[Differential diagnosis and management of intramuscular myxomas: A review of our experience]. / Diagnóstico diferencial y manejo de mixomas intramusculares: revisión de nuestra experiencia.

BACKGROUND: Intramuscular myxoma is a rare benign soft tissue tumour of mesenchymal origin, which appears as a painless mass of slow growth. Early diagnosis is important in order to differentiate it from other entities, especially soft tissue sarcoma. CLINICAL CASES: Two cases, both women with a mean age of 52.5 years (range 40-65) are presented. The first was seen due to growth of a gluteal mass, and the second by coccydynia. Computed tomography and nuclear magnetic resonance were the diagnostic tests of choice. In one case, where there was a single but large lesion, radical extirpation of the gluteal muscle was chosen. In the other case, in which the lesions were multiple, individualised excision of cysts was performed. Postoperative functional limitation was low in both types of surgery, with good oncological results being obtained. CONCLUSION: Intramuscular myxomas are benign lesions. There are no cases of malignancy or recurrence due to incomplete resection. It has to be determined whether they are single or multiple, since in the latter case, they could be due to syndromes such as Mazabraud syndrome, which is associated with bone fibrous dysplasia, or Albright syndrome that is also associated with pigmented skin spots.

Rendimiento diagnóstico de la punción aspiración con aguja fina de tejido tiroideo / Diagnostic efficacy of fine needle aspiration of thyroid tissue

Introducción. La punción aspiración con aguja fina (PAAF) de la glándula tiroides constituye un proceso diagnóstico que permite determinar de forma segura y fiable, si un nódulo tiroideo es benigno o maligno. Objetivo. El objetivo del estudio fue evaluar la eficacia diagnóstica de la PAAF en nuestro centro. Material y métodos. Se llevó a cabo de 2009 a 2013 un estudio retrospectivo de pacientes con nódulo tiroideo sospechoso de ser maligno. Las variables del estudio fueron: edad, sexo, tamaño del nódulo tiroideo, realización de PAAF, estudio anatomo-patológico de la biopsia y diagnóstico definitivo. Se comparó el rendimiento diagnóstico de la PAAF frente a los resultados de la biopsia posoperatoria. Resultados. Durante los cinco años del estudio, se practicó PAAF de tejido tiroideo a 112 pacientes (30,2 %, hombres, y 69,8 %, mujeres), con un tamaño medio nodular de 2 cm (rango: 1 a 4). La PAAF fue positiva para neoplasia maligna en 26 casos (23,2 %) y negativa en 86 casos (76,8 %). Los resultados del rendimiento de la prueba fueron: sensibilidad de 45,5 % (intervalo de confianza 95 % [IC95%] 28,1-63,6), especificidad de 86,1 % (IC95% 76,5-92,8), valor predictivo positivo de 57,7 % (IC95% 36,9-76,6) y valor predictivo negativo de 79,1 % (IC95% 69-87,1). Conclusión. Tras este análisis, se obtiene un resultado malo con posibilidad de ser mediocre, por lo que habría que replantearse la utilidad de esta prueba invasiva en nuestro centro y la búsqueda de posibles errores.

Background: Thyroid fine needle aspiration (FNA) is a safe and reliable diagnostic procedure for determining if a thyroid nodule is benign or malignant. Objective: The objective of this study was to evaluate the efficacy of FNA diagnosed in our center. Material and methods: Retrospective study of patients with thyroid nodule suspicious for malignancy, in the period 2009 to 2013. The variables used in this study were: age, sex, size of thyroid nodule, FNA performance, pathology and definitive diagnosis. The diagnostic accuracy of FNA was compared with the results of postoperative biopsy. Results: During the 5-year study, FNA of thyroid tissue was performed at 112 patients (30.2% men and 69.8% women), with nodules of average size of 2 cm (range 1-4). FNA was positive for malignancy in 26 cases (23.2%) and negative in 86 cases (76.8%). The performance results of the test were: sensitivity 45.5% (confidence interval [CI] 95%: 28.1% -63.6%), specificity of 86.1% (95% CI: 76.5 % - 92.8%), positive predictive value of 57.7% (95% CI: 36.9% - 76.6%) and negative predictive value of 79.1% (95% CI: 69% - 87 1%) Conclusion: A bad result with the possibility of being mediocre is obtained with this analysis, which should rethink the usefulness of this invasive test in our center and search for possible errors.

[Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study]. / Relación del tamaño tumoral con la recidiva tras cirugía conservadora en el cáncer de mama en estadio tumoral T1-T2. Estudio poblacional.

BACKGROUND: Conservative surgery can be regarded as the standard treatment for most early stage breast tumors. However, a minority of patients treated with conservative surgery will present local or locoregional recurrence. Therefore, it is of interest to evaluate the possible factors associated with this recurrence. METHODS: A population-based retrospective study using data from the Tumor Registry of Castellón (Valencia, Spain) of patients operated on for primary nonmetastatic breast cancer between January 2000 and December 2008 was designed. Kaplan-Meier curves and log-rank test to estimate 5-year local recurrence were used. Two groups of patients were defined, one with conservative surgery and another with nonconservative surgery. Cox multivariate analysis was conducted. RESULTS: The total number of patients was 410. Average local recurrence was 6.8%. In univariate analysis, only tumor size and lymph node involvement showed significant differences. On multivariate analysis, independent prognostic factors were conservative surgery (hazard ratio [HR] 4.62; 95% confidence interval [CI]: 1.12-16.82), number of positive lymph nodes (HR 1.07; 95% CI: 1.01-1.17) and tumor size (in mm) (HR 1.02; 95% CI: 1.01-1.06). CONCLUSIONS: Local recurrence after breast-conserving surgery is higher in tumors >2 cm. Although tumor size should not be a contraindication for conservative surgery, it should be a risk factor to be considered.

Antecedentes: la cirugía conservadora es un patrón de referencia del tratamiento de la mayor parte de los tumores mamarios en estadios iniciales. Sin embargo, una minoría de pacientes intervenidas con esta opción tendrá recurrencia local o locorregional. Por ello resulta de interés evaluar los posibles factores relacionados con esta recurrencia. Material y métodos: estudio retrospectivo, con base poblacional, efectuado con base en los datos del Registro de Tumores de Castellón (Comunidad Valenciana, España) de pacientes intervenidas de cáncer primario de mama no metastático de enero de 2000 a diciembre de 2008. Se utilizaron las curvas de Kaplan-Meier y la prueba de log-rank para estimar la recurrencia local a cinco años. Se definieron dos grupos de pacientes, uno con cirugía conservadora y otro con cirugía no conservadora de la mama. Se realizó un estudio multivariado de Cox. Resultados: se encontraron 410 pacientes con promedio de 6.8% de recurrencias locales. En el análisis univariado sólo el tamaño tumoral y la afectación ganglionar demostraron diferencias significativas. En el análisis multivariado los factores pronóstico independientes fueron: la cirugía conservadora (Hazard ratio [HR] 4.62; IC [intervalo de confianza] 95% 1.12-16.82), el número de ganglios linfáticos positivos (HR 1.07; IC 95% 1.01-1.17) y el tamaño del tumor en milímetros (HR 1.02; IC 95% 1.01-1.06). Conclusiones: la recurrencia local postcirugía conservadora de mama es mayor en tumores de más de 2 cm. Aunque el tamaño del tumor no debería ser una contraindicación para esta cirugía sí deben tomarse en cuenta como un factor de riesgo.

[Breast cancer screening: have there been any changes during the last decade? A study in a Spanish unit].

BACKGROUND: Breast screening programs in Spain cover almost 100% of population. The objective of the present study was to analyze if there have been any changes during the last decade in our breast screening unit (Unidad de Prevención del Cáncer de Mama de Castellón) that can also be extrapolated to other breast screening units. METHODS: We conducted a retrospective and descriptive analysis reviewing patients seen in our breast screening unit between January 1, 2000 and December 31, 2009. Patients with a final diagnosis of carcinoma, year of diagnosis, age, histological type, infiltration, surgical procedure and tumor extension were analyzed. RESULTS: A total of 311 breast cancers were diagnosed among 90,010 women who were seen at our breast screening unit. Mean age of the patients was 56 years. A progressive increase of the target population was seen (24,004 persons in 2000 and 31,950 in 2009). Histological type, percentage of infiltrative tumors and lymph node involvement did not show significant differences by year. Differences were observed for tumor size (pT category of TNM classification) and breast conservation surgery. CONCLUSIONS: Tumor stage in cancers diagnosed in breast screening units progressively decreased when the program was being implemented. There is a maximum level among which tumor characteristics remain constant. Changes in screening programs can modify these characteristics.