Extramammary Paget's disease of the breast: an unusual location with prognostic implications.

Extramammary Paget's disease is a neoplastic process of intraepidermal origin; its management and prognosis are very different from those of mammary Paget's disease. We present a case of extramammary Paget's disease located in the breast. This is an exceptional location, whose differential diagnosis is important because of its therapeutic and prognostic implications.

Palpable breast lesions: utility of Doppler sonography for diagnosis of malignancy.

This study was designed to find whether there are any differences between benign and malignant palpable breast lesions as they are seen on grey-scale and colour-Doppler and on power-Doppler sonography; to determine which variables for each technique are most helpful in distinguishing any such differences; and to see whether the use of an echo-enhancing agent gives better results in the differential diagnosis. Forty-five palpable breast lesions (16 benign and 29 malignant) were evaluated in a preoperative study using grey-scale sonography, colour-Doppler sonography and power-Doppler sonography before and after administration of an echo-enhancing agent (Levovist). We reached the following conclusions: (1) In the grey-scale ultrasound study of palpable breast lesions the presence of microcalcifications, acoustic shadowing and non-well-defined margins are related to malignancy. (2) Colour- and power-Doppler sonography may help in the differential diagnosis. (3) The use of an echo enhancer (Levovist) accentuates these differences and enables them to be noted in other variables, such as pulsatility index, nodule-to-vascularity ratio and number of poles.

Primitive leiomyosarcoma of the breast: case report and review of the literature.

Sarcomas of the breast account for under 1% of breast tumours. Leiomyosarcomas are less common, being a subgroup of sarcomas of the breast. Only 23 cases with immunohistochemical or electron microscopy confirmation are reported in the literature. The case of a 58-year-old woman with a leiomyosarcoma 4 cm in diameter in the upper external quadrant of the right breast is presented. Mammography and sonography were compatible with a fibroadenoma or phylloides tumour, and fine-needle aspiration (FNA) suggested medullary carcinoma. The patient underwent a Madden-type modified radical mastectomy and axillary lymphadenectomy. Adjuvant chemotherapy was implemented with Adriamycin (four cycles of 21 days). One year after surgery the patient is tumour free.

A case of breast cancer associated with juvenile papillomatosis of the male breast.

Juvenile papillomatosis of the breast (JPB) was first described in 1980 and is occasionally associated with breast cancer. The literature reports only four cases of JPB in males; none of them associated simultaneously with breast cancer. We present a case of a male with JPB associated with a ductal carcinoma in the same gland.

[Usefulness of quantification and visual analysis of the uptake of (99m)Tc-MIBI in the diagnosis of mammary lesions]. / Utilidad de la cuantificación y análisis visual de la captación de (99m)Tc-MIBI en el diagnóstico de lesiones mamarias.

OBJECTIVE: Scintigraphy studies with (99m)Tc-MIBI are widely used in the diagnosis of non-invasive breast cancer and their results have been verified by many studies. However, the scintigraphic technique produces erroneous false negative and positive results. This study aims to verify how the different characteristics of the uptake of (99m)Tc-MIBI (intensity, size, morphology, etc.) can help to increase sensitivity and specificity of breast scintigraphy. MATERIALS AND METHODS: We have studied 201 patients (84 breast cancer and 117 benign lesions). All of them underwent a breast scintigraphy with (99m)Tc-MIBI and anatomopathological study. A semiquantitative analysis (by T/F indexes) and visual study were performed in the lesions that presented radiodrug uptake. RESULTS: Eleven false positive results and 8 false negative results were obtained in the study of the 201 patients. The analysis of the T/F indexes did not demonstrate any significant differences between the benign and malignant lesions (p>0,05). There is a statistically significant correlation (p<0.05) between the tracer uptake morphology and the AP diagnosis and between the localization of the lesion in a breast quadrant and the uptake intensity. CONCLUSIONS: Quantification of (99m)Tc-MIBI uptake by T/F indexes does not provide any conclusive data on the lesion's malignancy, however, a more detailed analysis of the characteristics of the tracer uptake would permit us to make the correct diagnosis and would reduce the false positive and negative results of this technique.

Lung volume reduction surgery after lung transplantation for emphysema-chronic obstructive pulmonary disease.

Lung Volume Reduction Surgery (LVRS) has become a palliative treatment for patients with advanced emphysema and disabling dyspnea. After single lung transplantation in chronic obstructive pulmonary disease, LVRS may be indicated to improve graft dysfunction caused by native lung hyperinflation compressing the grafted lung. This common complication is the subject of our study, which showed LVRS to be helpful to manage this situation. We performed an observational retrospective and descriptive study using the data of 293 patients transplanted in our center between January 1996 and October 2011. Some of the patients who underwent a single lung transplantation developed native lung hyperinflation years after the transplantation, interfering with respiratory function due to graft compression.

Lung cancer in patients with lung transplants.

OBJECTIVE: The aim of our study was to describe the incidence of lung cancer in patients after lung transplantation (LT). MATERIALS AND METHODS: We performed an observational, retrospective, descriptive study based on data from 340 patients undergoing lung transplantation between October 1993 and December 2010. We collected data about the donors, recipients, intra- and postoperative periods, and survivals. RESULTS: We identified 9 (2.6%) patients who developed lung cancer after LT. Their average age was 56 ± 9.3 years (range, 18-63). All cases were men with 8/9 (88.8%) having received a single lung transplant. All cancers developed in the native lung. The indications for transplantation were: emphysema type chronic obstructive pulmonary disease (COPD; n = 5), idiopathic pulmonary fibrosis (n = 3), or cystic fibrosis (n = 1); 77% of them were former smokers. All of the COPD patient were affected. The interval from transplantation to diagnosis was 53.3 ± 12 months (range 24-86). Survival after cancer diagnosis was 49.3 ± 6.3 (range = 0-180) months. CONCLUSIONS: LT was associated with a relatively high incidence of lung cancer, particularly in the native lung. In our series, lung cancer was related more to patients with emphysema-type COPD and a history of smoking. We believe that these patients should be closely followed to establish the diagnosis and apply early treatment.

Results of lung transplantation in idiopathic pulmonary fibrosis patients.

Lung transplantation (OLT) remains the only available therapy for patients with end-stage idiopathic pulmonary fibrosis (IPF). The objective of this study was to review our experience of OLT for end-stage IPF (IPFLT) patients, seeking to identify variables associated with survival for comparison with outcomes of other indications for LT (OILT). From October 1993 to December 2009, we performed 310 consecutive OLT in 301 patients for treatment of various end-stage pulmonary conditions. The indications for OLT were: IPF (n=89, 30.5%) chronic obstructive pulmonary disease (n=82), cystic fibrosis (n=80), bronchiectasis (n=12), alfa-1-antitrypsin deficit (n=6), primary pulmonary hypertension (n=4), bronchiolitis obliterans (n=4), other conditions (n=15). We observed significant differences in the actuarial survival between the IPFLT and the OILT groups particularly at the expense of worse perioperative 30-day and early 1-year mortality in the IPFLT group. Upon univariate and multivariate analyses, the need for cardiopulmonary bypass, previous recipient ventilator dependence, and donor age>50 years were all associated with poorer survival rates among IPF patients. In our experience, survival did not differ between patients who underwent a single versus a bilateral sequential lung transplant (BSLT); however, BSLT cases were associated with short-term damage but long-term survival. The functional results in the IPFLT group were excellent. We observed significant improvements in the values of arterial oxygen pressure (PaO2), arterial carbon dioxide pressure (PaCO2), forced vital capacity (FVC%) and forced expiratory volume in 1 second (FEV1%) at 6, 12, and 36 months compared to their pretransplant baseline results.

Experience of the Reina Sofia hospital in lobar lung transplantation.

The number of patients awaiting lung transplantation has steadily increased over the past decade, but the number of donors has remained relatively stable. Owing to the increasing scarcity of donor lungs, especially for pediatric and small adult recipients, advanced operative strategies for the use of larger grafts for smaller recipients have been developed. Size matching between donors and recipients represents one of the organ distribution criteria widely accepted by lung transplantation teams. However, in some cases it is not possible to allocate a donor to the corresponding size-compatible recipient. To avoid possible complications derived from the implantation of oversized lungs into smaller recipients, various methods of downsizing are applied for cadaveric donor lungs, such as lobar transplantation. We review our experience in 6 patients undergoing volume reduction of the lung graft by lobar resection at the time of transplantation. Graft volume reduction by anatomic resection (lobar transplantation) is a reliable and safe procedure to overcome size disparities between the donor and the recipient of a lung transplant, and thus to maximize the number of donors.

Cosmogenic neutrinos and signals of TeV gravity in air showers and neutrino telescopes.

The existence of extra dimensions allows the possibility that the fundamental scale of gravity is at the TeV. If that is the case, gravity could dominate the interactions of ultrahigh energy cosmic rays. In particular, the production of microscopic black holes by cosmogenic neutrinos has been estimated in a number of papers. We consider here gravity-mediated interactions at larger distances, where they can be calculated in the eikonal approximation. We show that for the expected flux of cosmogenic neutrinos these elastic processes give a stronger signal than black hole production in neutrino telescopes. Taking the bounds on the higher-dimensional Planck mass M(D) (D=4 + n) from current air shower experiments, for n=2(6) elastic collisions could produce up to 118 (34) events per year at IceCube. On the other hand, the absence of any signal would imply a bound of M(D) > or approximately 5 TeV.

TeV strings and the neutrino-nucleon cross section at ultrahigh energies.

In scenarios with the fundamental unification scale at the TeV one expects string excitations of the standard model fields at accessible energies. We study the neutrino-nucleon cross section in these models. We show that duality of the scattering amplitude forces the existence of a tower of massive leptoquarks that mediate the process in the s channel. Using the narrow-width approximation we find a sum rule for the production rate of resonances with different spin at each mass level. We show that these contributions can increase substantially the standard model neutrino-nucleon cross section, although they seem insufficient to explain the cosmic ray events above the Greisen-Zatsepin-Kuz'min cutoff energy.

Familial papillary carcinoma of the thyroid: report of three families.

OBJECTIVE: To report our experience of the clinical characteristics, treatment and outcome of familial papillary carcinoma. DESIGN: Descriptive study. SETTING: Tertiary referral centre, Spain. PATIENTS: Eight patients from three families. INTERVENTIONS: Treatment for familial papillary carcinoma of thyroid. MAIN OUTCOME MEASURES: Age, sex, reason for consultation, preoperative investigation, indication for operation and type, variety of papillary carcinoma and characteristics (size, adenopathies, multicentricity and bilaterality), treatment with 131I, and outcome. RESULTS: The mean (SD) age was 46 (14) years, and seven were women. In all but one patient, who was admitted for hypercalcaemia and operated on for primary hyperparathyroidism, cervical palpation and ultrasound showed a thyroid nodule. Needle aspiration suggested papillary carcinoma in 6/7, who were all treated by total thyroidectomy. Four patients with enlarged nodes also had bilateral neck disection. All the papillary carcinomas were well-differentiated, mean (SD) diameter was 1.5 (1) cm and in four were microcarcinomas. Three patients presented with invaded nodes. They were all treated postoperatively with 131I, except the patient with hyperparathyroidism who had a microcarcinoma of 0.5 cm. After a median (range) follow-up of 1 (0, 6-7) years the patients are well, except one had a high thyroglobulin concentration seven years later; however clinical exploration and morphological screening were within normal limits and he was treated with 131I 5.6 x 10(9) Bq. CONCLUSIONS: About a third of familial papillary carcinomas of the thyroid have lymph node involvement at the time of diagnosis, and have a relatively good prognosis if treated in accordance with the stage of the disease.

El arco axilar de Langer: una variación anatómica con importancia quirúrgica / No disponible

El arco muscular de Langer es la variación anatómica muscularmás frecuente de la axila, y su existencia puede llegar acondicionar el resultado de gestos diagnósticos y terapéuticosrelevantes, como es el caso de la linfadenectomía. También seha relacionado con cuadros clínicos derivados de la compresiónde estructuras neurovasculares de la axila. Presentamosdos casos de arco axilar y se realizan consideraciones anatómicas,clínicas y diagnósticas que apoyan la importancia de estaestructura desde el punto de vista quirúrgico(AU)

The muscular arch of Langer is the most common anatomicalmuscular variation in the axilla, the existence of whichmay condition the result of relevant diagnostic and therapeuticinterventions, such as in the case of lymphadenectomy. It hasalso been related to clinical features derived from the compressionof neurovascular structures in the axilla. We present twocases of axillary arch and address anatomical, clinical and diagnosticissues to support the importance of this structure from asurgical point of view(AU)

Fibroadenoma en tejido mamario ectópico axilar / No disponible

La aparición de un tumor axilar obliga a realizar el diagnósticodiferencial con diversas entidades benignas y malignas. Laexistencia de tejido mamario ectópico en la axila es uno de loscuadros benignos que se deben considerar. Más infrecuente esencontrar patología asociada a ese tejido de localización anómala.En este trabajo presentamos el caso de una pacientecon un fibroadenoma dependiente de una glándula axilar ectópica(AU)

An axillary tumour appearance forces to do a differential diagnosisamong several benign and malignant entities. Axillaryectopic breast is one of the benign processes to be considered.Related pathology to this anomalous localised tissue is a moreinfrequent event. In this work we present a case of fibroadenomainside axillary ectopic breast gland(AU)

Fístula quilosa postlinfadenectomía axilar / No disponible

Dentro de las complicaciones de la linfadenectomía axilar,el diagnóstico de una fístula quilosa es un hecho excepcionalque puede interferir con el manejo posterior de lospacientes, especialmente en aquellos casos oncológicos queprecisan tratamientos adyuvantes. Se presenta un caso clínicode fístula quilosa postlinfadenectomía axilar por cáncerde mama. Se realiza una revisión de la literatura y se comentandiversos aspectos de su patogenia, diagnóstico ytratamiento

The diagnosis of a chylous fistula is an exceptional eventamong the complications of axillary lymphadenectomy thatcan interfere with the management of these patients, speciallythose oncologic cases that need adjuvant treatments. We presenta case of chylous fistula secondary to axillary postlymphadenectomyin the treatment of a breast cancer. A literaturereview is made and we comment about several aspects of itspatogeny, diagnosis and management (AU)

Angiosarcoma de mama postradioterapia ¿un tumor de importancia creciente? / No disponible

El angiosarcoma postradioterapia es un tumor raro que surgeasociado al tratamiento conservador del cáncer de mama.Es preciso diferenciarlo de otras formas de angiosarcoma relacionadoscon la mama como son el angiosarcoma primario yel síndrome de Stewart-Treves. Suelen presentarse como sarcomasde alto grado localizado en la piel o tejido subcutáneoy con menos frecuencia en el parénquima mamario. Tienenun periodo de latencia variable aunque inferior al de otros sarcomasradioinducidos. El único tratamiento curativo es la cirugía,si bien la elevada tendencia a la recurrencia de estos tumoreshace que la cirugía radical no sea capaz de prevenir lareaparición de la enfermedad en muchos casos. Presentamosdos casos de angiosarcoma radioinducido con distinta evolucióntras su tratamiento(AU)

Postradiation angiosarcomas are infrequent tumours thatarise associated to conservative treatment of breast cancer. Itis needed to distinguish between them and other types of breastangiosarcomas like primary angiosarcoma or Stewar-Trevessyndrome. They usually present as high grade sarcomaslocated at skin or subcutaneous tissue and less frequent in breastparenchyma. They have a variable latency time that is lowerthan the other radioinduced sarcomas. Surgery is the onlycurative treatment although the high relapse rate makes thatradical surgery is not be able to prevent the recurrence in mostcases. We present two cases of radioinduced angiosarcomawith different outcome after their treatment(AU)