Epithelioid inflammatory myofibroblastic sarcoma: the youngest case reported

Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare variant of the inflammatory myofibroblastic tumor. It has an aggressive clinical course and a high rate of recurrence. EIMS primarily affects children and young adults. Hereby, we report this entity in a 4-month-old infant who presented with an abdominal mass. Imaging studies revealed a large hypodense mesentery-based lesion involving the right half and mid-region of the abdomen. The mass with an attached segment of the small bowel was excised in toto. Grossly, a large encapsulated tumor was identified arising from the mesentery of the small bowel. The histological examination showed a tumor consisting of epithelioid to spindle cells loosely arranged in a myxoid background with numerous blood vessels and lymphoplasmacytic inflammatory infiltrate. On immunohistochemistry, the tumor cells showed positivity for ALK1 (nuclear), desmin, SMA, CD68, and focal positivity for CD30. A final diagnosis of EIMS of the small intestine was rendered. To the best of our knowledge, this case is the youngest reported case in literature.

Systemic ALK-positive anaplastic large cell lymphoma involving implant site: a fortuitous association

Anaplastic lymphoma kinase (ALK) positive, anaplastic large cell lymphoma involving the non-mammary implant is an extremely rare presentation. Irrespective of the type or site, the implant-associated primary ALCL is morphologically and immunophenotypically similar to ALK-negative ALCLs. Herein, we present the case of a 42-year-old male who developed a lytic lesion after an implant for a right femur fracture. The lytic lesion biopsy revealed anaplastic large cell lymphoma with ALK protein expression. Imaging findings showed the widespread dissemination of disease all over the body, entrapping the implant too. ALCL involving the bone implant is a very unusual and rare presentation that needs to be documented.

ALK+ Anaplastic large cell lymphoma with extensive cardiac involvement: A rare case report and review of the literature

Cardiac lymphoma is a rare entity. In this setting, the secondary involvement of the heart is far more frequent than the primary cardiac lymphoma. Herein, we present an autopsy case of a disseminated anaplastic lymphoma kinase (ALK)-positive anaplastic large cell lymphoma with a dominant mediastinal involvement. Extensive cardiac infiltration with the near replacement of the myocardial wall by the neoplastic cells was observed. A total of nine isolated case reports of anaplastic large cell lymphoma with cardiac involvement were found in the English-language literature, and a widespread cardiac and thymic infiltration by the systemic ALK-positive anaplastic large cell lymphoma has not been documented. An incidental regenerative nodule was also identified in the liver. The patient died of pulmonary thromboembolism and cardiac arrest.

Prevalência do rearranjo do gene ROS1 em carcinoma de pulmão de células não pequenas não escamoso, EGFR e ALK negativo: análise de uma coorte brasileira / Prevalence of ROS1 gene rearrangements in EGFR-Negative and ALK-negative nonsquamous NSCLC: analysis of a Brazilian cohort

Introdução: A prevalência do câncer de pulmão tem aumentado cerca de 2% ao ano e é considerado um problema de saúde pública mundial, sendo a principal causa de morte por câncer entre homens e mulheres. O Câncer de Pulmão de Células Não Pequenas (CPCNP) representa 85-90% dos cânceres de pulmão. A detecção do rearranjo do gene ROS1, considerada um importante fator preditivo para direcionamento terapêutico, constitui uma etapa crítica no tratamento de CPCNP. Objetivo: Avaliar a prevalência do rearranjo do gene ROS1 em pacientes portadores de CPCNP não escamoso, sem mutação de EGFR ou rearranjo de ALK, diagnosticados na Região da Foz do Rio Itajaí, Estado de Santa Catarina, Brasil, no período de 02/01/2019 a 27/07/2020. Materiais e Métodos: Estudo observacional, retrospectivo e prospectivo, descrito e analítico com 95 pacientes que possuíam material de biópsia suficiente para a realização de novas análises e que não apresentavam mutação de EGFR ou rearranjo de ALK. Os pacientes com imuno-histoquímica positiva para a proteína ROS1 foram testados pelo método de FISH, utilizando-se uma sonda de DNA do tipo break-apart para o gene ROS1. Foi realizada uma análise descritiva da amostra, e os resultados foram apresentados em números absolutos e porcentagens, representados por tabelas. O teste de qui-quadrado (χ2) foi empregado para comparação das frequências entre os grupos analisados. Resultados: 52,6% foram pacientes do sexo masculino; a idade mediana foi de 64 anos; 54,7% declararam-se tabagistas; 40,0% apresentavam doença estágio IV; 29,5% apresentaram tumores com alta expressão de PD-L1. Quanto a expressão de ROS1 por imuno-histoquímica: 89,5% foram identificados como ROS1+ em 0% das células tumorais, 4,2% como ROS1+ em <70% das células, e 6,3% como ROS1+ em ≥70% das células do tumor; portanto, 10,5% apresentaram resultados positivos para expressão de ROS1. Estes pacientes foram submetidos à análise de rearranjo de ROS1 pelo método de FISH e 7 (7,4%) apresentaram resultados positivos. Conclusão: Na população estudada, a análise pelo método de FISH mostrou uma prevalência de 7,4% para rearranjos do gene ROS1

Introduction: Lung cancer prevalence has been increasing at rate of 2% per year and is considered a major public health concern worldwide, being the main cause of cancer death among women and men. Non-small cell lung cancer (NSCLC) represents 85-90% of total lung cancer. Detecting the rearrangement of the ROS1 gene is critical to the treatment of NSCLC. Objective: To assess the prevalence of the ROS1 gene rearrangement in patients diagnosed with non-squamous NSCLC patients diagnosed between January 2019 to July 2020 at Foz do Rio Itajaí, in the state of Santa Catarina, Brazil. Materials and Methods: This is a retrospective and prospective observational study Ninety-five NSCLC whose tumors were negative for EGFR mutation and ALK rearrangement and who had enough tumor tissue to carry out additional molecular analysis. Patients whose tumors were positive for ROS1 by immune-histochemistry were tested using by FISH using a break-apart DNA probe (Abbot Molecular) for the ROS1 gene. A descriptive analysis was performed and results were presented as absolute frequencies and percentages and depicted in charts. Frequencies were compared with the chi-squared test (χ2). Results: 52,6% were male, mean and median age were 65,10 and 64 years, respectively. 54,7% self-declared as smokers; 40,0% had stage IV disease; 29,5% had tumours with high expression of PD-L1. Regarding the expression of ROS1 by immunohistochemistry: 89,5% were identified as ROS1+ in 0% of cells, 4,2% as ROS1+ in <70% of cells, and 6,3% as ROS1+ in ≥70% of the cells; therefore, 10,5% displayed positive results for the expression of ROS1+. These tumors were subjected to the analysis of ROS1 rearrangement by FISH and 7 (7,4%) were positive. Conclusion: We observed 7,4% prevalence for ROS1 gene rearrangements in this pre-selected population

Caso atípico de leucemia mieloide aguda con coexistencia de NPM1-A e inversión del cromosoma 16 / A rare case of acute myeloid leukemia with coexistence of NPM1-A mutation and chromosome 16 inversion

Introducción: La leucemia mieloide aguda (LMA) es un grupo heterogéneo de desórdenes clonales con una gran variabilidad en términos de patogénesis, características morfológicas, genéticas e inmunofenotípicas. Las mutaciones en el gen NPM1 representan una de las más comunes en las LMA y está asociada con una respuesta clínica favorable. Por citogenética, la inversión del cromosoma 16 define el subgrupo de las LMA de factor de unión al grupo con un pronóstico favorable. Objetivo: Describir un caso con diagnóstico de LMA en los cuales el estudio molecular del gen NPM1 y de la inv(16) fueron positivos. Caso clínico: A nivel molecular, la hibridación in situ fluorescente fue positivo a la inv(16) y por biología molecular fue positivo tanto a la inv(16) como al gen NPM1-A, elementos de baja frecuencia de aparición. Se le administró a la paciente un esquema de poliquimioterapia no intensiva para mejorarla clínicamente. Después de una mejoría clínica inicial, la paciente comenzó con complicaciones y falleció. Conclusiones: La coexistencia de estas dos mutaciones es muy poco frecuente en pacientes con LMA, y a pesar de ser de buen pronóstico la paciente falleció a los pocos días de tratamiento(AU)

Introduction: Acute myeloid leukemia (AML) is a heterogeneous group of clonal disorders with great variability in terms of pathogenesis, morphological, genetic and immunophenotypic characteristics. NPM1 mutations represent one of the most common in AML and are associated with favorable clinical response. By cytogenetics, chromosome 16 inversion defines, with a favorable prognosis, the core‐binding factor for the subgroup of AMLs Objective: To describe a AML case in which the molecular study of the NPM1 gene and the chromosome 16 inversion were positive. Clinical case: At the molecular level, fluorescent in situ hybridization was positive for chromosome 16 inversion and, by molecular biology, it was positive for both chromosome 16 inversion and for the NPM1-A gene, elements with a low frequency of appearance. The patient was administered a non-intensive combination as part of a chemotherapy regimen to improve her clinical status. After initial clinical improvement, the patient began with complications and died. Conclusions: The coexistence of these two mutations is very rare in patients with AML. Despite presenting a good prognosis, the patient died after a few days of treatment(AU)

Molecular profile of non-small cell lung cancer in northeastern Brazil / Perfil molecular do carcinoma pulmonar de células não pequenas no Nordeste brasileiro

ABSTRACT Objective: To investigate the histological subtypes and mutational profiles of non-small cell lung cancer in Brazil, looking for correlations among histological subtypes, expression of anaplastic lymphoma kinase (ALK), EGFR mutation status, and programmed death-ligand 1 (PD-L1) expression. Methods: We evaluated 173 specimens obtained from patients with lung adenocarcinoma in northeastern Brazil. Expression of PD-L1 and ALK was evaluated by immunohistochemistry; EGFR mutation status was evaluated by sequencing. We categorized the histological subtypes in accordance with the International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society classification. Results: The most common histological subtypes of lung adenocarcinoma were solid predominant (in 46.8%), acinar predominant (in 37.0%), and lepidic predominant (in 9.8%). ALK expression was detected in 10.4% of the samples, and 22.0% of the tumors harbored EGFR mutations. The most common EGFR mutation was an exon 21 L858R point mutation (in 45.5%), followed by an exon 19 deletion (in 36.3%). The tumor proportion score for PD-L1 expression was ≥ 50% in 18.2% of the samples, 1-49% in 32.7%, and 0% in 49.5%. The solid predominant subtype was significantly associated with wild-type EGFR status (p = 0.047). Positivity for PD-L1 expression was not found to be significantly associated with ALK expression or EGFR mutation status. Conclusions: Our results suggest that the molecular profile of non-small cell lung cancer in northeastern Brazil differs from those of populations in other regions of the country, with ALK positivity being higher than the other biomarkers. Further studies including clinical and genetic information are required to confirm these differences, as well as studies focusing on populations living in different areas of the country.

RESUMO Objetivo: Investigar os subtipos histológicos e perfis de mutação do carcinoma pulmonar de células não pequenas no Brasil, bem como as correlações entre os subtipos histológicos, a expressão do gene anaplastic lymphoma kinase (ALK, quinase do linfoma anaplásico), o estado de mutação do gene EGFR e a expressão de programmed death-ligand 1 (PD-L1, ligante de morte celular programada 1). Métodos: Avaliamos 173 espécimes provenientes de pacientes com adenocarcinoma pulmonar no Nordeste brasileiro. A expressão de PD-L1 e ALK foi avaliada por meio de imuno-histoquímica, ao passo que o estado de mutação do EGFR foi avaliado por meio de sequenciamento. Os subtipos histológicos foram classificados de acordo com a International Association for the Study of Lung Cancer/American Thoracic Society/European Respiratory Society. Resultados: Os subtipos histológicos mais comuns de adenocarcinoma pulmonar foram o predominantemente sólido (em 46,8%), o predominantemente acinar (em 37,0%) e o predominantemente lepídico (em 9,8%). A expressão de ALK foi detectada em 10,4% das amostras, e 22,0% dos tumores apresentavam mutações do gene EGFR. As mutações mais comuns do EGFR foram a mutação pontual L858R no éxon 21 (em 45,5%) e a deleção do éxon 19 (em 36,3%). O tumor proportion score relativo à expressão de PD-L1 foi ≥ 50% em 18,2% das amostras, = 1-49% em 32,7% e = 0% em 49,5%. O subtipo predominantemente sólido relacionou-se significativamente com EGFR selvagem (p = 0,047). A expressão positiva de PD-L1 não se relacionou significativamente com a expressão de ALK ou o estado de mutação do EGFR. Conclusões: Nossos resultados sugerem que o perfil molecular do carcinoma pulmonar de células não pequenas no Nordeste brasileiro difere do de populações em outras regiões do país: a expressão positiva de ALK é maior que os demais biomarcadores. Mais estudos com informações clínicas e genéticas são necessários para confirmar essas diferenças, além de estudos que se concentrem em populações em diferentes áreas do país.

Distribution of molecular subtypes of advanced lung adenocarcinoma and clinical outcomes in a center of Argentina

The prevalence of relevant oncogenic drivers in lung adenocarcinoma varies in our region and data on clinical outcomes is scarce. The objective of the study was to describe the prevalence of KRAS, BRAF and EGFR mutations and ALK translocations in patients with advanced lung adenocarcinoma, and to depict the clinical outcome according to treatment strategies. Patients with adequate tumor biopsy sampling were included. KRAS, BRAF and EGFR mutations were studied by Sanger sequencing. ALK translocations were studied by fluorescent in situ hybridization (FISH) and immunohistochemistry (IH) with antibodies against ALK with clones D5F3 and 5A4. Informed consent was signed by 118 patients and 84 (72%) with complete molecular analysis were included. KRAS mutations were detected in 16 samples (19%), EGFR in 11 (13%), 9 of them conferring sensitivity to EGFR inhibitors, and BRAF mutations in 1 (1%). ALK translocations were detected in 3 samples (4%). Median follow-up was 42.4 [interquartile range (IQR): 27.0-64.2] months. Globally, median overall survival was 10.3 [IQR: 5.6-20.2] months. Median survival was 10.8 [IQR: 6.0-20.3] months in the group of patients without detectable molecular alteration, 9.6 [IQR: 3.7-16.1] months in KRAS mutant population (HR: 1.08; p = 0.82) and 32.5 [IQR: 19.6-38.4] months in patients with ALK translocations or sensitizing EGFR mutated tumors treated with tyrosine kinase inhibitors (HR: 0.27; p = 0.03). In conclusion, the prevalence of molecular alterations and outcomes in our population is similar to that reported in other studies in Western countries.

La prevalencia de alteraciones en oncogenes en adenocarcinoma de pulmón varía en nuestra región. El objetivo fue describir la prevalencia de mutaciones en KRAS, BRAF y EGFR y las translocaciones de ALK en pacientes con adenocarcinoma de pulmón y estudiar la supervivencia de acuerdo a subtipos moleculares. Se incluyeron pacientes con biopsias adecuadas para el estudio. Se evaluó el estado mutacional de KRAS, BRAF y EGFR por secuenciación con la técnica de Sanger. Las translocaciones de ALK se estudiaron por hibridación in situ por fluorescencia (FISH) e inmunohistoquimica (IHQ) contra ALK (clones D5F3 y 5A4). De 118 pacientes evaluados, se incluyeron 84 (72%) con análisis molecular completo. Se detectaron mutaciones de KRAS en 16 muestras (19%), EGFR en 11 (13%), y BRAF en 1 muestra (1%). Se detectaron rearreglos de ALK en 3 muestras (4%). La mediana de seguimiento de los pacientes fue de 42.4 [rango intercuatilo (RIC): 27.0-64.2] meses. Globalmente, la mediana de supervivencia en la población fue 10.3 [RIC: 5.6-20.2] meses y fue de 10.8 [RIC: 6.0 20.3] meses en pacientes sin alteraciones moleculares detectables. La mediana de supervivencia de los pacientes con mutación en KRAS fue de 9.6 [RIC: 3.7-16.1] meses (HR: 1.08; p = 0.82) y 32.5 [RIC: 19.6-38.4] meses en el grupo con rearreglos de ALK o mutaciones en EGFR tratados con inhibidores de tirosina quinasa (HR: 0.27; p = 0.03). En conclusión, la prevalencia de alteraciones moleculares en nuestra población fue similar a otros países occidentales.

Inflammatory myofibroblastic tumor of the prostate after transurethral resection of the prostate with negative expression of anaplastic lymphoma kinase: a case report

ABSTRACT CONTEXT: Inflammatory myofibroblastic tumors are a rare type of soft-tissue tumor. Inflammatory myofibroblastic tumors are characterized by rearrangements involving the anaplastic lymphoma kinase gene locus on 2p23. Case Report: We report the case of a 67-year-old Chinese male who presented with dysuria and fever. Magnetic resonance imaging showed an irregular prostatic mass with an isointense signal and obscure boundary. Histopathological evaluation showed that the mass consisted mainly of spindle-shaped cells. Immunohistochemical evaluation showed that the tumor cells were negative for anaplastic lymphoma kinase. CONCLUSIONS: Inflammatory myofibroblastic prostate tumors are rare lesions with unclear etiology. The pathological diagnosis is very important.

Análise da expressão imunoistoquímica da nucleofosmina, Ki67 e p53 como fatores prognósticos em câncer de pênis / Evaluation of prognostic value of the immunohistochemistry expression of the nucleophosmine, p53 and Ki67 in patients with penile carcinoma

O carcinoma epidermóide do pênis tem incidência significativa em países em desenvolvimento como o Brasil. O tratamento dos tumores invasivos consiste na ressecção da lesão primária e linfadenectomia bilateral, procedimento associado a alta taxa de morbidade. O estudo de fatores prognósticos do tumor primário pode ajudar na seleção dos pacientes candidatos às linfadenectomias. A expressão imunoistoquímica do ki-67, do p53 e da nucleofosmina (NPM) se associam a pior prognóstico em diversas neoplasias. Estudamos retrospectivamente 112 pacientes portadores de carcinoma epidermóide do pênis, submetidos a cirurgia do tumor primário no Departamento de Cirurgia Pélvica do AC Camargo Cancer Center. Os blocos de parafina foram revisados e submetidos a coloração imunoistoquímica para NPM, ki-67 e p53. A leitura foi realizada no dispositivo Aperio®. A imunorreatividade da NPM, Ki67 e p53 foi relacionada a fatores clínicos e patológicos: idade, estado civil, raça, tempo de evolução da doença, antecedentes venéreos, estadiamento clínico, espessura do tumor, grau de diferenciação, embolização linfovascular, estadiamento patológico, tipo de invasão. Analisamos quais fatores influenciaram o risco de metástases linfonodais e sobrevida global (SG) e livre de doença (SLD). Os testes estatísticos de associação utilizados foram o Qui-quadrado, teste de Fischer, a regressão logística múltipla. Na análise de sobrevida utilizamos o Kaplan e Meier, o Log-rank e o modelo de riscos proporcionais de cox. A imunorreatividade do p53 estava alta em 42,3% dos casos e se associou a maior ocorrência de recidivas, mas não a outras variáveis. A imunorreatividade do Ki67 estava alta em 89,1% dos casos e não se associou a nenhuma variável. A NPM apresentou imunoexpressão baixa em 50% dos casos e se associou a maiores estadios clínicos T e N e invasão de corpo cavernoso. A imunorreatividade do p53, da NPM e do Ki67 não se associaram a metástases linfonodais. A ocorrência de metástases linfonodais foi influenciada pelo estadiamento clínico N (p=0,001), grau de diferenciação (p=0,007), invasão vascular (p=0,004), invasão perineural (p<0,001), infiltração de corpos cavernosos (p=0,004), infiltração da uretra (p=0,013) e espessura tumoral (p=0,008). No modelo multivariado, estadiamento clínico N (RR=5,5); IC [1,4-20,8], infiltração de corpos cavernosos (RR=3,9); IC [1,2-12,3] e invasão perineural (RR=4,9); IC [1,5-16,2] foram fatores independentes de risco de metástases linfonodais. A SG ao final de 120 meses foi de 47,3% e foi influenciada por raça (p=0,009), recidivas (p=0,018), grau moderado e alto (p=0,031), infiltração de corpos cavernosos (p=0,037), invasão vascular (p=0,02), invasão perineural (p=0,030), espessura tumoral >5 mm (p=0,015) e metástases linfonodais (p=0,003). A imunoexpressão da NPM, do Ki67 e do p53 não influenciou a SG. Na análise multivariada, a invasão vascular (RR=1,9; IC [1,0-3,6]) se associou a menor SG. A SLD foi influenciada por infiltração de corpo cavernoso (p<0,001), infiltração da uretra (p=0,032), infiltração vascular (p<0,001), metástases linfonodais (p<0,001) e alta imunoexpressão do p53 (p=0,008). A imunorreatividade do Ki67 e da NPM não influenciaram a SLD. Na análise multivariada apenas a invasão de corpo cavernoso (RR=4,0; IC [1,4-11,3]) e a ocorrência de metástases linfonodais (RR=4,2;IC[1,4-13,1]) se associaram a menor SLD. Os resultados permitem concluir que a alta expressão do p53 se associou a pior SLD na análise univariada e a perda de expressão da NPM se associou a maiores estadios clínico e patológico

Penile carcinoma still has relevant incidence in developing countries like Brazil. The gold standard for the treatment of invasive lesions remains amputation followed by bilateral lymphadenectomy, procedures associated with high morbidity. The identification of prognostic factors could help to select the best candidates to lymphadenectomies. The immunoreactivity of p53, nucleophosmin (NPM) and ki67 has been associated with the prognosis of many tumors. A retrospective study of 112 patients with penile carcinoma submitted to amputation and lymphadenectomy at the Division of Urology of A.C.Camargo Cancer Center was undertaken to evaluate the prognostic value of immunoreactivity of p53, NPM and Ki67 in the primary tumor. The immunoreactivity of these proteins were correlated with the followed factors: age, race, marital status, time to diagnosis, venereal history, clinical stage, tumor thickness, histological grade, lymphovascular embolization, corpora cavernosa and urethra infiltration, pattern of invasion, lymph node metastasis, overall survival (OS) and disease free survival (DFS). The association among variables was done by the chi-square test and the survival analysis were performed with the Kaplan & Meier technique and the multi-factorial analysis by the Cox regression technique. The p53 immunoreactivity was high in 42,3% of the cases and was associated with high recurrence rates, but not with other variables. Ki67 immunoreactivity was high in 89,1% of the cases and was not associated with any variable. NPM immunostaining was considered low in 50% of the cases and was associated with higher clinical stages N and T and corpora cavernosa invasion, but not with other variables. There was no association between NPM, p53 and Ki67 immunostaining and lymph node metastasis. Clinical stage N (p=0,001), grade of differentiation (p=0,007), vascular invasion (p=0,004), perineural invasion (p<0,001), corpora cavernosa infiltration (p=0,004), urethral infiltration (p=0,013) and tumor thickness (p=0,008) were significant for the incidence of lymph node metastasis. The multivariate analysis revealed that clinical stage N (RR=5,5; CI [1,4-20,8]), corpora cavernosa infiltration (RR=3,9; CI [1,2-12,3]) and perineural invasion (RR=4,9; CI [1,5-16,2]) were significant for the incidence of lymph node metastasis. The OS at the end of 120 months was 47,3% and was influenced by race (p=0,009), recurrences (p=0,018), moderate or high pathologic grade (p=0,031), corpora cavernosa infiltration (p=0,037), lymphovascular embolization (p=0,02), perineural invasion (p=0,030), tumor thickness (p=0,015) and lymph node metastasis (p=0,03). There was no association between p53, NPM and Ki67 immunoreactivity and OS. Multivariate analysis revealed that vascular invasion (RR=1,9; CI [1,0-3,6]) influenced OS. DFS was influenced by corpora cavernosa infiltration (p<0,001), urethra infiltration (p=0,032), lymphovascular embolization (p<0,001), lymph node metastasis (p<0,001) and p53 immunostaining (p=0,008). NPM and Ki67 immunoreactivity did not influence DFS. Multivariate analysis revealed that corpora cavernosa infiltration (RR=4,0; CI [1,4-11,3]) and lymph node metastasis (RR=4,2; CI [1,4-13,1]) influenced DFS. These results showed that higher p53 expression was associated with a worst DFS at univariate analysis and the low NPM imunoexpression was associated with higher clinical and pathological stages

Asociación de carcinoma ductal infiltrante de mama y linfoma no hodgkin anaplásico de células B grandes. Presentación de un caso clínico / Association of breast ductal carcinoma and anaplastic Non-Hodgkin Lyphoma of big B cells

Se presenta el caso de una paciente de 63años de edad a quien se le realizó mastectomía radical modificada del seno derecho, con vaciamiento axilar, después de biopsia trucut de mama que reportó carcinoma ductal infiltrante pobremente diferenciado, grado nuclear 3, con receptores de estrógenos y progestágenos positivos, y con estatificación IIIA. El estudio histopatológico del espécimen quirúrgico confirmó el diagnóstico de la biopsia de carcinoma ductal infiltrante moderada-mente a mal diferenciado, grado nuclear 3,encontrándose invasión linfática

We present the case of a 63-year-old female patient who underwent a modified radical mastectomy of the right breast, with axillary emptying, after a trucut breast biopsy that reported a poorly differentiated infiltrating ductal carcinoma, nuclear grade 3, estrogen and progestin receptor positive, and with staging IIIA. Histopathological study of the surgical specimen confirmed the biopsy diagnosis of moderately to poorly differentiated infiltrating ductal carcinoma, nuclear grade 3, with lymphatic invasion