Prospective trial of adipose-derived regenerative cell (ADRC)-enriched fat grafting for partial mastectomy defects: the RESTORE-2 trial.

AIMS: Women undergoing breast conservation therapy (BCT) for breast cancer are often left with contour defects and few acceptable reconstructive options. RESTORE-2 is the first prospective clinical trial using autologous adipose-derived regenerative cell (ADRC)-enriched fat grafting for reconstruction of such defects. This single-arm, prospective, multi-center clinical trial enrolled 71 patients post-BCT with defects ≤150 mL. METHODS: Adipose tissue was collected via syringe lipoharvest and then processed during the same surgical procedure using a closed automated system that isolates ADRCs and prepares an ADRC-enriched fat graft for immediate re-implantation. ADRC-enriched fat graft injections were performed in a fan-shaped pattern to prevent pooling of the injected fat. Overall procedure times were less than 4 h. The RESTORE-2 protocol allowed for up to two treatment sessions and 24 patients elected to undergo a second procedure following the six month follow-up visit. RESULTS: Of the 67 patients treated, 50 reported satisfaction with treatment results through 12 months. Using the same metric, investigators reported satisfaction with 57 out of 67 patients. Independent radiographic core laboratory assessment reported improvement in the breast contour of 54 out of 65 patients based on blinded assessment of MRI sequence. There were no serious adverse events associated with the ADRC-enriched fat graft injection procedure. There were no reported local cancer recurrences. Injection site cysts were reported as adverse events in ten patients. CONCLUSION: This prospective trial demonstrates the safety and efficacy of the treatment of BCT defects utilizing ADRC-enriched fat grafts.

Siliconoma cervical tras mastectomía y reconstrucción con prótesis / No disponible

Los implantes de gel de silicona han sido desde su aparición en 1960 el material protésico más utilizado en la reconstrucción mamaria postmastectomía, así como en la mamoplastia de aumento. Una de las complicaciones más frecuentemente reconocida es su ruptura, cuya incidencia se estima entre un 0,2 y un 4% en relación con la edad del implante. Una consecuencia de la rotura de la prótesis es la migración de la silicona a los ganglios linfáticos y la aparición de siliconomas en los territorios de drenaje de la mama. En la literatura son muchos los casos descritos de linfadenopatía axilar tras la rotura de prótesis mamarias. Se presenta un caso de siliconoma en la región cervical en una paciente con reconstrucción postmastectomía(AU)

Silicone breast implants are widely been used since 1960. They are the material prosthetic choice for a great number of implant designs both postmastectomy reconstruction, as well as breast augmentation. Prosthesis rupture is one of the most frequently known complication, whose incidence is estimated between 0.2 and 4%, increasing with the age of the implant. One consequence of implant rupture is silicone migration to lymphatic nodes and the formation of siliconomas in the lymphatic drainage of the breast. The literature offers many cases of axillary lymphadenopathy after ruptured breasts implants. We present the case of a siliconoma in the cervical region after postmastectomy implant placement(AU)

Radiation-Induced Leiomyosarcoma after Breast Cancer Treatment and TRAM Flap Reconstruction.

The development of a radiation-induced sarcoma (RIS) in the post mastectomy thoracic treatment volume is an infrequent, but recognized, event. Its frequency is rising in relation with increasing survival of breast cancer patients treated with adjuvant radiation therapy, and is associated with poor prognosis despite treatment. We present a case of leiomyosarcoma in a patient who underwent mastectomy followed by radiotherapy for invasive ductal carcinoma. A delayed TRAM flap reconstruction was performed 10 years after and a rapid growing mass under the reconstructed flap appeared, on routine follow-up, twenty years later. This report analyzes the diagnostic and therapeutic approach of patients with RIS.

Linfangiosarcoma en paciente mastectomizada (síndrome de Stewart-Treves) / No disponible

El linfangiosarcoma postmastectomía (LPM) es un tumorvascular muy infrecuente y agresivo, que asienta habitualmenteen brazos portadores de un linfedema de larga evolución,tras una mastectomía radical por cáncer. Su incidencia es del0,45% en pacientes que sobreviven 5 años tras la mastectomíaradical. La etiología de estos tumores es aún completamentedesconocida. En la actualidad no existe un tratamientoestandarizado. Las opciones terapéuticas incluyen la exéresisquirúrgica, amputación de la extremidad afectada, desarticulación,radioterapia y quimioterapia. El pronóstico es malo. Lasupervivencia tras el diagnóstico oscila entre 8 y 15 meses.Presentamos el caso de una paciente con linfangiosarcomapostmastectomía radical y radioterapía(AU)

Lymphangiosarcoma postmastectomy is an uncommonvascular tumor, arising in the area of chronically lymphoedematousextremity, after radical mastectomy and radiotherapyin patients with breast cancer. It shows an incidence of 0,45%among patients that survive more than five years after radicalmastectomy. The etiology of this enigmatic tumor is not yetcompletely understood. There is no standard treatment. Thetreatment options include radical ablative surgery, amputation,radiation therapy and chemotherapy. The prognosis is poor.Survival after diagnosis ranged from 8 to 15 months. We reportthe case of patients with LPM and RT(AU)

Unidades de patología mamaria: virtuales o reales / No disponible

En la actualidad el concepto de Unidades de Patología Mamariase encuentra totalmente aceptado, debido a la introduccióndel enfoque multidisciplinario en el tratamiento de la patologíamamaria, por lo que se han establecido como estructurasdentro de los centros públicos y privados, cuya proliferación hadeterminado la necesidad de la aplicación de normas mínimasque aseguren un funcionamiento de alta calidad.Existen dos modelos de Unidades de Patología Mamaria: eleuropeo y el americano, en los que se ha analizado su origen yconformación, así como los requisitos indispensables para suactividad. Estas dos visiones de un mismo concepto, constituyenla plataforma ideal para perfeccionar el cuidado de lamama tanto para mujeres con enfermedad benigna como maligna,sin embargo en cada país existen diferencias en la calidaddel tratamiento de la patología mamaria que aunque resulteninaceptables son una realidad.La aplicación de los modelos de Unidades de Patología Mamariadeben cubrir las exigencias del tratamiento de las pacientes,para ello es necesario que adquieran personalidad propia,autonomía, sean multidisciplinares, estén formadas por especialistascon dedicación exclusiva a la patología mamaria, cuentencon la suficiente carga de pacientes y sean auditables en sus procedimientosy resultados, es decir, funcionen como verdaderasunidades reales, y no unidades virtuales, con la categoría y el reconocimientoque les corresponden(AU)

Nowadays the concept of Breast Units is totally accepted,owing to the introduction of multidisciplinary approach in thetreatment of the breast diseases, by the establishment as structuresinside the public and private centers, whose proliferationhas determined the necessity of the application of minimumrequirements, which assure high quality performance.There are two models of Breast Units: the European andthe American, in that it has been analyzed its origin and conformation,as well as the requirements needed for its activity.These two visions of the same concept, constitute the idealplatform to perfect the care of the breast for women with bothbenign and malignant disease, nevertheless in each countryexist differences in the quality of the treatment of the breastpathology that although are unacceptable are a reality.The application of Breast Unit models must cover the qualityrequirements in the treatment of the patients. For it is necessarythat acquire their own personality, autonomy, be multidisciplinaries,are formed by specialists with exclusive dedication to thebreast disease, count with enough charge of patients and be auditedin its procedures and results, that is to say, work as truereal units and not virtual units, with the corresponding recognitionand categorization that its correspond(AU)

[Consensus meeting on selective biopsy of the sentinel node in breast cancer. Spanish Society of Senology and Breast Disease]. / Reunión de Consenso sobre la biopsia selectiva del ganglio centinela en el cáncer de mama. Sociedad Española de Senología y Patología Mamaria.

Selective biopsy of the sentinel node is a useful diagnostic technique in the management of breast cancer that has been introduced into the clinical practice and is widely used and accepted. Based on its results, adequate staging can be made with less associated morbidity. However, at present, there are many methodological variations in how it is done that are pending to be answered in on-going trials and investigations. This involves making Consensus Meetings to try to homogenize the aspects related with the method and indication of the technique. The conclusions of the Consensus Meeting held in Murcia and organized by The Spanish Society of Senology and Breast Disease are expressed in this document.

Reunión de Consenso sobre la Biopsia Selectiva del Ganglio Centinela en el Cáncer de Mama. Sociedad Española de Senología y Patología Mamaria / No disponible

La biopsia selectiva del ganglio centinela es una técnicadiagnóstica útil en el manejo del carcinoma de mama que seha introducido en la práctica clínica con una gran difusión yaceptación. Sus resultados permiten realizar una adecuada estadificacióncon una menor morbilidad asociada. No obstante,en la actualidad, existen numerosas variaciones metodológicasen su ejecución pendientes de ser contestadas en ensayos e investigacionesen curso. Esto implica realizar reuniones de consensopara tratar de homogeneizar los aspectos relacionadoscon el método y la indicación de la técnica. En este documentose reflejan las conclusiones de la Reunión de Consenso celebradaen Murcia y organizada por la Sociedad Española deSenología y Patología Mamaria

No disponible

Enfermedad inflamatoria mamaria asociada con los conductos / No disponible

No disponible

Infiltrating ductal carcinoma and synchronous malignant phyllodes tumour. Diagnostic and therapeutic approaches

Simultaneous presentation of breast cancer and malignant phyllodes tumour is rare. A female patient presented with a nodule in her left breast (infiltrating ductal carcinoma). On magnetic nuclear resonance another suspicious lesion (malignant phyllodes) was found in the right breast. Bilateral mastectomy was performed. Thirty two months later the patient is still free of disease. The approach to dealing with synchronous breast tumours should be the same as that normally used (AU)

Estudio de validación de la linfogammagrafía y biopsia del ganglio centinela en cáncer de mama / Validation study of the lymphadenectomy and sentinel node biopsy in the breast cancer

Objetivo: La afectación de los ganglios axilares constituyeel principal factor pronóstico en cáncer de mama en cuantosupervivencia global. El propósito de este trabajo es el de presentarlos resultados de la primera fase de realización de labiopsia del ganglio centinela en cáncer de mama en nuestrocentro.Métodos: Se incluyó un total de 50 pacientes a las que serealizó la biopsia del ganglio centinela, seguida de linfadenectomíade los niveles I y II. Las indicaciones fueron tumor inferiora 2,5 cm de diámetro sin sospecha de afectación axilar,pacientes con carcinoma ductal in situ extenso y sin quimioterapiaprevia.Resultados: La tasa de detección general fue del 98%.Hubo un falso negativo. Se encontraron micrometástasis entres pacientes.Conclusión: La biopsia del ganglio centinela es un métodofiable para determinar el estado de los ganglios linfáticosregionales en pacientes con cáncer de mama

Objective: The status of the axilla is the single most importantprognostic indicator of overall survival in patients withbreast cancer. The aim of this study was to validate sentinelnode biopsy for axillary staging after the initial learning phase.Methods: A total of 50 patients, who had standard sentinelnode biopsy followed by level I and II axillary clearance,were recruited prospectively. Accepted indications were tumorless than 2,5 cm without suspicious findings in the axilla, patientswith large ductal carcinoma in situ and patients withoutpreoperative chemotherapy.Results: The overall detection rate was 98 per cent. Therewas one false negative. Micrometastases were found in threepatients.Conclusion: The sentinel node biopsy is a reliable methodfor determining the status of the regional lymph nodes in patientswith breast cancer

[Hepatic trauma (90 consecutive cases treated in 9 years]. / Traumatismos hepáticos (90 casos consecutivos tratados en nueve años).

90 consecutive hepatic traumatisms at the Hospital de Navarra are presented over a period of 9 years, excluding those which did not overcome the initial reanimation phase and those diagnosed as necropsy. The etiology is presented (76 closed and 14 open), the degree of lesion, associated intra and extra-abdominal lesions plus the results (12.2% mortality) and causes of death related to the degree of lesion and associated lesion. Finally, our casuistics and results are compared with those appearing in the existing bibliography on the subject.