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Posteriormente&#44; Ellington et al&#46; comentan un nuevo caso con dicha mutaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&#46; Al-Ibraheemi et al&#46; realizaron estudios gen&#243;micos por microarray en ocho de sus casos&#44; y los dos que mostraron caracter&#237;sticas histol&#243;gicas sarcomatosas revelaron cambios en el n&#250;mero de copias gen&#243;micas&#46; Ambos presentaron cariotipos moleculares complejos &#40;hiperdiploide&#47;tetraploide&#41;&#58; uno&#44; con una p&#233;rdida de heterocigosidad de las regiones cromos&#243;micas 1 p y 11p&#44; y el otro con p&#233;rdida del cromosoma 14 y de los fragmentos 10p&#44; 22q11<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46; La identificaci&#243;n de las mismas alteraciones citogen&#233;ticas en los distintos componentes de la lesi&#243;n apoyan la consideraci&#243;n del HFI como un proceso neopl&#225;sico&#44; clasificaci&#243;n con la que estamos de acuerdo&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Pese a que no existen asociaciones reconocidas del HFI con ning&#250;n trastorno familiar o sindr&#243;mico&#44; hemos encontrado un caso relacionado con esclerosis tuberosa<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> y otro con s&#237;ndrome de Williams &#40;SW&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#46; En el segundo&#44; al encontrarse una m&#237;nima expresi&#243;n de elastina dentro del tumor&#44; los autores hipotetizan que una microdeleci&#243;n en el gen de la elastina puede predisponer al desarrollo de HFI<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El HFI es una entidad cl&#237;nicamente heterog&#233;nea que afecta a localizaciones muy variadas&#46; Habitualmente&#44; se presenta en forma de n&#243;dulo &#250;nico mal delimitado de unos 0&#44;5 a 10 cm de di&#225;metro sin afectaci&#243;n epid&#233;rmica<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&#46; No obstante&#44; se han descrito variantes cl&#237;nicas como multic&#233;ntrico<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a>&#44; gigantes &#40;de hasta 20 cm&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&#44; con hiperpigmentaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#44; hipertricosis e hiperhidrosis<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Generalmente&#44; son asintom&#225;ticos&#44; pero pueden presentarse como n&#243;dulos infiltrados o adheridos a planos profundos&#44; dificultando as&#237; el diagn&#243;stico diferencial con una neoplasia maligna<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>&#46; Sus localizaciones m&#225;s habituales son la axila&#44; la zona alta de la espalda&#44; los brazos y el &#225;rea genital<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;21&#44;22</span></a>&#46; Presentan un crecimiento acelerado en los cinco primeros a&#241;os de vida con posterior estabilizaci&#243;n&#46; No se han descrito pacientes con involuci&#243;n o met&#225;stasis&#44; pero s&#237; dos casos con &#225;reas sarcomatosas&#46; El tratamiento de elecci&#243;n es la escisi&#243;n quir&#250;rgica completa con bordes libres<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&#46; Las cifras de recidiva publicadas se sit&#250;an en torno al 15&#37;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;16&#44;23-26</span></a>&#44; si bien&#44; en centros especializados estas pueden disminuir hasta el 1&#37;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La inmunohistoqu&#237;mica del hamartoma fibroso de la infancia es inespec&#237;fica y similar a otros tumores&#46; El componente fibrobl&#225;stico es t&#237;picamente positivo para vimentina y actina de m&#250;sculo liso&#44; pero tambi&#233;n puede revelar reactividad focal para c&#250;mulo de diferenciaci&#243;n 68 &#40;CD68&#41;&#44; desmina y factor XIIIa&#44; pero no para S100&#44; marcador que s&#237; te&#241;ir&#225; el tejido adiposo&#46; En cuanto al componente inmaduro&#44; muestra caracter&#237;sticamente positividad para c&#250;mulo de diferenciaci&#243;n 34 &#40;CD34&#41;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;25</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Describimos las principales caracter&#237;sticas histopatol&#243;gicas e inmunohistoqu&#237;micas &#40;IHQ&#41; de 21 casos de HFI y revisamos sus principales diagn&#243;sticos diferenciales en funci&#243;n de su patr&#243;n predominante&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materiales y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio observacional retrospectivo que incluy&#243; los casos diagnosticados de HFI de entre los a&#241;os 1990 y 2015 en el Centro M&#233;dico Voth&#44; el Departamento de Dermatopatolog&#237;a del Hospital Universitario de la Princesa de Madrid y el Friedrichshafen Dermatopathologie&#44; en Friedrichshafen &#40;Alemania&#41;&#46; En cada caso&#44; el tejido se fij&#243; en formalina tamponada al 5&#37;&#44; se proces&#243; habitualmente y se incluy&#243; en parafina&#46; Se ti&#241;eron secciones de 4 &#956;m con hematoxilina y eosina y&#44; para los estudios con IHQ&#44; se montaron secciones de 4 &#956;m en portaobjetos con carga positiva&#46; Estas se dejaron secar m&#225;s tarde durante la noche a 45<span class="elsevierStyleHsp" style=""></span>&#176;<span class="elsevierStyleSmallCaps">C</span>&#46; Los portaobjetos se desparafinaron en xilol durante 30 minutos&#44; se rehidrataron usando concentraciones graduadas de etanol y se incubaron durante 30 minutos a 95<span class="elsevierStyleHsp" style=""></span>&#176;C en tamp&#243;n &#225;cido etilendiaminotetraac&#233;tico &#40;EDTA&#41; &#40;pH &#61; 9&#44;0&#41;&#46; Se enfriaron a temperatura ambiente durante 20 minutos&#46; Despu&#233;s del enfriamiento r&#225;pido con bloqueo de fosfatasa alcalina y biotina&#44; usando avidina&#44; las secciones se incubaron con los diferentes anticuerpos utilizados &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Esta revisi&#243;n ha sido aprobada por un comit&#233; de &#233;tica en investigaci&#243;n y se llev&#243; a cabo de acuerdo con los principios &#233;ticos de la Declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas cl&#237;nicas y epidemiol&#243;gicas</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las biopsias pertenec&#237;an a 13 hombres y ocho mujeres&#46; La mediana de edad al diagn&#243;stico de las lesiones era de un a&#241;o &#40;rango de cinco meses a 24 a&#241;os&#41;&#46; Estas se presentaban localizadas en sitios t&#237;picos &#40;axila&#44; miembro superior&#44; regi&#243;n dorsal y cervical posterior&#41; en 18 de nuestros pacientes y en sitios at&#237;picos &#40;cadera&#44; mano&#44; perianal&#41; en los otros tres &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Hallazgos histopatol&#243;gicos</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los casos se caracterizaban por presentar una morfolog&#237;a trif&#225;sica con una proporci&#243;n variable de tejido fibrobl&#225;stico&#47;miofibrobl&#225;stico&#44; mesenquimal inmaduro y adiposo maduro en dermis o subcutis &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1&#44; 2 y 3</a>&#41;&#46; En t&#233;rminos generales&#44; las lesiones se describieron como mal delimitadas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Las trab&#233;culas fibrosas var&#237;an en grosor y disposici&#243;n&#44; y contienen haces de c&#233;lulas en forma de huso dispersos aleatoriamente entre haces de col&#225;geno &#40;con colecciones de fibroblastos de aspecto inmaduro&#44; formando patrones en espiral&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Los n&#243;dulos mixoides de tejido mesenquimal inmaduro estaban compuestos por c&#233;lulas redondas o estrelladas primitivas&#44; indiferenciadas&#44; dispuestas libremente o embebidas en un estroma mixoide &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Finalmente&#44; podemos observar &#225;reas de tejido adiposo maduro &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 y 2</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La proporci&#243;n relativa de cada componente era muy variable&#46; Uno de ellos se consider&#243; &#171;predominante&#187; si ocupaba igual o m&#225;s del 45&#37; de toda la lesi&#243;n&#46; Siete casos presentaron una distribuci&#243;n equitativa&#59; en nueve&#44; el componente predominante fue el adiposo&#44; y en cuatro&#44; fue el fibrobl&#225;stico&#46; Encontramos un predominio significativo del tejido mesenquimal inmaduro en uno de nuestros pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se puede observar m&#237;nimos focos de infiltrado inflamatorio en cuatro casos y en uno&#44; alguna figura mit&#243;tica&#44; pero sin necrosis o atipia nuclear&#46; Ninguno de nuestros pacientes mostr&#243; caracter&#237;sticas morfol&#243;gicas sarcomatosas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; los casos testados para desmina<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#44; podoplanina<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#44; c&#250;mulo de diferenciaci&#243;n 31 &#40;CD31&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#44; ant&#237;geno epitelial de membrana &#40;EMA&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#44; CD63 &#40;NKI&#47;C3&#41; &#40;Mouse Monoclonal Antibody&#59; anticuerpo monoclonal de rat&#243;n contra CD63&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> y la expresi&#243;n nuclear de beta-catenina nuclear<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> fueron negativos &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">En este trabajo describimos una serie de 21 casos de esta entidad poco frecuente&#46; Con una cierta predominancia masculina 1&#44;6&#58;1&#44; es una neoplasia de aparici&#243;n en la infancia&#46; Si bien&#44; hasta el 20&#37; de los HFI se reconocen al nacimiento&#44; la mayor&#237;a se diagnostican alrededor de los dos a&#241;os de edad<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46; Saab et al&#46;&#44; identificaron el 88&#37; de los casos antes de los dos a&#241;os&#44; el 7&#37; entre los tres y los cinco a&#241;os y el 5&#37; despu&#233;s de los cinco a&#241;os<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46; En nuestra serie&#44; el 76&#37; de los casos se observaron en lactantes y el 24&#37; tras los dos a&#241;os de edad&#46; Ocasionalmente&#44; se han descrito en la literatura pacientes diagnosticados entre la segunda&#44; tercera y cuarta d&#233;cada de la vida&#44; probablemente debido a un retraso en el diagn&#243;stico y no a una verdadera presentaci&#243;n tard&#237;a de la entidad&#46; Ji et al&#46;&#44; publicaron un paciente diagnosticado a los 47 a&#241;os de edad pese a presentar una lesi&#243;n de lento crecimiento progresivo en la regi&#243;n craneocervical izquierda de 42 a&#241;os de evoluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#46; De forma similar&#44; en nuestra serie presentamos un paciente de 24 a&#241;os que reconoci&#243; la aparici&#243;n de la lesi&#243;n en la infancia&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En cuanto a la localizaci&#243;n&#44; nuestros casos tienen predilecci&#243;n por el miembro superior &#40;n &#61; 8&#44; 40&#37;&#41;&#44; la espalda &#40;n &#61; 5&#44; 24&#37;&#41; y la axila &#40;n &#61; 3&#41;&#46; Los estudios iniciales del HFI enfatizaban dichas ubicaciones como sitios de preferencia&#44; si bien con el tiempo otras han sido publicadas&#46; Pese a que hasta el 20&#37; de las lesiones en la literatura aparecen en &#225;rea genital&#44; en nuestros casos solo hab&#237;a una en la regi&#243;n perianal<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;20&#8211;22</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La variabilidad cl&#237;nica y baja frecuencia de esta neoplasia benigna&#44; que puede tener patr&#243;n infiltrativo&#44; plantea como problema principal el diagn&#243;stico diferencial con otras entidades que requieren una actitud m&#225;s agresiva&#46; El correcto diagn&#243;stico depende&#44; en gran medida&#44; de la identificaci&#243;n morfol&#243;gica de los tres componentes histol&#243;gicos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;12&#44;16&#44;17&#44;28&#8211;30</span></a>&#46; En nuestra opini&#243;n&#44; es importante localizar el componente mesenquimal inmaduro que&#44; independientemente de su proporci&#243;n&#44; siempre debe estar presente&#46; Una histolog&#237;a trif&#225;sica &#40;tejido mesenquimal inmaduro&#44; fibrobl&#225;stico y adiposo&#41; nos permitir diferenciar tumoraciones con predominio de tejido adiposo como&#58; la lipofibromatosis&#44; el tumor neural similar a la lipofibromatosis &#40;donde encontramos adem&#225;s cierta atipia citol&#243;gica&#41; y el lipoblastoma&#59; de predominio fibrobl&#225;stico como&#58; la fibromatosis de tipo desmoide &#40;poco frecuente en ni&#241;os y proliferaci&#243;n compacta de miofibroblastos&#41;&#44; los miofibromas &#40;patr&#243;n bif&#225;sico&#44; puede presentar necrosis y&#47;o calcificaci&#243;n hacia el centro de la lesi&#243;n&#41;&#44; los fibromas aponeur&#243;ticos calcificantes &#40;que contienen adem&#225;s n&#243;dulos calcificados rodeados de c&#233;lulas epitelioides&#41;&#44; el nevus fibrobl&#225;stico del tejido conectivo &#40;puede reconocerse por la localizaci&#243;n d&#233;rmica y la ausencia de mes&#233;nquima inmaduro&#41; y el fibroblastoma de c&#233;lulas gigantes&#46; Las hendiduras presentes en el fibroblastoma pueden estar vac&#237;as u ocupadas por material amorfo mucinoso y est&#225;n revestidas por una hilera discontinua de c&#233;lulas tumorales&#46; En este tumor&#44; adem&#225;s&#44; es frecuente encontrar c&#233;lulas multinucleadas y presenta reordenamiento de la subunidad B del factor de crecimiento derivado de plaquetas &#40;PDGFB&#41;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;9&#44;21&#44;24&#44;28</span></a>&#46; Aunque ambas entidades tienen hendiduras&#44; las zonas hialinizadas con grietas del HFI&#44; tambi&#233;n denominadas patr&#243;n pseudoangiomatoso&#44; habitualmente son f&#225;cilmente distinguibles por pat&#243;logos experimentados&#46; Respecto a este &#250;ltimo patr&#243;n en HFI&#44; su frecuencia es variable entre series &#40;hasta en un 53&#37; de los HFI del estudio de Saab et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> y hasta en un 30&#37; en el de Abrahami et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#59; frente al 14&#37; encontrado en nuestra serie&#41;&#44; es caracter&#237;sticamente negativo para marcadores endoteliales m&#225;s espec&#237;ficos que CD34&#44; como CD31 y podoplanina &#40;D2-40&#41;&#44; puesto que sus hendiduras no est&#225;n tapizadas por endotelio<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;9&#44;21&#44;24&#44;28</span></a>&#46; En caso del predominio de componente mesenquimal inmaduro&#44; adem&#225;s de por las caracter&#237;sticas propias de cada tumor&#44; podemos distinguir el schwannoma celular&#44; el tumor maligno de la vaina del nervio perif&#233;rico y el neurofibroma &#40;monomorfo&#41; por la fuerte positividad para S100 en el tejido mesenquimal&#44; a diferencia del HFI donde solo se ti&#241;e el tejido adiposo<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#8211;30</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el HFI es considerado un proceso neopl&#225;sico benigno de la infancia con una histolog&#237;a trif&#225;sica caracter&#237;stica cuyo tratamiento de elecci&#243;n es la escisi&#243;n quir&#250;rgica&#46; Consideramos prioritario identificar su componente mesenquimal inmaduro para facilitar el diagn&#243;stico histopatol&#243;gico&#46; Nuestros resultados confirman los hallazgos cl&#237;nicos&#44; histol&#243;gicos e inmunohistoqu&#237;micos observados previamente en la literatura y son ejemplos iconogr&#225;ficos que esperamos que puedan ayudar a realizar un diagn&#243;stico diferencial con otras entidades&#44; evitando as&#237; conductas agresivas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">El hamartoma fibroso de la infancia &#40;HFI&#41; es tumor poco frecuente de tejidos blandos en lactantes y ni&#241;os&#44; caracterizado histopat&#243;logicamente por su morfolog&#237;a trif&#225;sica y curso benigno&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Presentamos las caracter&#237;sticas histopatol&#243;gicas e inmunohistoqu&#237;micas de una serie de 21 casos de HFI y revisamos sus principales diagn&#243;sticos diferenciales&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Las lesiones predominaron en varones con una edad media de 3&#44;7 a&#241;os &#40;5 meses-24 a&#241;os&#41; en localizaciones previamente descritas&#46; Histopatol&#243;gicamente&#44; se caracterizaron por proporciones variables de tejido fibrobl&#225;stico&#44; mesenquimal y adiposo maduro&#46; Tres casos &#40;21&#37;&#41; mostraron zonas hialinizadas con artefactos en grietas&#44; que imitaban al fibroblastoma de c&#233;lulas gigantes&#46; Presentaron tinci&#243;n positiva para actina de m&#250;sculo liso 8&#47;13 &#40;61&#37;&#41; en el componente fibrobl&#225;stico&#44; CD34 en 6&#47;8 &#40;75&#37;&#41; en el mesenquimal inmaduro y fibrobl&#225;stico&#59; y S100 en el tejido adiposo en 7&#47;7 &#40;100&#37;&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Nuestros hallazgos histopatol&#243;gicos son superponibles a los descritos en series amplias&#46; No obstante&#44; la heterogeneidad cl&#237;nica obliga a conocer las variantes de esta entidad dentro de su t&#237;pica histomorfolog&#237;a trif&#225;sica&#44; para lograr un correcto diagn&#243;stico y manejo terap&#233;utico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fibrous hamartoma of infancy &#40;FHI&#41; is a rare soft-tissue tumor usually seen in infants and young children&#46; Histologically&#44; the tumor is characterized by a triphasic morphology&#44; and the clinical course is benign&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We described the histopathologic and immunohistochemical features in a series of 21 cases of FHI and reviewed the main entities to consider in differential diagnosis&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Most patients in the series were male&#46; The mean age was 3&#46;7 years &#40;range&#44; 5 months&#8211;24 years&#41;&#44; and lesions were found in locations that have been previously reported&#46; Histopathologically&#44; the tumors were composed of variable proportions of fibroblastic&#44; mesenchymal&#44; and mature adipose tissue&#46; Three of the 13 immunohistochemically stained biopsies &#40;14&#37;&#41; contained hyalinized zones with cracking artifacts&#44; mimicking giant cell fibroblastoma&#46; Eight of the 13 stained with smooth-muscle actin &#40;61&#37;&#41; were positive in the fibroblastic component&#44; 6 of the 8 stained with CD34 &#40;75&#37;&#41; were positive in the immature mesenchymal and fibroblastic components&#44; and all 7 stained with S100 were positive &#40;100&#37;&#41; in adipose tissue&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our histopathologic findings are consistent with those described in larger series&#46; However&#44; in order to reach a precise diagnosis and plan treatment&#44; clinical heterogeneity obliges us to become familiar with variations in the characteristic triphasic histology of FHI&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Alto" => 622
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        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41; Panor&#225;mica de HE que muestra una lesi&#243;n mal delimitada en dermis reticular con cantidades variables de tejido adiposo&#44; fibrobl&#225;stico y mesenquimal inmaduro&#46; B&#41; A mayor aumento se observan bandas densas de tejido fibroso proyect&#225;ndose en el tejido graso maduro&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HE&#58; hematoxilina-eosina&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A&#41; HFI d&#233;rmico e hipod&#233;rmico B&#41; A mayor aumento&#44; bandas densas de tejido fibroso proyect&#225;ndose en el tejido graso maduro&#46; C&#41; Trab&#233;culas entrelazadas de tejido fibroso que presentan colecciones de fibrocitos de aspecto inmaduro en patrones de espiral&#46; D&#41; Componente mesenquimatoso inmaduro bas&#243;filo entremezclado con tejido fibroso&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HFI&#58; hamartoma fibroso de la infancia&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1359
            "Ancho" => 1500
            "Tamanyo" => 766559
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A&#41; Panor&#225;mica de HF&#46; B&#44; C y D&#41; A mayor aumento&#44; haces y espirales de tejido fibrobl&#225;stico y mesenquimal inmaduro&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">HF&#58; hamartoma fibroso&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1531
            "Ancho" => 1500
            "Tamanyo" => 605786
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A&#41; Panor&#225;mica de una extirpaci&#243;n simple de un HFI subcut&#225;neo&#46; B&#41; A mayor aumento&#44; tejido graso y fibrobl&#225;stico&#46; C&#41; La actina del m&#250;sculo liso decora el tejido fibroso maduro&#46; D&#41; &#193;reas de positividad para CD34&#44; marcando componente inmaduro&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HFI&#58; hamartoma fibroso de la infancia&#46;</p>"
        ]
      ]
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        "identificador" => "tbl0005"
        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
        ]
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">HFI&#58; hamartoma fibroso de la infancia&#59; MS&#58; miembro superior&#46;</p>"
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                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas histol&#243;gicas</th></tr><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tejido fibrobl&#225;stico &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tejido adiposo maduro &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tejido mesenquimal &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Axila&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Hombro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Axila&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Espalda&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">19&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Espalda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">20&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perianal&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">21&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cervical posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">TOTAL&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">13&#58;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Predominancia de los componentes n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;04&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas e histol&#243;gicas de la serie de pacientes con HFI&#46; Predominancia de los componentes seg&#250;n si representa igual o m&#225;s del 45&#37; de toda la lesi&#243;n&#58; n &#40;&#37;&#41;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CD31&#58; c&#250;mulo de diferenciaci&#243;n 31&#59; CD34&#58; c&#250;mulo de diferenciaci&#243;n 34&#59; NA&#58; No aplica&#59; PGM1&#58; fosfoglucomutasa-1&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">La positividad para un determinado tejido se marca con la letra correspondiente &#40;A&#58; adiposo&#59; F&#58; fibrobl&#225;stico&#59; M&#58; mesenquimal&#41;&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Las tinciones que no muestran predominancia por un determinado tejido se marcan con los signos&#58; &#43;&#58; positivo&#59; &#8211;&#58; negativo&#59; &#177;&#58; leve&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Aquellas muestras que no fueron te&#241;idas para un determinado anticuerpo no se han completado&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Los casos testados para desmina &#40;2&#41;&#44; NKIC3 &#40;2&#41;&#44; EMA &#40;3&#41; y la expresi&#243;n nuclear de beta-catenina nuclear &#40;1&#41; no se han incluido&#46;</p>"
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CD31&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Podoplanina&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">F&#43;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">13&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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ORIGINAL
Hamartoma fibroso de la infancia: una serie de 21 casos y revisión de la literatura
Fibrous Hamartoma of Infancy: A Series of 21 Cases and Review of the Literature
L. Martos-Cabreraa,
Corresponding author
marialuisa.martoscabrera@gmail.com

Autor para correspondencia.
, R. Sampedro-Ruiza, Y.C. Pérez-Gonzálezb, T. Mentzelc, M. Llamas-Velascoa
a Department of Dermatology, Hospital Universitario de la Princesa, Fundación de Investigación Sanitaria (IIS-IP), Madrid, España
b Voth Laboratorios Diagnósticos, Madrid, España
c Friedrichshafen Dermatopathologie, Friedrichshafen, Alemania
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">La Organizaci&#243;n Mundial de la Salud &#40;OMS&#41; define el hamartoma fibroso de la infancia &#40;HFI&#41; como un tumor pedi&#225;trico de tejidos blandos&#44; benigno&#44; pobremente delimitado&#44; caracterizado por una histolog&#237;a trif&#225;sica compuesta por fasc&#237;culos fibrobl&#225;sticos&#44; tejido adiposo maduro y n&#243;dulos de c&#233;lulas mesenquimales inmaduras en un estroma mixoide primitivo<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a>&#46; Fue descrito por primera vez en 1956 por Reye et al&#46; como un &#171;fen&#243;meno reactivo&#187;&#44; que denomin&#243; tumor subd&#233;rmico fibromatoso de la infancia<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> y posteriormente&#44; renombrado como HFI por Enzinger et al&#46; basados en su presentaci&#243;n cl&#237;nica y sus caracter&#237;sticas hamartomatosas<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#46; A partir del 2005&#44; comienzan a notificarse casos aislados con alteraciones citogen&#233;ticas complejas&#58; t &#40;6&#59; 12&#59; 8&#41; &#40;q25&#59; q24&#46;3&#59; q13&#41;&#44; t &#40;2&#59; 3&#41; &#40;q31&#59; q21&#41;&#44; y reordenamientos cromos&#243;micos&#58; &#40;1&#44; 2&#44; 4 y 17&#41;<a class="elsevierStyleCrossRefs" href="#bib0170"><span class="elsevierStyleSup">4&#8211;6</span></a>&#46; Sin embargo&#44; no es hasta el 2016 cuando Park et al&#46; describen&#44; en 12 de sus casos&#44; una mutaci&#243;n tipo inserci&#243;n&#47;duplicaci&#243;n en el ex&#243;n 20 del receptor del factor de crecimiento epid&#233;rmico &#40;EGFR&#41;&#44; sugiriendo que se trata de un proceso neopl&#225;sico<a class="elsevierStyleCrossRef" href="#bib0185"><span class="elsevierStyleSup">7</span></a>&#46; Posteriormente&#44; Ellington et al&#46; comentan un nuevo caso con dicha mutaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">8</span></a>&#46; Al-Ibraheemi et al&#46; realizaron estudios gen&#243;micos por microarray en ocho de sus casos&#44; y los dos que mostraron caracter&#237;sticas histol&#243;gicas sarcomatosas revelaron cambios en el n&#250;mero de copias gen&#243;micas&#46; Ambos presentaron cariotipos moleculares complejos &#40;hiperdiploide&#47;tetraploide&#41;&#58; uno&#44; con una p&#233;rdida de heterocigosidad de las regiones cromos&#243;micas 1 p y 11p&#44; y el otro con p&#233;rdida del cromosoma 14 y de los fragmentos 10p&#44; 22q11<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46; La identificaci&#243;n de las mismas alteraciones citogen&#233;ticas en los distintos componentes de la lesi&#243;n apoyan la consideraci&#243;n del HFI como un proceso neopl&#225;sico&#44; clasificaci&#243;n con la que estamos de acuerdo&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Pese a que no existen asociaciones reconocidas del HFI con ning&#250;n trastorno familiar o sindr&#243;mico&#44; hemos encontrado un caso relacionado con esclerosis tuberosa<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">10</span></a> y otro con s&#237;ndrome de Williams &#40;SW&#41;<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#46; En el segundo&#44; al encontrarse una m&#237;nima expresi&#243;n de elastina dentro del tumor&#44; los autores hipotetizan que una microdeleci&#243;n en el gen de la elastina puede predisponer al desarrollo de HFI<a class="elsevierStyleCrossRef" href="#bib0205"><span class="elsevierStyleSup">11</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El HFI es una entidad cl&#237;nicamente heterog&#233;nea que afecta a localizaciones muy variadas&#46; Habitualmente&#44; se presenta en forma de n&#243;dulo &#250;nico mal delimitado de unos 0&#44;5 a 10 cm de di&#225;metro sin afectaci&#243;n epid&#233;rmica<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">12</span></a>&#46; No obstante&#44; se han descrito variantes cl&#237;nicas como multic&#233;ntrico<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">13&#44;14</span></a>&#44; gigantes &#40;de hasta 20 cm&#41;<a class="elsevierStyleCrossRef" href="#bib0225"><span class="elsevierStyleSup">15</span></a>&#44; con hiperpigmentaci&#243;n<a class="elsevierStyleCrossRef" href="#bib0230"><span class="elsevierStyleSup">16</span></a>&#44; hipertricosis e hiperhidrosis<a class="elsevierStyleCrossRefs" href="#bib0235"><span class="elsevierStyleSup">17&#8211;19</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Generalmente&#44; son asintom&#225;ticos&#44; pero pueden presentarse como n&#243;dulos infiltrados o adheridos a planos profundos&#44; dificultando as&#237; el diagn&#243;stico diferencial con una neoplasia maligna<a class="elsevierStyleCrossRef" href="#bib0250"><span class="elsevierStyleSup">20</span></a>&#46; Sus localizaciones m&#225;s habituales son la axila&#44; la zona alta de la espalda&#44; los brazos y el &#225;rea genital<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;21&#44;22</span></a>&#46; Presentan un crecimiento acelerado en los cinco primeros a&#241;os de vida con posterior estabilizaci&#243;n&#46; No se han descrito pacientes con involuci&#243;n o met&#225;stasis&#44; pero s&#237; dos casos con &#225;reas sarcomatosas&#46; El tratamiento de elecci&#243;n es la escisi&#243;n quir&#250;rgica completa con bordes libres<a class="elsevierStyleCrossRef" href="#bib0260"><span class="elsevierStyleSup">22</span></a>&#46; Las cifras de recidiva publicadas se sit&#250;an en torno al 15&#37;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">15&#44;16&#44;23-26</span></a>&#44; si bien&#44; en centros especializados estas pueden disminuir hasta el 1&#37;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">La inmunohistoqu&#237;mica del hamartoma fibroso de la infancia es inespec&#237;fica y similar a otros tumores&#46; El componente fibrobl&#225;stico es t&#237;picamente positivo para vimentina y actina de m&#250;sculo liso&#44; pero tambi&#233;n puede revelar reactividad focal para c&#250;mulo de diferenciaci&#243;n 68 &#40;CD68&#41;&#44; desmina y factor XIIIa&#44; pero no para S100&#44; marcador que s&#237; te&#241;ir&#225; el tejido adiposo&#46; En cuanto al componente inmaduro&#44; muestra caracter&#237;sticamente positividad para c&#250;mulo de diferenciaci&#243;n 34 &#40;CD34&#41;<a class="elsevierStyleCrossRefs" href="#bib0255"><span class="elsevierStyleSup">21&#44;25</span></a>&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Describimos las principales caracter&#237;sticas histopatol&#243;gicas e inmunohistoqu&#237;micas &#40;IHQ&#41; de 21 casos de HFI y revisamos sus principales diagn&#243;sticos diferenciales en funci&#243;n de su patr&#243;n predominante&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Materiales y m&#233;todos</span><p id="par0035" class="elsevierStylePara elsevierViewall">Se dise&#241;&#243; un estudio observacional retrospectivo que incluy&#243; los casos diagnosticados de HFI de entre los a&#241;os 1990 y 2015 en el Centro M&#233;dico Voth&#44; el Departamento de Dermatopatolog&#237;a del Hospital Universitario de la Princesa de Madrid y el Friedrichshafen Dermatopathologie&#44; en Friedrichshafen &#40;Alemania&#41;&#46; En cada caso&#44; el tejido se fij&#243; en formalina tamponada al 5&#37;&#44; se proces&#243; habitualmente y se incluy&#243; en parafina&#46; Se ti&#241;eron secciones de 4 &#956;m con hematoxilina y eosina y&#44; para los estudios con IHQ&#44; se montaron secciones de 4 &#956;m en portaobjetos con carga positiva&#46; Estas se dejaron secar m&#225;s tarde durante la noche a 45<span class="elsevierStyleHsp" style=""></span>&#176;<span class="elsevierStyleSmallCaps">C</span>&#46; Los portaobjetos se desparafinaron en xilol durante 30 minutos&#44; se rehidrataron usando concentraciones graduadas de etanol y se incubaron durante 30 minutos a 95<span class="elsevierStyleHsp" style=""></span>&#176;C en tamp&#243;n &#225;cido etilendiaminotetraac&#233;tico &#40;EDTA&#41; &#40;pH &#61; 9&#44;0&#41;&#46; Se enfriaron a temperatura ambiente durante 20 minutos&#46; Despu&#233;s del enfriamiento r&#225;pido con bloqueo de fosfatasa alcalina y biotina&#44; usando avidina&#44; las secciones se incubaron con los diferentes anticuerpos utilizados &#40;<a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0040" class="elsevierStylePara elsevierViewall">Esta revisi&#243;n ha sido aprobada por un comit&#233; de &#233;tica en investigaci&#243;n y se llev&#243; a cabo de acuerdo con los principios &#233;ticos de la Declaraci&#243;n de Helsinki&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0085">Caracter&#237;sticas cl&#237;nicas y epidemiol&#243;gicas</span><p id="par0045" class="elsevierStylePara elsevierViewall">Las biopsias pertenec&#237;an a 13 hombres y ocho mujeres&#46; La mediana de edad al diagn&#243;stico de las lesiones era de un a&#241;o &#40;rango de cinco meses a 24 a&#241;os&#41;&#46; Estas se presentaban localizadas en sitios t&#237;picos &#40;axila&#44; miembro superior&#44; regi&#243;n dorsal y cervical posterior&#41; en 18 de nuestros pacientes y en sitios at&#237;picos &#40;cadera&#44; mano&#44; perianal&#41; en los otros tres &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0090">Hallazgos histopatol&#243;gicos</span><p id="par0050" class="elsevierStylePara elsevierViewall">Los casos se caracterizaban por presentar una morfolog&#237;a trif&#225;sica con una proporci&#243;n variable de tejido fibrobl&#225;stico&#47;miofibrobl&#225;stico&#44; mesenquimal inmaduro y adiposo maduro en dermis o subcutis &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1&#44; 2 y 3</a>&#41;&#46; En t&#233;rminos generales&#44; las lesiones se describieron como mal delimitadas &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0055" class="elsevierStylePara elsevierViewall">Las trab&#233;culas fibrosas var&#237;an en grosor y disposici&#243;n&#44; y contienen haces de c&#233;lulas en forma de huso dispersos aleatoriamente entre haces de col&#225;geno &#40;con colecciones de fibroblastos de aspecto inmaduro&#44; formando patrones en espiral&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>&#41;&#46; Los n&#243;dulos mixoides de tejido mesenquimal inmaduro estaban compuestos por c&#233;lulas redondas o estrelladas primitivas&#44; indiferenciadas&#44; dispuestas libremente o embebidas en un estroma mixoide &#40;<a class="elsevierStyleCrossRef" href="#fig0015">fig&#46; 3</a>&#41;&#46; Finalmente&#44; podemos observar &#225;reas de tejido adiposo maduro &#40;<a class="elsevierStyleCrossRefs" href="#fig0005">figs&#46; 1 y 2</a>&#41;&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">La proporci&#243;n relativa de cada componente era muy variable&#46; Uno de ellos se consider&#243; &#171;predominante&#187; si ocupaba igual o m&#225;s del 45&#37; de toda la lesi&#243;n&#46; Siete casos presentaron una distribuci&#243;n equitativa&#59; en nueve&#44; el componente predominante fue el adiposo&#44; y en cuatro&#44; fue el fibrobl&#225;stico&#46; Encontramos un predominio significativo del tejido mesenquimal inmaduro en uno de nuestros pacientes &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">Se puede observar m&#237;nimos focos de infiltrado inflamatorio en cuatro casos y en uno&#44; alguna figura mit&#243;tica&#44; pero sin necrosis o atipia nuclear&#46; Ninguno de nuestros pacientes mostr&#243; caracter&#237;sticas morfol&#243;gicas sarcomatosas&#46;</p><p id="par0070" class="elsevierStylePara elsevierViewall">En nuestro estudio&#44; los casos testados para desmina<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a>&#44; podoplanina<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#44; c&#250;mulo de diferenciaci&#243;n 31 &#40;CD31&#41;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">4</span></a>&#44; ant&#237;geno epitelial de membrana &#40;EMA&#41;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">3</span></a>&#44; CD63 &#40;NKI&#47;C3&#41; &#40;Mouse Monoclonal Antibody&#59; anticuerpo monoclonal de rat&#243;n contra CD63&#41;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">2</span></a> y la expresi&#243;n nuclear de beta-catenina nuclear<a class="elsevierStyleCrossRef" href="#bib0155"><span class="elsevierStyleSup">1</span></a> fueron negativos &#40;<a class="elsevierStyleCrossRef" href="#fig0020">fig&#46; 4</a>&#41;&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia></span></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0095">Discusi&#243;n</span><p id="par0075" class="elsevierStylePara elsevierViewall">En este trabajo describimos una serie de 21 casos de esta entidad poco frecuente&#46; Con una cierta predominancia masculina 1&#44;6&#58;1&#44; es una neoplasia de aparici&#243;n en la infancia&#46; Si bien&#44; hasta el 20&#37; de los HFI se reconocen al nacimiento&#44; la mayor&#237;a se diagnostican alrededor de los dos a&#241;os de edad<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#46; Saab et al&#46;&#44; identificaron el 88&#37; de los casos antes de los dos a&#241;os&#44; el 7&#37; entre los tres y los cinco a&#241;os y el 5&#37; despu&#233;s de los cinco a&#241;os<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a>&#46; En nuestra serie&#44; el 76&#37; de los casos se observaron en lactantes y el 24&#37; tras los dos a&#241;os de edad&#46; Ocasionalmente&#44; se han descrito en la literatura pacientes diagnosticados entre la segunda&#44; tercera y cuarta d&#233;cada de la vida&#44; probablemente debido a un retraso en el diagn&#243;stico y no a una verdadera presentaci&#243;n tard&#237;a de la entidad&#46; Ji et al&#46;&#44; publicaron un paciente diagnosticado a los 47 a&#241;os de edad pese a presentar una lesi&#243;n de lento crecimiento progresivo en la regi&#243;n craneocervical izquierda de 42 a&#241;os de evoluci&#243;n<a class="elsevierStyleCrossRef" href="#bib0285"><span class="elsevierStyleSup">27</span></a>&#46; De forma similar&#44; en nuestra serie presentamos un paciente de 24 a&#241;os que reconoci&#243; la aparici&#243;n de la lesi&#243;n en la infancia&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">En cuanto a la localizaci&#243;n&#44; nuestros casos tienen predilecci&#243;n por el miembro superior &#40;n &#61; 8&#44; 40&#37;&#41;&#44; la espalda &#40;n &#61; 5&#44; 24&#37;&#41; y la axila &#40;n &#61; 3&#41;&#46; Los estudios iniciales del HFI enfatizaban dichas ubicaciones como sitios de preferencia&#44; si bien con el tiempo otras han sido publicadas&#46; Pese a que hasta el 20&#37; de las lesiones en la literatura aparecen en &#225;rea genital&#44; en nuestros casos solo hab&#237;a una en la regi&#243;n perianal<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;20&#8211;22</span></a>&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">La variabilidad cl&#237;nica y baja frecuencia de esta neoplasia benigna&#44; que puede tener patr&#243;n infiltrativo&#44; plantea como problema principal el diagn&#243;stico diferencial con otras entidades que requieren una actitud m&#225;s agresiva&#46; El correcto diagn&#243;stico depende&#44; en gran medida&#44; de la identificaci&#243;n morfol&#243;gica de los tres componentes histol&#243;gicos<a class="elsevierStyleCrossRefs" href="#bib0195"><span class="elsevierStyleSup">9&#44;12&#44;16&#44;17&#44;28&#8211;30</span></a>&#46; En nuestra opini&#243;n&#44; es importante localizar el componente mesenquimal inmaduro que&#44; independientemente de su proporci&#243;n&#44; siempre debe estar presente&#46; Una histolog&#237;a trif&#225;sica &#40;tejido mesenquimal inmaduro&#44; fibrobl&#225;stico y adiposo&#41; nos permitir diferenciar tumoraciones con predominio de tejido adiposo como&#58; la lipofibromatosis&#44; el tumor neural similar a la lipofibromatosis &#40;donde encontramos adem&#225;s cierta atipia citol&#243;gica&#41; y el lipoblastoma&#59; de predominio fibrobl&#225;stico como&#58; la fibromatosis de tipo desmoide &#40;poco frecuente en ni&#241;os y proliferaci&#243;n compacta de miofibroblastos&#41;&#44; los miofibromas &#40;patr&#243;n bif&#225;sico&#44; puede presentar necrosis y&#47;o calcificaci&#243;n hacia el centro de la lesi&#243;n&#41;&#44; los fibromas aponeur&#243;ticos calcificantes &#40;que contienen adem&#225;s n&#243;dulos calcificados rodeados de c&#233;lulas epitelioides&#41;&#44; el nevus fibrobl&#225;stico del tejido conectivo &#40;puede reconocerse por la localizaci&#243;n d&#233;rmica y la ausencia de mes&#233;nquima inmaduro&#41; y el fibroblastoma de c&#233;lulas gigantes&#46; Las hendiduras presentes en el fibroblastoma pueden estar vac&#237;as u ocupadas por material amorfo mucinoso y est&#225;n revestidas por una hilera discontinua de c&#233;lulas tumorales&#46; En este tumor&#44; adem&#225;s&#44; es frecuente encontrar c&#233;lulas multinucleadas y presenta reordenamiento de la subunidad B del factor de crecimiento derivado de plaquetas &#40;PDGFB&#41;<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;9&#44;21&#44;24&#44;28</span></a>&#46; Aunque ambas entidades tienen hendiduras&#44; las zonas hialinizadas con grietas del HFI&#44; tambi&#233;n denominadas patr&#243;n pseudoangiomatoso&#44; habitualmente son f&#225;cilmente distinguibles por pat&#243;logos experimentados&#46; Respecto a este &#250;ltimo patr&#243;n en HFI&#44; su frecuencia es variable entre series &#40;hasta en un 53&#37; de los HFI del estudio de Saab et al&#46;<a class="elsevierStyleCrossRef" href="#bib0255"><span class="elsevierStyleSup">21</span></a> y hasta en un 30&#37; en el de Abrahami et al&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">9</span></a>&#59; frente al 14&#37; encontrado en nuestra serie&#41;&#44; es caracter&#237;sticamente negativo para marcadores endoteliales m&#225;s espec&#237;ficos que CD34&#44; como CD31 y podoplanina &#40;D2-40&#41;&#44; puesto que sus hendiduras no est&#225;n tapizadas por endotelio<a class="elsevierStyleCrossRefs" href="#bib0155"><span class="elsevierStyleSup">1&#44;9&#44;21&#44;24&#44;28</span></a>&#46; En caso del predominio de componente mesenquimal inmaduro&#44; adem&#225;s de por las caracter&#237;sticas propias de cada tumor&#44; podemos distinguir el schwannoma celular&#44; el tumor maligno de la vaina del nervio perif&#233;rico y el neurofibroma &#40;monomorfo&#41; por la fuerte positividad para S100 en el tejido mesenquimal&#44; a diferencia del HFI donde solo se ti&#241;e el tejido adiposo<a class="elsevierStyleCrossRefs" href="#bib0290"><span class="elsevierStyleSup">28&#8211;30</span></a>&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; el HFI es considerado un proceso neopl&#225;sico benigno de la infancia con una histolog&#237;a trif&#225;sica caracter&#237;stica cuyo tratamiento de elecci&#243;n es la escisi&#243;n quir&#250;rgica&#46; Consideramos prioritario identificar su componente mesenquimal inmaduro para facilitar el diagn&#243;stico histopatol&#243;gico&#46; Nuestros resultados confirman los hallazgos cl&#237;nicos&#44; histol&#243;gicos e inmunohistoqu&#237;micos observados previamente en la literatura y son ejemplos iconogr&#225;ficos que esperamos que puedan ayudar a realizar un diagn&#243;stico diferencial con otras entidades&#44; evitando as&#237; conductas agresivas&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0100">Conflicto de intereses</span><p id="par0095" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Hallazgos histopatol&#243;gicos"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Discusi&#243;n"
        ]
        9 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Conflicto de intereses"
        ]
        10 => array:1 [
          "titulo" => "Bibliograf&#237;a"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2020-07-01"
    "fechaAceptado" => "2020-12-13"
    "PalabrasClave" => array:2 [
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec1380595"
          "palabras" => array:4 [
            0 => "Hamartoma fibroso de la infancia"
            1 => "Tejido conectivo"
            2 => "Tejido fibroso"
            3 => "Tumores pedi&#225;tricos"
          ]
        ]
      ]
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1380594"
          "palabras" => array:4 [
            0 => "Fibrous hamartoma of the infancy"
            1 => "Connective tissue"
            2 => "Fibrous tissue"
            3 => "Pediatric tumors"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "es" => array:3 [
        "titulo" => "Resumen"
        "resumen" => "<span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Introducci&#243;n</span><p id="spar0125" class="elsevierStyleSimplePara elsevierViewall">El hamartoma fibroso de la infancia &#40;HFI&#41; es tumor poco frecuente de tejidos blandos en lactantes y ni&#241;os&#44; caracterizado histopat&#243;logicamente por su morfolog&#237;a trif&#225;sica y curso benigno&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">M&#233;todos</span><p id="spar0130" class="elsevierStyleSimplePara elsevierViewall">Presentamos las caracter&#237;sticas histopatol&#243;gicas e inmunohistoqu&#237;micas de una serie de 21 casos de HFI y revisamos sus principales diagn&#243;sticos diferenciales&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Resultados</span><p id="spar0135" class="elsevierStyleSimplePara elsevierViewall">Las lesiones predominaron en varones con una edad media de 3&#44;7 a&#241;os &#40;5 meses-24 a&#241;os&#41; en localizaciones previamente descritas&#46; Histopatol&#243;gicamente&#44; se caracterizaron por proporciones variables de tejido fibrobl&#225;stico&#44; mesenquimal y adiposo maduro&#46; Tres casos &#40;21&#37;&#41; mostraron zonas hialinizadas con artefactos en grietas&#44; que imitaban al fibroblastoma de c&#233;lulas gigantes&#46; Presentaron tinci&#243;n positiva para actina de m&#250;sculo liso 8&#47;13 &#40;61&#37;&#41; en el componente fibrobl&#225;stico&#44; CD34 en 6&#47;8 &#40;75&#37;&#41; en el mesenquimal inmaduro y fibrobl&#225;stico&#59; y S100 en el tejido adiposo en 7&#47;7 &#40;100&#37;&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Conclusi&#243;n</span><p id="spar0140" class="elsevierStyleSimplePara elsevierViewall">Nuestros hallazgos histopatol&#243;gicos son superponibles a los descritos en series amplias&#46; No obstante&#44; la heterogeneidad cl&#237;nica obliga a conocer las variantes de esta entidad dentro de su t&#237;pica histomorfolog&#237;a trif&#225;sica&#44; para lograr un correcto diagn&#243;stico y manejo terap&#233;utico&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Introducci&#243;n"
          ]
          1 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "M&#233;todos"
          ]
          2 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Resultados"
          ]
          3 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Conclusi&#243;n"
          ]
        ]
      ]
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0040">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Fibrous hamartoma of infancy &#40;FHI&#41; is a rare soft-tissue tumor usually seen in infants and young children&#46; Histologically&#44; the tumor is characterized by a triphasic morphology&#44; and the clinical course is benign&#46;</p></span> <span id="abst0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">We described the histopathologic and immunohistochemical features in a series of 21 cases of FHI and reviewed the main entities to consider in differential diagnosis&#46;</p></span> <span id="abst0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Most patients in the series were male&#46; The mean age was 3&#46;7 years &#40;range&#44; 5 months&#8211;24 years&#41;&#44; and lesions were found in locations that have been previously reported&#46; Histopathologically&#44; the tumors were composed of variable proportions of fibroblastic&#44; mesenchymal&#44; and mature adipose tissue&#46; Three of the 13 immunohistochemically stained biopsies &#40;14&#37;&#41; contained hyalinized zones with cracking artifacts&#44; mimicking giant cell fibroblastoma&#46; Eight of the 13 stained with smooth-muscle actin &#40;61&#37;&#41; were positive in the fibroblastic component&#44; 6 of the 8 stained with CD34 &#40;75&#37;&#41; were positive in the immature mesenchymal and fibroblastic components&#44; and all 7 stained with S100 were positive &#40;100&#37;&#41; in adipose tissue&#46;</p></span> <span id="abst0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Our histopathologic findings are consistent with those described in larger series&#46; However&#44; in order to reach a precise diagnosis and plan treatment&#44; clinical heterogeneity obliges us to become familiar with variations in the characteristic triphasic histology of FHI&#46;</p></span>"
        "secciones" => array:4 [
          0 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0035"
            "titulo" => "Methods"
          ]
          2 => array:2 [
            "identificador" => "abst0040"
            "titulo" => "Results"
          ]
          3 => array:2 [
            "identificador" => "abst0045"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
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        "etiqueta" => "Figura 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
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            "Alto" => 622
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">A&#41; Panor&#225;mica de HE que muestra una lesi&#243;n mal delimitada en dermis reticular con cantidades variables de tejido adiposo&#44; fibrobl&#225;stico y mesenquimal inmaduro&#46; B&#41; A mayor aumento se observan bandas densas de tejido fibroso proyect&#225;ndose en el tejido graso maduro&#46;</p> <p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">HE&#58; hematoxilina-eosina&#46;</p>"
        ]
      ]
      1 => array:7 [
        "identificador" => "fig0010"
        "etiqueta" => "Figura 2"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
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        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr2.jpeg"
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">A&#41; HFI d&#233;rmico e hipod&#233;rmico B&#41; A mayor aumento&#44; bandas densas de tejido fibroso proyect&#225;ndose en el tejido graso maduro&#46; C&#41; Trab&#233;culas entrelazadas de tejido fibroso que presentan colecciones de fibrocitos de aspecto inmaduro en patrones de espiral&#46; D&#41; Componente mesenquimatoso inmaduro bas&#243;filo entremezclado con tejido fibroso&#46;</p> <p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">HFI&#58; hamartoma fibroso de la infancia&#46;</p>"
        ]
      ]
      2 => array:7 [
        "identificador" => "fig0015"
        "etiqueta" => "Figura 3"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr3.jpeg"
            "Alto" => 1359
            "Ancho" => 1500
            "Tamanyo" => 766559
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0065" class="elsevierStyleSimplePara elsevierViewall">A&#41; Panor&#225;mica de HF&#46; B&#44; C y D&#41; A mayor aumento&#44; haces y espirales de tejido fibrobl&#225;stico y mesenquimal inmaduro&#46;</p> <p id="spar0070" class="elsevierStyleSimplePara elsevierViewall">HF&#58; hamartoma fibroso&#46;</p>"
        ]
      ]
      3 => array:7 [
        "identificador" => "fig0020"
        "etiqueta" => "Figura 4"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr4.jpeg"
            "Alto" => 1531
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        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0075" class="elsevierStyleSimplePara elsevierViewall">A&#41; Panor&#225;mica de una extirpaci&#243;n simple de un HFI subcut&#225;neo&#46; B&#41; A mayor aumento&#44; tejido graso y fibrobl&#225;stico&#46; C&#41; La actina del m&#250;sculo liso decora el tejido fibroso maduro&#46; D&#41; &#193;reas de positividad para CD34&#44; marcando componente inmaduro&#46;</p> <p id="spar0080" class="elsevierStyleSimplePara elsevierViewall">HFI&#58; hamartoma fibroso de la infancia&#46;</p>"
        ]
      ]
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        "etiqueta" => "Tabla 1"
        "tipo" => "MULTIMEDIATABLA"
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        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at1"
            "detalle" => "Tabla "
            "rol" => "short"
          ]
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        "tabla" => array:2 [
          "leyenda" => "<p id="spar0090" class="elsevierStyleSimplePara elsevierViewall">HFI&#58; hamartoma fibroso de la infancia&#59; MS&#58; miembro superior&#46;</p>"
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                  \t\t\t\t\tvoid\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caracter&#237;sticas cl&#237;nicas</th><th class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Caso&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sexo&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Edad &#40;a&#241;os&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Localizaci&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tejido fibrobl&#225;stico &#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tejido adiposo maduro &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Tejido mesenquimal &#37;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Axila&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">65&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">24&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">55&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Hombro&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">15&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t">16&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Axila&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">40&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">35&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">17&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Mujer&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">MS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">30&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">18&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">0&#44;75&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Espalda&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t">60&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Perianal&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">25&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
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                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Var&#243;n&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Cervical posterior&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">50&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">10&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t">TOTAL&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">13&#58;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&#44;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Predominancia de los componentes n &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">4 &#40;14&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9 &#40;38&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1 &#40;0&#44;04&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">7 &#40;33&#37;&#41;&nbsp;\t\t\t\t\t\t\n
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          "es" => "<p id="spar0085" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nicas e histol&#243;gicas de la serie de pacientes con HFI&#46; Predominancia de los componentes seg&#250;n si representa igual o m&#225;s del 45&#37; de toda la lesi&#243;n&#58; n &#40;&#37;&#41;</p>"
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          "leyenda" => "<p id="spar0100" class="elsevierStyleSimplePara elsevierViewall">CD31&#58; c&#250;mulo de diferenciaci&#243;n 31&#59; CD34&#58; c&#250;mulo de diferenciaci&#243;n 34&#59; NA&#58; No aplica&#59; PGM1&#58; fosfoglucomutasa-1&#46;</p><p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">La positividad para un determinado tejido se marca con la letra correspondiente &#40;A&#58; adiposo&#59; F&#58; fibrobl&#225;stico&#59; M&#58; mesenquimal&#41;&#46;</p><p id="spar0110" class="elsevierStyleSimplePara elsevierViewall">Las tinciones que no muestran predominancia por un determinado tejido se marcan con los signos&#58; &#43;&#58; positivo&#59; &#8211;&#58; negativo&#59; &#177;&#58; leve&#46;</p><p id="spar0115" class="elsevierStyleSimplePara elsevierViewall">Aquellas muestras que no fueron te&#241;idas para un determinado anticuerpo no se han completado&#46;</p><p id="spar0120" class="elsevierStyleSimplePara elsevierViewall">Los casos testados para desmina &#40;2&#41;&#44; NKIC3 &#40;2&#41;&#44; EMA &#40;3&#41; y la expresi&#243;n nuclear de beta-catenina nuclear &#40;1&#41; no se han incluido&#46;</p>"
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">CD31&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Podoplanina&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M&#43;&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43; Vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">3&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">M &#43;A&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43; Vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43; Vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&#43;M&#43;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43;Vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#43; Vasos&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">7&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">A&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">F&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#177;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">-&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">9&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
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                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
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Article information
ISSN: 00017310
Original language: Spanish
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