Adenocarcinoma gástrico en adolescente de 17 años de edad (2015)

espanolEl adenocarcinoma gastrico representa el 0,05% de las neoplasias gastrointestinales pediatricas, predomina en el genero femenino y el tipo histologico indiferenciado es el mas frecuente. Presentamos el caso de una paciente femenina de 17 anos de edad, que fue atendida en el Hospital Materno Infantil en la ciudad de Tegucigalpa, Honduras, procedente de una area rural de la region suroriental del pais, con historia de dolor abdominal localizado en epigastrio de 1 mes de evolucion, urente, intenso e incapacitante; generalizado en abdomen e irradiado a la espalda en las ultimas 2 semanas, acompanado de vomito postprandial, aproximadamente en 6 episodios diarios y hematemesis ocasional. Otros datos revelados en la anamnesis fueron perdida de peso no cuantificado y astenia, sin antecedentes familiares de neoplasia. La realizacion de una endoscopia digestiva alta revelo: lesion ulcero infiltrante Bormann III de aspecto maligno que ocupaba todo el cuerpo y antro gastrico, el estudio histopatologico confirmo: adenocarcinoma gastrico difuso invasivo grado 4, se indico tomografia axial computarizada de abdomen, la cual adicionalmente reporto: proceso neoplasico de camara gastrica, ascitis importante, signos de carcinomatosis peritoneal, y linfangitis carcinomatosa a nivel toracico. La serologia para Helicobacter pylori resulto negativa. El tratamiento consistio en nutricion parenteral, quimioterapia metronomica y cuidados paliativos;la paciente fallecio al mes de ser ingresada al centro asistencial. Se pretende generar conocimiento cientifico que brinde a los pacientes con sintomatologia gastrointestinal persistente un manejo orientado a descartar la existencia de cancer gastrico, mejorando asi su sobrevida. EnglishGastric Adenocarcinoma represents 0,05% of the pediatric gastrointestinal malignancies. It has higher prevalence in women, being undifferentiated type carcinoma the most common. We present the case of a 17 year old female patient that was admitted to the Hospital Materno Infantil, In Tegucigalpa, Honduras; who was originally from the south eastern region of the country. She presented a history of abdominal pain localized in the epigastric area, characterized by:burning sensation, and a continous, intense, disabling quality that progressed for one month. Two weeks later the pain became generalized in the abdomen and radiated to her back. Furthermore, she referred 6 daily episodes of postprandial vomiting, with abundant food content and ocasional hematemesis. Additionally, patient interview revealed unquantifiable weight loss and asthenia. No known personal or familial cancer history. Gastrointestinal endoscopy revealed: ulcero infiltrative lesion Borman III of malignant appearance that invaded stomach body and antrum. Biopsy showed: an invasive and diffuse gastric adenocarcinoma, grade 4 WHO. Axial computed Tomography reported a neoplasic process of stomach chamber with considerable ascites and evidence of peritoneal carcinomatosis. Thorax scan showed pulmonary carcinomatous lymphangitis.Serological studies for H. pylori were negative. Parenteral nutrition, metronomic chemotherapy, and palliative care were started; however, one month after hospitalization patient expired. We aim to generate scientific knowledge that will provide patients with persistent gastrointestinal symptoms with a treatment protocol that asists in precluding gastric adenocarcinoma as their main diagnosis thus improving their survival rate.