Ductal carcinoma in situ within a fibroadenoma: A case report and review of literature.

BACKGROUND: Fibroadenoma (FA) is the most common tumor found in young women, although it can occur in any age group. Ductal carcinoma in situ (DCIS) that is confined in a FA is rare; it is most frequently reported as an incidental finding. CASE SUMMARY: We report a case of DCIS within a FA in a 46-year-old female without cancer-related personal and family histories. The patient was diagnosed with a breast conglomerate of nodules and was followed for 1 year. In the current control image study, we found suspicious microcalcification, as a new finding, within one of the nodules. Consequently, a core biopsy of the tumor, which appeared hypoechoic, oval, and circumscribed, was performed. The pathological diagnosis was ductal carcinoma in situ within a fibroepithelial lesion. The patient underwent breast-conserving surgery and received radiotherapy as well as endocrine therapy (tamoxifen). CONCLUSION: We recommend a multidisciplinary approach for adequate treatment and follow-up.

High-risk lesions of the breast: concurrent diagnostic tools and management recommendations.

Breast lesions with uncertain malignant behavior, also known as high-risk or B3 lesions, are composed of a variety of pathologies with differing risks of associated malignancy. While open excision was previously preferred to manage all high-risk lesions, tailored management has been increasingly favored to reduce overtreatment and spare patients from unnecessary anxiety or high healthcare costs associated with surgical excision. The purpose of this work is to provide the reader with an accurate overview focused on the main high-risk lesions of the breast: atypical intraductal epithelial proliferation (atypical ductal hyperplasia), lobular neoplasia (including the subcategories lobular carcinoma in situ and atypical lobular hyperplasia), flat epithelial atypia, radial scar and papillary lesions, and phyllodes tumor. Beyond merely presenting the radiological aspects of these lesions and the recent literature, information about their potential upgrade rates is discussed in order to provide a useful guide for appropriate clinical management while avoiding the risks of unnecessary surgical intervention (overtreatment).

Radiogenomics analysis identifies correlations of digital mammography with clinical molecular signatures in breast cancer.

In breast cancer, well-known gene expression subtypes have been related to a specific clinical outcome. However, their impact on the breast tissue phenotype has been poorly studied. Here, we investigate the association of imaging data of tumors to gene expression signatures from 71 patients with breast cancer that underwent pre-treatment digital mammograms and tumor biopsies. From digital mammograms, a semi-automated radiogenomics analysis generated 1,078 features describing the shape, signal distribution, and texture of tumors along their contralateral image used as control. From tumor biopsy, we estimated the OncotypeDX and PAM50 recurrence scores using gene expression microarrays. Then, we used multivariate analysis under stringent cross-validation to train models predicting recurrence scores. Few univariate features reached Spearman correlation coefficients above 0.4. Nevertheless, multivariate analysis yielded significantly correlated models for both signatures (correlation of OncotypeDX = 0.49 ± 0.07 and PAM50 = 0.32 ± 0.10 in stringent cross-validation and OncotypeDX = 0.83 and PAM50 = 0.78 for a unique model). Equivalent models trained from the unaffected contralateral breast were not correlated suggesting that the image signatures were tumor-specific and that overfitting was not a considerable issue. We also noted that models were improved by combining clinical information (triple negative status and progesterone receptor). The models used mostly wavelets and fractal features suggesting their importance to capture tumor information. Our results suggest that molecular-based recurrence risk and breast cancer subtypes have observable radiographic phenotypes. To our knowledge, this is the first study associating mammographic information to gene expression recurrence signatures.

Her-2 positive mucinous carcinoma breast cancer, case report.

INTRODUCTION: Mucinous carcinoma is a variant of invasive breast carcinomas that accounts for 2% of them and has a better prognosis in contrast to the non-specific invasive carcinoma. They regularly are positive for estrogen and progesterone receptors and, generally, they do not overexpress HER2. When HER2 is positive, the first line treatment is trastuzumab; although the resistance is 52-89% for the non-specific carcinoma, it has been described just once in mucinous carcinoma. CASE SUMMARY: A 48-year-old female presented with a lump in her right breast and after a biopsy, it was diagnosed as mucinous carcinoma in the core biopsy and surgical resection, with positive hormone receptors and HER2 positive (3+) in 100% of the tumor cells. She was treated with neoadjuvant chemotherapy based on trastuzumab and pertuzumab with no pathological response. DISCUSSION: There are few pure mucinous carcinomas positive for HER2. Mucinous carcinomas are positive for HER2 account for less than 5% of invasive ductal carcinoma. Furthermore, our case was resistance to chemotherapy. Most mucinous carcinomas test negative for HER2, so they usually would not be treated with trastuzumab, in this case because the expression of HER2 in the biopsies we initiated it. CONCLUSION: It's important to know that cases of mucinous carcinoma positive for HER2 exist and to be aware of the clinical problems that they may present: resistance to trastuzumab. Also, we need to understand the responsible mechanisms of this resistance and use immunohistochemistry for MUC which may predict it.

[Detection of invasive breast lobular carcinoma by image analysis: comparison between mammography and ultrasound]. / Evaluación por imagen en la detección del carcinoma lobulillar invasor de mama: comparación de la mamografía y el ultrasonido.

BACKGROUND: Early detection of lobular cancer has for long implied a challenge for diagnostic imaging due to the peculiar histology it presents that makes clinical and radiology detection rather difficult. OBJECTIVE: The aim of our study was to compare the sensitivity and specificity of mammography and ultrasound for the diagnosis of invasive breast lobular carcinoma. MATERIAL AND METHODS: This is a retrospective study of women with histopathological diagnosis of invasive breast lobular carcinoma in the period between September 2006 and August 2009. All patients underwent mammography and ultrasound. The final pathology report was used as reference standard and the sensitivity and specificity of mammography and ultrasound were evaluated statistically using chi-square test (chi2). RESULTS: The analysis included 654 patients who underwent biopsy. Among them, 148 (22.62%) were positive and 506 (77.37%) negative for cancer. The average age was 48 years (range 18-89). The sensitivity of ultrasound was higher in the group of invasive lobular cancer (ILC) in 14/14 (100%) cases, in contrast to 87/111 (78%) cases of invasive ductal carcinoma (IDC) and 9/18 (50 %) cases of ductal carcinoma in situ (DCIS). The mammography showed greater sensitivity in the group of DCIS in 17/18 (94%) cases, unlike 9/14 (64%) cases of ILC and 89/111 (80%) cases of IDC. CONCLUSIONS: Ultrasound improves the detection of ILC with sensitivity up to 100% compared to 64% by mammography. The combination of both diagnostic tests showed sensitivity equal to the ultrasound, but it decreased 30% the specificity in this group.

El ultrasonido en el hombro doloroso: estudio de 42 pacientes / Ultrasound of the painful shoulder: study of 42 patients

Los autores valoran la eficacia del Ultrasonido para el diagnóstico y etapificación de lesiones del manguito rotador. El estudio se llevó cabo en forma prospectiva y longitudinal, en pacientes con diagnóstico de hombro doloroso, en quienes realizaron un examen pasivo y lo compararon con el hombro contralateral. Se estudiaron 42 pacientes, en 29 de los cuales se comparó el resultado con el de la cirugía y en 24 con la Resonancia Magnética. Las lesiones se clasificaron de acuerdo a los criterios de Wiener y Seitz, la que permite el conocimiento de la extensión del daño y correlacionarlo con el encontrado en la cirugía. Los resultados de Ultrasonido concordaron con los de la cirugía en 28/29 pacientes, obteniendo valores de significancia 0.0001, lo que demuestra que el ultrasonido es un método confiable y seguro para el abordaje del paciente con hombro doloroso

Imagen por resonancia magnética del disrrafismo espinal / Magnetic resonance imaging of spine dysrraphism

Se practicó RM a 35 pacientes con diagnóstico de disrrafismo espinal en los cuales se logró determinar la localización exacta de los defectos como espina bifida o meningocele, además se definió su extensión y las patologías asociadas como el lipoma, la siringomielia, la distematomielia, médula anclada, así como la malformación de Arnold Chiari. Se considera que la RM es el método de elección en los pacientes con disrrafismo espinal, debido a que es un método no invasivo, multiplanar y que permite delimitar los defectos de la línea media de manera precisa

Manifestaciones radiológicas del síndrome de Garlin: carcinoma nervoide de células basales / Radiological manifestations of the Gorlin's syndrome: nevoid carcinoma of basal cells

El síndrome de Gorlin se caracteriza por la presencia de múltiples carcinomas nevoides de células basaloides, quistes mandibulares y displasias vertebrales y costales múltiples. Se hace una revisión de los hallazgos radiológicos y los aspectos clínicos más importantes de esta enfermedad