Evaluation of clinical, pathological and epidemiological profile of patients with breast cancer in the microregion of Lavras ­ MG

Breast cancer is associated with high frequency and mortality in Brazilian women. There have been limited studies portraying the characteristics of breast cancer cases in the countryside of the state of Minas Gerais for a long period of time, a fact that will allow us to better understand the epidemiology of these tumors. This descriptive study aims to analyze the epidemiology and clinical features of patients with breast cancer treated at a public health service facility in Lavras, MG. Methods: This is a transversal study with 299 women diagnosed with breast cancer between 2002 and 2022, based on data collection from medical records and subsequent descriptive analysis. Results: There were a total of 317 cases, and 299 were eligible for the study. The mean age at diagnosis was 54.2 years, and 36.1% of the patients were under 50 years old at diagnosis. Positive family history was found in 17.0% of the patients. The diagnosis was made by clinical alteration detected on physical examination in 71.5% of cases, and lump was the most frequent type of lesion (89.0%). Invasive carcinoma was 93.1% of the cases, and the mean tumor size was 28.6 mm. The average time between first medical appointment and diagnosis was 63.2 days, and between diagnosis and beginning of treatment was 39.6 days. Conclusions: This study showed that a significant number of cases occurred in women outside the recommended age for screening in Brazil. Diagnosis was predominantly performed by clinical examination, with delays in obtaining the histological diagnosis, and the stage at diagnosis was high, and these facts were associated with the health system limitations (AU)

Severe anaphylactic reaction to patent blue in breast cancer surgery

Sentinel lymph node biopsy in the surgical treatment of initial breast cancer has been increasingly adopted to assess axillary status as a way to replace total lymphadenectomy. The sentinel lymph node can be identified using coloring agents or radiopharmaceuticals. In Brazil, patent blue is the most used dye for this type of procedure, with high rates of identification and safety; however, in some cases, the use of this substance can lead to the occurrence of anaphylactic reactions. The case presented here refers to a 41-year-old female patient admitted for a surgical procedure for total mastectomy associated with sentinel lymph node biopsy with patent blue. After surgical initiation, the patient developed severe anaphylactic shock, staying 21 days in the intensive care unit (ICU) for recovery. Most anaphylactic reactions that occur in the transoperative period are mediated by IgE antibodies, resulting in the degranulation of mast cells and basophils, with the release of mediators such as histamine, prostaglandins, proteoglycans, and cytokines, leading to the clinical manifestations of anaphylaxis. There is evidence that part of the population is allergic to patent blue, and may present with manifestations ranging from hives and pruritus to severe cardiovascular collapse, requiring hospitalization in an ICU. The purpose of this article was to report a case of severe anaphylactic reaction to patent blue and to review the literature regarding this infrequent and potentially serious situation.

Hereditary breast cancer: review and current approach

Hereditary breast cancer is a complex and important condition, representing about 10% of all breast cancer cases. Identifying highrisk patients and possible carriers of pathogenic genetic variants with indication for genetic testing is an essential step to care for these patients and their families. Treatment can be influenced, both surgical and adjuvant, by the existence of mutation, providing the possibility of better results and preventive measures. In Brazil, access to oncogeneticists and genetic counseling is limited. Mastologists and their teams must be trained to identify and conduct the approach of these patients, with the objective of offering an adequate and preventive care, as well as early diagnostics. In the present study, a literature review of hereditary breast cancer aspects, diagnostic, and implications, in patients with and without breast cancer, was performed, aiming to assist in the proper management offered by mastologists, considering general and Brazilian characteristics.

Análise dos resultados de mamografias de rastreamento realizadas em um serviço público do interior de Minas Gerais / Analysis of screening mammograms results carried out in a public health service in Minas Gerais

Objetivo: Analisar os resultados das mamografias de rastreamento realizadas em um serviço público de saúde, assim como as taxas de solicitação de exames e biópsias adicionais e as características dos tumores detectados por esses exames. Métodos: Realizou-se um estudo descritivo, retrospectivo, baseado na análise dos registros de mamografias de pacientes atendidas no Centro Estadual de Atenção Especializada (CEAE), na cidade de Lavras (MG). Resultados: Houve um total de 3.032 mamografias de rastreamento, no período analisado, sendo encontrados 145 (4,7%) exames alterados, dos quais 130 foram analisados no estudo. Frente ao resultado de mamografia alterado, foram solicitados 127 exames de imagem adicionais e 22 biópsias mamárias, culminando no achado de 13 carcinomas de mama. A maior parte dos carcinomas diagnosticados (38,5% do total) encontrava-se na faixa etária de 40-49 anos. O estadiamento dos tumores detectados mostrou que a grande maioria estava nos estádios I (46,1%) e IIA (30,8%) e que a maior parte das pacientes foi submetida à cirurgia conservadora (84,6%) e não recebeu tratamento quimioterápico (53,8%). Conclusão: O rastreamento mamográfico permanece como ferramenta essencial para o diagnóstico precoce e aumento das taxas de cura do câncer de mama. A realidade do carcinoma de mama não é homogênea, havendo diferenças significativas entre países diferentes e entre regiões distintas de um mesmo país. A redução do diagnóstico tardio do câncer de mama em nosso meio exige a revisão das recomendações oficiais vigentes para o início do rastreamento mamográfico, visando à melhoria nos números acerca da doença em nosso país.

Objective: To analyze the results of screening mammograms performed in a public health service and the rates of tests and additional biopsies requested, as well as the characteristics of the tumors detected by these tests. Methods: A descriptive, retrospective study was carried out, based on the analysis of mammograms records of patients assisted at the Centro Estadual de Atenção Especializada (CEAE) in the city of Lavras (MG). Results: A total of 3,032 screening mammograms were carried out during the study period, and 145 (4.7%) abnormal tests were found, of which 130 were analyzed in the study. When compared to the result of altered mammography, 127 additional imaging tests and 22 breast biopsies were requested, culminating in the discovery of 13 breast carcinomas. Most diagnosed carcinomas (38.5% of total) were among the age group of 40-49 years. The staging of the tumors showed that most were in stage I (46.1%) and IIA (30.8%) and that most patients were submitted to the conservative surgery (84.6%) and did not undergo chemotherapy (53.8%). Conclusion: Mammographic screening remains an essential tool for early diagnosis and increased rates of cure from breast cancer. The reality of breast cancer is not homogeneous, with significant differences among countries and among different regions of the same country. The reduction of late breast cancer diagnosis in our midst requires the revision of the current official recommendations for the onset of mammographic screening, to improve the numbers of the disease in our country.

Surgical Margins in Breast Cancer: Finally Defined?.

It is proven that breast conservative surgery plus radiotherapy is safe and has equivalent results when compared to mastectomy. It is known that positive surgical margins increase the risk of local recurrence. The effect of increasing negative margin width after breast-conserving therapy on local recurrence is controversial. There is no consensus on what constitutes adequate negative margins in breast conservative surgery. There is also an evident association between widely negative margins and excessive breast tissue ressection, with poor cosmetic outcomes. Besides, reexcisions represent elevated costs and psychological trauma to the patients. Definition of what constitutes an adequate margin for both invasive and noninvasive breast cancer is clearly needed. We review here the evolution of surgical margins concepts in breast cancer and try to establish the ideal and current surgical approach for each patient.

Rastreamento mamográfico no câncer de mama / Mammographic screening for breast cancer

O câncer de mama permanece como uma doença de elevada mortalidade não só no Brasil, mas em diversos países em todo o mundo. Muitos esforços vêm sendo direcionados para a melhora dos resultados obtidos pelas modalidades terapêuticas (cirurgia, radioterapia e tratamento sistêmico), com o auxílio de estudos genéticos e de biologia tumoral, porém, o diagnóstico precoce continua sendo ferramenta fundamental para a melhora de sobrevida, possibilidade de cura e, consequentemente, redução das taxas de mortalidade pela doença. Como método de rastreamento, a mamografia é amplamente utilizada e demonstrou ser um exame capaz de reduzir a mortalidade específica por câncer de mama, constituindo-se na mais importante técnica de imagem para as mamas. Questionamentos sobre os possíveis riscos do rastreamento mamográfico ganharam força nos últimos anos e este artigo objetiva revisar dados sobre os benefícios e riscos do rastreamento, avaliando as reais evidências da atualidade.

Breast cancer remains a disease with high mortality not only in Brazil but also in many countries around the world. Many efforts have been directed to improve the results of therapeutic modalities (surgery, radiotherapy and systemic treatment), with the aid of genetic studies and tumor biology, but early diagnosis remains an essential tool for improving survival, the possibility of cure and consequently reducing mortality rates from the disease. As a screening method, mammography is widely used and proved to be a test that can reduce the specific mortality from breast cancer, constituting the most important imaging technique for the breasts. Questions about the possible risks of mammography screening gained strength in recent years and this article aims to review data of the benefits and risks of screening, assessing the current real evidence.

Características clínico-patológicas e estadiamento ao diagnóstico de pacientescom câncer de mama em um centro de saúde do interior de Minas Gerais / Clinicopathologic features and staging at diagnosis of patientswith breast cancer in a health center of Minas Gerais

Objetivo: Descrever as características clínico-patológicas e o estadiamento no momento do diagnóstico de pacientes com câncer de mama atendidas em um serviço público de atenção secundária no interior de Minas Gerais. Método: Realizou-se um estudo descritivo, retrospectivo, a partir da análise de prontuários médicos de pacientes atendidas no Serviço de Mastologia do Centro de Referência da Saúde ?Risoleta Tolentino Neves? (Centro Viva Vida), em Lavras (MG). Foram selecionados todos os casos de diagnóstico de câncer de mama no período de janeiro de 2008 a junho de 2013. Resultados: Houve um total de 125 casos e 112 foram elegíveis para o estudo. A idade média das pacientes foi de 56 anos (25?89 anos). Setenta e quatro pacientes (66%) eram pós-menopausa ao diagnóstico. O diagnóstico se deu por lesão clínica em 67% dos casos e o nódulo foi o tipo de lesão mais encontrada (85,6%). A forma de carcinoma in situ representou 8,9% e a invasora 91,1% do total. O tamanho médio do tumor foi de 2,52 cm (0,7?8,0 cm). O estadiamento mais prevalente foi o estadio II (37,5%), seguido do estadio I (30,35%). Conclusões: O câncer de mama ainda representa um importante problema de saúde pública no Brasil. A casuística apresentada mostrou dados que reforçam a presença de realidades diferentes no que diz respeito ao câncer de mama no território brasileiro, revelando números melhores que a média nacional quanto ao estadiamento da doença no momento do diagnóstico, porém com evidente necessidade de melhorias no que tange ao diagnóstico precoce. O conhecimento epidemiológico pode ser uma ferramenta extremamente útil para alcançarem-se essas melhorias e reduzir a mortalidade nas diferentes regiões do país.

Objective: To describe the clinicopathological characteristics and the stage at diagnosis of patients with breast cancer treated at a public secondary care center in Minas Gerais. Method: A descriptive, retrospective study was realized, based on analysis of medical records of patients assisted at the Breast Unit of the Centro de Referência da Saúde ?Risoleta Tolentino Neves? (Centro Viva Vida), in Lavras (MG), Brazil. All diagnosed cases of breast cancer from January 2008 to June 2013 were selected. Results: There were a total of 125 cases and 112 were eligible for the study. The mean age of the patients was 56 years (25 ?89 years). Seventy-four patients (66%) were postmenopausal at diagnosis. The diagnosis was made by clinical le sion in 67% of cases and the lump was the most frequent type of injury (85.6%). In situ carcinoma was 8.9% and invasive carcinoma was 91.1% of total. The mean tumor size was 2.52 cm (0.7?8.0 cm). The most prevalent staging was stage II (37.5%), followed by stage I (30.35%). Conclusions: Breast cancer remains an important public health problem in Brazil. The presented casuistry showed data that reinforce the presence of different realities with regard to breast cancer in Brazilian territory, revealing better figures than the national average about the disease stage at diagnosis, but with evident necessity for improvements regarding early diagnosis. Epidemiological knowledge can be an extremely useful tool to achieve up these improvements and reduce the mortality in different regions of the country.

Carcinoma inflamatório de mama associadoa trombo em trânsito no átrio direito etromboembolismo pulmonar ao diagnóstico / Inflammatory breast carcinoma associated with thrombus in transitthrough the right atrium and pulmonary thromboembolism at diagnosis

O câncer de mama inflamatório representa de 1 a 4% dos casos de carcinoma invasivo de mama, possuindo maior agressividade e mortalidade, maiores taxas de acometimento linfonodal e elevada incidência de metástases ao diagnóstico e nos primeiros dois anos de evolução. A taxa de tromboembolismo venoso em pacientes com câncer de mama não é bem definida, estando em níveis inferiores quando comparada a outros sítios de câncer. A presença de comorbidades, idade elevada e, principalmente, o estágio da doença parecem ser importantes fatores de risco para ocorrência de episódios tromboembólicos em portadoras de carcinoma mamário. Objetivamos, aqui, relatar um caso de carcinoma de mama inflamatório associado à presença incomum de trombo em trânsito em átrio direito e tromboembolismo pulmonar ao diagnóstico. Devido a sua gravidade, os fenômenos tromboembólicos devem ser suspeitados e não negligenciados em pacientes oncológicos, na presença de possíveis sinais e sintomas correlacionados.

Inflammatory breast cancer represents from 1 to 4% of cases of invasive breast carcinoma, showing increased aggressiveness and mortality, higher rates of lymph node involvement and high incidence of metastases at diagnosis and during the first two years of evolution. The rate of venous thromboembolism in breast cancer patients is not well defined, being at lower levels when compared to other sites of cancer. The presence of comorbidities, older age, and especially the stage of the disease appear to be important risk factors for the occurrence of thromboembolic events in women with breast carcinoma. Here, we aim to report an inflammatory breast carcinoma case associated with the unusual presence of thrombus in transit through the right atrium and pulmonary embolism at diagnosis. Due to its severity, thromboembolic phenomena must be suspected and not overlooked in cancer patients, in the presence of possible signs and symptoms correlated.

Neoplasia Lobular da mama: revisão / Lobular neoplasia of the breast: review

A neoplasia lobular da mama se refere às lesões caracterizadas pela hiperplasia lobular atípica e pelo carcinoma lobular in situ. A neoplasia lobular não é apenas um fator de risco, mas um precursor não obrigatório para desenvolvimento de carcinoma invasivo. O carcinoma lobular in situ do tipo pleomórfico é subtipo de neoplasia lobular com comportamento agressivo, com alto grau nuclear e pode mimetizar o carcinoma ductal in situ de alto grau. O manejo e o seguimento das pacientes portadoras de neoplasia lobular é controverso, especialmente, quando o diagnóstico é feito através da core biopsy. Os estudos moleculares e genômicos têm sido capazes de identificar genes que podem ser dirimir dúvidas quanto à sua patogênese e permitir abordagem que permite abordagens terapêuticas mais seguras e adequadas. Esta revisão procura estabelecer o conceito mais atual sobre a abordagem da neoplasia lobular da mama.

Lobular neoplasia of the breast refers to lesions featuring atypical lobular hyperplasia and lobular carcinoma in situ. Recent evidence suggests that lobular neoplasia is not only a risk factor, but is also a non-obligate precursor for invasive carcinoma. Pleomorphic lobular carcinoma in situ is a subtype of lobular neoplasia with agressive behaviour, that has high-grade nuclei and may simulate high-grade ductal carcinoma in situ. The management and follow-up of patients diagnosed with lobular neoplasia is a current issue of debate, specially when the diagnostic is given by core biopsy. Molecular and genomic studies have identified genes that may be important in understanding its pathogenesis and may lead to news therapeutic interventions.

Radioterapia adjuvante no câncer de mama operável / Adjuvant radiotherapy in operable breast cancer

O tratamento do câncer de mama inicial começa com a obtenção do controle locorregional. A radioterapia adjuvante é uma modalidade de tratamento local utilizada no câncer de mama para reduzir a recidiva local após o tratamento cirúrgico. A associação entre um adequado controle local e o aumento de sobrevida tem sido frequentemente observada. Os mecanismos, entretanto, através dos quais a aplicação da radiação ionizante no sítio tumoral primário pode resultar em efeitos sistêmicos, são um grande motivo de debates. Este artigo revisa dados sobre o papel da radioterapia adjuvante no câncer de mama operável, tanto pós-cirurgia conservadora quanto pós- mastectomia, assim como seus resultados locais e sistêmicos

The treatment of early breast cancer begins with the locorregional control. Adjuvant radiotherapy is a local treatment modality employed in breast cancer to reduce the local recurrence following surgery. The association between optimal local control and improved survival has been commonly observed. The mechanisms however whereby the application of ionizing radiation to the primary tumor site can result in systemic effects is subject of much debate. This article reviews data about the role of adjuvant radiotherapy in operable breast cancer post-conservative surgery and post-mastectomy as well as its local and systemic results

Ocorrência sincrônica de carcinoma mucinoso microinvasivo em mama esquerda e linfoma em axila direita / Synchronous ocurrence of microinvasive mucinous carcinoma in left breast and lymphoma in right axilla

Os linfomas correspondem a 3,5% das neoplasias malignas em mulheres. O carcinoma mucinoso invasivo corresponde entre 2 a 4% dos cânceres mamários. No presente artigo, relata-se o diagnóstico, o tratamento e a evolução de um caso raro de ocorrência sincrônica de carcinoma mucinoso microinvasivo em mama esquerda e linfoma de células B em axila direita.

Lymphomas account for 3.5% of all cancers in women. Invasive mucinous carcinoma accounts from 2 to 4% of breast carcinomas. In this paper, we report the diagnosis, treatment and outcome of a rare case of synchronous occurrence of microinvasive mucinous carcinoma in the left breast, and B-cell lymphoma in the right axilla.

Trastuzumab no câncer de mama / Trastuzumab in breast cancer

O trastuzumab, anticorpo monoclonal contra o sítio extracelular do receptor do fator de crescimento epidérmico humano tipo 2 (HER2), vem tendo crescente utilização no tratamento do câncer de mama, promovendo melhora nos resultados e se firmando como opção terapêutica de impacto para pacientes que apresentam tumores HER2 positivo. Aproximadamente 20 a 30% dos carcinomas de mama apresentam superexpressão e/ou amplificação do gene HER2. Tal fato confere comportamento tumoral mais agressivo e piora no prognóstico das pacientes acometidas. Este artigo revisa dados sobre a utilização clínica e a eficácia do trastuzumab no tratamento do câncer de mama inicial e avançado

Trastuzumab, a monoclonal antibody against the extracellular domain of the human epidermal growth factor receptor type 2 (HER2), has been increasingly used in breast cancer treatment, improving the outcomes and becoming established as a therapeutic option of impact for patients who express HER2 positive tumors. Approximately 20 to 30% of breast carcinomas present over-expression and/or amplification of the HER2 gene. This fact attributes a more aggressive tumoral behavior and a worsening prognostic of the affected patients. This article reviews data on the clinical usage and efficacy of trastuzumab in the both early and advanced breast cancer treatment

Correlação entre achados anatomopatológicos de lesões mamárias não palpáveis exames de imagem / Correlation between anatomophatological real find of non-palpable breast lesion and test of image

Objetivos: Descrever cirurgias guiadas por agulhamento de lesões mamárias não palpáveis e avaliar sua correlação anatomopatológica. Métodos: Realizou-se um estudo descritivo, retrospectivo, a partir da análise dos prontuários de pacientes da Clínica de Mastologia do Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG). Foram selecionados todos os casos de pacientes submetidas à biópsia cirúrgica de lesão mamária não palpável após agulhamento guiado por mamografia ou ultrassonografia, durante o período de 3/8/2004 a 25/5/2006. Foram analisadas as seguintes variáveis: idade da paciente à época da cirurgia, tipo de lesão mamária apresentada ao exame de imagem e resultado anatomopatológico. Resultados: Houve um total de 261 cirurgias. Foram elegíveis 236 casos. A idade média das pacientes foi de 50,9 anos (19-91 anos). Em 120 casos (50,85%), a biópsia foi realizada em virtude de microcalcificações mamárias; em 95 casos (40,25%), por nódulo; em 15 casos (6,36%), por assimetria focal e em 6 casos (2,54%), por distorção arquitetural. O resultado anatomopatológico foi benigno em 170 casos (72,03%) e maligno em 66 (27,97%). Conclusões: A casuística do Serviço de Mastologia do IPSEMG está de acordo com os dados encontrados na literatura. A biópsia cirúrgica de lesões mamárias não palpáveis guiada por agulhamento é um procedimento capaz de estabelecer o correto diagnóstico diferencial dessas lesões, diagnosticar o câncer de mama em fases iniciais e promover a remoção completa das lesões em tempo cirúrgico, frequentemente, único.

Objectives: To describe surgical biopsies after wire localization of non palpable mammary lesions and to consider their anatomopathological correlation. Methods: A descriptive and retrospective study was realized through analysis of handbooks of patients at Mastology Clinics of the Instituto de Previdência dos Servidores do Estado de Minas Gerais (IPSEMG). All cases of patients submitted to surgical biopsy of non-palpable mammary lesion after wire localization for mammography or ultrasound, during the period of 8/3/2004 to 5/25/2006, were selected. The variables analyzed were: age of the patient at the time of the surgery, type of breast lesion presented during the tests of image and anatomopathological result. Results: There were a total of 261 surgeries, which 236 cases were elected. The average age of the patients was 50,9 years (19-91 years). In 120 cases (50.85%) the biopsy was made due to the mammary microcalcifications; in 95 cases (40.25%) for nodule; in 15 cases (6.36%) for focal asymmetry and in 6 cases (2.54%) for architectural distortion. The anatomopathological result was benign in 110 cases (12.03%) and malignant in 66 (27.91%). Conclusions: The casuistic of the Mastology Service of IPSEMG is compatible with the data founded in literature. The surgical management of non-palpable breast lesions after wire localization is a procedure which is able to establish the differential diagnostic of these lesions, breast cancer diagnosis in early stage and to promote the complete removal of the injuries in frequently single surgical time.

Seminoma primário do mediastino / Primary mediastinal seminoma

O seminoma é um tumor maligno de células germinativas que possui como sitio primário preferencial os testículos, embora existam raros casos de localização extra-gonadal. Os autores relatam caso de seminoma primário de mediastino em paciente masculino, 26 anos de idade, que apresentava dispnéia progressiva, tosse seca, rouquidão, dor torácica eventual, obstrução óbvia da veia cava superior e massa volumosa e palpável no mediastino ântero-superior. O diagnóstico etiológico foi suspeitado pelos exames de imagem, anatomopatológico e marcadores séricos e firmado pelo estudo imuno-histoquimico. Não havia evidência de metástase à distância, mas o tumor estava localmente avançado. O tratamento proposto foi poliquimioterápico com esquema PEB (cispiatina, etoposide e bleomicina) e o paciente evoluiu sem maiores intercorrências.

The seminoma is a malignant germ cell tumor that is rarely placed in an extra-testicular position. A 26 years old male patient with primary mediastinal seminoma was studied. His symptoms were: progressive dyspnea, unproductive cough, hoarseness, occasional chest pain, obvious superior vena cava obstruction, and a huge and palpable mass located in the upper anterior mediastinum. Image exams, serum markers and histological study led to diagnosis, of seminoma which was confirmed by immunohistochemical study. There was no evidence of distant metastatic disease although it was locally advanced. After the beginning of the treatment with chemotherapy, the patient's symptoms were improved.