Polymorphus low-grade adenocarcinoma of the maxilla: pathological findings and reconstructive considerations.

Polymorphous low-grade adenocarcinoma (PLGA) is a rare, malignant salivary gland tumor, which is found almost exclusively in minor salivary glands, primarily those in the palate. We report a case of PLGA arising from minor salivary gland of the palate in a 63-year-old female patient. The tumor was resected through the oral cavity performing a bilateral maxillectomy and surgical defect was reconstructed using a free radial forearm flap combined with iliac crest bone graft. The patient was free of disease at 48 months follow-up. The histopathological features of PLGA, the importance of differential diagnosis from pleomorphic adenoma and adenoid cystic carcinoma and the type of reconstruction are discussed in this article.

[Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound-guided core needle biopsy]. / Estadificación ganglionar axilar prequirúrgica en el cáncer de mama: parámetros ecográficos y biopsia con aguja gruesa ecoguiada.

OBJECTIVE: To analyze the role of core needle biopsy of axillary lymph nodes with suspected metastases from breast cancer and to correlate the imaging and histologic findings. MATERIAL AND METHODS: We retrospectively studied 74 patients diagnosed with breast cancer who underwent ultrasound-guided core needle biopsy of axillary lymph nodes with characteristics suggestive of metastases on ultrasonography. The following ultrasonographic findings were considered suspicious for metastases: cortical thickening and changes in the hilar fat and/or non-hilar cortical vascular flow. Patients with negative findings after axillary biopsy underwent sentinel node biopsy. RESULTS: Core needle biopsy confirmed lymph node metastases in 47 (63.5%) patients. The 27 patients (36.5%) with negative findings after lymph node biopsy underwent sentinel node biopsy; 3 (11%) of these had a positive sentinel lymph node and underwent axillary lymph node resection. Of the 50 lymph nodes with metastases, 44 (88%) had cortical thickening, 20 (40%) had changes in the hilar fat, and 29 (58%) had non-hilar cortical vascular flow. All biopsies of lymph nodes with both cortical thickening and non-hilar cortical vascular flow were positive, yielding a 100% positive predictive value in this series. CONCLUSIONS: Ultrasound-guided core needle biopsy of axillary lymph nodes that are suspicious for metastases from breast cancer at ultrasonography is a highly effective procedure that has low morbidity. Findings of cortical thickening and non-hilar cortical vascular flow in the same lymph node yield a positive predictive value of 100% in this series.

Estadificación ganglionar axilar prequirúrgica en el cáncer de mama: parámetros ecográficos y biopsia con aguja gruesa ecoguiada / Preoperative staging of axillary lymph nodes in breast cancer: ultrasonographic parameters and ultrasound-guided core needle biopsy

Objetivo. Analizar el papel de la biopsia con aguja gruesa de adenopatías axilares con sospecha ecográfica de metástasis en pacientes con cáncer de mama, y la correlación radiopatológica. Material y métodos. Estudio retrospectivo de 74 pacientes diagnosticadas de cáncer de mama, a las que se realizó biopsia con aguja gruesa ecoguiada de adenopatías axilares con características ecográficas indicativas de metástasis. Consideramos hallazgos ecográficos sospechosos de metástasis: engrosamiento cortical, alteración de la grasa hiliar y/o flujo vascular cortical no hiliar. Las pacientes con biopsia axilar negativa se incluyeron en el protocolo de biopsia de ganglio centinela. Resultados. La biopsia con aguja gruesa confirmó metástasis ganglionar en 47 (63,5%) pacientes. Las 27 pacientes (36,5%) con biopsia negativa se incluyeron en el protocolo de biopsia de ganglio centinela y 3 (11%) presentaron ganglio centinela positivo, realizándose linfadenectomía axilar. De las 50 adenopatías con metástasis, 44 (88%) presentaron engrosamiento cortical, 20 (40%) alteración de la grasa hiliar y 29 (58%) flujo vascular cortical no hiliar. En todas las adenopatías con engrosamiento cortical y flujo vascular cortical no hiliar la biopsia fue positiva, indicando un valor predictivo positivo del 100% en esta serie. Conclusiones. La biopsia con aguja gruesa ecoguiada de adenopatías axilares con sospecha ecográfica de metástasis por cáncer de mama es un procedimiento con alta efectividad diagnóstica y baja morbilidad. La presencia de engrosamiento cortical y flujo vascular cortical no hiliar en la misma adenopatía mostró un valor predictivo positivo del 100% en esta serie (AU)

Objective. To analyze the role of core needle biopsy of axillary lymph nodes with suspected metastases from breast cancer and to correlate the imaging and histologic findings. Material and methods. We retrospectively studied 74 patients diagnosed with breast cancer who underwent ultrasound-guided core needle biopsy of axillary lymph nodes with characteristics suggestive of metastases on ultrasonography. The following ultrasonographic findings were considered suspicious for metastases: cortical thickening and changes in the hilar fat and/or non-hilar cortical vascular flow. Patients with negative findings after axillary biopsy underwent sentinel node biopsy. Results. Core needle biopsy confirmed lymph node metastases in 47 (63.5%) patients. The 27 patients (36.5%) with negative findings after lymph node biopsy underwent sentinel node biopsy; 3 (11%) of these had a positive sentinel lymph node and underwent axillary lymph node resection. Of the 50 lymph nodes with metastases, 44 (88%) had cortical thickening, 20 (40%) had changes in the hilar fat, and 29 (58%) had non-hilar cortical vascular flow. All biopsies of lymph nodes with both cortical thickening and non-hilar cortical vascular flow were positive, yielding a 100% positive predictive value in this series. Conclusions. Ultrasound-guided core needle biopsy of axillary lymph nodes that are suspicious for metastases from breast cancer at ultrasonography is a highly effective procedure that has low morbidity. Findings of cortical thickening and non-hilar cortical vascular flow in the same lymph node yield a positive predictive value of 100% in this series (AU)