Collagen content and C-X-C motif chemokine ligand 12 expression in neoplastic breast stroma.

OBJECTIVE: This study aimed to evaluate the expression of C-X-C motif chemokine ligand 12 and its C-X-C chemokine receptor type 4, and the tumor-stroma ratio using collagen stromal content of breast cancer samples, correlating it with clinicopathological data. METHODS: Through a retrospective cohort study, samples were obtained from female patients, over 18 years of age, with the disease in stages 1-4, who underwent mastectomy or lumpectomy. The biopsies were provided by the Oncology sector of the Hospital das Clínicas of Universidade Federal de Pernambuco, Recife city, in 2011-2014, including samples of invasive ductal carcinoma, ductal carcinoma in situ, or benign changes (fibroadenoma and hypertrophy), which were analyzed between 2020 and 2022 by immunohistochemistry for the expression of stromal cell characteristics. Collagen content was tested by Gomori staining and digital analysis of images. RESULTS: Absence of stromal expression of C-X-C motif chemokine ligand 12 was associated with longer disease-free survival (disease-free survival=0.481), and expression of C-X-C chemokine receptor type 4 was associated with lower disease-free survival. An association was observed between clinicopathological variables and stromal expression of chemokines, that is, an association of stromal C-X-C motif chemokine ligand 12 with histological grade, angiolymphatic invasion, and an association between C-X-C chemokine receptor type 4 expression and histological grade. Analyses of digital pixels images of collagen and tumor cells showed a lower percentage of collagen in the invasive ductal carcinoma samples (39%), unlike samples without neoplasms (78%). CONCLUSION: Low expression of C-X-C motif chemokine ligand 12 may be associated with a worse prognosis for breast cancer. Collagen staining analyzed using digital images represents an opportunity for clinical application and is indicative of the prognosis of the tumor microenvironment in breast carcinoma.

The Use of Convolutional Neural Networks in the Prediction of Invasive Ductal Carcinoma in Histological Images of Breast Cancer.

This paper presents a deep learning approach for automatic detection and visual analysis of Invasive Ductal Carcinoma (IDC) tissue regions. The method proposed in this work is a convolutional neural network (CNN) for visual semantic analysis of tumor regions for diagnostic support. Detection of IDC is a time-consuming and challenging task, mainly because a pathologist needs to examine large tissue regions to identify areas of malignancy. Deep Learning approaches are particularly suitable for dealing with this type of problem, especially when many samples are available for training, ensuring high quality of the learned features by the classifier and, consequently, its generalization capacity. A 3-hidden-layer CNN with data balancing reached both accuracy and F1-Score of 0.85 and outperforming other approaches from the literature. Thus, the proposed method in this article can serve as a support tool for the identification of invasive breast cancer.

Clinicopathological and immunohistochemical behavior of ductal carcinoma of the salivary and lacrimal gland in a Mexican Mestizo population.

PURPOSE: Salivary gland tumors are rare and include benign and malignant entities with different behavior and prognosis. Salivary gland carcinoma accounts for 0.2% of all cancers and 5-9% of head and neck carcinomas. We aim to describe the clinicopathological characteristics and discuss the immunohistochemical findings of salivary ductal carcinoma. METHODS: We obtained 17 cases (2.3%) of salivary ductal carcinoma (SDC) from 727 patients with parotid tumors at our cancer center from a database covering a 22-year period (1996-2018). Two pathologists confirmed the diagnosis and excluded 6 cases. Eleven cases were assessed by immunohistochemistry (IHC) for HER2, estrogen receptor (ER), progesterone receptor (PR), androgen receptor (AR), mammaglobin, P53, GATA3, S100, cytokeratins (7,8,14,18, and 20), P63, PAX8, calponin, and SOX10. RESULTS: Eleven SDC cases were in advanced stage, and 80% had metastasis. All cases were surgically treated, and 40% received different adjuvant chemotherapy regimens. we found that most patients were dead of disease. The histological and immunohistochemical analysis showed that 70% of cases were high-grade, 40% were positive for HER2, and 50% for AR. Moreover, a high Ki-67 proliferative index was detected in all cases. We observed luminal differentiation in 50% of cases. CONCLUSION: SDC is a rare entity and survival is very poor. It is histologically similar to ductal carcinoma of the breast. However, important differences exist that help to distinguish them in case of synchronous cancers. The clinical behavior of SDC seems to be more aggressive and IHC analysis is useful for designing therapies.

The tumor immune contexture of salivary duct carcinoma.

BACKGROUND: Salivary duct carcinoma (SDC) is a rare and aggressive malignancy. Recently, biomarker studies found promising targetable alterations. In this study, we provide a descriptive analysis of tumor and immune biomarkers and survival associations. METHODS: We extracted clinical data and performed immunohistochemistry for AR, AR-V7, HER-2, PD-L1, LAG-3, and tumor-infiltrating immune cells. RESULTS: We included 17 patients. Age ranged from 42 to 85 years old; HER-2 was overexpressed or amplified in 65%. AR was positive in 88% of patients, while AR-V7 was positive in 13% by IHC. We found low scores of immune infiltration and a PD-L1 expression in 53%. We found no clinically significant association between biomarkers and survival outcomes. CONCLUSION: In this small series of SDC, biomarkers do not seem to correlate with disease biology, although they provide additional treatment options. SDC may harbor a different immune profile compared to other subtypes, with an indication of T-cell dysfunction.

Carcinoma del conducto salival: estudio clínico/patológico e inmunohistoquímico de 5 casos / Salivary duct carcinoma: a clinicopathologic and inmunohistochemical study of 5 cases

El carcinoma del conducto salival es un tumor epitelial maligno agresivo, que involucra principalmente a la glándula parótida, con características histológicas semejantes al carcinoma ductal de glándula mamaria. El propósito de este trabajo fue presentar los resultados clínico-patológicos de cinco casos de carcinoma del conducto salival primario de glándula parótida y evaluar la expresión de Ki67. Histológicamente, el carcinoma del conducto salival presentó nidos epiteliales con patrones papilar, sólido y cribiforme, comedonecrosis tanto en la lesión primaria como en los nodos linfoides metastásicos y, además, invasión perineural. Se demostró con Ki 67 una alta proliferación celular en cuatro (80 %) de los cinco casos estudiados. Se concluyó que: el carcinoma del conducto salival es una lesión maligna de mal pronóstico, raramente informado en la literatura odontológica, con características histológicas semejantes a las del carcinoma ductal de alto grado de la mama; la comedonecrosis es un signo específico de esta enfermedad; puede desarrollarse "de novo" o en un adenoma pleomórfico preexistente; su diagnóstico diferencial histopatológico es fundamental para planificar su tratamiento y determinar su pronóstico, a pesar de su tratamiento quirúrgico y radioterapia postoperatoria es un tumor agresivo con alta proliferación celular, infiltración perineural, recurrencias y metástasis.

Salivary duct carcinoma is an aggressive malignant epithelial tumor, primarily involving the parotid gland, with histologic features similar to ductal carcinoma of the breast. The purpose of this work was to report the clinicopathological results of five cases of primary salivary duct carcinoma of the parotid gland and evaluate the expression of Ki67. Histologically, salivary duct carcinoma presented epithelial nests with papillary, solid, and cribriform patterns, with comedonecrosis in both the primary lesion and the metastatic limph nodes, and perineural invasion. A high cell proliferation was demonstrated with Ki67 in four (80 %) of the five cases studied. We concluded that: salivary duct carcinoma is a malignant lesion with a poor prognosis, rarely reported in the dental literature, with histological characteristics similar to those of high-grade ductal carcinoma of the breast; comedonecrosis is a specific sign of this disease; may develop "de novo" or in a pre-existing pleomorphic adenoma; its differential histopathological diagnosis is essential to plan its treatment and determine its prognosis; despite its surgical treatment and postoperative radiotherapy, it is an aggressive tumor with high cell proliferation, perineural infiltration, recurrences and metastasis.

Análisis comparativo del Carcinoma Lobulillar Invasor versus Carcinoma Ductal Invasor: ¿entidades clínica o biológicamente diferentes? / Comparative analysis of Invasive Lobular Carcinoma versus Invasive Ductal Carcinoma: clinically or biologically different entities?

Introducción El Carcinoma Lobulillar Invasor (cli) es el tipo histológico especial más común del cáncer de mama. Presenta características histopatológicas asociadas a buen pronóstico, pero algunos estudios sugieren que los resultados a largo plazo pueden ser peores que los del Carcinoma Ductal Invasor (cdi). Objetivo Los objetivos principales del estudio fueron evaluar las características clínico-patológicas del cli y establecer el valor pronóstico. Material y método Se seleccionaron 244 pacientes con cli y se utilizó como grupo control a 524 pacientes con cdi, comparándolas con relación 2 a 1. Resultados No se observaron diferencias en edad, estado menopáusico, motivo de consulta e invasión linfovascular. Fueron más frecuentemente multifocales, multicéntricos, de mayor tamaño, bajo grado histológico y her2 negativo. La cirugía conservadora se realizó con menos frecuencia. No hubo diferencias significativas en recaída a distancia, cáncer de mama contralateral, sobrevida libre de enfermedad y global. Conclusiones Las pacientes con cli no tuvieron mejores resultados a pesar de un fenotipo biológico más favorable. La histología ductal o lobulillar no debería ser un factor en el manejo de la patología, y no debería considerarse un factor pronóstico o predictivo determinante al momento del diagnóstico

Introduction Invasive Lobular Carcinoma (ilc) is the second most common histologic type of breast cancer. Typically, displays features associated with a good prognosis, but some studies suggest that outcomes of ilc may be worse than for Invasive Ductal Carcinoma (idc). Objective The main purpose of this study was to evaluate the clinical-pathological characteristics of Lobular Breast Carcinoma and establish his prognostic value. Materials and method We selected a group of 244 patients with ilc and compared with 524 patients whit idc in relation 2:1. Results There were no differences in age, menopausal status, symptoms at time of diagnosis, and lymph vascular invasion. ilc were larger, low histological grade and her2 negative, more often mulfifocal and multicentric. Breast-preservation therapy was less frequent for Invasive Lobular Carcinoma. Distant relapse, contralateral cancer, overall survival, disease-free survival, did not differ between idc and ilc. Conclusions Women with ilc do not have better clinical outcomes than patients with idc, despite the fact that the biologic phenotype of ilc is quite favorable. The ductal or lobular histology should not be a factor in the therapeutic decision-making process, and should not be considered an important prognostic or predictive factor at diagnosis

Multiplatform Investigation of Plasma and Tissue Lipid Signatures of Breast Cancer Using Mass Spectrometry Tools.

Plasma and tissue from breast cancer patients are valuable for diagnostic/prognostic purposes and are accessible by multiple mass spectrometry (MS) tools. Liquid chromatography-mass spectrometry (LC-MS) and ambient mass spectrometry imaging (MSI) were shown to be robust and reproducible technologies for breast cancer diagnosis. Here, we investigated whether there is a correspondence between lipid cancer features observed by desorption electrospray ionization (DESI)-MSI in tissue and those detected by LC-MS in plasma samples. The study included 28 tissues and 20 plasma samples from 24 women with ductal breast carcinomas of both special and no special type (NST) along with 22 plasma samples from healthy women. The comparison of plasma and tissue lipid signatures revealed that each one of the studied matrices (i.e., blood or tumor) has its own specific molecular signature and the full interposition of their discriminant ions is not possible. This comparison also revealed that the molecular indicators of tissue injury, characteristic of the breast cancer tissue profile obtained by DESI-MSI, do not persist as cancer discriminators in peripheral blood even though some of them could be found in plasma samples.

Caracterización histopatológica del cáncer de mama infiltrante HER2 positivo en el Hospital Hermanos Ameijeiras / Histopathological description of HER2 Positive Infiltrating Breast Cancer at Hermanos Ameijeiras Hospital

RESUMEN Introducción: La sobreexpresión del HER2 en el carcinoma de mama está asociada a un curso clínico adverso y menor sobrevida por lo que resulta necesario determinar las características histopatológicas presentes en el carcinoma de mama infiltrante en las pacientes que lo padecen, con el fin de establecer una terapéutica correcta e individualizada. Objetivos: Determinar las características histopatológicas más frecuentes presentes en el carcinoma de mama con sobreexpresión del gen HER2. Métodos: Estudio observacional, transversal en el período de enero 2010 a diciembre 2012. Se incluyeron 93 pacientes. Se exploraron variables sociodemográficas, clínicas e hstopatológicas. En el análisis estadístico se utlizaron frecuenicas absolutas y relativas. Resultados: La media de edad fue de 55,1 años y el 68,8 por ciento era de piel blanca. La mama más afectada fue la derecha con el 45,2 por ciento y la localización más frecuente el cuadrante supero-externo con el 26,9 por ciento. El carcinoma ductal invasivo representó el 71 por ciento del total. El grado nuclear 3 se encontró en 81,7 por ciento casos y la necrosis tumoral 88,2 por ciento. Los receptores estrogénicos fueron positivos en 50,5 por ciento y los receptores de progesterona fueron negativos en 59,1 por ciento. El análisis histológico del cáncer de mama será de utilidad para individualizar la terapia de cada una de las pacientes. Conclusiones: Es importante continuar la investigación con la incorporación de otras variables de interés, tales como, respuesta al tratamiento y supervivencia, además de la prueba de hibridización in situ detectada por fluorescencia en las pacientes del universo en las que se constató HER2 2+ para definir su estatus y orientar mejor su tratamiento(AU)

ABSTRACT Introduction: HER2 overexpression in breast carcinoma is associated with the adverse clinical course and shorter survival, so it is necessary to determine the histopathological characteristics present in infiltrating breast carcinoma in patients with it, in order to establish correct and individualized therapy. Objectives: To determine the histopathological characteristics that are most frequently present in breast carcinoma with overexpression of HER2 gene in the studied patients. Methods: Observational, cross-sectional study from January 2010 to December 2012. Nine three patients were included. Sociodemographic, clinical, and pathological variables were explored. Absolute and relative frequencies were used in the statistical analysis. Results: The mean age was 55.1 years; 68.8 percent were white skinned. The most affected breast was the right one in 45.2 percent and the most frequent location was the upper-external quadrant in 26.9 percent. Invasive ductal carcinoma represented 71 percent of the total. Nuclear grade 3 was found in 81.7 percent cases and tumor necrosis 88.2 percent. Estrogen receptors were positive in 50.5 percent and progesterone receptors were negative in 59.1 percent. Histological analysis of breast cancer will be useful to individualize the therapy of each patient. Conclusions: It is important to continue the investigation with the incorporation of other variables of interest, such as response to treatment and survival, in addition to the in situ hybridization test detected by fluorescence in the patients of the universe in which HER2 2+ was found to define the status and better guide the treatment(AU)

Adenopatía axilar metastásica a causa de cáncer primario oculto de mama / Axillary metastatic adenopathy due to hidden breast primary cancer

Se describe el caso clínico de una paciente de 56 años que acudió a la consulta de Oncología del Hospital Gubernamental de Mbabane, en Swazilandia, por padecer una adenopatía en la axila izquierda de varios meses de evolución, confirmada por ecografía. Se realizó una biopsia por aspiración con aguja fina, cuyo resultado reveló la metástasis de un carcinoma ductal. Se completaron los estudios preoperatorios, se determinó el estadio de la entidad clínica (IIA) y se remitió a la paciente a la consulta de Cirugía para realizar una disección axilar y luego aplicar radioterapia en la axila y la mama

The clinical report of a 56 year-old patient who went to the Oncology Service of the Government Hospital from Mbabane, in Swaziland, for suffering an adenopathy in the left armpit with a clinical course of several months, confirmed by echography is described. An aspiration biopsy with fine needle was carried out whose result revealed the metastasis of a ductal carcinoma. The preoperative studies were completed, the stage of the clinical entity was determined (IIA) and the patient was referred to the Surgery service to carry out an axillary dissection and then to apply radiotherapy in the armpit and breast

Dynamic Effects of CYP2D6 Genetic Variants in a Set of Poor Metaboliser Patients with Infiltrating Ductal Cancer Under Treatment with Tamoxifen.

Breast cancer is a group of multigenic diseases. It is the most common cancer diagnosed among women worldwide and is often treated with tamoxifen. Tamoxifen is catalysed by cytochrome P450 2D6 (CYP2D6), and inter-individual variations in the enzyme due to single nucleotide polymorphisms (SNPs) could alter enzyme activity. We evaluated SNPs in patients from Colombia in South America who were receiving tamoxifen treatment for breast cancer. Allelic diversity in the CYP2D6 gene was found in the studied population, with two patients displaying the poor-metaboliser phenotype. Molecular dynamics and trajectory analyses were performed for CYP2D6 from these two patients, comparing it with the common allelic form (CYP2D6*1). Although we found no significant structural change in the protein, its dynamics differ significantly from those of CYP2D6*1, the effect of such differential dynamics resulting in an inefficient enzyme with serious implications for tamoxifen-treated patients, increasing the risk of disease relapse and ineffective treatment.

Salivary gland tumors: Molecular characterization and therapeutic advances for metastatic disease.

Salivary gland cancers represent a rare group of tumors composed by over 20 histological subtypes. Initially treated as one single disease, its diagnosis, prognosis, and treatment are currently being stratified based on morphology. More recently, insight has been provided on the molecular characterization of each subtype, further improving diagnostic accuracy and paving the way for personalized therapy. In this article, we provide a comprehensive review of recent breakthroughs, preliminary results of novel therapy, and future directions on the treatment of these complex malignancies.

Computational Feasibility Analysis of Electrochemotherapy With Novel Needle-Electrode Arrays for the Treatment of Invasive Breast Ductal Carcinoma.

Breast cancer represents a rising problem concerning public health worldwide. Current efforts are aimed to the development of new minimally invasive and conservative treatment procedures for this disease. A treatment approach for invasive breast ductal carcinoma could be based on electroporation. Hence, in order to determine the effectiveness of electrochemotherapy in the treatment of this disease, 12 electrode models were investigated on realistic patient-specific computational breast models of 3 patients diagnosed by Digital Breast Tomosynthesis imaging. The electrode models exhibit 4, 5, and 6 needles arranged in 4 geometric configurations (delta, diamond, and star) and 3 different needle spacing resulting in a total of 12 needle-electrode arrays. Electric field distribution in the tumors and a surrounding safety margin of 1 cm around the tumor edge is computed using the finite element method. Efficiency of the electrode arrays was determined hierarchically based on (1) percentage of tumor volume reversibly electroporated, (2) percentage of tumor volume irreversibly electroporated, (3) percentage of treated safety margin volume, (4) minimal invasiveness, that is, minimal number of electrodes used, (5) minimal activated electrode pairs, and (6) minimal electric current. Results show that 3 electrode arrays (4 needle-delta, 5 needle-diamond, and 6 needle-star) with fixed-geometry configuration could be used in the treatment with electrochemotherapy of invasive breast ductal carcinomas ranging from 1 to 5 cm3 along with a surrounding safety margin of 1 cm.

Anti-nuclear antibodies in patients with breast cancer.

To study the prevalence of anti-nuclear antibodies (ANA) in breast cancer patients and its association with tumour characteristics. Ninety-one patients with breast mass detected by image studies and assigned to conduct diagnostic biopsy and eventual surgical treatment were studied for demographical, tumour data and presence of ANA. Serum of positive ANA patients was screened for the extractable nuclear antigen (ENA) profile. As comparison, 91 healthy individuals matched for age and from the same geographical area were included. In this sample 72 of 91 (79·1%) had malignant lesions (83% ductal infiltrative carcinoma). ANA was positive in 44·4% of patients with malignant tumour and in 15·7% of those with benign lesions (malignant versus benign with P = 0·03). Controls had ANA positivity in 5·4%, and when compared with tumour samples showed P < 0·0001. The most common immunofluorescence pattern was a fine dense speckled pattern. In the ANA-positive patients with malignant lesions, seven had positivity for ENA profile (three for anti-RNP and anti-Sm, one for just anti-RNP, two for anti-Ro and anti-La e two for just anti-La). It was not possible to associate ANA positivity with tumour histological characteristics or staging or with patient's age. A negative association of ANA with hormonal (oestrogen or oestrogen plus progesterone) receptor status was found (P = 0·01). In this sample, there was a high prevalence of ANA positivity in breast cancer patients with a negative association with the presence of hormonal receptors. More studies are needed to understand the real value of this finding.

Invasive ductal carcinoma: relationship between pathological characteristics and the presence of axillary metastasis in 220 cases.

Objective: to analyze the relation of anatomopathological features and axillary involvement in cases of invasive ductal carcinoma. Methods: this is a cross-sectional study of 220 breast cancer patients submitted to radical mastectomy or quadrantectomy with axilar emptying, from the Mastology Service of the Assis Chateaubriand Maternity School, Ceará, Brazil. We submitted the tumors to histological processing and determined the histological (HG), tubular (TG) and nuclear (NG) grades, and the mitotic index (MI) by the classification of Scarff-Bloom-Richadson, verified the presence of angiolymphatic invasion (AI) and measured the largest tumor diameter (TD). We then correlated these variables with the presence of axillary metastases. Results: the mean patients'age was 56.81 years ± 13.28. Tumor size ranged from 0.13 to 22 cm, with an average of 2.23cm ± 2.79. HG3, TG3 and NG3 prevailed, respectively 107 (48.6%), 160 (72.7%) and 107 (48.6%). Mitotic indexes 1, 2 and 3 presented a homogeneous distribution, respectively 82 (37.2%), 68 (31%) and 70 (31.8%). We observed no relation between the HG, TG and NG with the occurrence of axillary metastases (p=0.07, p=0.22 and p=0.21, respectively). Mitotic indices 2 and 3 were related with the occurrence of axillary metastases (p=0.03). Tumors larger than 2cm and cases that presented angiolymphatic invasion had a higher index of axillary metastases (p=0.0003 and p<0.0001). Conclusion: elevated mitotic indexes, tumors with a diameter greater than 2cm and the presence of angiolymphatic invasion were individuallyassociatedwith the occurrence of axillary metastases.

Objetivo: analisar a relação das características anatomopatológicas com o comprometimento axilar em casos de carcinoma ductal invasor. Métodos: estudo transversal de 220 pacientes com câncer de mama, submetidas à mastectomia radical ou quadrantectomia com esvaziamento axilar, oriundos do Serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil. Os tumores foram submetidos a processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN), índice mitótico (IM) pela classificação de Scarff-Bloom-Richadson, verificada a presença de invasão angiolinfática (IA) e mensurado o maior diâmetro do tumor (DT). Tais variáveis foram correlacionadas com a presença de metástases axilares. Resultados: a média de idade das pacientes foi 56,81 anos ± 13,28. O tamanho do tumor variou de 0,13 a 22 cm, com média de 2,23cm ± 2,79. Os GH3, GT3 e GN3 prevaleceram: n=107 (48,6%), n=160 (72,7%) e n=107 (48,6%), respectivamente. Os índices mitóticos 1, 2 e 3 apresentaram distribuição homogênea: n=82 (37,2%), n=68 (31%) e n=70 (31,8%), respectivamente. Não foi evidenciada relação do GH, GT e GN com a ocorrência de metástases axilares (p=0,07; p=0,22 e p=0,21). Índices mitóticos 2 e 3 apresentaram relação com a o ocorrência de metástases axilares (p=0,03). Tumores maiores do que 2cm e casos com invasão angiolinfática apresentaram maior índice de metástases axilares (p=0,0003 e p<0,0001). Conclusão: índices mitóticos elevados, tumores com diâmetro maior do que 2cm e presença de invasão angiolinfática apresentaram isoladamente relação com a ocorrência de metástases axilares.

Myiasis associated with an invasive ductal carcinoma of the left breast: case study.

Most breast cancers originate in the ductal epithelium and are referred to as invasive ductal carcinoma. In this study we report on the clinical procedures adopted to diagnose myiasis in association with infiltrating metastatic breast carcinoma in a female patient. A 41 years old woman came to the Federal Hospital of Andaraí complaining of intense itching, warmth, redness and hardening of the breast, which had acquired the aspect of an orange peel. A lesion in the left breast was cavitated, dimpled, had fetid odor, and had fibrotic and infected air nodules filled with exudate and Dipteran larvae. The tissue was cleaned and 33 larvae were extracted. The patient was hospitalized and received Ivermectin. Eighteen of the larvae extracted from the patient were placed in 70% alcohol, and twelve were placed in a container with sterile wood shavings under controlled conditions until they metamorphosed into adults. The taxonomic identification of the flies revealed that the culprit was Cochliomyia hominivorax. A histopathological exam conducted three months earlier had revealed infiltrating ductal carcinoma. Two months after the myiasis treatment, the breast tissue had healed. The patient had waited ten days from the onset of the myiasis to seek treatment, and that delay interfered negatively in the prognosis of both the neoplasm and the myiasis. This study is relevant to public health in view of the strong social impact of myiasis.

Invasive ductal carcinoma: relationship between pathological characteristics and the presence of axillary metastasis in 220 cases / Carcinoma ductal invasor: relação de características anatomopatológicas com a presença de metástases axilares em 220 casos

ABSTRACT Objective: to analyze the relation of anatomopathological features and axillary involvement in cases of invasive ductal carcinoma. Methods: this is a cross-sectional study of 220 breast cancer patients submitted to radical mastectomy or quadrantectomy with axilar emptying, from the Mastology Service of the Assis Chateaubriand Maternity School, Ceará, Brazil. We submitted the tumors to histological processing and determined the histological (HG), tubular (TG) and nuclear (NG) grades, and the mitotic index (MI) by the classification of Scarff-Bloom-Richadson, verified the presence of angiolymphatic invasion (AI) and measured the largest tumor diameter (TD). We then correlated these variables with the presence of axillary metastases. Results: the mean patients'age was 56.81 years ± 13.28. Tumor size ranged from 0.13 to 22 cm, with an average of 2.23cm ± 2.79. HG3, TG3 and NG3 prevailed, respectively 107 (48.6%), 160 (72.7%) and 107 (48.6%). Mitotic indexes 1, 2 and 3 presented a homogeneous distribution, respectively 82 (37.2%), 68 (31%) and 70 (31.8%). We observed no relation between the HG, TG and NG with the occurrence of axillary metastases (p=0.07, p=0.22 and p=0.21, respectively). Mitotic indices 2 and 3 were related with the occurrence of axillary metastases (p=0.03). Tumors larger than 2cm and cases that presented angiolymphatic invasion had a higher index of axillary metastases (p=0.0003 and p<0.0001). Conclusion: elevated mitotic indexes, tumors with a diameter greater than 2cm and the presence of angiolymphatic invasion were individuallyassociatedwith the occurrence of axillary metastases.

RESUMO Objetivo: analisar a relação das características anatomopatológicas com o comprometimento axilar em casos de carcinoma ductal invasor. Métodos: estudo transversal de 220 pacientes com câncer de mama, submetidas à mastectomia radical ou quadrantectomia com esvaziamento axilar, oriundos do Serviço de Mastologia da Maternidade Escola Assis Chateaubriand, Ceará, Brasil. Os tumores foram submetidos a processamento histológico e, em seguida, foram determinados os graus histológico (GH), tubular (GT), nuclear (GN), índice mitótico (IM) pela classificação de Scarff-Bloom-Richadson, verificada a presença de invasão angiolinfática (IA) e mensurado o maior diâmetro do tumor (DT). Tais variáveis foram correlacionadas com a presença de metástases axilares. Resultados: a média de idade das pacientes foi 56,81 anos ± 13,28. O tamanho do tumor variou de 0,13 a 22 cm, com média de 2,23cm ± 2,79. Os GH3, GT3 e GN3 prevaleceram: n=107 (48,6%), n=160 (72,7%) e n=107 (48,6%), respectivamente. Os índices mitóticos 1, 2 e 3 apresentaram distribuição homogênea: n=82 (37,2%), n=68 (31%) e n=70 (31,8%), respectivamente. Não foi evidenciada relação do GH, GT e GN com a ocorrência de metástases axilares (p=0,07; p=0,22 e p=0,21). Índices mitóticos 2 e 3 apresentaram relação com a o ocorrência de metástases axilares (p=0,03). Tumores maiores do que 2cm e casos com invasão angiolinfática apresentaram maior índice de metástases axilares (p=0,0003 e p<0,0001). Conclusão: índices mitóticos elevados, tumores com diâmetro maior do que 2cm e presença de invasão angiolinfática apresentaram isoladamente relação com a ocorrência de metástases axilares.

Myiasis associated with an invasive ductal carcinoma of the left breast: case study

ABSTRACT Most breast cancers originate in the ductal epithelium and are referred to as invasive ductal carcinoma. In this study we report on the clinical procedures adopted to diagnose myiasis in association with infiltrating metastatic breast carcinoma in a female patient. A 41 years old woman came to the Federal Hospital of Andaraí complaining of intense itching, warmth, redness and hardening of the breast, which had acquired the aspect of an orange peel. A lesion in the left breast was cavitated, dimpled, had fetid odor, and had fibrotic and infected air nodules filled with exudate and Dipteran larvae. The tissue was cleaned and 33 larvae were extracted. The patient was hospitalized and received Ivermectin. Eighteen of the larvae extracted from the patient were placed in 70% alcohol, and twelve were placed in a container with sterile wood shavings under controlled conditions until they metamorphosed into adults. The taxonomic identification of the flies revealed that the culprit was Cochliomyia hominivorax. A histopathological exam conducted three months earlier had revealed infiltrating ductal carcinoma. Two months after the myiasis treatment, the breast tissue had healed. The patient had waited ten days from the onset of the myiasis to seek treatment, and that delay interfered negatively in the prognosis of both the neoplasm and the myiasis. This study is relevant to public health in view of the strong social impact of myiasis.

Squamoid eccrine ductal carcinoma

Abstract Squamoid eccrine ductal carcinoma is an eccrine carcinoma subtype, and only twelve cases have been reported until now. It is a rare tumor and its histopathological diagnosis is difficult. Almost half of patients are misdiagnosed as squamous cell carcinoma by the incisional biopsy. We report the thirteenth case of squamoid eccrine ductal carcinoma. Female patient, 72 years old, in the last 6 months presenting erythematous, keratotic and ulcerated papules on the nose. The incisional biopsy diagnosed squamoid eccrine ductal carcinoma. After excision, histopathology revealed positive margins. A wideningmargins surgery and grafting were performed, which again resulted in positive margins. The patient was then referred for radiotherapy. After 25 sessions, the injury reappeared. After another surgery, although the intraoperative biopsy showed free surgical margins, the product of resection revealed persistent lesion. Distinction between squamoid eccrine ductal carcinoma and squamous cell carcinoma is important because of the more aggressive nature of the first, which requires wider margins surgery to avoid recurrence.