Hiperplasia ductal atípica de mama: correlación de la biopsia percutánea y los resultados de la biopsia quirúrgica

Objetive

The purpose was to evaluate the prevalence of carcinoma found at surgical biopsy of llesions identified as atypical ductal hyperplasia by percutaneous breast biopsy.

Methods

We performed a retrospective study of all asymptomatic patients with a result of atypical ductal hyperplasia on percutaneous breast biopsy and who underwent surgical excision from January 2002 to December 2010.

Results

Sixty-eight patients were found to have atypical ductal hyperplasia at percutaneous breast biopsy and were evaluated with surgical biopsy. Seventeen patients (25%) had carcinoma at surgical excision, 10 had ductal carcinoma in situ, and 7 patients had invasive carcinoma. The mammographic characteristics associated with malignancy were analyzed.

Conclusions

A finding of atypical ductal hyperplasia at percutaneous breast biopsy frequently corresponds to cancer and is therefore an indication for surgical excision.     

Tumor filodes de la mama. A propósito de dos casos

Phyllodes tumor of the breast is a highly uncommon fibroepithelial tumor, representing 0.3 to 0.9% of all breast tumors. The definitive diagnosis is histological and the goal of treatment is wide and complete surgical excision of the tumor with disease-free margins.     

Descenso de la edad al diagnóstico en el cáncer de mama

Introduction

Increasingly younger women are apparently diagnosed with breast cancer. The aim of this study was to determine whether age at diagnosis of this disease is declining.

Material and methods

We calculated incidence rates for breast cancer in Zaragoza (Spain) by age groups. The median age at diagnosis over a 20-year period was calculated. A Joinpoint regression was subsequently performed to determine the trend.

Results

The median showed a downward trend with an annual percentage change of -0.3% (95% CI -0.6, -0.1) over the 20-year period. The crude incidence rates for age groups showed that the positive trend was highest among women aged more than 85 years, PAC = 14% (95% CI 4.03; 25.9), followed by the group aged 40-44 years with a PAC of 10% (95% CI 3.4, 17.1).

Conclusions

The median age at diagnosis of breast cancer has declined over the past 20 years.     

Tumor filodes maligno: a propósito de un caso y revisión de la literatura

Phyllodes tumor of the breast is a rare neoplasm, representing less than 1% of all breast tumors. The definitive diagnosis of these fibroepithelial tumors is histologic. Local recurrence occurs in 20% of cases. Although uncommon, these tumors can metastasize to other organs. Treatment is surgical with wide excision and disease-free margins. We present the case of a patient with phyllodes tumor who developed lung involvement.     

Linfomas primarios de mama. Presentación de nuestra casuística y revisión de la literatura científica

Less than 1% of all malignant breast tumors are due to primary lymphoma.     

Implementación de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama tratadas en hospitales comarcales de la Comunidad Autónoma de Cantabria

Objective

To evaluate the results of sentinel lymph node (SLN) biopsy in women with breast cancer treated in hospitals without a nuclear medicine unit.

Subjects and methods

Eighty-eight patients with early-stage breast cancer treated in two district hospitals between February 2007 and July 2010 were included. The day before surgery a lymphoscintigraphy was performed in the specialized hospital. Intraoperative localization of the SLN was accomplished by the combined use of a hand-held gamma probe and a manual gamma-camera.

Results

Surgical localization of the SLN was successful in 97.7% of the patients. The mean number of lymph nodes excised by each procedure and each surgical team was 2.1±1.4 and 2.5±1.2. Axillary lymph node dissection was performed in 27.2% of the patients. There was one false-negative result and one false-positive result.

Conclusion

The implementation of SLN biopsy in district hospitals provides similar results to those obtained in the supervising hospital.     

Actualización en linfomas primarios de mama: serie de casos y revisión de la literatura

Introduction

Primary breast lymphomas (PBL) are a rare malignant disease of the breast that can be mistaken for breast carcinoma. Knowledge of PBL allows a correct diagnostic-therapeutic approach to this uncommon malignancy (0.04- 0.5% of breast cancers).

Material and methods

This update is based on an analytic retrospective study of a series of cases recorded at the Hospital Príncipe de Asturias and a comprehensive review of the oncologic and gynecologic literature available.

Discussion

PBL are virtually indistinguishable from breast carcinomas because of their similar age distribution, clinical presentation and imaging features. Diagnosis can only be confirmed by histology. The most effective treatment is combined therapy based on chemotherapy (the most widely used being the CHOP-R regimen). Surgery and radiotherapy play a secondary role. The course of PBL varies widely, from early dissemination to complete remission. Prognostic factors play an important role in PBL. Prompt diagnosis is essential to improve outcome.

Conclusion

Because of their low prevalence, PBL are a diagnostic-therapeutic challenge. There is no agreement on treatment regimens, and outcome is highly variable. New in-depth studies are required to unify criteria and knowledge of this entity.     

Cáncer de mama en la mujer joven

Objective

To review the characteristics of breast cancer in young women.

Material and methods

The scientific literature was reviewed, indicating the etiological factors, diagnostic methods and treatment options, with special reference to the factors that can concur in young patients such as premature menopause, loss of fertility, pregnancy after breast cancer and breast cancer during pregnancy.

Results

Importantly, breast cancer in young women is very rare but is on the increase. Tumors are larger in young women and have positive margins, making the disease more aggressive and leading to higher mortality. Diagnosis is more difficult than in older women and the triple test (mammography, ultrasound and biopsy) is of great importance. Treatment options are the same as in older women.

Conclusions

Breast cancer in young women shows certain characteristics that differentiate it in some respects from breast cancer diagnosed in older women.     

Resultados de la aplicación de la técnica SNOLL versus tumorectomía guiada con arpón en el cáncer de mama

Objective

To compare the results of the SNOLL technique with those of wire-guided lumpectomy in the treatment of breast cancer.

Material and methods

A retrospective study conducted in the Breast Pathology Unit of the Vigo University Hospital from May 2010 to February 2012.

Results

We studied 73 patients. The SNOLL technique was used in 34 women and wire-guided lumpectomy in 39. In both groups, the most common histological type was infiltrating ductal carcinoma (94% and 64.1%, respectively, P=.005). In the intraoperative study, 55.3% of tumors in the SNOLL group and 44.7% of those in the wire-guided group were found to touch the surgical margin. The rate of margin extension in the same intervention was higher in the SNOLL group (P=.160). The reoperation rate for margin extension was 0% in the SNOLL group and 13% in the wire-guided group (P=.57). In the final surgical specimen, the mean disease-free margin was 7.21 mm in the SNOLL group and 4.66 mm in the wire-guided group (P=.01).

Conclusions

The re-excision rate was similar in the two groups. The SNOLL technique allows a greater margin of safety.     

Cribado con resonancia magnética de la mama contralateral en pacientes con cáncer de mama

Case report

We report the case of a woman with an invasive carcinoma of the right breast, in whom magnetic resonance imaging (MRI) identified a ductal carcinoma in situ in the contralateral breast. This tumor had not been detected by other diagnostic tests.

Discussion

The authors review recent series that discuss the issue of MRI screening of the contralateral breast. The clinical impact of MRI screening is assessed.

Conclusions

MRI of the contralateral breast in breast cancer patients detects a small, but significant, number of breast cancers that would have been missed if MRI had not been performed. The effect of these findings on prognosis remains uncertain.     

Influencia de las características tumorales del cáncer de mama en mujeres menores de 35 años en el pronóstico de la enfermedad

Background and objective

Two per cent of breast cancers develop in women aged 35 years old or younger. The aim of this study was to analyze the influence of the histological characteristics of the tumor and axillary involvement on the prognosis of the disease.

Methods

We performed a retrospective study of 71 women aged 35 years old or younger diagnosed with breast cancer in the 12 de Octubre Hospital from 1983 to 2000. A survival curve was designed using the Kaplan-Meier method.

Results

The most important prognostic factor was tumoral extension at diagnosis. A total of 66.7% of the patients in initial stage IV died within 5 years of follow-up. For stages 0 and I, 92.3% and 100% of the patients, respectively, were alive and had no evidence of disease. The most frequent histological type was infiltrating ductal carcinoma. Outcome was not influenced by tumoral type or histological grade. Recurrence was more frequent in patients with positive receptors than in those with negative receptors. One of the most important prognostic factors was axillary involvement. Recurrence occurred in 71.4% of the patients with nodal involvement compared with 31.4% of those without nodal invasion. The greater the number of affected nodes, the higher the risk of recurrence. Alteration of P53 and c-erb 2 were poor prognostic factors.

Conclusions

Tumoral size and stage, axillary involvement and the number of affected nodes were associated with a higher risk of recurrence and worse 5-year outcome. The presence of positive receptors was also related to an unfavorable outcome. Fifty percent of women lived for more than 15 years.     

Enfermedad de Paget de la mama y síndrome de Rokitansky. Una excepcional asociación

We present the case of a woman with Rokitansky syndrome who developed Paget's disease of the breast at the age of 70 years. This is the first report in the literature of the simultaneous association of these two diseases.     

Evaluación de la seguridad y la eficacia de la endometrectomía histeroscópica en la menometrorragia

Objective

To analyze the safety and efficacy of hysteroscopic endometrectomy in patients with menometrorrhagia.

Material and methods

We performed a retrospective study of 119 patients with menometrorrhagia. Histology, early and late complications, symptom recurrence, and reinterventions were evaluated.

Results

The mean age of the patients was 45 years (range, 25-72). With a median follow-up of 14 months (range, 9-54), menometrorrhagia was improved in 92.8%. A total of 30.9% showed amenorrhea, 26.3% hypomenorrhea, and 35.4% eumenorrhea. Complications occurred in seven patients (5.9%), early complications in six (three uterine perforations and three intraoperative hemorrhages), and there was one late complication (hematometra). Symptom recurrence was observed at the end of follow-up in eight patients (7.2%). Treatment failure was associated with incomplete endometrial resection and the presence of intraoperative complications. Treatment efficacy decreased during follow-up and was 96% at 6 months and 87% at 3 years. Reinterventions were performed in 7.3% (eight patients); of these, hysterectomy was performed in three patients.

Conclusions

Hysteroscopic endometrectomy is a safe and effective surgical treatment for menometrorrhagia.     

Hiperplasia estromal pseudoangiomatosa de la mama (HEPA): estudio clínico,radiológico y patológico de 4 casos

Pseudoangiomatous stromal hyperplasia (PASH) is a rare benign breast lesion, characterized by a benign overgrowth of fibrous connective tissue of the breast, which produces numerous spaces resembling vascular structures. This entity most commonly affects premenopausal women but cases have been described at all ages ranging from 12 to 75 years. PASH is usually an incidental histological finding after surgery for benign or malignant tumors but may also present as a mass or painless nodule mimicking fibroadenoma. Ultrasound-guided percutaneous biopsy allows the type of lesion to be determined and malignancies, such as low-grade angiosarcoma, to be excluded. We report four new cases of PASH with distinct clinical presentations. The first two cases presented as a single painless breast mass, the third as an incidental finding in the surgical specimen from a quadrantectomy performed for an intraductal breast carcinoma, and the fourth case occurred in a man with unilateral gynecomastia.     

Cáncer de mama ectópico axilar

Ectopic breast tissue occurs in 2-6% of the general population. The most frequent location is the axillary region. Ectopic breast tissue is subject to the same hormonal influences and risk of disease, including carcinoma, as anatomical breast. The incidence of carcinoma in ectopic tissue is approximately 0.3% of all breast cancers. Treatment should follow the same recommendations as those for breast tumors with the same tumor-node-metastasis stage.     

Tratamiento con análogos de la GnRH en la endometriosis de la pared abdominal

Abdominal wall endometriosis is uncommon and is almost always adjacent to surgical scars at the site of previous abdominal operations. The maximum incidence is 0.03-0.4% in patients with previous cesarean section. The interval between the procedure and symptom onset is usually 1 to 20 years.     

La enfermedad de Paget de la mama en nuestra área: revisión 1998-2012

Paget disease of the breast is a relatively rare entity with a favorable prognosis. For many years, the gold standard treatment has been mastectomy. However, breast-conserving surgery is now feasible and should be evaluated as the first-line option whenever negative margins with acceptable cosmetic results can be achieved. Imaging techniques are essential to exclude an underlying carcinoma and play an important role in selecting candidates for breast-conserving treatment and in follow-up.     

Utilidad de la prueba de la fibronectina fetal y de la longitud del cérvix en la predicción del parto prematuro en gestantes sintomáticas

Objective

To evaluate the usefulness of fetal fibronectin and cervical length in predicting preterm birth in women with preterm uterine contractions.

Material and methods

A prospective study was conducted at the Virgen Macarena Hospital in Seville that included 153 pregnant women with suspected preterm labor and intact membranes. Cervical length was measured by transvaginal sonography and a rapid qualitative fibronectin test was performed in the emergency consultation. Women with a negative fibronectin test and cervical length ≥ 30 mm were not hospitalized or treated with tocolytics or corticosteroids.

Results

The mean gestational age at diagnosis was 223,02 ± 19,98 days, and 267,52 ± 14,15 days at delivery. Preterm birth < 37 weeks rate was 23% and 7,4% for deliveries < 35 weeks. There is an association between cervical length < 30 mm and birth < 37 weeks (OR, 3,68; 95% CI, 1,53-8,84), and with delivery in the following 14 days (OR, 3,35; 95% CI, 1,30-21,95). With the association of both tests we gain specificity in predicting preterm birth.

Conclusion

Cervical length is the test with higher specificity (E) and negative predictive value (VPN) for the prediction of preterm birth in women with symptomatic contractions.