Metaplastic carcinoma of the breast with squamous differentiation: prognostic factors and multidisciplinary treatment.

BACKGROUND: The objective of this study was to analyze the characteristics of patients diagnosed with metaplastic carcinoma of the breast with squamous differentiation and to identify the particular clinical and histological characteristics that need to be taken into account in this type of tumors. CASE PRESENTATION: Retrospective observational study of two patients managed at our hospital between 2014 and 2020 (15 months mean follow-up), plus all cases published in the last 7 years (8 patients). Thus, a total of 10 cases were analyzed, all with less than 2 years mean global survival. Studied variables were: age, medical background, tumor size, axillary involvement, radiological characteristics, surgical approach, complementary treatments, histologic characteristics, and progression of the disease. In 50% of cases, the disease appeared as a palpable mass of rapid growth, associated with axillary infiltration; 80% of the tumors were triple negative; 30% of them progressed to distant metastatic disease in 30%. CONCLUSIONS: This unusual carcinoma requires a complex multidisciplinary treatment. Its prognosis is unfavorable due to its high local aggressiveness, with rapid progression and appearance of metastatic disease. The predominance of different histological components may determine the response to medical treatments.

Carcinoma mioepitelial de mama / Myoepithelial carcinoma of the breast

El carcinoma mioepitelial de mama (o mioepitelioma maligno) es un tumor poco frecuente compuesto exclusivamente por células mioepiteliales malignas. Su diagnóstico supone un reto, y viene dado por los hallazgos anatomopatológicos apoyados por las técnicas de inmunohistoquímica. Presentamos un caso clínico y revisión bibliográfica

Myoepithelial carcinoma of the breast (or malignant myoepithelioma) is a rare tumor composed exclusively of malignant myoepithelial cells. Its diagnosis is a challenge and is reached through pathological findings supported by immunohistochemical techniques. We present a case report and a review of the literature

Angiosarcoma de mama radioinducido / Radiotherapy-induced angiosarcoma of the breast

El angiosarcoma radioinducido de mama tras tratamiento quirúrgico conservador y radioterapia complementaria en una paciente con cáncer de mama es una entidad poco frecuente, de difícil diagnóstico y mal pronóstico. Se presenta el caso de una mujer de 71 años, con antecedentes personales de carcinoma ductal infiltrante de mama izquierda, a la que se practicó tumorectomía y linfadenectomía axilar (pT1cpN0M0), y recibió tratamiento adyuvante con radioterapia y hormonoterapia. 77 meses después del tratamiento, la paciente consultó al presentar una lesión cutánea en la mama izquierda. Tras valoración clínica, radiológica e histológica y con el diagnóstico de angiosarcoma de mama, se practicó mastectomía izquierda. Posteriormente no recibió tratamiento complementario

Radiotherapy-induced angiosarcoma of the breast after conservative surgical treatment and complementary radiotherapy in a patient with breast cancer is a rare condition, with both difficult diagnosis and poor prognosis. We present the case of a 71-year-old woman with a personal history of infiltrating ductal carcinoma of the left breast, who underwent tumorectomy and axillary lymphadenectomy (pT1cpN0M0), and received adjuvant treatment with radiotherapy and hormone therapy. 77 months after treatment, the patient consulted with a skin lesion on her left breast. After clinical, radiological and histological assessment and with the diagnosis of angiosarcoma of the breast, a mastectomy of her left breast was performed. The patient did not receive complementary treatment

Carcinoma de células acinares de mama / Primary acinic cell carcinoma of the breast

El carcinoma de células acinares primario de mama es un tumor raro que muestra similitudes con neoplasias de las glándulas salivales; y aunque pertenece al grupo de carcinomas de mama "triple negativos", su comportamiento biológico parece ser más favorable. Se presenta el caso de una mujer de 54 años, sin antecedentes oncoginecológicos, remitida a la consulta de patología mamaria para valoración por mamografía de screening que informa de BIRADS IV en mama derecha. A la exploración física, las mamas y axilas son normales a la inspección y a la palpación, tratándose de una lesión no palpable. El estudio citológico tras punción ecoguiada informa de sospecha de malignidad, motivo por el cual se practica biopsia excisional radioguiada que informa de la presencia de un carcinoma de células acinares de mama. Se realizó tratamiento quirúrgico conservador en mama-axila derecha y recibió radioterapia adyuvante. Tras 6 años del diagnóstico, se encuentra libre de enfermedad

Primary acinic cell carcinoma of the breast is a rare tumor that shows similarities with neoplasms of the salivary glands; and although it belongs to the group of "triple negative" breast cancer, its biological behavior seems to be more favorable. We present the case of a 54-year-old woman, with no gynecological cáncer history, referred to the mammary pathology office for evaluation after mammography screening that reports BIRADS IV in the right breast. On physical examination, the breasts and axillas are normal to inspection and palpation, being this the case of a non-palpable lesion. The cytological study after echoguided puncture reports suspicion of malignancy, which is why a radioguided excisional biopsy is performed, which shows the presence of an acinic cell carcinoma of the breast. Conservative surgical treatment is performed in the right breast-axilla, together adjuvant radiotherapy. 6 years after diagnosis, the patient is free of disease

Nefroma mesoblástico congénito / Congenital mesoblastic nephroma

Introducción: El nefroma mesoblástico congénito (NMC) (hamartoma leiomiomatoso o mesenquimal) es una neoplasia renal congénita. Se diagnostica en los seis primeros meses de vida. Su comportamiento clínico es benigno y el tratamiento es quirúrgico. Paciente y métodos: Describimos el caso de un paciente de una semana de edad que presenta una masa renal. En la ecografía es sólida y sustituye al riñón. El TAC muestra una lesión con márgenes mal delimitados y la estructura heterogénea. Macroscópicamente en la pieza quirúrgica se identificaba una masa intrarrenal bien delimitada, sólida, homogénea, blanquecina y con aspecto fasciculado. Microscópicamente se observa una neoformación compuesta por una población monótona de células fusiformes dispuestas en haces entrelazados. La lesión carece de cápsula y en la interfase con el parénquima renal normal hay células tumorales que rodean a los túbulos y a los glomérulos. Conclusiones: La edad en el momento del diagnóstico y la correcta extirpación del riñón son los dos factores pronósticos más relevantes

Introduction: Congenital mesoblastic nephroma (CMN) (leiomomatous or mesenchymal hamartoma) is a benign congenital renal neoplasm. This tumor is usually diagnosed along the first six months of life and surgery is current treatment. Patient and methods: A one week of life patient with a renal mass is reported. Ultrasonographically, the mass appearance was solid and replaces the kidney. Computerized tomography (CT) showed a lesion with irregular margins and heterogeneous structure. Grossly, a well delimited intrarenal mass, white, solid, homogeneus and fasciculated was identified. Microscopically, the tumor was composed by a monotonous population of fusiform cells showing an interlacing fasciculated pattern. The mass lacks capsule and the interphase with normal renal parenchyma showed spindle cells surrounding renal tubuli and glomerula. Conclusions: Best prognostic factors are the adequate extirpation and age at the diagnosis

Epirubicin, cyclophosphamide and weekly paclitaxel as neoadjuvant chemotherapy for stage II and III breast cancer.

PURPOSE: To assess the efficacy and the toxicity of a new combination of epirubicin, cyclophosphamide and paclitaxel as neoadjuvant chemotherapy for breast cancer. METHODS: Patients with stage II and III breast cancer received 3-4 cycles of epirubicin 75 mg/m(2) plus cyclophosphamide 600 mg/m(2) on day 1, and paclitaxel at a dose of 100 mg on days 1, 8, 15 and 22 on a 28-day cycle. RESULTS: Forty-nine patients were enrolled in the study. Stage II was present in 16 patients (32.7%) and stage III in 33 patients (67.3%). Relevant toxicities were nausea/vomiting grades III-IV in 6 patients (12.2%) and neutropenia grade III-IV in 33 patients (67.3%). The overall clinical response rate was 83.7%. Partial response was observed in 25 patients (51%), complete response in 16 patients (32.7%), stable disease in 7 patients (14.3%) and progression in 1 patient. Thirty-three non-inflammatory breast cancer patients underwent surgery, 29 with breast-conserving surgery (87.9%). Pathological complete response was found in 5 patients (15.1%). CONCLUSIONS: The combination of epirubicin, cyclophosphamide and weekly paclitaxel as given in this study is safe and shows good activity in the neoadjuvant setting of stage II and III breast cancer patients.