80% de los c\u00e1nceres de tiroides). Puede ocurrir a cualquier edad, pero la mayor\u00eda de pacientes est\u00e1n entre los 30 y 50 a\u00f1os, muchos de ellos son mujeres (M:H 3:1). Usualmente se presenta como un n\u00f3dulo solitario, [&hellip;]<\/p>\n","protected":false},"featured_media":0,"parent":5970,"menu_order":8,"template":"","meta":[],"tags":[],"course_area":[17],"authors":[],"class_list":["post-5979","course","type-course","status-publish","hentry","course_area-thyroid"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.6 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Carcinoma papilar - Eurocytology<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.eurocytology.eu\/es\/course\/citologia-de-mama\/carcinoma-de-mama\/carcinoma-papilar\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Carcinoma papilar - Eurocytology\" \/>\n<meta property=\"og:description\" content=\"El carcinoma papilar de tiroides (CPT) es uno de los tumores malignos m\u00e1s comunes de la gl\u00e1ndula tiroides (&gt;80% de los c\u00e1nceres de tiroides). Puede ocurrir a cualquier edad, pero la mayor\u00eda de pacientes est\u00e1n entre los 30 y 50 a\u00f1os, muchos de ellos son mujeres (M:H 3:1). 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