Construction of Low-Cost Simulators for Training in Minimally Invasive Breast Procedures.

Objective: The aim of this work was to describe a technique for building low-cost simulators for training in minimally invasive breast procedures guided by ultrasound (US) and stereotactic mammography (MMG), focusing mainly on training medical professionals studying related areas. Materials and Methods: Low-cost phantoms were developed using organic structures that mimic breast tissue, such as chicken breast and eggplant, and materials that simulate breast lesions. A step-by-step description of the preparation and use of these simulators was made, enabling the reproducibility of the technique by the physicians in training themselves. Results: The low-cost phantoms showed a high degree of echogenic and radiological similarity with human breast tissue, allowing adequate training in minimally invasive procedures. Conclusion: It was possible to build low-cost phantoms that allow training in US- and stereotactic MMG-guided minimally invasive breast procedures.

Evaluation of the histological and immunohistochemical subtype of breast cancer patients from a referral hospital in the inland of the state of São Paulo

Introduction: The immunohistochemical markers used in breast cancer cases allow the classification of tumors into four subtypes: luminal A (1), luminal B (2), HER2 positive (3), and triple-negative or basal-like (4). This study aimed to evaluate the histological and immunohistochemical profile of breast cancer patients from a referral hospital in the inland of the state of São Paulo and understand the particularities of the prognosis based on the tumor-node-metastasis staging. Methods: This retrospective observational epidemiological cohort study was carried out at Hospital Regional de Presidente Prudente, with the first half of 2020 as the time frame. The research target population was women diagnosed with breast cancer who underwent immunohistochemical examination. We excluded patients with breast carcinoma in situ and incomplete medical records, which made data analysis impossible. After classifying the cases into four molecular subtypes based on immunohistochemistry, identifying the histological grade, and verifying the pathological staging criteria, we gathered the data and addressed the pathological-prognostic staging to investigate the prognosis of each patient. Results: We analyzed 49 patients with a complete immunohistochemical profile. Among them, luminal A (44.9%) was the most prevalent molecular subtype, followed by luminal B (36.7%). The least prevalent subtypes were triple-negative (16.8%) and HER2 (2%). Pathological-prognostic staging was possible in 73.5% of cases. Conclusions: The molecular subtype is important for tumor evaluation and has direct implications for the staging of breast cancer patients.

Evaluation of breast pathologies in puerperal women assisted at a philanthropic hospital in Presidente Prudente (SP), Brazil: longitudinal cohort

Breast milk is the main source of nourishment for the healthy growth and development of newborns up do six months, and after that, it serves as a supplement up to two years. The act of breastfeeding, in addition to being an important means of forming an affective bond between the mother and infant, also promotes maternal, social and environmental benefits. Although its importance has been proven, it is known that there are several reasons that lead to the early interruption of breastfeeding, including breast complications. Our aim was to determine the incidence of complications related to breastfeeding in puerperal women seen at Hospital Regional, a philanthropic hospital in Presidente Prudente (SP) and the possible factors that led to their appearance as well. Methods: A quantitative-qualitative longitudinal study was carried out with puerperal women cared for at Hospital Regional of Presidente Prudente. A structured interview was administered in three stages: the first during the puerperal women's hospitalization and the others, through telephone contact at respectively 30 and 90 days after delivery, to monitor breastfeeding. Results: Of the total number of patients interviewed, 24.3% had some breast complications resulting from breastfeeding. Still in the immediate postpartum period at 30 days, this proportion reached 42.23%, decreasing at 90 days to 17.47%. Furthermore, of the puerperal women that showed any complication, 74% of them were single, 54% had brown skin color, 42.9% had completed high school and 52% were primiparous. Moreover, the patients who had a Cesarean section (53,8%) showed more complications than the ones who had natural childbirth (35,1%).

Ductal Carcinoma in situ: Underestimation of Percutaneous Biopsy and Positivity of Sentinel Lymph Node Biopsy in a Brazilian Public Hospital.

BACKGROUND: Mammography screening has become widely spread and provided a marked increase in ductal carcinoma in situ (DCIS) diagnosis. In DCIS, the ductal epithelium proliferates without invasion through the basal cell membrane. However, histologic underestimation can happen in some cases. OBJECTIVE: To analyze the rate of histologic underestimation (histopathologic results upgraded to invasive carcinoma after surgery) and the rate of positive results of sentinel lymph node biopsy (SLNB) in patients diagnosed with DCIS in a Brazilian public hospital. METHODS: We reviewed medical records of all consecutive patients admitted between 2009 and 2013 whose initial diagnosis was DCIS through core needle biopsy. DCIS cases with a high risk of invasion underwent SLNB. We excluded cases with invasion or micro-invasion components in the first biopsy. RESULTS: A total of 86 women were included, most with microcalcifications as the primary radiological lesion (73.2%), and underwent preoperative biopsy, with an invasive component in 21 (24.4%) in the final pathology report. Most had invasive carcinoma of no special type (NST): 52.3% (n = 11) and microinvasive tumors (7 cases, 33.3%). The main factors associated with histologic underestimation were nodular lesion (61.9%, p<0.001) and an ultra-sonography-guided biopsy (71.4%, p=0.0005). The positivity rate of SLNB was 4.3%. All these patients underwent mastectomy, and the initial histologic pattern was solid DCIS. CONCLUSION: The "histologic underestimation" rate among patients with DCIS was not low, and less than 5% of patients who underwent SLNB had axillary positivity. This result suggests that patients who have DCIS and a high risk of invasion and undergoing mastectomy should have SLNB. As to the patients who will undergo lumpectomy, SLNB could be omitted and could be performed if patients have upgraded to invasive breast cancer.

Metachronic Breast and Cerebellar Neoplasm in a Young Patient.

Several factors trigger the development of genetic mutations that are responsible for causing a neoplasm. Medulloblastoma is a malignant and invasive cerebellar neoplasm, that affects children and young adults. Mucinous carcinoma is a special type of breast cancer. Being a special atypical subtype of invasive carcinoma, it most frequently affects women of advanced age and represents 1 to 7% of all breast cancers. The reported case aims to show the rarity of the occurrence of desmoplastic medulloblastoma and mammary mucinous carcinoma in a young patient in a short period of time, in different sites, without direct anatomical attachment and without occurrence of metastasis. Initially, this patient had a desmoplastic medulloblastoma and was treated with lumpectomy and radiotherapy. After 13 months, the patient was diagnosed with a mucinous breast carcinoma, underwent mastectomy, adjuvant chemotherapy and is currently undergoing endocrinotherapy. We conclude, based on the metachronous characteristic of the neoplasia and clinical characteristics, that the patient is likely to have Li-Fraumeni syndrome, an autosomal dominant disease with mutation of the TP53 gene, which is the the main involved. Because the patient does not present all the characteristics of the phenotype of the syndrome, she can thus be classified as having Li-Fraumeni variant or Li-Fraumeni-like syndrome.

Diversos fatores desencadeiam o desenvolvimento de mutações genéticas que são responsáveis por originar uma neoplasia. O meduloblastoma é uma neoplasia cerebelar maligna e invasiva que acomete crianças e adultos jovens. O carcinoma mucinoso é um tipo de câncer de mama especial por ser um subtipo atípico de carcinoma invasivo, que acomete com maior frequência mulheres de idade avançada e representa entre 1 a 7% do total de neoplasias mamárias. O caso relatado tem como objetivo mostrar a raridade da ocorrência do meduloblastoma desmoplásico e carcinoma mucinoso mamário em uma paciente jovem em um curto período de tempo, em diferentes sítios sem ligação anatômica direta e sem ocorrência de metástase. Inicialmente, esta paciente possuía um meduloblastoma desmoplásico e foi tratada com tumorectomia e radioterapia. Após 13 meses, a paciente foi diagnosticada com carcinoma mucinoso de mama, sendo submetida a mastectomia, quimioterapia adjuvante e atualmente está sendo tratada com endocrinoterapia. Concluímos, com base na característica metacrônica da neoplasia e características clínicas, que a paciente apresenta a síndrome de Li-Fraumeni, doença autossômica dominante com mutação do gene TP53, que é o principal gene envolvido nesta síndrome. Por não apresentar as características completas do fenótipo da síndrome, a paciente pode assim ser classificada como portadora de uma variante da síndorme de Li-Fraumeni ou síndrome do tipo Li-Fraumeni.

Metachronic breast and cerebellar neoplasm in a young patient / Neoplasias mamária e cerebelar metacrônicas em uma paciente jovem

Abstract Several factors trigger the development of genetic mutations that are responsible for causing a neoplasm. Medulloblastoma is a malignant and invasive cerebellar neoplasm, that affects children and young adults. Mucinous carcinoma is a special type of breast cancer. Being a special atypical subtype of invasive carcinoma, it most frequently affects women of advanced age and represents 1 to 7% of all breast cancers. The reported case aims to show the rarity of the occurrence of desmoplastic medulloblastoma and mammary mucinous carcinoma in a young patient in a short period of time, in different sites, without direct anatomical attachment and without occurrence of metastasis. Initially, this patient had a desmoplastic medulloblastoma and was treated with lumpectomy and radiotherapy. After 13 months, the patient was diagnosed with a mucinous breast carcinoma, underwent mastectomy, adjuvant chemotherapy and is currently undergoing endocrinotherapy. We conclude, based on the metachronous characteristic of the neoplasia and clinical characteristics, that the patient is likely to have Li-Fraumeni syndrome, an autosomal dominant disease with mutation of the TP53 gene, which is the the main involved. Because the patient does not present all the characteristics of the phenotype of the syndrome, she can thus be classified as having Li-Fraumeni variant or Li-Fraumeni-like syndrome.

Resumo Diversos fatores desencadeiam o desenvolvimento de mutações genéticas que são responsáveis por originar uma neoplasia. O meduloblastoma é uma neoplasia cerebelar maligna e invasiva que acomete crianças e adultos jovens. O carcinoma mucinoso é um tipo de câncer de mama especial por ser um subtipo atípico de carcinoma invasivo, que acomete com maior frequência mulheres de idade avançada e representa entre 1 a 7% do total de neoplasias mamárias. O caso relatado tem como objetivo mostrar a raridade da ocorrência do meduloblastoma desmoplásico e carcinoma mucinoso mamário em uma paciente jovem em um curto período de tempo, em diferentes sítios sem ligação anatômica direta e sem ocorrência de metástase. Inicialmente, esta paciente possuía um meduloblastoma desmoplásico e foi tratada com tumorectomia e radioterapia. Após 13 meses, a paciente foi diagnosticada com carcinoma mucinoso de mama, sendo submetida a mastectomia, quimioterapia adjuvante e atualmente está sendo tratada com endocrinoterapia. Concluímos, com base na característica metacrônica da neoplasia e características clínicas, que a paciente apresenta a síndrome de Li-Fraumeni, doença autossômica dominante com mutação do gene TP53, que é o principal gene envolvido nesta síndrome. Por não apresentar as características completas do fenótipo da síndrome, a paciente pode assim ser classificada como portadora de uma variante da síndorme de Li-Fraumeni ou síndrome do tipo Li-Fraumeni.

Anaplastic lymphoma mimicking breast carcinoma / Linfoma anaplásico mimetizando carcinoma mamário

This case describes an uncommon presentation of ALK-negative anaplastic large T-cell lymphoma with breast infiltration, mimicking triple-negative carcinoma. The incidence of ALK-negative anaplastic large T-cell lymphoma usually occurs in adults in their fifth and sixth decade of life and can affect lymph nodes and extranodal sites, including skin, soft tissue, and gastrointestinal tract. The non-Hodgkin's lymphoma of the breast is uncommon, accounting for 0.04 to 0.05% of all malignant breast tumors. Diagnosis of ALK-negative anaplastic large T-cell lymphoma is challenging both to physicians and pathologists. Based on the complete medical history, clinical and imaging exams and histopathological evaluation of the lesion site biopsy, it is possible to establish an adequate diagnosis. The case describes a woman aged 37 years with palpable nodules in the left breast as well as erythematous lesions on the right leg. The analysis of the breast nodules biopsy shows that they mimic triple-negative carcinoma. However, only with immunohistochemical examination was it possible to verify the expression of the CD30 antigen, and only after a complete systemic evaluation, the diagnosis of ALK-negative anaplastic large T-cell lymphoma was performed. Misdiagnosis can lead to inadequate therapy and result in disease progression or unnecessary damages to the patient.

Este caso descreve uma incomum apresentação de linfoma anaplásico de grandes células T ALK negativo com infiltrado mamário, mimetizando carcinoma triplo negativo. A incidência do linfoma anaplásico de grandes células T ALK negativo, ocorre comumente em adultos na quinta e sexta década de vida e pode acometer linfonodos e locais extranodais, incluindo pele, tecido mole e trato gastrointestinal. O linfoma não-Hodgkin da mama é incomum, compondo 0,04 a 0,05% de todos os tumores de mama malignos. O diagnóstico de linfoma anaplásico de grandes células T ALK negativo é desafiador tanto para clínicos como para patologistas. O estabelecimento de um diagnóstico adequado é possível com base em histórico médico completo, exames clínicos e de imagem e avaliação histopatológica da biópsia do local da lesão. O caso relata uma mulher de 37 anos com nódulos palpáveis na mama esquerda em conjunto com lesões eritematosas na perna direita. Ao se analisar a biópsia dos nódulos da mama, esses mimetizavam carcinoma triplo negativo, no entanto, somente com exame imunohistoquímico foi possível verificar a expressão do antígeno CD30, e, apenas após uma avaliação sistêmica completa, foi realizado o diagnóstico de linfoma anaplásico de grandes células T ALK negativo. O diagnóstico equivocado pode acarretar terapia inadequada e resultar em progressão da doença ou em danos desnecessários ao paciente.