RESUMEN
BACKGROUND: metaplastic breast carcinoma (MBC) is uncommon, characterized by a heterogeneous mixture of histologic characteristics. OBJECTIVE: evaluate clinical and pathological characteristics in a population of patients with MBC in a reference center. MATERIALS AND METHODS: retrospective analysis of cases diagnosed with MBC at INCAN database from 2005-2011 was performed. Univariate assessment of clinical variables and their impact on disease free survival(DFS) and overall survival (OS) were evaluated. RESULTS: the records of 20 patients were identified. Median age was 49.5 (range: 33-75). Clinical stages at diagnosis were 6 I-II (30%) and 14 III-IV (70%). Three year OS was 52.1%. Patients< 40 years had an OS of 32.8 months vs. ≥ 40 years of 17.8 (p = 0.097). OS in stage I-II was 13.5 months vs. 23.3 months in III-IV (p = 0.99). Those who received neoadjuvant therapy had an OS of 26.57 vs. 14.36 in those who did not(p = 0.54). Those who received adjuvant therapy had an OS of 31.2 months vs. 11.15 in those who did not (p = 0.036). CONCLUSIONS: MBC has bad prognosis, nevertheless, age < 40 years and hormone receptor positivity, as well as adjuvant treatment seems to be factors that have an influence OS.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Humanos , Persona de Mediana Edad , PronósticoRESUMEN
El tumor phyllodes es una neoplasia fibroepitelial rara; constituye el 0.3 al 0.9% de tumores de mama y 2-3% de los tumores fibroepiteliales de mama. Puede presentarse a cualquier edad y no hay características confiables para predecir su comportamiento clínico. Se deben evaluar varios parámetros, incluyendo la celularidad estromal, atipia, mitosis, crecimiento estromal excesivo, infiltración de bordes y presencia o ausencia de necrosis. La mayor parte de estos tumores son benignos, pero hasta 30% pueden presentar tejido conectivo maligno. Las metástasis generalmente son hematógenas más que linfáticas y se presentan en un 13% de los casos. La disección de ganglios axilares generalmente no se recomienda. El tumor phyllodes benigno y maligno recurre de manera local en el 25%, por lo que se recomienda el seguimiento de los casos.
Phyllodes tumors is a rare fibroepithelial neoplasm; constitute about 0.3-0.9% of breast tumors and 2-3% of fibroepithelial breast tumors. They usually occur in middle-aged to elderly women but can occur at any age. No single feature is reliable to predict clinical behavior of phyllodes tumors. Several histological parameters should be evaluated, including stromal cellularity, atypia, mitoses, stromal overgrowth, infiltrative borders, and presence or absence of necrosis. Most of these tumors are benign, but up to 30% show malignant stroma. Metastases usually are hematogenous rather than lymphatic have been reported to occur at a rate of 13% as malignant phyllodes tumors usually spread by a hematogenous rather than a lymphatic route; axillary lymph node dissection is generally not recommended. The benign and malignant tumors phyllodes resort locally in 25% and follow up of patients is recomended.
RESUMEN
La enfermedad de Paget extramamaria (EPE) es una patología maligna observada, sobre todo, en áreas donde existe alta densidad de glándulas apocrinas. Presentamos el caso clínico de una paciente de 68 años de edad, atendida en la Clínica de Colposcopia del Servicio de Oncología, del Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, con diagnóstico de enfermedad de Paget a nivel vulvar, vagina, región de periné y región perianal, manejada con sesiones de vaporización con láser, con evolución satisfactoria. Dado que es una enfermedad poco frecuente, más común en el sexo femenino y en la raza blanca, con mayor incidencia en la séptima década de la vida, como es el caso de nuestra paciente, el objetivo de este trabajo es presentar una revisión de la evaluación clínica, haciendo énfasis en el diagnóstico diferencial, uso de colposcopia para diagnóstico y tratamiento conservador fraccionado con vaporización de láser. La baja incidencia de la enfermedad de Paget de la vulva, vagina, periné y región perianal, así como la ausencia de informes sobre la posibilidad de tratamiento no quirúrgico, motivan a informar a la comunidad científica sobre el manejo con vaporización láser, con la intención de evitar la morbilidad que puede traer consigo el manejo quirúrgico convencional.
Extramammary Paget's disease (EPD) is a malignant disease observed, especially in areas with high density of apocrine glands. We report a case of a patient of 68 years old, attended at the Colposcopy Clinic of Oncology, National Institute of Perinatology Isidro Espinosa de los Reyes, diagnosed with Paget's disease of the vulva, vagina, perineum region and perianal region, and managed with laser vaporization sessions with satisfactory outcome. Since it is a rare disease, more common in females and in whites, with the highest incidence in the seventh decade of life, as is the case of our patient, propose in this paper to present a review of the clinical evaluation with emphasis on the differential diagnosis, use of colposcopy for diagnosis and dividing up conservative treatment with laser vaporization of the disease. The low incidence of Paget's disease of the vulva, vagina, perineum and perianal region, and the absence of reports on the possibility of nonsurgical treatment encouraged to inform the scientific community about the management with laser vaporization, with the intention of avoiding morbidity that can lead to the conventional surgical maneuvers.