Paciente de 68 años de edad, blanca, con antecedentes de diabetes

mellitus tipo 2 que acudió a consulta en el año 2006 por presentar

palidez cutáneo mucosa, ligera toma del estado general, pérdida de
peso y dificultad para ingerir alimentos sólidos.
Datos positivos al examen físico:
Palidez cutánea mucosa ligera, adenopatías cervicales múltiples no
dolorosas de consistencia dura, adherida a planos profundos y sin
modificaciones de la piel que la recubre.
.
Examen de orofaringe: Amígdalas y pared posterior de la faringe
congestiva, lesión ulcerosa en la pared posterior de la faringe con
borde oscuro rodeado de marcada inflamación.
Estudios realizados
Hemograma:
Hb 100g/L
Alteraciones hemáticas: macrocitosis ligera.
Leucocitos: 6.6 x 109 /L
Conteo diferencial:
Polimorfo nuclear neutrófilo 0.46 x 109 /L
Linfocitos 0.52 x 109 /L
Monocitos 0.01 x 109 /L
Eosinófilos 0.01 x 109 /L
Plaquetas: 200 x 109 /L
Biopsia de la lesión de orofaringe: linfoma no Hodgkin de alto grado de
malignidad extraganglionar de amígdala (Figura 1)
Punción medular: integridad medular.
Azul de prusia: positivo
Conteo de reticulocitos: 15 x 10-3
Eritrosedimentación: 102mm/h
Hierro sérico: 17 µmol/L.
TGP: 7U/L, TGO: 4U/L
Glucemia: 8 mmol/L
Creatinina: 54.3 µmol/L
Ácido Úrico: 400µmol/L
Ultrasonido abdominal: No se observaron alteraciones
Rx de tórax: negativo
Se concluye diagnóstico como linfoma no Hodgkin de alto grado de
malignidad extraganglionar de amígdala. Se indicó tratamiento con
esquema Chop–Bleo (ciclosfofamida, ariamicina, oncovin, prednisona,
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