Caracterización clínico-patológica y manejo de pacientes con mastitis granulomatosa crónica en un centro de alta complejidad / Clinicopathological characterization and management of patients with chronic granulomatous mastitis in a high complexity center

Introducción. La mastitis granulomatosa crónica es una enfermedad inflamatoria poco frecuente y con mayor incidencia en el sexo femenino. Su sintomatología y su presentación clínica causan gran ansiedad tanto en el paciente como en el personal médico, debido a su comportamiento similar al de la patología mamaria maligna. No hay una etiología clara ni un manejo terapéutico definido. El objetivo de este estudio fue determinar las características clínico-patológicas, el tratamiento y la evolución de las pacientes con mastitis granulomatosa, durante el periodo de estudio. Métodos. Estudio retrospectivo en el que se revisaron las historias clínicas de pacientes con diagnóstico y manejo de trastorno inflamatorio de la mama no especificado (N61X), entre enero de 2010 y diciembre de 2019. Se encontraron 236 pacientes, se excluyeron 176 por no cumplir con el diagnóstico de mastitis granulomatosa crónica o por no tener un seguimiento adecuado. Se evaluaron las características sociodemográficas, clínicas y de evolución, comparando la respuesta que se obtuvo con cada tratamiento. Resultados. Se incluyeron 60 pacientes femeninas que presentaron manifestaciones variadas. El 38,3 % (n=23) recibieron manejo antibiótico, el 30 % (n=18) fue tratado con corticoides, el 8,3 % (n=5) recibió antibióticos más corticoides y se realizó manejo expectante en el 16,6 % (n=10). El 6,6 % (n=4) de los pacientes fueron llevados a cirugía. Discusión. La mejor respuesta y la menor tasa de recidiva se encontró en las pacientes que fueron sometidas a observación y en aquellas que recibieron corticoides

Introduction. Chronic granulomatous mastitis is a rare inflammatory disease with a higher incidence in females. Its symptoms and its clinical presentation cause great anxiety both in the patient and in the medical personnel, due to its behavior similar to that of malignant breast disease. There is no clear etiology or defined therapeutic management. The objective of this study was to determine the clinical-pathological characteristics, treatment and evolution of the patients with granulomatous mastitis, during the study period. Methods. Retrospective study in which the medical records of patients with diagnosis and management of unspecified inflammatory disorder of the breast (N61X) were reviewed, between January 2010 and December 2019. Two-hundred-thirty-six patients were found, 176 were excluded for not complying with the diagnosis of chronic granulomatous mastitis or for not having an adequate follow-up. The sociodemographic, clinical and evolution characteristics were evaluated, comparing the response obtained with each treatment. Results. Sixty female patients who presented varied manifestations were included, of which 38.3% (n=23) received antibiotic treatment, 30% (n=18) were treated with steroids, 8.3% (n=5) received antibiotics plus steroids, expectant management was performed in 16, 6% (n = 10), and 6.6% (n=4) of the patients were taken to surgery.Discussion. The best response and the lowest recurrence rate were found in patients who were observed and in those who received steroids

Galactocele medicamentosa pós-mamoplastia de aumento: relato de caso e revisão da literatura / Galactocele due to drugs prescribed after augmentation mammoplasty: a case report and literature review

A mamoplastia de aumento é um procedimento cirúrgico muito comum e seguro na cirurgia plástica, mas o mesmo não está isento de complicações. A galactocele após mamoplastia de aumento é raramente descrita na literatura. Este relato de caso refere-se a uma paciente de 34 anos de idade, que fazia uso de sulpirida há 2 anos e 4 meses e desenvolveu galactocele cerca de 100 dias após mamoplastia de aumento. O diagnóstico deve ser suspeitado quando se observar uma mama aumentada de volume, associada a calor local, dor ou desconforto mamário no pós-operatório. Acredita-se que a melhor conduta seja a drenagem cirúrgica, a fim de confirmar o diagnóstico de galactocele e excluir a presença de abscesso mamário.

Augmentation mammaplasty is a common and safe plastic surgery procedure, but it is not free from complications. Galactocele after augmentation mammaplasty is rarely described in the literature. We discuss the case of a 34-year-old woman who had been taking sulpiride for 2 years and 4 months and developed galactocele approximately 100 days after augmentation mammaplasty. However, diagnosis should be suspected if breast size increases and it is associated with postoperative local heat, pain or breast discomfort. We believe that the surgeon must surgically drain galactocele to confirm diagnosis, especially to exclude the presence of breast abscess.

Alterações funcionais benignas da mama / Benign functional alteration of the breast

A alteração funcional benigna da mama está intimamente relacionada à ansiedade e ao medo do câncer de mama. Acomete cerca de 70% das mulheres, 54% de mamas normais à autópsia, 34% de biópsias mamária e 40% de todos os cânceres de mama. Tem sido observada maior incidência nas pacientes de alto poder econômico. O diagnóstico é basicamente clínico e está relacionado à história de dor mamária pré-menstrual de caráter progressivo, ocupando todo o ciclo, além da presença de vários "nódulos". Ocorre na idade reprodutiva com pico entre mulheres de 30 a 40 anos. O quadro clínico passa obrigatoriamente por dor e nodularidade. O diagnóstico radiológico se restringe à mamografia e ao ultrassom sem alterações patológicas. A confirmação diagnóstica é dada pelo estudo anatomopatológico, através de punção aspirativa por agulha fina, trocarte e biópsia cirúrgica. A principal conduta terapêutica é afastar a causa oncológica como responsável pela mastalgia, portanto o exame físico das mamas, adicionado aos exames subsidiários, é obrigatório. Com a exclusão de processo neoplásico, 60% a 80% das pacientes têm remissão espontânea da dor. A presença de nodularidade deve ser tratada de acordo com o resultado anatomopatológico. A indicação de retirada da área somente ocorre na vigência de diagnóstico duvidoso ou suspeito e, até mesmo, nos casos de refratariedade ao tratamento clínico. O tratamento medicamentoso se baseia no emprego de várias drogas, tais como progesterona, antiprolactinas, agentes antigonadotropinas, medicamentos competidores com os receptores hormonais para estrogênio, uso de análogo de GnRH (goserelina), ácido gamalinoleico, restrição de metilxantinas, vitaminas E e A, complexo B, diuréticos e anti-inflamatórios...

A comunicação médico-paciente na percepção de mulheres com nódulo mamário e indicação de biópsia / Doctor-patient communication as perceived by women with a mammary nodule recommended for biopsy

Compreender como a comunicação com mastologistas é percebida e interpretada no diagnóstico de nódulo mamário com indicação de biópsia. Métodos: estudo qualitativo, com abordagem hermenêutica e crítica, efetuado em serviço de referência, em Recife, PE. Foram realizadas entrevistas semiestruturada com 16 mulheres entre 35-63 anos de idade. Formaram-se dois grupos de mulheres (Grupo 1 com e Grupo 2 sem hipótese diagnóstica de câncer). Resultados: nenhuma mulher relatou interesse do médico por sua percepção da doença. A relação com mastologistas foi satisfatória para o Grupo 1, sobretudo, pela sinceridade e atitude solidária ao facilitar o acesso a consultas e exames. No Grupo2 predominou a percepção de falta de reciprocidade. A comunicação médico-paciente sucedeu, principalmente, enquanto era necessária ao profissional, para apreender demandas reconhecidas cientificamente e fornecer informações, sendo mais demorada e esclarecedora com o Grupo 1. A banalização do nódulo benigno pelo médico resultou numa enorme insatisfação das mulheres do Grupo 2 quanto às informações obtidas, em particular, na definição do diagnóstico e conduta. Em geral, desconsiderou-se direito da paciente de opinar sobre suas conveniências. Conclusões: a comunicação médico-paciente teve caráter informativo e paternalista, com maior atenção dedicada às mulheres com suspeita de câncer. Nenhuma delas, ainda quando muito insatisfeitas, visaram de fato um projeto terapêutico individual. Dialogar é tarefa difícil para médicos e pacientes...

To understand how communication with mastologists is perceived and interpreted on diagnosis of a mammary nodule recommended for biopsy. Methods: a qualitative, hermeneutical and critical, study was carried out at a referral center in Recife, in the Brazilian State of Pernambuco. Semistructured interviews were conducted with 16 women aged between 35 and 63 years. Two groups of women were formed (Group 1 with a possible cancer diagnosis and Group 2 without). Results: no woman reported any interest on the part of the physician in her perception of the disease. The relation with the mastologists was satisfactory for Group 1, especially in terms of sincerity and solidarity in providing access to consults and examinations. In Group 2, the perception of a lack of reciprocity was predominant. Doctor-patient communication succeeded principally when there was a need for the health worker to meet scientifically recognized requirements and provide information, with more time being taken and more clarification given with Group 1. The trivialization of a benign nodule by the physician resulted in enormous dissatisfaction among women in Group 2 in terms of information obtained, in particular in the diagnosis and course of action to be taken. Generally speaking, the patient's right to express an opinion regarding their degree of comfort was disregarded. Conclusions: doctor-patient communication is informative and paternalistic in nature, with greater attention being given to women suspected to have cancer. None of them, even where very dissatisfied, aimed at an individual treatment project. Dialogue is difficult for doctors and patients...

Mastopatia Diabética: una entidad infrecuente a diferenciar / Diabetic mastitis: an uncommon entity differentiate

Introducción: La Diabetes mellitus produce microvasculitis y alteración histoarquitectural de la mama. Se encuentra en el 1% de la mastopatía benigna. Sin embargo, la distorsión delparénquima produce sintomatología inflamatoria clínicamente similar a las mastopatías inflamatorias infecciosas. Su diagnóstico imagenológico, es a su vez, de gran dificultad interpretativa. Estos parámetros inespecíficos, desembocan a tratamientos que no logran eficacia en la enfermedad, más aún si se ignora el contexto de la enfermedad de origen, la cual essistémica. Objetivos: destacar la importancia del diagnóstico diferencial de esta infrecuente entidad patológica. Material y Métodos: se revisaron historias clínicas de un servicio de mastología por el término de seis meses, a efectos de recabar información estadística. Resultados: histológicamente, estas pacientes presentaron rasgos microscópicos que consisten en una lobulitis linfocitaria que afecta al epitelio y gran vasculitis edematosa. El diagnóstico histológico es crucial para llegar al tratamiento. Conclusiones: la mastopatía de las pacientes diabéticas insulinodependientes es la manifestación crónica de eventos sistémicos, producido en un porcentaje muy bajo de pacientes con la enfermedad. La correcta interpretación clínica y mamográfica, además de la sospecha semiológica desembocanen el adecuado tratamiento de esta enfermedad, inserta en un contexto sistémico.

Introduction: Diabetes mellitus occurs histoarquitectural microvasculitis and alteration of the breast. It is found in 1% of benign breast disease . However, distortion occurs parenchymal inflammatory symptoms clinically similar to infectious inflammatory breast disease. Its diagnostic imaging , is in turn highly interpretive difficulty. These non specific parameters lead to effective treatments that fail in the disease , especially if the context of disease origin is unknown, which is systemic. Objectives: To highlight the importance of the differential diagnosis of this rare disease entity. Material and Methods : Clinical histories mastology service for a period of six months for the purpose of collecting statistical data were reviewed.Results: Histologically , these patients had microscopic features consisting lobulitis lymphocytic affecting large edematous epithelium and vasculitis. Histological diagnosis is crucial to get the treatment. Conclusions: Diabetic mastopathy in insulin dependent patients is chronic manifestation of systemic events , produced in a very low percentage of patients with the disease. The correct clinical and mammographic interpretation, in addition to lead to suspicion semiológica proper treatment of this disease, inserted in a systemic context.

El ultrasonido como método diagnóstico de patología mamaria oculta en mujeres con mama densa: serie clínica / Ultrasound as a Diagnostic Method of Hidden Breast Pathology in Women with Dense Breasts (case series)

Objetivo: Determinar la importancia y utilidad del ultrasonido mamario como método de imagen complementario en pacientes con mamas densas, ACR 3 y 4. Materiales y métodos: Estudio observacional longitudinal de tipo prospectivo. Se evaluaron 483 pacientes femeninas que asistieron a la Clínica de Mamas (San Cristóbal, Estado Táchira) durante el periodo de febrero de 2010 a febrero de 2011 con mamas densas en mamografía, sin hallazgo clínico ni radiológico, con evaluación ultrasonográfica complementaria y posterior estudio histopatológico según grado de sospecha de lesión por categorización BI-RADS. Resultados: La edad promedio de las pacientes fue de 45,15 años, menarquía a los 12,57 años y mamas densas ACR 3, la mayoría sin antecedentes de cáncer de mama ni uso de terapia de reemplazo hormonal. Se diagnosticaron 304 lesiones ocultas, el 10,8% con características ultrasonográficas de sospecha y el 2,2% con hallazgos histopatológicos de malignidad. Conclusiones: Se demuestra la importancia del ultrasonido como método complementario de rastreo en pacientes con mama densa.

Objective: To determine the importance and usefulness of breast ultrasounds as supplementary imaging method in patients with dense breasts, ACR 3 and 4. Materials and methods: Prospective observational longitudinal type study. We evaluated 483 female patients in the Clínica de Mama (San Cristobal, Tachira Ste.) from February 2010 to February 2011 with dense breasts in mammography without clinical or radiological findings, with additional ultrasonographic evaluation and a histopathological study according to the degree of lesion suspicion by BIRADS categorization. Results: The average age of the patients was 45.15 years, The menarche age was 12.57 years and ACR 3 breasts. Most patients did not have a background of breast cancer, nor did they use hormone replacement therapy. 304 hidden lesions were diagnosed, 10.8% with suspicious ultrasonographic features and 2.2% with histopathological malignancy findings. Conclusions: The importance of the ultrasound as a complementary screening method is proven in patients with dense breasts.

Enfoque comunitario y preventivo de las mastopatías / Community and preventive approach of the mastopathies

Las mujeres por el interés que prestan a su integridad física y espiritual, hacen especial cuidado de su salud y brindan atención a diferentes partes de su cuerpo. Constituyen motivo frecuente de consulta, procesos patológicos tanto benignos como malignos (mastopatías), que afectan el tejido mamario y son un problema de salud. Teniendo en cuenta la importancia del enfoque preventivo y comunitario de esta problemática, se realizó una revisión documental sobre el tema, con el objetivo de describir las acciones de salud dirigidas a la disminución de los indicadores de morbilidad y mortalidad por mastopatías. Se utilizaron para esto los métodos teóricos de análisis-síntesis e inducción-deducción

Women due to interest related to its physical and spiritual integrity, pay attention to its health and also t o different parts of its body. However, this is the frequent reason for consultation of the pathologic, benign and malignant (mastopathies) involving the breast tissue and are a serious health problem. Taking into account the significance of preventive and community approach to describe the health actions directed to decrease of indicators of morbility and mortality from mastopathies. Theoretical methods of analysis-synthesis and induction-deduction were used

Patrón difuso de la mama / Diffuse pattern of the breast

Presentación que se observa con más frecuencia al realizar un estudio ultrasonográfico de la mama, en la que pueden visualizarse distintas modificaciones, denominadas displasias mamarias. Se describen las patologías que pueden presentar un patrón difuso.

Biópsia excisional por agulhamento de lesões mamárias não palpáveis: indicações, técnica e resultados / Excisonal biopsy with wirw localization of non palpable breast lesions: indicators, technique and results

Com o aumento do rastreamento mamográfico, identificam-se cada vez mais lesões menores e não palpáveis, surgindo a necessidade de localiza-las tanto para diagnóstico como para tratamento. Neste trabalho, descreveram-se a técnica e suas indicações e apresentaram-se os resultados dos casos de agulhamento do Serviço de Mastologia e Radiologia do Hospital de Clínicas de Porto Alegre (HCPA). Métodos: Avaliaram-se, retrospectivamente, 586 casos de agulhamento operados no período de 1995 a 2004. As indicações para o procedimento foram as alterações mamográficas de lesões não palpáveis, classificadas de acordo o sistema BIRADS. Resultados: A principal indicação cirúrgica foram as microcalcificações, num total de 373 casos (63,7%), seguidas de nódulos em 37,2%. A idade média das pacientes foi de 53 anos (23 a 82). O valor preditivo positivo (VPP) geral para malignidade foi de 0,30 (177/586 casos). As alterações funcionais benignas da mama (AFBMs) corresponderam ao diagnóstico mais comum (34,1%). Noventa e quatro por cento dos casos de carcinoma ductal in situ (CDIS) foram diagnosticados mamograficamente como microcalcificações. Conclusões: Considerando os dados apresentados e a experiência do serviço, a biópsia por agulhamento continua sendo o principal procedimento para diagnóstico e tratamento de lesões não palpáveis. Trata-se de um método seguro, porém não isento de riscos.

With the increasing use of mammography, more and smaller non- palpable lesions are found, bringing the need of localize them for diagnostic and even therapeutic purposes. We describe the surgical technique, indications and results with the well-known standard procedure of excision after wire localization. Method: We retrospectively evaluated the result of 586 wire localizations between 1995 and 2004. The indications for the procedure were non-palpable mammographic abnormalities classified according to BIRADS system. Results: The main indication for this procedure were microcalcifications in 63.7% of the cases (n=373), followed by lumps 37.2%. The mean age of these patients was 53 years (range 23- 82 years). We observed an overall positive predictive value (PPV) for malignancy of 0.30 (177/586 cases). Benign fybrocistic changes was found as the most common pathological diagnosis (34.1%). Ninety-four per cent of the ductal carcinoma in situ were detected mammographically as microcalcifications. Conclusions: The authors call attention for the use of a very careful and delicate surgical technique in order to achieve the best results. Our experience confirm that the wire-guided excision of non-palpable breast lesions is a safe and reliable diagnostic/therapeutic procedure.

Sistema para diagnóstico citológico de la mastopatía fibroquística por biopsia aspirativa con aguja fina / The cytodiagnosis of fibrocystic mastopathy use of fine needle aspiration biopsy (FNAB)

Se estudiaron 124 mastopatías benignas con hiperplasia epitelial diagnosticadas por citología aspirativa durante los años 2005-2006 y que fueron intervenidas quirúrgicamente. OBJETIVO: establecer criterios diagnósticos citológicos para los grados de Mastopatía fibroquística y crear un sistema cito patológico. MÉTODOS: en las láminas revisadas se definió, grado de celularidad con el análisis de 10 campos ópticos panorámicos 5x, patrones citológicos, atipia celular y elementos del fondo. RESULTADOS: la celularidad aumenta de leve a marcada desde la Mastopatía fibroquística Grado I a la Mastopatía fibroquística Grado III; en el patrón de agrupación presentado, las sábanas monoestratificadas en panal de abeja de talla pequeña y mediana se presentaron en los Grados del I al III, pero los grupos poliestratificados en bolas circunscritos con o sin empalizadas periféricas predominaron en los Grados II y III, al igual que la presencia de sábanas de epitelio apocrino con o sin papilomatosis; los grupos poliestratificados, discohesivos fueron característicos del Grados III. La atipia leve o moderada se presentó en aislados casos de los Grados I y II y la severa en el Grado III. En los elementos del fondo analizados las células mioepiteliales o núcleos bipolares desnudos fueron un elemento constante en los Grados del I al III. CONCLUSIONES: los errores presentados que provocaron la no correlación cito histológica fueron de muestreo e interpretación de la biopsia aspirtiva con aguja fian (BAAF) y en menor frecuencia errores de muestreo de la biopsia convencional cuyas causas fundamentales pueden ser en el momento de la exéresis del nódulo por el cirujano o por la toma de un número inadecuado de fragmentos por el anatomopatólogo en la pieza quirúrgica.

One hundred and twenty four benign mastopathies with epithelial hyperplasia were studied, diagnosed by aspiration cytology during 2005-2006 operated on. OBJECTIVE: To establish cytology diagnostic criteria for fibrocystic mastopathy degrees, and to create a cytopathology system. METHODS: In study slides it was defined the cellular degree with analysis of ten 5x- panoramic optical fields, cytological patterns, cellular atypia, and background elements. RESULTS: Cellularity increase from slight to marked of Grade I fibrocystic mastoplasty to Grade III fibrocystic mastoplasty in grouping pattern presented; monostratified sheets in little and medium size honeycomb were in I and III degrees, but in polystratified groups in limited balls with or without peripheral stockades predominate in II and III Grades, as well as presence of sheets of aprocrine epithelium with or without papillomatosis; non-cohesive polystratified groups were characteristic of III Grades. Slight or moderade atypia was present in isolated cases of I and II Grades, and the severe one in III Grade. In analyzed background elements myoepithelial cells or naked bipolar nuclei were a persistent element in I and III Grades. CONCLUSIONS: Errors presented provoking the non-cytohistological correlation were sampling end interpretation of fine needle aspiration biopsy (FNAB), and in a lower frequency, the sampling errors of conventional biopsy whose main causes may be at nodule exeresis by surgeon, or by taking of a unsuitable number of fragments by anatomist-pathologist in surgical sample.

Imágenes en mastopatia diabética / Mr imaging of diabetic mastopathy

Objective: To retrospectively analyze the clinical records and imaging data of patients with diabetic mastopathy according to pathological findings of samples obtained by histological puncture with ultrasound guidance. Methods: Between 2002 and 2007, six patients were diagnosed with diabetic mastopathy, and their medical records and MR images were assessed. All patients underwent both mammography and ultrasound examination. One of them was additionally submitted to MRI. Results: The patients' mean age was 36.6 years. Mammograms showed asymmetric tissue densifications without micro calcifications, while ultrasound examination evidenced ill-defined solid nodular or pseudonodular areas greater than 2 cm, with posterior sonic attenuation. Magnetic resonance imaging revealed a nodular area with poorly defined contours with enhancement similar to normal breast tissue. By performing eco-guided biopsy, it was possible to establish the differential histological diagnosis of breast carcinoma and to confirm diabetic mastopathy. Conclusion: Diabetic mastopathy presents mammographic and ultrasound imaging features indistinguishable from breast cancer. Since MRI does not reveal pathological stromal enhancement it can be helpful for a differential diagnosis. The echo-guided biopsy allows the diagnosis of this condition.

Objetivo: Analizar retrospectivamente las historias clínicas e imágenes de pacientes conmastopatía diabética, según hallazgos en anatomía patológica de muestras obtenidas por punción histológica con guía ecográfica. Material y Métodos: Entre los años 2002 y 2007, se diagnosticaron 6 pacientes con mastopatía diabética, evaluándose sus historias clínicas e imágenes. A todas las pacientes se le efectuó mamografía y ecografía; a una paciente se realizó además resonancia magnética. Resultados: La edad promedio de las pacientes fue de 36,6 años. Las mamografías mostraron densificaciones tisulares asimétricas sin microcalcificaciones; las ecografías evidenciaron áreas sólidas nodulares o seudonodulares mal definidas, mayores a 2 cm, con atenuación sónica posterior y la resonancia magnética: un área nodular de contornos mal delimitados con realce similar al tejido mamario normal. La punción biopsia ecoguiada pudo establecer el diagnóstico histológico diferencial con carcinoma mamario y confirmar mastopatía diabética. Conclusión: La mastopatía diabética presenta características imaginológicas en mamografía y ecografía que pueden ser similares al carcinoma. La resonancia magnética, al no presentar realce patológico estromal, puede colaborar en el diagnostico diferencial. La biopsia eco-guiada permite el diagnóstico de esta patología.

Patología mamaria benigna / Benignant pathology of the breast

The benignant pathology of the breast involves a group of several pathologies, from simple congenital malformations through complex disorders, development anomalies, injureis, both chronic and acute infections, non infectious inflammatory processes, benignant tumors and functional disorders such as mammary dysplasia. The authors of this report describe successivelvy the characteristics of mammary anomalies, inflammatory processes (mastitis) benignant tumors of the breast (fibroadenoma), tumor phyllodes, papillary tumors, mammary dysplasias. In every case the diagnosis, with radiologic imaging and nuclear imaging, with other diagnostic techniques, follow-up and surgical approach, are described and detailed.

Tratamiento de la displasia mamaria atípica con tamoxifeno como profilaxis del cáncer de mama en Santiago de Cuba / Treatment of the atypical mammary dysplasia with tamoxifeno as prophylaxis of breast cancer in Santiago de Cuba

Se realizó un estudio retrospectivo de 7 años (2001 – 2007) en la consulta especializada de mastología del Hospital Provincial Docente Saturnino Lora Torres de Santiago de Cuba, radicada en el Policlínico de Especialidades perteneciente a dicha institución. Se obtuvieron los datos clínicos de 164 pacientes con displasia mamaria de diferentes grados y alta predisposición a padecer cáncer, las cuales eran tratadas y consultadas bimensualmente por cirujanos, quienes concluyeron que el control hormonal y el examen periódico de las mujeres afectadas, mejoraron el pronóstico e incrementaron los índices de curación.

A 7 year-old retrospective study (2001 - 2007) was carried out in the breast specialized department from Saturnino Lora Torres Teaching Provincial Hospital from Santiago de Cuba, sited in the Specialties Polyclinic belonging to this institution. The clinical data of 164 patients with mammary dysplasia of different grades and high predisposition to suffer from cancer, who were treated and examined every two months by surgeons were obtained. They concluded that the hormonal control and the periodic examination of the affected women, improved the prognosis and increased the cure rates.

Mastopatia diabética: um inusitado diagnóstico diferencial: relato de caso / Diabetic mastopathy: an unusual differential diagnosis: a case report

A mastopatia diabética acomete mulheres na pré-menopausa com diabetes mellitus tipo 1 de longa data. Seu diagnóstico é feito associando achados clínicos (espessamento ou nódulo mamário endurecidos, uni ou bilateral), radiológicos (aumento da densidade mamária), ultra-sonográficos (acentuada sombra acústica posterior) e histopatológicos (fibrose e infiltrado linfocítico perivascular e periductal). Pode simular carcinoma. Neste artigo relata-se um caso de paciente com mastopatia diabética.

Diabetic mastopathy affects premenopausal women with longstanding type 1 diabetes mellitus. The diagnosis is based on clinical findings (uni or bilateral hardened, palpable mass) associated with radiological (increase in breast density), sonographic (marked posterior acoustic shadowing), and histopathological (fibrosis and perivascular and periductal lymphocytic infiltration) findings. This disease may clinically simulate a breast carcinoma. The case of a patient with diabetic mastopathy is reported.

Apresentação das lesões mamárias císticas à ultra-sonografia utilizando a elastografia / Features of cystic breast lesions at ultrasound elastography

OBJETIVO: Demonstrar a apresentação mais freqüente das lesões mamárias císticas utilizando a elastografia e discutir a sua aplicabilidade. MATERIAIS E MÉTODOS: A casuística compôs-se de 150 pacientes encaminhadas para realização de biópsia mamária percutânea com 175 lesões. Foram excluídas as lesões com diagnóstico histológico de lesões sólidas (153 lesões) e incluídas as lesões com características císticas à histologia (22 lesões), incluindo cistos complicados, lesões papilíferas, lesões inflamatórias, hiperplasia de células colunares típica e ectasia ductal. Estas lesões foram classificadas de forma retrospectiva por meio da elastografia, conforme escores criados pelos autores, variando de 1 a 4. RESULTADOS: Das 22 lesões encaminhadas, 13 (59 por cento) correspondiam a cistos, uma (4,6 por cento) a ectasia ductal, duas (9,2 por cento) a lesões inflamatórias, cinco (22,6 por cento) a lesões papilíferas e uma (4,6 por cento) a hiperplasia de células colunares. Foram encontrados 17 escores 2, quatro escores 3, um escore 4 e nenhum escore 1, com especificidade de 95 por cento. CONCLUSÃO: As lesões císticas mamárias têm diferentes apresentações à elastografia, conforme o resultado histológico, sendo este um método útil para a sua diferenciação e de fácil aplicabilidade na clínica diária.

OBJECTIVE: To demonstrate the most frequent features of cystic breast lesions at ultrasound elastography, discussing the applicability of this method. MATERIALS AND METHODS: The present casuistic included 150 patients referred for percutaneous breast biopsy of 175 lesions. Histologically diagnosed solid lesions (153 lesions) were excluded; lesions histologically diagnosed as cystic (22 lesions), including complicated cysts, papillary lesions, inflammatory lesions, typical columnar cell hyperplasia and duct ectasia were retrospectively classified by means of elastography, according to a scoring system developed by the authors, with categories ranging between 1 and 4. RESULTS: Thirteen (59 percent) of the 22 lesions evaluated corresponded to cysts, one (4.6 percent) to duct ectasia, two (9.2 percent) to inflammatory lesions, five (22.6 percent) to papillary lesions, and one (4.6 percent) to columnar cell hyperplasia. The scoring system was applied with the following results: 17 category 2 lesions, four category 3 lesions, one category 4 lesion, and none category 1 lesion, with a 95 percent specificity. CONCLUSION: Different features of cystic breast lesions are demonstrated by elastography according to histological results, representing a useful and easily applicable method for differentiating benign from malignant breast lesions.

Importancia de la información en el control de los síntomas de la displasia mamaria / Importance of information in the control of the symptoms of breast dysplasia

INTRODUCCIÓN. La displasia mamaria es un problema de salud de gran repercusión social, por el estrés y la ansiedad que suelen acompañarla. El presente trabajo tuvo el objetivo de valorar diferentes variantes de conducta ante esta afección. MÉTODOS. Se realizó un estudio retrospectivo-prospectivo con 3668 pacientes diagnosticadas de displasia mamaria, y atendidas por esta razón entre enero de 1991 y diciembre de 2004 en el Hospital Universitario Comandante «Manuel Fajardo¼. RESULTADOS. La incidencia de displasia mamaria (enfermedad fibroquística) en la consulta de patología mamaria fue del 50 por ciento, seguida en frecuencia por el fibroadenoma y las enfermedades inflamatorias. Se realizó el estudio en dos etapas: una con carácter retrospectivo (1991-1996) y otra con carácter prospectivo (1997-2004). La evolución de los casos que solo recibieron información fue similar a la de los pacientes que fueron sometidos a otros esquemas de tratamiento médico, en ambas etapas. Se necesitó exéresis quirúrgica en el 16,21 por ciento y 13,42 por ciento de los pacientes, respectivamente, a causa de dudas en relación con un carcinoma. CONCLUSIONES. La información médica es una opción que puede utilizarse en más del 70 por ciento de las mujeres que presentan displasia mamaria (enfermedad fibroquística). Tiene la ventaja de que los resultados son más duraderos que los del tratamiento médico, y de que disminuye el consumo innecesario de medicamentos. El tratamiento quirúrgico de la enfermedad fibroquística está solo justificado ante la duda de cáncer y en lesiones que no se modifican ni duelen durante el ciclo menstrual, sobre todo en el caso de mujeres mayores de 35 años(AU)

INTRODUCTION. Breast dysplasia is a health problem of great social impact due to the stress and anxiety accompanying it. The present paper was aimed at assessing different variants of behavior before this affection. METHODS. A retrospective prospective study was conducted among 3 688 patients that were diagnosed breast dysplasia and received attention from January 1991 to December 2004 in «Comandante Manuel Fajardo¼ Teaching Hospital. RESULTS. The incidence of breast dysplasia (fibrocystic disease) at the breast pathology office was 50 percent, followed in frequency by fibroadenoma and inflammatory diseases. A two-stage study was undertaken: one with retrospective character (1991-1996) and the other with prospective character (1997-2004). The evolution of the cases that received only information was similar to that of those that underwent other medical treatment schemes, in both stages. Surgical exeresis was necessary in 16.21 percent and 13.42 percent of the patients, respectively, due to suspicion of carcinoma. CONCLUSIONS. Medical information is an option that may be used in more than 70 percent of females with breast dysplasia (fibrocystic disease). Some of its advantages are that the results last more than those of medical treatment and that it reduces the unnecessary administration of drugs. The surgical treatment of the fibrocystic disease is only justified when cancer is suspected and in lesions that neither modify nor hurt during the menstrual cycle, mainly in females over 35(AU)

Análise morfométrica de micronúcleos e colágeno intersticial em tumores de mama / Morphometric analysis of micronucleuses and interstitial collagen in breast tumors

O presente trabalho estabeleceu a densidade de micronúcleos e a distribuição do colágeno intersticial no tecido tumoral benigno e maligno de mama humana. Foram utilizadas a reação histoquímica de Feulgen e tricrômico de Masson, e a análise digital de imagens. Foram selecionados fragmentos de tecido mamário, diagnosticados como Fibroadenoma (FA), Doença fibrocística (DF) e Carcinoma Ductal Infiltrante (CDI). Para controle, foram utilizadas amostras de plástica mamária com tecido normal. A reação histoquímica foi realizada através da reação de Feulgen, para evidenciação dos micronúcleos, e, para a análise de colágeno intersticial, foi utilizada a coloração tricrômico de Masson. O número médio de micronúcleos exibiu valores semelhantes em amostra de FA (90,8 ± 4,5), DF (80,3 ± 4,0) e tecido normal (83,0 ± 4,1). Entretanto, valores significativamente menores que aqueles foram encontrados no CDI (176,5 ± 88,3). Quanto à distribuição do colágeno intersticial, constatou-se um aumento estatisticamente significante (p< 0,001) nos casos de FA (8101,4 ± 405,07) e DF (7046,78 ± 352,33), quando comparados ao tecido mamário normal (1733,13 ± 86,65) e ao CDI (2165,94 ± 108,29). Pode-se concluir que tanto o método de análise de imagem como a reação de Feulgen mostraram-se eficientes para evidenciar as alterações do núcleo celular e da matriz extracelular de tumores de mama.

Clinicopathologic features of breast disease in Jamaica: findings of the Jamaican Breast Disease Study, 2000-2002 / Características clínico-patológicas de la enfermedad de mamas en Jamaica: hallazgos del estudio jamaicano de la enfermedad de mamas, 2000-2002

OBJECTIVE: To describe the clinicopathologic profile of breast disease in Jamaica. METHODS: The Jamaican Breast Disease Study is an ongoing prospective, multidisciplinary investigation of breast disease at the University Hospital of the West Indies (UHWI). The initial phase was a prevalence survey comprising all consenting patients referred to the Surgical Outpatient Department (SOPD) UHWI, for breast disease. Demographic, clinical, radiologic and pathologic information were recorded for each patient and the data for the first three years (2000-2002) were analyzed. RESULTS: A total of 1189 patients was enrolled for the study period (28.8% of all new SOPD patients). The age range was10 to 93 years (mean/SD = 36.5 +/- 16.4 years) with a female : male ratio of 14:1. Most patients (67.8%) presented with a palpable lump and the clinical diagnosis was benign in the majority (70.4%) of patients. Fibroadenoma was the most common benign histologic result (39.4% of all biopsies) followed by non-proliferative (fibrocystic) disease (19.3% of all biopsies). Proliferative disease without atypia, complex fibroadenoma and atypical ductal hyperplasia accounted for 6.9%, 2.6% and 0.4% of biopsies respectively. Overall, 23.4% of biopsies showed malignant histology (10.8% patients); invasive ductal carcinoma accounted for the majority of these cases (69.5%). CONCLUSIONS: The majority of patients with breast disease in Jamaica are young women with clinically benign disease. There was a low prevalence of clinically significant premalignant disease. This is the first study to prospectively describe the clinicopathologic features of breast disease in Jamaica and supports the need for advocating breast cancer screening to facilitate detection of significant premalignant disease and early stages of breast cancer.

OBJETIVO: Describir el perfil clínico-patológico de la enfermedad de mamas en Jamaica. MÉTODOS: El "Estudio jamaicano de la enfermedad de mamas" - que continua realizándose en la actualidad en el Hospital Universitario de West Indies (HUWI) - consiste en una investigación prospectiva y multidisciplinaria de la enfermedad de mamas. La fase inicial fue un estudio de prevalencia que abarcó a todos los pacientes que dieron su consentimiento, y que fueron remitidos al Departamento de Cirugía Ambulatoria (DCA) de HUWI a causa de la enfermedad de mamas. Se registró información demográfica, clínica, radiológica y patológica de cada paciente, así como los datos referidos a los primeros tres años (2000-2002). RESULTADOS: Un total de 1189 pacientes fueron captados para el periodo de estudio (28.8% de todos los pacientes nuevos del DCA). El rango de edad fue de 10 a 93 años (media/SD = 36.5 + / - 16.4 años) con una proporción hembra:varón de 14:1. La mayoría de los pacientes (67.8%) presentó un nódulo palpable y el diagnóstico clínico fue benigno en la mayoría (70.4%) de los pacientes. El fibroadenoma fue el resultado histológico benigno más común (39.4% de todas las biopsias) seguido por la enfermedad (fibrocística) no proliferativa (19.3% de todas las biopsias). La enfermedad proliferativa sin atipia, el fibroadenoma complejo y la hiperplasia ductal atípica representaron el 6.9%, 2.6% y 0.4% de las biopsias respectivamente. En general, el 23.4% de las biopsias mostraron histología maligna (10.8% de los pacientes); el carcinoma ductal invasivo representó la mayoría de estos casos (69.5%). CONCLUSIONES: La mayor parte de los pacientes con la enfermedad de mamas en Jamaica son mujeres jóvenes con enfermedades clínicamente benignas. Hubo una baja prevalencia de enfermedades premalignas clínicamente significativas. Este es el primer estudio dirigido a describir prospectivamente las características clínico-patológicas de la enfermedad de mamas en Jamaica, y respalda la necesidad de abogar por el pesquisaje del cáncer de mamas, a fin de facilitar la detección de enfermedades premalignas significativas y las fases tempranas del cáncer de mamas.

Mastopatía diabética: presentación de caso / Diabetic masthopathy: case presentation

La mastopatía diabética es una entidad poco frecuente y de relativa nueva definición que puede simular una neoplasia maligna. Se presenta principalmente en pacientes diabéticas premenopáusicas insulino-dependientes con antecedentes de hiperglucemias prolongadas. Su etiopatogenia se asocia con el depósito estromal de colágeno y una infiltración linfocitaria de células B de causa autoinmune. La presentación clínica y radiológica no permiten concluir con un diagnóstico certero, siendo necesario la realización de biopsia con aguja gruesa y en la mayoría de los casos biopsia incisional. Presentamos el manejo de un caso en nuestra unidad.

Diabetic masthead is uncommon breast lesion and relative new definition that can be mistaken by a malignant neoplasia. It is mostly described in premenopausal patient’s diabetic and insulin dependent with history of persistent hyperglycemia. The ethiopatogenic is associated with extensive lymphocytic infiltration mostly B cells is detected an autoimmune reaction. Neither clinical nor radiologic exams rule out malignancy, so core biopsy and even incision biopsy are mandatory: Ephiteloid fibroblast in dense fibrous stroma is unique to the condition in diabetics. We present a case report, diagnosed and treated in our center.