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Material Y Métodos UNIVERSIDAD COMPLUTENSE DE MADRID FACULTAD DE MEDICINA Departamento de Anatomía Patológica PATRONES ULTRAESTRUCTURALES DE LOS TUMORES MIXOIDES DE PARTES BLANDAS MEMORIA PARA OPTAR AL GRADO DE DOCTOR PRESENTADA POR Carmen González Lois Bajo la dirección del doctor Miguel Ángel Martínez González Madrid, 2005 ISBN: 84-669-2811-1 UNIVERSIDAD COMPLUTENSE DE MADRID FACULTAD DE MEDICINA Y CIRUGÍA DEPARTAMENTO DE ANATOMÍA PATOLÓGICA PATRONES ULTRAESTRUCTURALES DE LOS TUMORES MIXOIDES DE PARTES BLANDAS Director: Miguel Ángel Martínez González Carmen González Lois Abril de 2005 Hospital Universitario “Doce de Octubre” Ctra. de Andalucía Km 5,400 Madrid 28041 Madrid, Abril de 2005 Dr. Miguel Angel Martínez González, Médico Adjunto del Hospital Universitario “Doce de Octubre” y Profesor Asociado del Departamento de Anatomía Patológica de la Universidad Complutense de Madrid, certifica que: Dña. Carmen González Lois ha realizado bajo mi dirección la tesis doctoral cuyo título es: “Patrones ultraestructurales de tumores mixoides de partes blandas” Esta tesis representa un trabajo original y contiene observaciones novedosas por lo que resulta válido para su presentación con objeto de la obtención del grado de doctor. Y para que así conste, firmo el presente certificado en Abril de 2005. Fdo.: Miguel Ángel Martínez González. ______________________________________________________________Agradecimientos AGRADECIMIENTOS: La realización de este trabajo hubiera sido imposible sin la inestimable colaboración de un grupo de personas a las que me gustaría agradecerles su ayuda. En primer lugar, a Miguel Ángel Martínez González, Director de esta tesis, cuya dedicación constante y brillantes aportaciones han sido el impulso de este trabajo. Por su paciencia infinita. Al Profesor Martínez Tello, Jefe del Departamento de Anatomía Patológica del Hospital Doce de Octubre, por todos estos años de formación y por los medios puestos a nuestra disposición. A Gustavo Pérez Espejo, Jefe de Servicio del Departamento de Anatomía Patológica del Hospital Doce de Octubre, por su sabiduría que ha hecho más fácil el camino. A Claudio Ballestín, responsable del Área de inmunohistoquímica del Departamento de Anatomía Patológica de este mismo hospital, por su desinteresada colaboración técnica. A todos los componentes de la sección de Microscopía Electrónica del Hospital Doce de Octubre: Paco, Ángel, Domingo y Mª Jesús, por el trabajo bien hecho. A todos los compañeros que en los momentos de flaqueza me dieron ánimos para seguir adelante. A mi familia y amigos por su constante apoyo. II ______________________________________________________________________Índice ÍNDICE II ______________________________________________________________________Índice ÍNDICE ----------------------------------------------------------------------- II INTRODUCCIÓN------------------------------------------------------------ 1 -LOS TUMORES MIXOIDES DE PARTES BLANDAS-------------- 2 -Cuáles son los tumores mixoides de partes blandas ----------------- 3 -TÉCNICAS DE ESTUDIO ------------------------------------------------ 5 -Histoquímica-------------------------------------------------------------- 5 -Inmunohistoquímica ----------------------------------------------------- 6 -Citogenética--------------------------------------------------------------- 7 -Microscopía electrónica ------------------------------------------------- 7 -Estudio diagnóstico ------------------------------------------------------ 8 -Estudio histogenético ---------------------------------------------------- 9 -PLANTEAMIENTO DEL PROBLEMA------------------------------- 13 -OBJETIVOS --------------------------------------------------------------- 14 MATERIALES Y MÉTODO --------------------------------------------- 16 -Procedencia de las muestras ------------------------------------------ 17 -Criterio de selección de los casos ------------------------------------ 17 -Estudio de los casos---------------------------------------------------- 21 -Métodos ultraestructurales -------------------------------------------- 21 RESULTADOS------------------------------------------------------------- 25 -Tumores adipocíticos -------------------------------------------------- 27 -Lipoma de células fusiformes------------------------------------- 27 -Liposarcoma mixoide ---------------------------------------------- 28 III ______________________________________________________________________Índice -Liposarcoma pleomórfico-------------------------------------- 28 -FIGURAS ---------------------------------------------------------- I -Tumores fibroblásticos/miofibroblásticos -------------------------- 31 -Fascitis nodular ----------------------------------------------------- 31 -Miofibroblastoma de tipo mamario ------------------------------ 31 -Fibroblastoma desmoplásico -------------------------------------- 32 -Mixofibrosarcoma -------------------------------------------------- 32 -Sarcoma fibromixoide de bajo grado ---------------------------- 34 -FIGURAS ------------------------------------------------------------ V -Tumores de músculo liso---------------------------------------------- 36 -Tumores de músculo esquelético ------------------------------------ 38 -FIGURAS ------------------------------------------------------------ X -Tumores condrales ----------------------------------------------------- 40 -Tumores de diferenciación incierta ---------------------------------- 41 -Mixomas y tumor fibromixoide osificante ---------------------- 41 -FIGURAS --------------------------------------------------------- XIII -Condrosarcoma mixoide extraesquelético y paracordomas --- 45 -Cordomas --------------------------------------------------------------- 46 -FIGURAS ------------------------------------------------------------- XVI -Tumores neurales ------------------------------------------------------ 48 -FIGURAS -------------------------------------------------------------- XX -Miscelánea: tumores de tipificación incierta y otros.-------------- 52 -FIGURAS ------------------------------------------------------------- XXI -Estudio de gelatina de Wharton -------------------------------------- 53 -FIGURAS ----------------------------------------------------------- XXIII IV ______________________________________________________________________Índice -TABLAS -------------------------------------------------------------------i DISCUSIÓN ---------------------------------------------------------------- 54 -Tumores adipocíticos -------------------------------------------------- 55 -Lipoma de células fusiformes------------------------------------- 55 -Definición-------------------------------------------------------- 55 -Consideraciones generales ------------------------------------- 55 -Características clínicas ----------------------------------------- 56 -Características macro- y microscópicas---------------------- 56 -Técnicas especiales --------------------------------------------- 57 -Características ultraestructurales------------------------------ 57 -Liposarcoma mixoide ---------------------------------------------- 58 -Definición-------------------------------------------------------- 58 -Consideraciones generales ------------------------------------- 58 -Características clínicas ----------------------------------------- 59 -Características macro- y microscópicas---------------------- 60 -Técnicas especiales --------------------------------------------- 62 -Características ultraestructurales------------------------------ 62 -Origen y desarrollo del tejido adiposo --------------------------- 64 -El antígeno CD34--------------------------------------------------- 67 -Tumores fibroblásticos/miofibroblásticos -------------------------- 70 -Fascitis nodular ----------------------------------------------------- 70 -Fibroblastoma desmoplásico -------------------------------------- 70 -Definición-------------------------------------------------------- 70 -Características clínicas ----------------------------------------- 70 V ______________________________________________________________________Índice -Características macro-microscópicas y técnicas especiales 71 -Características ultraestructurales------------------------------ 71 -Miofibroblastoma--------------------------------------------------- 72 -Definición-------------------------------------------------------- 72 -Características clínicas ----------------------------------------- 72 -Características macroscópicas y microscópicas------------- 72 -Características ultraestructurales------------------------------ 73 -Mixofibrosarcoma -------------------------------------------------- 73 -Definición y consideraciones generales---------------------- 73 -Características clínicas ----------------------------------------- 74 -Características macroscópicas--------------------------------- 74 -Características microscópicas e inmunohistoquímicas----- 75 -Características citogenéticas----------------------------------- 75 -Características ultraestructurales------------------------------ 75 -Sarcoma fibromixoide de bajo grado ---------------------------- 80 -Definición y consideraciones generales---------------------- 80 -Características macroscópicas y microscópicas------------- 80 -Características inmunohistoquímicas------------------------- 81 -Características citogenéticas----------------------------------- 81 -Características ultraestructurales------------------------------ 82 -Miofibroblastos--------------------------------------------------------- 82 -Proliferaciones de miofibroblastos -------------------------------
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