[Metaplastic carcinoma of the breast and the impact of the p63 and cytokeratin 5/6: experience of 40 patients]. / Carcinoma metaplásico de mama y repercusión de la expresión de p63 y citoqueratina 5/6: experiencia de 40 pacientes.

BACKGROUND: Metaplasic carcinoma of the breast was initially described by Huvos in 1974. It is a rare and aggressive entity characterized by the presence of mesenchymal and epithelial components. OBJECTIVE: To know the incidence and biologic behaviour of the metaplasic carcinoma of the breast at the Instituto de Enfermedades de la Mama, FUCAM, AC. METHODS: Data on women diagnosed with metaplasic carcinoma of the breast between January 2005 and December 2014 was collected by retrospectively reviewing in FUCAM. Clinical, pathological and immunohistochemical characteristics were assessed. The five-year disease-free survival (DFS) and overall survival (OS) were evaluated. RESULTS: a total of 4198 patients have been diagnosed with breast cancer in our institution, 40 (0.95%) of them with metaplasic carcinoma. The median age of the patients was 46 years (27-73). 60% of the patients were diagnosed with an advanced clinical stage (III) and the triple-negative subtype was the most frequently found. A mean follow-up of 24 months showed rates of overall survival and disease-free survival of 80% and 69.9%, respectively. The presence of both, cytokeratins 5/6 and p63, seems to have a negative impact in local recurrence. CONCLUSION: this study demonstrates that metaplasic carcinoma is a rare and aggressive disease. Expression of both tumor cytokeratins was associated with a worse outcome.

[Breast Cancer Survival: Clinical andPathological Prognostic Factors Analysis]. / Supervivencia de pacientes con cáncer de mama. Análisis por factores pronóstico, clínicos y patológicos.

Background: Breast cancer is the leading cause of cancer death in women in Mexico, is a heterogeneous disease, and knowledge of prognostic factors are critical in making treatment decisions. Objetive: determine the overall survival (OS) and disease-free survival (DFS) at 5 years, analyzed by risk groups. Material and methods: Patients diagnosed with breast treated at the Institute of Breast Diseases FUCAM from July 2005 to December 2014 were included. Simple frequencies were used for analysis of the general characteristics, and 5- year OS and DFS were analyzed using Kaplan-Meier curves. A subset analysis of the clinical stage and comparing survival in those patients diagnosed by mammography screening program was performed. Results: 4,902 patients with breast cancer were included, general clinical and pathological features are described and 3,762 patients were included for analysis of 5-year OS and DFS. The average age at diagnosis was 53.7 years; 13.3% were <40 years, which deleteriously reflects on the supervivencia global 76 vs 84% in >40. At diagnosis predominated locally advanced stages (45%), OS and DFS at 5 years was 96.8 ± 0.6% and 93.4%±0.9 respectively for early stages, 74.6 ± 1.7% and 68.7 ± 2% for locally advanced and 35.9 ± 5.1% and 37.4 ± 10.3% for metastatic tumors. Women diagnosed in the screening program had significantly better OS and DFS compared with symptomatic patients (95 and 93% vs 79 and 77%). For biological subtypes, OS and DFS was 89 and 84% for luminal, 81 and 81% for luminal Her +, 74 and 78% for pure Her 2, and 69 and 73% for triple negative. Conclusion: Knowledge of the prognostic factors that affect survival of patients with breast cancer is essential for categorizing risk groups and to individualize treatment in order to improve life expectancy.

Multifactorial analysis of survival and recurrences in differentiated thyroid cancer. Comparative evaluation of usefulness of AGES, MACIS, and risk group scores in Mexican population.

Many risk factors have been identified in differentiated thyroid cancer, with them, some prognostic scores have been designed to asign the risk of recurrence and survival. In Mexican population, this type of study is scarce. This is a retrospective review of 180 patients with differentiated thyroid cancer completely treated at the Hospital de Oncologia, IMSS, in Mexico City from 1980 to 1990. All prognostic factors were analyzed and a score obtained either by the method of AGES, MACIS, or SKMH. Correlation of recurrences and survival was carried out according to score or risk assignment. There was a predominance of females (4.8:1), 48% had metastatic cervical nodes, median tumor size was 4 cm, 16% had multiple macroscopic thyroid tumors, in 12% resection was incomplete, 96% were papillary, and 4% follicular cancers. According to AGES, 46% were high risk patients, 49.4% with MACIS and 45.5% with SKMH, respectively. Median follow-up was 8.3 years. There were 67 (37%) recurrences. Ten-year overall survival was 89.4% and disease-free survival was 79.2%. There was no statistical significant difference of survival of AGES until the score reached 6 or more or the MACIS score reached 8 or more. Cox multivariate model showed that above the age of 45, tumor size of 5 cm or more, follicular histology, multiple macroscopic thyroid tumors, and extracapsular node invasion affected ten-year survival. In conclusions our patients are diagnosed at more advanced stages than patients in the U.S. or European countries. Nearly one half of our patients belonged to the high-risk group. This study confirms that patients over the age of 45, tumor size > 5 cm, and follicular histology are adverse prognostic factors and report that extracapsular node invasion and multiple macroscopic thyroid tumors are also adverse prognostic factors. In Mexican population, with 50% of high-risk patients, AGES and MACIS scores reached statistical differences with higher qualifications than observed in the U.S.

[Breast cancer in Mexico. Is it a young women disease?]. / Cáncer de mama en México. Enfermedad de mujeres jóvenes?

Breast cancer in México has the second place in frequency in general population (10.6%) as well as in females (16.4%). There has been found an increase in mortality from 3.6, in 1985, to 6 x 100,000 inhabitants, in 1994. Breast cancer diagnosis is made in advanced stages (III, IV, N.C.) in two out of three of our patients and a great proportion of them are younger than 50 years old. In order to know if age at diagnosis of breast cancer women in Mexico is similar of that of women of other countries, and in consequence, if breast screening has to be done as they have determined, we analyzed the age at diagnosis of 29,075 mexican women with breast cancer from 1993 to 1996. We found that median age of our patients was 51 years, one decade younger than that of European or white American women (60-64 years), and 45.5% of Mexican women are less than 50 years old at diagnosis of breast cancer, therefore, breast cancer screening indications adopted in Mexico, do not cover, not even theoretically, almost 50% of our women. It is mandatory to determine indications of breast screening according to our reality.

The surgeon as prognostic factor for local recurrence and survival in the anal sphincter preservation for mid-rectal cancer.

BACKGROUND: The prognostic factors in rectal adenocarcinoma are influenced by the tumor stage. However, it is important to evaluate the role of the surgeon as part of the prognostic factors affecting local recurrence and survival rates in a group of patients with mid-rectal cancer treated with low anterior resection at a cancer referral center, and those treated at general hospitals. MATERIALS AND METHODS: Eighty-two patients with mid rectal adenocarcinoma stage II and III who underwent low anterior resection from January 1980 to December 1995, were retrospectively analyzed. Forty-two patients were treated at a cancer center (Group I) and 40 patients were treated at general hospitals (Group II). Cox regression analysis for local recurrence and survival was performed. RESULTS: There were 42 males and 40 females with a mean age of 55.8 +/- 14.9 years. No differences were found between both groups in terms of the following: age; gender; stage; grade of differentiation; number of positive lymph nodes; infiltration of neighboring organs, and administration of adjuvant chemoradiation therapy (POST RT). However, significant differences in the number of studied lymph nodes per specimen and follow-up were found. The median follow-up for the entire group was 49 months. Local recurrence occurred in 9.5% of patients in Group I vs. 50% in Group II (p = 0.0001). The 5-year survival in Group I was 63% vs. 54% in Group II (p = 0.04). The favorable prognostic factors for local recurrence and survival were: surgical treatment at a cancer center, and no lymph node metastases. CONCLUSION: The prognostic factors for local recurrence and survival depends mainly on the surgeon and on the post-surgical tumor stage.

Carotid body tumors in inhabitants of altitudes higher than 2000 meters above sea level.

BACKGROUND: Carotid body tumors (CBTs) are rare. Diagnosis is usually delayed until the tumors reach a critical volume and a mass appears in the neck, which is often asymptomatic. METHODS: We reviewed retrospectively the cases with CBT diagnosed from 1965 to 1995 in the Hospital de Oncologia in Mexico City with inhabitants at an altitude higher than 2200 m above sea level to see whether these tumors have the same characteristics as those of inhabitants of countries of lower altitudes. We reviewed the clinical features, diagnostic procedures, therapy, results, and complications. RESULTS: There were 120 CBT cases, which represent 79% of the parapharyngeal space tumors diagnosed at our hospital; 116 (96%) were benign and 4 (3.3%) were malignant. Women predominated (89%), and the female-male ratio was 8.3:1. Five patients had multiple paragangliomas, and one had a family history of CBT. Eighty patients (66%) underwent surgery. This was done by cervical approach in 78 cases (97%), and 2 (2.5%) required additional mandibulotomy. There were three deaths due to brain ischemia after carotid ligature. Forty-one patients were followed without treatment, due to advanced age, concomitant diseases, or great volume of the tumor. Median follow-up of these patients was 47 months, during which time no patient reported additional symptoms, accelerated enlargement of the tumor, or metastasis. With a median follow-up of 54 months, only one patient developed local recurrence and three patients developed distant metastasis. CONCLUSIONS: We conclude that cases of CBT in our high-altitude population differ significantly from those cases in inhabitants of cities in the U.S. or Europe of less than 1500 m above sea level. Those of high altitudes have an evident female predominance (8.3:1), low rate of bilaterality (5%), and a family history of 1% versus a discrete female predominance (2:1), bilaterality from 10% to 20%, and family history from 7% to 25% in low altitudes. When adequate criteria are used to determine surgical resectability, a complete resection is achieved in 85% of cases, with low or null mortality and high local control.

[Impact of the interval between surgery and radiotherapy in the initial phases of breast cancer in patients who did not receive systemic adjuvant therapy]. / Impacto del intervalo entre la cirugia y la radioterapia, en pacientes con cáncer mamario etapas iniciales, sin manejo sistémico adyuvante.

The purpose was to evaluate the effect of surgery-radiotherapy delay in the outcome of patients treated for early breast cancer, who did not receive adjuvant systemic therapy. We retrospectively analyzed data from 623 patients with breast cancer diagnosis stage I and II and with clinically negative axillary node, treated over a 18 year period. Patients were grouped in basis of the delay in the beginning of their radiation therapy, after surgery. Group 1 (270 patients) began radiation within 4 weeks of surgery, group 2 (285 patients) began 5-8 weeks after surgery and group 3 (68 patients) had a delay greater than 9 weeks. Median follow up in the total group was 64 months. Patients received a dose of 50-60 Gy to the tumor bed and/or 50 Gy to the nodes. Age, menopausal stage, clinical stage of disease, histological diagnosis, pathologic tumor size, and nodes metastasis, were similarly distributed among the 3 groups. Comparisons of local-control, overall 10-year survival and disease free survival curves between the three groups were done, no differences were observed among group 1 and 3, showed no significant differences in overall survival or local-control, however disease free survival was negatively affected by a delay in the administration of radiation (p = 0.05). It was concluded that delay in the beginning of radiation therapy longer than 8 weeks after surgery in breast cancer stage I and II patients treated without systemic therapy, decrease significantly disease free survival.

[Reintervention to complete the surgical treatment of thyroid cancer. Indications and histopathological findings]. / Reintervención para completar el tratamiento quirúrgico en cáncer de tiroides. Indicaciones y hallazgos histopatológicos.

In Mexico, 39% of 158 patients operated on for thyroid cancer require reoperative thyroid surgery. We retrospectively reviewed the indications and histopathological findings of 60 patients reoperated on because of: a) suspected persistent or recurrent disease; b) high risk patients treated by lobectomy; c) different histology; d) complete lack of information, e) and distant metastasis. In 53 cases (88%), the initial surgery was nodulectomy or lobectomy, and in seven (11%) was subtotal or near-total thyroidectomy. Among the 60 reoperations, 50 were completion total thyroidectomy and 10 were near-total thyroidectomy. In 27 cases (45%) a neck dissection was additionally done. Histologic examination revealed thyroid carcinoma in 32 cases (53%) and neck node metastasis in 28 cases (47%). Complications included six cases (9%) of permanent palsy of the recurrent laryngeal nerve after the initial surgery outside of our hospital and two cases (1.75%) of reoperated cases. In four reoperated patients (6.6%), permanent hypoparathyroidism was developed. It is mandatory to complete thyroidectomy and neck dissection in a high proportion of patients initially treated in general hospitals due to an inadequate criteria in the selection of the extension of thyroidectomy and treatment of neck node metastases. Histologic findings of these patients support our indications to complete the surgical treatment.

Papillary thyroid cancer in Mexico: review of 409 cases.

This is a retrospective review of 409 cases of papillary thyroid cancer treated at the Hospital of Oncologia, National Medical Center, IMSS in Mexico City. The clinical features, histopathologic findings, analysis of recurrences and survivals according to age, sex, tumor size, and modality of treatment are described. The results showed that tumoral diameter > 5 cm, distant metastasis at diagnosis, age > 40 years, and tumoral infiltration beyond the thyroid capsule significantly affect the patient's survival.

Evolucion de la hepatitis cronica en el enfermo de cancer. / Chronic hepatitis evolution in cancer patients

Se estudiaron 44 casos de hepatitis cronica y cancer y 15 de hepatitis cronica como unica enfermedad con objeto de conocer si la neoplasia modifica el curso clinico de la hepatopatia.Se observo que cuando coinciden ambas, la evolucion de la hepatitis cronica activa es menos agresiva y no se relaciona con el diagnostico histologico o el tratamiento. De estos enfermos 66 por ciento cursaron asintomaticos y solo 23 por ciento desarrollaron cirrosis hepatica En el segundo grupo 45 por ciento tuvieron sintomas y signos de hepatopatia aguda, y 72 por ciento presentaron manifestaciones clinicas de lesion hepatocelular cronica

Factores pronosticos del melanoma. / Prognostic factors of melanoma

Se revisaron los factores pronosticos del melanoma en 69 casos controlados a largo, plazo encontrando que los factores que influyen sobre la supervivencia son diametro de la lesion, nivel de Clark, espesor tumoral, presencia de satelites, infiltracion linfatica o vascular y sobre todo, presencia de ganglios metastaticos, por lo que cuando existen estos factores deben utilizarse medidas terapeuticas mas agresivas. La mayor parte de los casos estudiados se encontraron en estados avanzados, a pesar de lo cual se obtuvo supervivencia a 5 anos del 51 por ciento