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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El dermatomiofibroma &#40;DMF&#41; es un tumor benigno de estirpe miofibrobl&#225;stica poco frecuente en la edad pedi&#225;trica&#46; La primera descripci&#243;n en la literatura fue realizada por H&#252;gel en 1991 como &#171;fibromatosis en placa&#187;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a>&#46; Posteriormente&#44; es Kamino quien acu&#241;a el t&#233;rmino &#171;dermatomiofibroma&#187;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Cl&#237;nicamente se suelen presentar como una placa o un n&#243;dulo &#171;solitarios&#187;&#44; pueden ser m&#250;ltiples&#44; mal definidos&#44; con un leve eritema o hiperpigmentaci&#243;n&#44; y suelen ser asintom&#225;ticos aunque pueden ocasionar un prurito leve&#46; En la forma pedi&#225;trica las lesiones predominan en la regi&#243;n cervical &#40;56&#37;&#41; y tienen una tendencia a la remisi&#243;n espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>&#46; La forma del adulto&#44; sin embargo&#44; suele localizarse en los hombros o en la parte proximal de los miembros&#46; Es m&#225;s frecuente en mujeres &#40;96&#37;&#41; y no tiene tendencia a la remisi&#243;n espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>&#46; El diagn&#243;stico diferencial cl&#237;nico es muy amplio<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">El diagn&#243;stico del DMF es histol&#243;gico&#46; Se trata de una proliferaci&#243;n de c&#233;lulas fusiformes &#40;fibroblastos y miofibroblastos&#41; dispuestas con el eje mayor orientado de forma paralela a la superficie de la epidermis y respetando las estructuras anexiales&#46; La inmunohistoqu&#237;mica puede servir de ayuda para el diagn&#243;stico&#46; La expresi&#243;n de vimentina es constante&#44; la de actina de m&#250;sculo espec&#237;fica y de m&#250;sculo liso es variable&#44; y en algunos casos existe una expresi&#243;n focal de CD34&#43;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La ecograf&#237;a de alta frecuencia&#44; cada vez m&#225;s empleada en la pr&#225;ctica dermatol&#243;gica&#44; puede apoyar el diagn&#243;stico cl&#237;nico y ser &#250;til en el seguimiento de estos tumores benignos&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recogimos todos los pacientes menores de 16 a&#241;os con diagn&#243;stico de DMF de la base de datos de Anatom&#237;a Patol&#243;gica del Hospital Universitario de Fuenlabrada&#44; y seleccionamos aquellos a los que se les hab&#237;a realizado ecograf&#237;a&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los datos cl&#237;nicos se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se incluyeron 3 mujeres y 5 varones&#46; La edad al diagn&#243;stico oscil&#243; entre los 20 meses y los 15 a&#241;os&#46; Las lesiones se localizaban en el cuello &#40;6 pacientes&#41;&#44; en el hombro izquierdo &#40;un paciente&#41; y en la regi&#243;n occipital &#40;un paciente&#41;&#46; El tiempo de evoluci&#243;n de las lesiones fue de entre un mes y un a&#241;o antes de consultar por ellas&#46; Cl&#237;nicamente se trataba de lesiones nodulares o en placa&#44; mal delimitadas en 6 de los pacientes &#40;en 2 casos estaban bien delimitadas&#41;&#44; levemente eritematosas o hiperpigmentadas&#46; Uno de los pacientes presentaba 2 lesiones&#46; Tres de las lesiones eran dolorosas y 2 eran pruriginosas&#59; el resto eran asintom&#225;ticas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">La ecograf&#237;a con sonda de alta resoluci&#243;n &#40;Esaote MyLab&#174; Class <span class="elsevierStyleSmallCaps">C</span>&#44; sonda lineal de 18<span class="elsevierStyleHsp" style=""></span>MHz&#41; mostr&#243; unas lesiones redondeadas dermohipod&#233;rmicas hipoecoicas mal definidas&#44; no encapsuladas&#44; sin flujo doppler&#44; excepto en 2 casos&#44; que presentaban flujo doppler en la periferia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El diagn&#243;stico cl&#237;nico del DMF puede ser dif&#237;cil&#44; por lo que la ecograf&#237;a de alta resoluci&#243;n puede ayudar en el diagn&#243;stico diferencial y orientar el tratamiento&#44; fundamentalmente en aquellas lesiones de gran tama&#241;o o pruriginosas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El diagn&#243;stico diferencial ecogr&#225;fico incluye lesiones como el dermatofibroma&#44; que suele presentarse como lesiones d&#233;rmicas que pueden extenderse hacia tejido celular subcut&#225;neo&#44; con bordes mal definidos y espiculados&#44; sin vascularizaci&#243;n y con cambios en la ecogenicidad del tejido adyacente<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&#59; el neurofibroma de tipo placa&#44; que tambi&#233;n suelen ser lesiones hipoecoicas localizadas en dermis&#44; con bordes bien definidos y refuerzo posterior<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a>&#46; Otras lesiones&#44; como el nevus azul hipopigmentado&#44; el piloleiomioma&#44; el hamartoma de m&#250;sculo liso y el nevus de tejido conectivo&#44; suelen estar mejor definidas&#46; El dermatofibrosarcoma protuberans presenta aspecto en medusa&#44; de morfolog&#237;a ovalada y bordes mal definidos de forma focal&#44; invadiendo el tejido celular subcut&#225;neo en forma de proyecciones tipo tent&#225;culo&#44; hipoecoicas con &#225;reas hiperecoicas focales y con refuerzo posterior y vascularizaci&#243;n abundante<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a>&#46; La fibromatosis desmoide y las cicatrices suelen presentarse con una morfolog&#237;a m&#225;s elongada&#44; aunque se han descrito casos de DMF con configuraci&#243;n lineal<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento&#44; la actitud expectante es una opci&#243;n v&#225;lida&#44; ya que se trata de un tumor de comportamiento benigno con escasa tendencia a la recurrencia&#46; En ocasiones&#44; debido a la sintomatolog&#237;a&#44; es precisa la extirpaci&#243;n&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En nuestra experiencia&#44; ante la sospecha cl&#237;nica y con una ecograf&#237;a de alta resoluci&#243;n compatible con el diagn&#243;stico&#44; una actitud adecuada ser&#237;a el seguimiento cl&#237;nico-ecogr&#225;fico&#44; reservando la biopsia para aquellas lesiones con unas caracter&#237;sticas at&#237;picas&#44; como un alto flujo doppler&#44; y la extirpaci&#243;n solo de las lesiones sintom&#225;ticas&#46; Esta actitud conservadora ser&#237;a v&#225;lida para todas las franjas etarias&#44; ya que evitar&#237;a extirpaciones innecesarias y el riesgo de defectos est&#233;ticos&#44; pero m&#225;s a&#250;n en la edad pedi&#225;trica&#44; en la que en la mayor&#237;a de los casos la cirug&#237;a lleva asociada la necesidad de anestesia general o sedaci&#243;n&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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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">Exploraci&#243;n f&#237;sica&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">Caracter&#237;sticas ecogr&#225;ficas&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">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">15 a&#241;os&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">Un mes&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">Dolor&#44; estable&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">N&#243;dulo mal delimitado hiperpigmentado&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">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">11 a&#241;os&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">Meses&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">Asintom&#225;tico&#44; estable&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">N&#243;dulo mal delimitado&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">11 a&#241;os&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">Un a&#241;o&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">Asintom&#225;tico&#44; crecimiento&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 n&#243;dulos bien delimitados&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">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">11 a&#241;os&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 izquierdo&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">Meses&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">Dolor&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">N&#243;dulo mal delimitado&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">Lesi&#243;n hipoecoica dermis&#44; aumento de flujo en puntos de la periferia&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">10 a&#241;os&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">Meses&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">Asintom&#225;tico&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">N&#243;dulo mal delimitado eritematoso&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; aumento de flujo&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="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">10 a&#241;os&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">Meses&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">Asintom&#225;tico&#44; crecimiento ligero&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">N&#243;dulo bien delimitado&#44; ligeramente hiperpigmentado&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">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">9 a&#241;os&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">Occipital&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">Un a&#241;o&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">Prurito ocasional&#44; crecimiento progresivo&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">N&#243;dulo mal delimitado&#44; eritematoso&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">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">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">20 meses&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">8 meses&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">Pruriginoso&#44; fluctuante en tama&#241;o&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">Placa eritematopardusca&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2684614.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nico-ecogr&#225;ficas de los pacientes</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "Bibliograf&#237;a"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:10 [
            0 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Die plaqueformige dermale fibromatose"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; H&#252;gel"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Hautarzt"
                        "fecha" => "1991"
                        "volumen" => "42"
                        "paginaInicial" => "223"
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CARTA CIENTÍFICO-CLÍNICA
Caracterización clínico-ecográfica de dermatomiofibromas en edad pediátrica
Clinical and Ultrasound Features of Dermatofibromas in Pediatric Patients
H. Álvarez-Garrido
Corresponding author
helenaalvarezgarrido@hotmail.com

Autor para correspondencia.
, C. Horcajada-Reales, A. Hernández-Nuñez, J. Borbujo
Servicio de Dermatología, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, España
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">El dermatomiofibroma &#40;DMF&#41; es un tumor benigno de estirpe miofibrobl&#225;stica poco frecuente en la edad pedi&#225;trica&#46; La primera descripci&#243;n en la literatura fue realizada por H&#252;gel en 1991 como &#171;fibromatosis en placa&#187;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a>&#46; Posteriormente&#44; es Kamino quien acu&#241;a el t&#233;rmino &#171;dermatomiofibroma&#187;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a>&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Cl&#237;nicamente se suelen presentar como una placa o un n&#243;dulo &#171;solitarios&#187;&#44; pueden ser m&#250;ltiples&#44; mal definidos&#44; con un leve eritema o hiperpigmentaci&#243;n&#44; y suelen ser asintom&#225;ticos aunque pueden ocasionar un prurito leve&#46; En la forma pedi&#225;trica las lesiones predominan en la regi&#243;n cervical &#40;56&#37;&#41; y tienen una tendencia a la remisi&#243;n espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">3</span></a>&#46; La forma del adulto&#44; sin embargo&#44; suele localizarse en los hombros o en la parte proximal de los miembros&#46; Es m&#225;s frecuente en mujeres &#40;96&#37;&#41; y no tiene tendencia a la remisi&#243;n espont&#225;nea<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a>&#46; El diagn&#243;stico diferencial cl&#237;nico es muy amplio<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">4</span></a> &#40;<a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">El diagn&#243;stico del DMF es histol&#243;gico&#46; Se trata de una proliferaci&#243;n de c&#233;lulas fusiformes &#40;fibroblastos y miofibroblastos&#41; dispuestas con el eje mayor orientado de forma paralela a la superficie de la epidermis y respetando las estructuras anexiales&#46; La inmunohistoqu&#237;mica puede servir de ayuda para el diagn&#243;stico&#46; La expresi&#243;n de vimentina es constante&#44; la de actina de m&#250;sculo espec&#237;fica y de m&#250;sculo liso es variable&#44; y en algunos casos existe una expresi&#243;n focal de CD34&#43;<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5&#44;6</span></a>&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">La ecograf&#237;a de alta frecuencia&#44; cada vez m&#225;s empleada en la pr&#225;ctica dermatol&#243;gica&#44; puede apoyar el diagn&#243;stico cl&#237;nico y ser &#250;til en el seguimiento de estos tumores benignos&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Recogimos todos los pacientes menores de 16 a&#241;os con diagn&#243;stico de DMF de la base de datos de Anatom&#237;a Patol&#243;gica del Hospital Universitario de Fuenlabrada&#44; y seleccionamos aquellos a los que se les hab&#237;a realizado ecograf&#237;a&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">Los datos cl&#237;nicos se resumen en la <a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#46; Se incluyeron 3 mujeres y 5 varones&#46; La edad al diagn&#243;stico oscil&#243; entre los 20 meses y los 15 a&#241;os&#46; Las lesiones se localizaban en el cuello &#40;6 pacientes&#41;&#44; en el hombro izquierdo &#40;un paciente&#41; y en la regi&#243;n occipital &#40;un paciente&#41;&#46; El tiempo de evoluci&#243;n de las lesiones fue de entre un mes y un a&#241;o antes de consultar por ellas&#46; Cl&#237;nicamente se trataba de lesiones nodulares o en placa&#44; mal delimitadas en 6 de los pacientes &#40;en 2 casos estaban bien delimitadas&#41;&#44; levemente eritematosas o hiperpigmentadas&#46; Uno de los pacientes presentaba 2 lesiones&#46; Tres de las lesiones eran dolorosas y 2 eran pruriginosas&#59; el resto eran asintom&#225;ticas&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0035" class="elsevierStylePara elsevierViewall">La ecograf&#237;a con sonda de alta resoluci&#243;n &#40;Esaote MyLab&#174; Class <span class="elsevierStyleSmallCaps">C</span>&#44; sonda lineal de 18<span class="elsevierStyleHsp" style=""></span>MHz&#41; mostr&#243; unas lesiones redondeadas dermohipod&#233;rmicas hipoecoicas mal definidas&#44; no encapsuladas&#44; sin flujo doppler&#44; excepto en 2 casos&#44; que presentaban flujo doppler en la periferia&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">El diagn&#243;stico cl&#237;nico del DMF puede ser dif&#237;cil&#44; por lo que la ecograf&#237;a de alta resoluci&#243;n puede ayudar en el diagn&#243;stico diferencial y orientar el tratamiento&#44; fundamentalmente en aquellas lesiones de gran tama&#241;o o pruriginosas&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">El diagn&#243;stico diferencial ecogr&#225;fico incluye lesiones como el dermatofibroma&#44; que suele presentarse como lesiones d&#233;rmicas que pueden extenderse hacia tejido celular subcut&#225;neo&#44; con bordes mal definidos y espiculados&#44; sin vascularizaci&#243;n y con cambios en la ecogenicidad del tejido adyacente<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">7</span></a>&#59; el neurofibroma de tipo placa&#44; que tambi&#233;n suelen ser lesiones hipoecoicas localizadas en dermis&#44; con bordes bien definidos y refuerzo posterior<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">8</span></a>&#46; Otras lesiones&#44; como el nevus azul hipopigmentado&#44; el piloleiomioma&#44; el hamartoma de m&#250;sculo liso y el nevus de tejido conectivo&#44; suelen estar mejor definidas&#46; El dermatofibrosarcoma protuberans presenta aspecto en medusa&#44; de morfolog&#237;a ovalada y bordes mal definidos de forma focal&#44; invadiendo el tejido celular subcut&#225;neo en forma de proyecciones tipo tent&#225;culo&#44; hipoecoicas con &#225;reas hiperecoicas focales y con refuerzo posterior y vascularizaci&#243;n abundante<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a>&#46; La fibromatosis desmoide y las cicatrices suelen presentarse con una morfolog&#237;a m&#225;s elongada&#44; aunque se han descrito casos de DMF con configuraci&#243;n lineal<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a>&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En cuanto al tratamiento&#44; la actitud expectante es una opci&#243;n v&#225;lida&#44; ya que se trata de un tumor de comportamiento benigno con escasa tendencia a la recurrencia&#46; En ocasiones&#44; debido a la sintomatolog&#237;a&#44; es precisa la extirpaci&#243;n&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">En nuestra experiencia&#44; ante la sospecha cl&#237;nica y con una ecograf&#237;a de alta resoluci&#243;n compatible con el diagn&#243;stico&#44; una actitud adecuada ser&#237;a el seguimiento cl&#237;nico-ecogr&#225;fico&#44; reservando la biopsia para aquellas lesiones con unas caracter&#237;sticas at&#237;picas&#44; como un alto flujo doppler&#44; y la extirpaci&#243;n solo de las lesiones sintom&#225;ticas&#46; Esta actitud conservadora ser&#237;a v&#225;lida para todas las franjas etarias&#44; ya que evitar&#237;a extirpaciones innecesarias y el riesgo de defectos est&#233;ticos&#44; pero m&#225;s a&#250;n en la edad pedi&#225;trica&#44; en la que en la mayor&#237;a de los casos la cirug&#237;a lleva asociada la necesidad de anestesia general o sedaci&#243;n&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicto de intereses</span><p id="par0060" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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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">Meses&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">Dolor&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">N&#243;dulo mal delimitado&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">Lesi&#243;n hipoecoica dermis&#44; aumento de flujo en puntos de la periferia&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">10 a&#241;os&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">Meses&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">Asintom&#225;tico&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">N&#243;dulo mal delimitado eritematoso&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; aumento de flujo&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="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">10 a&#241;os&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">Meses&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">Asintom&#225;tico&#44; crecimiento ligero&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">N&#243;dulo bien delimitado&#44; ligeramente hiperpigmentado&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">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">9 a&#241;os&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">Occipital&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">Un a&#241;o&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">Prurito ocasional&#44; crecimiento progresivo&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">N&#243;dulo mal delimitado&#44; eritematoso&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&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">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">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">20 meses&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">8 meses&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">Pruriginoso&#44; fluctuante en tama&#241;o&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">Placa eritematopardusca&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">Lesi&#243;n hipoecoica dermis&#44; mal delimitada&#44; sin flujo&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
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        "descripcion" => array:1 [
          "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caracter&#237;sticas cl&#237;nico-ecogr&#225;ficas de los pacientes</p>"
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      "titulo" => "Bibliograf&#237;a"
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        0 => array:2 [
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              "identificador" => "bib0060"
              "etiqueta" => "1"
              "referencia" => array:1 [
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                  "contribucion" => array:1 [
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                      "titulo" => "Die plaqueformige dermale fibromatose"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "H&#46; H&#252;gel"
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                    0 => array:1 [
                      "Revista" => array:6 [
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                        "volumen" => "42"
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                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46; Kamino"
                            1 => "V&#46;B&#46; Reedy"
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                          "etal" => false
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                            0 => "J&#46; Roman&#237;"
                            1 => "L&#46; Leal"
                            2 => "A&#46; S&#225;ez"
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                        0 => array:2 [
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                            0 => "T&#46; Mentzel"
                            1 => "E&#46; Calonje"
                            2 => "C&#46;D&#46; Fletcher"
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                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.1993.tb03314.x"
                      "Revista" => array:6 [
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                  "contribucion" => array:1 [
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                          "etal" => false
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                    0 => array:2 [
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                        "tituloSerie" => "Am J Dermatopathol&#46;"
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                        "volumen" => "31"
                        "paginaInicial" => "44"
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                  "contribucion" => array:1 [
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                      "titulo" => "Dermatomyofibromas presenting in pediatric patients&#58; Clinicopathologic characteristics and differential diagnosis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
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                            1 => "D&#46; Azor&#237;n"
                            2 => "A&#46; Hern&#225;ndez-N&#250;&#241;ez"
                            3 => "A&#46; Guzm&#225;n"
                            4 => "A&#46; Torrelo"
                            5 => "M&#46; Herr&#225;iz"
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                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1600-0560.2011.01739.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Cutan Pathol&#46;"
                        "fecha" => "2011"
                        "volumen" => "38"
                        "paginaInicial" => "967"
                        "paginaFinal" => "972"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21752049"
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            6 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
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                      "titulo" => "Dermatofibroma&#58; Sonographic findings and pathologic correlation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "K&#46; Won"
                            1 => "S&#46; Park"
                            2 => "W&#46; Jin"
                            3 => "B&#46; Lew"
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                      ]
                    ]
                  ]
                  "host" => array:1 [
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                      "doi" => "10.1177/0284185117721263"
                      "Revista" => array:6 [
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            7 => array:3 [
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                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "High-frequency ultrasound imaging for cutaneous neurofibroma in patients with neurofibromatosis type 1"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "D&#46; Raffin"
                            1 => "J&#46; Zaragoza"
                            2 => "G&#46; Georgescou"
                            3 => "Y&#46; Mourtada"
                            4 => "A&#46; Maruani"
                            5 => "F&#46; Ossant"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1684/ejd.2017.3015"
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                        "fecha" => "2017"
                        "volumen" => "27"
                        "paginaInicial" => "260"
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                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/28524060"
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              "identificador" => "bib0100"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Jellyfish-like sonographic pattern can help recognition of dermatofibrosarcoma protuberans&#46; Report of 3 new cases and review of the literature"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "A&#46; Rodr&#237;guez Bandera"
                            1 => "G&#46; Moreno Bonilla"
                            2 => "M&#46; Feito Rodr&#237;guez"
                            3 => "M&#46; Beato Merino"
                            4 => "R&#46; de Lucas Laguna"
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                        ]
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                  "host" => array:1 [
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Article information
ISSN: 00017310
Original language: Spanish
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Idiomas
Actas Dermo-Sifiliográficas
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