<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>2312-3893</journal-id>
<journal-title><![CDATA[Revista Virtual de la Sociedad Paraguaya de Medicina Interna]]></journal-title>
<abbrev-journal-title><![CDATA[Rev. virtual Soc. Parag. Med. Int.]]></abbrev-journal-title>
<issn>2312-3893</issn>
<publisher>
<publisher-name><![CDATA[Sociedad Paraguaya de Medicina Interna]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S2312-38932018000200089</article-id>
<article-id pub-id-type="doi">10.18004/rvspmi/2312-3893/2018.05(02)89-094</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Quimioembolización transarterial en carcinoma hepatocelular atípico]]></article-title>
<article-title xml:lang="en"><![CDATA[Transarterial chemoembolization in atypical hepatocellular carcinoma]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[García Pacheco]]></surname>
<given-names><![CDATA[Andrea Verónica]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Dajaro Castro]]></surname>
<given-names><![CDATA[Leonel Alberto]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Bermeo Ortega]]></surname>
<given-names><![CDATA[Juan Carlos]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Benalcazar Decker]]></surname>
<given-names><![CDATA[Gonzalo Nicolás]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Universidad de Especialidades Espíritu Santo. Facultad de Medicina. Postgrado en Medicina Interna.]]></institution>
<addr-line><![CDATA[Guayaquil ]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Universidad de Especialidades Espíritu Santo. Facultad de Medicina. Postgrado en Cirugía General.]]></institution>
<addr-line><![CDATA[Guayaquil ]]></addr-line>
<country>Ecuador</country>
</aff>
<aff id="Af3">
<institution><![CDATA[,Hospital Luis Vernaza. Servicio de Gastroenterología. Programa de trasplante hepático.]]></institution>
<addr-line><![CDATA[Guayaquil ]]></addr-line>
<country>Ecuador</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>09</month>
<year>2018</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>09</month>
<year>2018</year>
</pub-date>
<volume>5</volume>
<numero>2</numero>
<fpage>89</fpage>
<lpage>94</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_arttext&amp;pid=S2312-38932018000200089&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_abstract&amp;pid=S2312-38932018000200089&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://scielo.iics.una.py/scielo.php?script=sci_pdf&amp;pid=S2312-38932018000200089&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[RESUMEN Una de las grandes controversias dentro del manejo médico integral del carcinoma hepatocelular es la estimación precisa de la efectividad de la terapia con quimioembolización transarterial. Las evidencias demuestran que la misma hace parte del núcleo de tratamiento para aquellos pacientes con tumores no resecables y, comparado con la resección hepática y ablación por radiofrecuencia, oferta supervivencia a largo plazo si cumplen las características de nódulo hasta 3 cm o menores sin invasión vascular. Presentamos un caso clínico de carcinoma hepatocelular atípico con manejo médico integral, mediante la quimioembolización transarterial, evidenciando por imágenes y macroscópicamente la efectividad de la misma hasta el trasplante hepático ortotópico.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[ABSTRACT One of the major controversies within the comprehensive medical management of hepatocellular carcinoma is the accurate estimation of the effectiveness of transarterial chemoembolization therapy. Evidence shows that it is part of the treatment nucleus for patients with unresectable tumors and, compared to hepatic resection and radiofrequency ablation, offers long-term survival if the characteristics of nodules up to 3 cm or less without vascular invasion are met. We present a clinical case of atypical hepatocellular carcinoma with integral medical management, through transarterial chemoembolization, evidencing its effectiveness by images and macroscopically until the orthotopic liver transplantation.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[carcinoma hepatocelular]]></kwd>
<kwd lng="es"><![CDATA[quimioembolización terapéutica]]></kwd>
<kwd lng="es"><![CDATA[trasplante de hígado]]></kwd>
<kwd lng="en"><![CDATA[hepatocellular carcinoma]]></kwd>
<kwd lng="en"><![CDATA[therapeutic chemoembolization]]></kwd>
<kwd lng="en"><![CDATA[liver transplantation]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Turnes]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Díaz]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Hernandez-Guerra]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Gómez]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Castells]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Bustamante]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Decisiones terapéuticas en el tratamiento del carcinoma hepatocelular y patrones de uso de sorafenib. Resultados del estudio internacional observacional GIDEON en España.]]></article-title>
<source><![CDATA[Gastroenterol Hepatol.]]></source>
<year>2015</year>
<volume>38</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>263-73.</page-range></nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Zani]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Pasquale]]></surname>
<given-names><![CDATA[L]]></given-names>
</name>
<name>
<surname><![CDATA[Bressanelli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Puoti]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Paris]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Coccaglio]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The epidemiological pattern of chronic liver diseases in a community undergoing voluntary screening for hepatitis B and C.]]></article-title>
<source><![CDATA[Dig Liver Dis.]]></source>
<year>2011</year>
<volume>43</volume>
<numero>8</numero>
<issue>8</issue>
<page-range>653-8</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Visag-Castillo]]></surname>
<given-names><![CDATA[V.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Liver transplantation for hepatocellular carcinoma.]]></article-title>
<source><![CDATA[Rev Med Hosp Gen Mex.]]></source>
<year>2018</year>
<volume>81</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>97-101</page-range></nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Raoul]]></surname>
<given-names><![CDATA[J-L]]></given-names>
</name>
<name>
<surname><![CDATA[Latournerie]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Guillygomarc'h]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Boudjema]]></surname>
<given-names><![CDATA[K]]></given-names>
</name>
<name>
<surname><![CDATA[Audrain]]></surname>
<given-names><![CDATA[O]]></given-names>
</name>
<name>
<surname><![CDATA[Boucher]]></surname>
<given-names><![CDATA[É.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Carcinoma hepatocelular.]]></article-title>
<source><![CDATA[EMC-Tratado de Medicina]]></source>
<year>2011</year>
<volume>15</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1-9</page-range></nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martínez]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Lledó]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Aicart-Ramos]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Mateos]]></surname>
<given-names><![CDATA[B]]></given-names>
</name>
<name>
<surname><![CDATA[Albillos]]></surname>
<given-names><![CDATA[A.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Carcinoma hepatocelular]]></article-title>
<source><![CDATA[Medicine-Programa de Formación Médica Continuada Acreditado.]]></source>
<year>2016</year>
<volume>12</volume>
<numero>12</numero>
<issue>12</issue>
<page-range>683-92</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<collab>European Association for the Study of the Liver.</collab>
<article-title xml:lang=""><![CDATA[EASL clinical practice guidelines]]></article-title>
<source><![CDATA[J Hepat]]></source>
<year>2016</year>
<volume>64</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>433-85</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Mitchell]]></surname>
<given-names><![CDATA[DG]]></given-names>
</name>
<name>
<surname><![CDATA[Bruix]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sherman]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sirlin]]></surname>
<given-names><![CDATA[CB.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Li-RADS (Liver Imaging Reporting and Data System)]]></article-title>
<source><![CDATA[Hepatology]]></source>
<year>2015</year>
<volume>61</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1056-65</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bruix]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Reig]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Sherman]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Evidence-based diagnosis, staging, and treatment of patients with hepatocellular carcinoma.]]></article-title>
<source><![CDATA[Gastroenterology]]></source>
<year>2016</year>
<volume>150</volume>
<numero>4</numero>
<issue>4</issue>
<page-range>835-53</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Forner]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Reig]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Varela]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Burrel]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Feliu]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Briceño]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Diagnóstico y tratamiento del carcinoma hepatocelular.]]></article-title>
<source><![CDATA[Med Clin]]></source>
<year>2016</year>
<volume>146</volume>
<numero>11</numero>
<issue>11</issue>
<page-range>511</page-range><publisher-loc><![CDATA[Barc ]]></publisher-loc>
</nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Wáng]]></surname>
<given-names><![CDATA[YX]]></given-names>
</name>
<name>
<surname><![CDATA[De Baere]]></surname>
<given-names><![CDATA[T]]></given-names>
</name>
<name>
<surname><![CDATA[Idée]]></surname>
<given-names><![CDATA[JM]]></given-names>
</name>
<name>
<surname><![CDATA[Ballet]]></surname>
<given-names><![CDATA[S.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Transcatheter embolization therapy in liver cancer]]></article-title>
<source><![CDATA[Chin J Cancer Res.]]></source>
<year>2015</year>
<volume>27</volume>
<numero>2</numero>
<issue>2</issue>
<page-range>96-121</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Martinez-Mier]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Esquivel-Torres]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Medina Granados]]></surname>
<given-names><![CDATA[JP]]></given-names>
</name>
<name>
<surname><![CDATA[Luna-Castillo]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Castillo-Chiquete]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
<name>
<surname><![CDATA[Calzada-Grijalva]]></surname>
<given-names><![CDATA[JF]]></given-names>
</name>
<name>
<surname><![CDATA[Gonzalez-Velazquez]]></surname>
<given-names><![CDATA[F.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Presentación, clasificación y evolución de los pacientes con carcinoma hepatocelular en un centro de Veracruz, México.]]></article-title>
<source><![CDATA[Rev gastroenterol méx.]]></source>
<year>2014</year>
<volume>79</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>171-9</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Bruix]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Sherman]]></surname>
<given-names><![CDATA[M.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Management of hepatocellular carcinoma]]></article-title>
<source><![CDATA[Hepatology]]></source>
<year>2011</year>
<volume>53</volume>
<numero>3</numero>
<issue>3</issue>
<page-range>1020-2</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Sapisochin]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Barry]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Doherty]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Fischer]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Goldaracena]]></surname>
<given-names><![CDATA[N]]></given-names>
</name>
<name>
<surname><![CDATA[Rosales]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Stereotactic body radiotherapy vs. TACE or RFA as a bridge to transplant in patients with hepatocellular carcinoma.]]></article-title>
<source><![CDATA[J Hepatol.]]></source>
<year>2017</year>
<volume>67</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>92-9</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Galle]]></surname>
<given-names><![CDATA[PR]]></given-names>
</name>
<name>
<surname><![CDATA[Tovoli]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Foerster]]></surname>
<given-names><![CDATA[F]]></given-names>
</name>
<name>
<surname><![CDATA[Wörns]]></surname>
<given-names><![CDATA[MA]]></given-names>
</name>
<name>
<surname><![CDATA[Cucchetti]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Bolondi]]></surname>
<given-names><![CDATA[L.]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The treatment of intermediate stage tumours beyond TACE: From surgery to systemic therapy.]]></article-title>
<source><![CDATA[J Hepatol.]]></source>
<year>2017</year>
<volume>67</volume>
<numero>1</numero>
<issue>1</issue>
<page-range>173-83</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
