Laparoscopic cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: Long term oncologic outcomes from the international PSOGI registry.

The laparoscopic approach for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (L-CRS + HIPEC) in highly selected patients was previously reported from the PSOGI registry with a demonstrable reduction in length of stay and post-operative morbidity. This study aims to update this international PSOGI registry with a larger cohort of patients and a longer follow-up period. METHODS: An international registry was designed through a networking database (REDCAP®). All centers performing L-CRS + HIPEC were invited through PSOGI to submit data on their cases. Variables such as demographics, clinical outcomes, and survival were analyzed. RESULTS: A total of 315 L-CRS + HIPEC cases were provided by 14 worldwide centers. A total of 215 patients were included in the L-CRS + HIPEC group. The median peritoneal cancer index (PCI) was 3 (3-5). The median length of stay was 7 days (5-10) and the major morbidity (Clavien-Dindo ≥3) was 6.1% after 30 days. The 5-year disease-free survival (DFS) per tumor origin was: 94% for PMP-LG, 85% for PMP-HG, 100% for benign multicyst peritoneal mesothelioma (MPM), 37.4% for colonic origin, and 54%(at 3 years) for ovarian origin. The 5 years overall survival (OS) per tumor origin was: 100% for PMP-LG, PMP-HG and MPM; 61% for colonic origin, and 74% (at 3 years) for ovarian origin. In addition, a total of 85 patients were analyzed in the laparoscopic risk-reducing HIPEC (L-RR + HIPEC). The median length of stay was 5 days (4-6) and the major morbidity was 6% after 30 days. The 5-year DFS per tumor origin was: 96% for perforated low grade appendiceal mucinous neoplasm (LAMN II) and 68.1% for colon origin. The 5 years OS per tumor origin was: 98% for LAMN II and 83.5% for colonic origin. CONCLUSIONS: Minimally invasive CRS + HIPEC is a safe procedure for selected patients with peritoneal carcinomatosis in specialized centers. It improves perioperative results while providing satisfactory oncologic outcomes. L-RR + HIPEC represents a promising strategy that could be evaluated in patients with high risk of developing peritoneal carcinomatosis into prospective randomized trials.

Terapia celular en los errores congénitos del metabolismo / Cell therapy in inborn errors of metabolism

No disponible

[DIEP flap reconstruction after palliative curettage mastectomy in locally advanced breast cancer]. / Colgajo DIEP de cobertura tras mastectomía de limpieza paliativa en cáncer de mama localmente avanzado.

BACKGROUND: Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. METHODS: We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. RESULTS: It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. CONCLUSION: The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment.

Colgajo DIEP de cobertura tras mastectomía de limpieza paliativa en cáncer de mama localmente avanzado / DIEP flap reconstruction after palliative curettage mastectomy in locally advanced breast cancer

Fundamento. La mastectomía de limpieza está indicada con carácter paliativo en el cáncer de mama localmente avanzado. Para cerrar el defecto cutáneo puede ser necesario el empleo de un injerto. Mostramos nuestra experiencia con el uso de un colgajo DIEP (Deep Inferior Epigastric artery Perforators) de cobertura tras la realización de una mastectomía de gran extensión. Material y métodos. Se muestra el caso de una paciente con un tumor de mama muy avanzado localmente, que era subsidiaria de un tratamiento quirúrgico agresivo tras la administración de quimioterapia. Resultados. Se consideró que el cierre que puede ofrecer un colgajo realizado con el músculo dorsal ancho esta insuficiente, por lo que se realizó un DIEP. La paciente presentó una evolución postoperatoria satisfactoria. Conclusiones. El colgajo DIEP de cobertura ofrece una gran extensión cutánea. Puede ser un recurso en casos muy seleccionados de tumores de mama localmente avanzados, en los que la cirugía se convierte en la principal arma terapéutica (AU)

Background. Curettage mastectomy is indicated as a palliative treatment in locally advanced breast cancer. We present our experience with the use of a DIEP flap reconstruction following extensive mastectomy. Methods. We report the case of a patient with very advanced local breast cancer that was subsidiary to aggressive palliative surgery after chemotherapy. Results. It was considered that the closure that could be performed with the latissimus dorsi muscle was unsuitable, therefore a DIEP flap was performed. The patient was discharged uneventfully. Conclusion. The DIEP reconstruction offers great cutaneous extension. It can be a resource in highly selected cases of locally advanced breast cancer in which surgery becomes the main treatment (AU)

La estadificación con resonancia magnética puede cambiar el manejo terapéutico en el cáncer de mama / Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer

Objetivo. Comparar 2 series de pacientes con cáncer de mama, una estadificadas mediante resonancia magnética (RM) preoperatoria y la otra con técnicas convencionales, y estudiar los cambios de tratamiento y el número de mastectomías y de reintervenciones por afectación de los bordes. Material y métodos. Se revisaron 600 pacientes divididas en 300 con RM preoperatoria (serie 1) y 300 sin RM (serie 2). Se valoraron: la edad, el estado menopáusico, el tamaño tumoral anatomopatológico, la multiplicidad y bilateralidad, el tratamiento quirúrgico y tipo de tratamiento, la administración de quimioterapia neoadyuvante y las reintervenciones por márgenes afectos. Las variables fueron comparadas con las pruebas t de Student y la Chi-cuadrado. Resultados. La edad media fue similar (51,5 y 51,8 años, p=0,71). El tamaño tumoral medio fue menor (p<0,001) en la serie 1 (16,9 vs 22,3mm). Se detectaron más tumores múltiples (p<0,001) en la serie 1 (28,7 vs 15,7%). La tasa de mastectomías en la serie 1 (25%) fue menor (p<0,001) que en la 2 (48%). Las técnicas de cirugía oncoplástica y bilaterales solo fueron realizadas en la serie 1. La quimioterapia neoadyuvante fue administrada más frecuentemente (p<0,001) en la serie 1 (30,7 vs 9,3%). La diferencia no fue significativa (p=0,095) en el número de reintervenciones por márgenes afectos (7,2% serie 1; 3,2% serie 2). Conclusión. Las mastectomías disminuyen al emplear la RM, con disponibilidad de técnicas de cirugía oncoplástica y quimioterapia neoadyuvante. Pese al aumento de cirugías conservadoras en la serie con RM, no observamos un aumento significativo del número de reintervenciones por márgenes afectos, aunque existe una tendencia (AU)

Objective. To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. Material and methods. We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. Results. The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9mm vs 22.3mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). Conclusion. When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance (AU)

[Using magnetic resonance imaging for staging can change the therapeutic management in patients with breast cancer]. / La estadificación con resonancia magnética puede cambiar el manejo terapéutico en el cáncer de mama.

OBJECTIVE: To compare two series of patients with breast cancer, one staged using preoperative MRI and the other staged using conventional techniques, analyzing the changes to treatment, the number of mastectomies, and the number of reinterventions due to involvement of the margins. MATERIAL AND METHODS: We reviewed 600 patients divided into 300 patients with preoperative MRI (series 1) and 300 without preoperative MRI (series 2). We recorded the following variables: age, menopausal status, tumor size on pathological examination, multiplicity and bilaterality, surgical treatment and type of treatment, the administration of neoadjuvant chemotherapy, and reintervention for involved margins. We used Student's t-test and the chi-square test to compare the variables between the two series. RESULTS: The mean age of patients in the two series was similar (51.5 and 51.8 years, P=0.71). The mean size of the tumor was smaller in series 1 (16.9 mm vs 22.3 mm) (P<.001). More multiple tumors were detected in series 1 (28.7 vs 15.7%) (P<.001). The rate of mastectomies was lower in series 1 (25 vs 48%) (P<.001). Oncoplastic and bilateral surgeries were performed only in series 1. Neoadjuvant chemotherapy was administered more often in series 1 (30.7 vs 9.3%) (P<.001). The difference in the number of reinterventions for involved margins did not reach significance (7.2% in series 1 vs 3.2% in series 2) (P=.095). CONCLUSION: When MRI was used for staging, neoadjuvant chemotherapy and oncoplastic surgery were used more often and the mastectomy rate decreased. Despite the increase in conservative surgery in patients staged with MRI, the number of reinterventions for involved margins did not increase, although there was a trend towards significance.

Transthoracic oesophagectomy with lymphadenectomy in 100 oesophageal cancer patients: multidisciplinary approach.

OBJECTIVES Analysis of the results on the treatment of esophageal cancer by transthoracic esophagectomy by a multidisciplinary team of surgeons and oncologists. METHODS Between January 1990 and December 2009, 100 consecutive patients underwent transthoracic esophagectomy. Data were collected prospectively and clinical, pathological and histological features of the tumors were analyzed as well as the results of postoperative morbidity and mortality. RESULTS The average patient age was 55 years (range 31- 83 years). In 59 cases the tumor was located in the lower third and in 41 cases in the middle third. Forty-six patients had adenocarcinoma and 54 squamous cell carcinoma. In 54 cases radio-chemotherapy was planned preoperatively. Classifi cation according to pathological tumor stage was: stage 0 in 21 patients, stage I in 10 patients, stage IIa in 28, stage IIb in 9, stage III in 21 and stage IV in 11. The mean number of lymph nodes examined was 14 (range 0-28). Hospital mortality occurred in 4 cases and postoperative complications in 29 patients (33%). The most frequent postoperative complication was pulmonary complications in 17 cases. The average hospital stay was 15.2 days (range 10-40 days) CONCLUSIONS The results of esophageal cancer have been improved in recent years due to the formation of multidisciplinary teams in this pathology. In our study we have shown that the results obtained with the transthoracic technique for cancer of the esophagus are within the ranges reported in the literature for teams with high prevalence of the disease.

Transthoracic oesophagectomy with lymphadenectomy in 100 oesophageal cancer patients: multidisciplinary approach

OBJECTIVES Analysis of the results on the treatment of esophageal cancer by transthoracic esophagectomy by a multidisciplinary team of surgeons and oncologists. METHODS Between January 1990 and December 2009, 100 consecutive patients underwent transthoracic esophagectomy. Data were collected prospectively and clinical, pathological and histological features of the tumors were analyzed as well as the results of postoperative morbidity and mortality. RESULTS The average patient age was 55 years (range 31- 83 years). In 59 cases the tumor was located in the lower third and in 41 cases in the middle third. Forty-six patients had adenocarcinoma and 54 squamous cell carcinoma. In 54 cases radio-chemotherapy was planned preoperatively. Classifi cation according to pathological tumor stage was: stage 0 in 21 patients, stage I in 10 patients, stage IIa in 28, stage IIb in 9, stage III in 21 and stage IV in 11. The mean number of lymph nodes examined was 14 (range 0-28). Hospital mortality occurred in 4 cases and postoperative complications in 29 patients (33%). The most frequent postoperative complication was pulmonary complications in 17 cases. The average hospital stay was 15.2 days (range 10-40 days) CONCLUSIONS The results of esophageal cancer have been improved in recent years due to the formation of multidisciplinary teams in this pathology. In our study we have shown that the results obtained with the transthoracic technique for cancer of the esophagus are within the ranges reported in the literature for teams with high prevalence of the disease (AU)

Morbidity, mortality, and pathological response in patients with gastric cancer preoperatively treated with chemotherapy or chemoradiotherapy.

BACKGROUND: Significant tumor downstaging has been achieved in patients with localized gastric adenocarcinoma by preoperative chemoradiotherapy (ChRT) or induction chemotherapy (Ch). However the influence of ChRT and Ch on postoperative outcomes has not yet been clarified, with very few studies examining this issue. We retrospectively analyzed the efficacy in terms of pathological response and early postoperative complications of two protocols of preoperative ChRT and Ch for locally advanced gastric cancer. METHODS: Between 2000 and 2008, 72 patients with operable locally advanced gastric cancer (cT3-4/N+) were treated with preoperative treatment: 1-patients receiving induction Ch or 2-neoadjuvant Ch followed by concurrent ChRT. Postoperative histopathological regression and surgical complications were investigated including variables related to patients, surgical variables, preoperative treatment, and tumor. RESULTS: There were no differences in the incidence of complications between the ChRT and Ch groups (30.9% vs. 33.3%). The most frequent complications were nonspecific surgical complications (pneumonia [12.5%] and infection from intravenous catheters [9.7%]). Risk factors for complications were high-body mass index (BMI > 25 kg/m(2) ) and extension of surgery to the pancreas and spleen. A major pathological response was observed in 33.3% of patients, being more frequent in the ChRT group (47.6% vs. 13.3%; χ(2) , P = 0.0024). CONCLUSIONS: Preoperative treatment with Ch or ChRT for locally advanced gastric cancer can be performed safely with an acceptable operative morbidity and low operative mortality rate with careful consideration of the added risk associated with BMI and surgical resection of the pancreas and spleen. Ch and ChRT is feasible and effective in terms of pathological response and R0 resection.

Association between [18F]fluorodeoxyglucose uptake and prognostic parameters in breast cancer.

BACKGROUND: This study analysed the correlation between [(18)F]fluorodeoxyglucose (FDG) uptake assessed by positron emission tomography (PET) in breast tumours, and histopathological and inmunohistochemical prognostic factors. METHODS: FDG-PET was performed before surgery in 275 women with primary breast cancer. The standarized uptake value (SUV) was compared with histopathological findings after surgery. RESULTS: A positive relationship was found between the SUV and tumour size (r = 0.46, P < 0.001), axillary lymph node status (P < 0.001), histological type (P < 0.001), histological grade (P < 0.001), oestrogen receptor status (P < 0.001), p53 (P < 0.001) and Ki-67 (P < 0.001) expression. Multivariable linear regression showed that tumour size, histological grade, Ki-67 expression, oestrogen receptor status and histological type were significantly related to the SUV. CONCLUSION: The SUV is a preoperative and non-invasive metabolic factor that relates to some prognostic factors in breast cancer.

Analysis of POSSUM score and postoperative morbidity in patients with rectal cancer undergoing surgery.

BACKGROUND: The Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) and later modifications (P-POSSUM y CR-POSSUM) have been used to predict morbidity and mortality rates among patients with rectal cancer undergoing surgery. These calculations need some adjustment, however. The aim of this study was to assess the applicability of POSSUM to a group of patients with rectal cancer undergoing surgery, analysing surgical morbidity by means of several variables. METHODS: between January 1995 and December 2004, 273 consecutive patients underwent surgery for rectal cancer. Information was gathered about the patients, tumour and therapy. To assess the prediction capacity of POSSUM, subgroups for analysis were created according to variables related to operative morbidity and mortality. RESULTS: The global morbidity rate was 23.6% (31.2% predicted by POSSUM). The mortality rate was 0.7% (6.64, 1.95 and 2.08 predicted by POSSUM, P-POSSUM and CR-POSSUM respectively). POSSUM predictions may be more accurate for patients younger than 51 years, older than 70 years, with low anaesthetic risk (ASA I/II), DUKES stage C and D, surgery duration of less than 180 minutes and for those receiving neoadjuvant therapy. CONCLUSION: POSSUM is a good instrument to make results between different institutions and publication comparable. We found prediction errors for some variables related to morbidity. Modifications of surgical variables and specifications for neoadjuvant therapy as well as physiological variables including life style may improve future prediction of surgical risk. More research is needed to identify further potential risk factors for surgical complications.

Peutz-Jeghers syndrome and duodeno-jejunal adenocarcinoma--therapeutic implications.

The Peutz-Jeghers syndrome (PJS) is an autosomal dominant hamartomatous poliposis describred in 1921. Hemminki in 1997 described the presence of LKB-1 mutation tumor-suppressor gen.The patients with PJS develop a higher cumulative incidence of gastrointestinal, pancreas and extraintestinal tumors, being occasion of a renew interest on hamartomatous polyposis syndromes regarding the clinical care, cancer surveillance treatment and long term follow-up.We report the case of a 38 years old male, diagnosed of PJS who developed a multiple adenocarcinoma in duodenum and yeyunum. Surgically treated and with a long-term free disease survival of 11 years represents the sixth case reported in the spanish literature of PJS associated with a gastrointestinal tumor.A critical review, molecular alterations and the established criteria of tumor screening and surveillance are reviewed.

[New developments in the surgical treatment of breast cancer]. / Novedades en el tratamiento quirúrgico del cáncer de mama.

Adecuate surgical treatment is mandatory in order to achieve cure in patients with breast cancer. Breast surgeons have to choice the best surgical technique over the breast and over the axillary nodes. Two new surgical aproaches have been implemented in the last decade: oncoplastic conservative surgery and sentinel lymph node biopsy. Oncoplastic surgery provides oncologic safety results and good cosmetic outcome. In this paper the technical steps and indications of different oncoplastic techniques in conservative breast surgery are review. Concerning to axillary surgery sentinel lymph node biopsy is the gold standard. However there are several controversial points in sentinel node biopsy referring to indications, identification and histological findings.

Novedades en el tratamiento quirúrgico del cáncer de mama / No disponible

Un tratamiento quirúrgico correcto es imprescindible para conseguir lacuración de las pacientes con cáncer de mama. El cirujano debe elegirla mejor cirugía tanto en la mama como en los ganglios axilares. Enla última década se han incorporado dos nuevas técnicas quirúrgicas:la cirugía oncoplástica conservadora y la biopsia de ganglio centinela.La cirugía oncoplástica aporta seguridad oncológica y buen resultadoestético. En este trabajo se revisan los pasos técnicos y las indicacionesde las diferentes técnicas oncoplásticas que se emplean en cirugía conservadorade mama. Respecto a la cirugía axilar, la biopsia de gangliocentinela es la técnica de elección actual. Sin embargo existen aspectoscontrovertidos en la biopsia del ganglio centinela respecto a indicaciones,técnicas de identifi cación y hallazgos histológicos(AU)

Adecuate surgical treatment is mandatory in order to achieve cure inpatients with breast cancer. Breast surgeons have to choice the bestsurgical technique over the breast and over the axillary nodes. Two newsurgical aproaches have been implemented in the last decade: oncoplasticconservative surgery and sentinel lymph node biopsy. Oncoplasticsurgery provides oncologic safety results and good cosmetic outcome.In this paper the technical steps and indications of different oncoplastictechniques in conservative breast surgery are review. Concerning to axillarysurgery sentinel lymph node biopsy is the gold standard. Howeverthere are several controversial points in sentinel node biopsy referringto indications, identifi cation and histological fi ndings(AU)

Carcinoma intraductal de mama con microinvasión (T1mic): revisión a propósito de 53 nuevos casos / No disponible

Introducción: El desarrollo de las campañas de diagnósticoprecoz del cáncer de mama está determinando un incrementoen el hallazgo de carcinomas intraductales, en ocasiones confocos de microinfiltración (T1mic). En la bibliografía ha existidodisparidad en los criterios para su definición, y en consecuenciaen la valoración de su incidencia, índice de afectaciónaxilar y actitud terapéutica.Material y métodos: De un total de 225 carcinomas intraductalesse han seleccionado 53 por cumplir los criterios paraser definidos como T1mic en la Clasificación TNM (1997). Seanalizan algunas características clínicas, morfológicas y biológicas,así como su tratamiento y seguimiento.Resultados: El 77,4% de los casos fueron hallazgo de unchequeo mamográfico. El subtipo comedo fue la variante másfrecuente (52%) sobre la que asentó la microinfiltración. En el49,1% de los casos se encontró dos o más focos de microinfiltración,hallazgo más frecuente sobre el subtipo comedo(60,7%). Se practicó cirugía conservadora en 24 casos y mastectomíaen 29 (15 de ellos con reconstrucción inmediata). Enninguna caso se encontró afectación axilar y tras un seguimientomedio de 70 meses todas están vivas (una con metástasisa distancia).Conclusiones: Es necesario unificar los criterios que defineneste estadio tumoral y seguir los propuestos por la clasificaciónTNM en su versión AJCC-1997. Aceptando estos criterios,el tratamiento será el mismo al indicado para elcarcinoma intraductal, y dado el bajo índice de afectación axilarse recomienda recurrir al estudio del ganglio centinela sóloen los casos en que el comedo sea el subtipo dominante o elcarcinoma intraductal muy extenso(AU)

Introduction: The development of screening campaignsfor breast cancer is producing an increment in the incidence ofintraductal carcinomas (DCIS) with foci of microinvasion(T1mic). However, there is a degree of inconsistency in the literaturewith respect to defining these carcinomas and as aconsequence, there is no consensus regarding the incidence ofaxillar involvement and the appropriate treatment for these tumours.Material and Methods: Of 225 patients with intraductalcarcinomas, 53 cases were selected that complied with the requisitesfor defining microinvasive carcinomas, according tothe TNM cancer staging criteria laid down in 1997 (T1mic < 1mm). The morphological and biological characteristics of thecarcinomas were analysed, as were the results of the treatmentfollowed.Results: Referral to our department was provoked by the resultsof a screening study in 78% of the cases. The comedosubtype was the most frequent DCIS variant found and it waspresent in 52,8% of the cases studied. In 26 cases (49,1%), 2 ormore foci of microinvasion were observed, this occurring morefrequently among the comedo variants (60,7%). Conservativesurgery was performed in 24 cases and mastectomy was carriedout in 29 cases (in 15 of which immediate breast reconstructionwas performed). Involvement of the axillary lymph nodes wasnot observed and after a mean period of 70 months, all the patientswere alive (one with a distant metastasis).Conclusions: In order to be able to reach definitive conclusionsregarding this type of carcinoma, it is necessary to unifythe criteria of definition according to those proposal by theAJCC in 1997. In accepting these criteria, the therapeutic recommendationsare the same as those followed for intraductalcarcinoma...(AU)

Carcinoma tubular de mama: revisión de una serie de 38 casos / No disponible

Introducción: El carcinoma tubular de mama (CTM) representaun subtipo de carcinoma infiltrante, bien diferenciado,poco frecuente, de diagnóstico diferencial en ocasiones difícil.Material y métodos: Estudio retrospectivo de 38 casos queanaliza algunas de sus características clínicas y biológicas, asícomo del tratamiento utilizado.Resultados: Edad media de 51,5 años, el motivo diagnósticomás común fue la presencia de una tumoración palpable(50%), y otro 50% resultado de un chequeo mamario. En trescasos se presentó un carcinoma bilateral (uno de ellos sincrónico).Tamaño tumoral medio de 1,4 cm; el 81,8% fueron pT1.Afectación ganglionar axilar en el 13,1% de los casos (todosCTM mixtos). Se observó alto índice de tumores RE positivos,bajo índice proliferativo (Ki67) y muy baja expresión de p53 yc-erbB2. En el 79% de los casos se practicó cirugía conservadoracon vaciamiento axilar. La supervivencia a 10 años fuedel 97,4%.Conclusiones: Carcinoma poco frecuente, cuyo hallazgoes cada vez más resultado de estudios de screening. Se presentacomo una imagen estelar que obliga al diagnóstico diferencialcon algunas lesiones benignas.Su habitual pequeño tamaño y buena diferenciación histológica,permiten el tratamiento conservador en la mayoría delos casos, siendo excepcional la afectación ganglionar axilar.Dado su buen pronóstico, se discute la utilidad/necesidadde tratamiento adyuvante e incluso la cirugía axilar en los detamaño < 1 cm, especialmente en las formas puras(AU)

Introduction: Tubular carcinoma (TC) is a rare and well-differentiatedhistological variant of all breast cancer. The diagnosisof TC is some occasions difficult.Material and methods: We conducted a retrospectivestudy that analyzes 38 cases of TC (it supposes 1,6% of BreastCancer treated in our Breast Unit).The clinical and biological features and the treatment areanalyzed.Results: The medium average age was of 51,5 years. Themore frequent consultation was the presence of a palpablebreast mass followed by the screening. In three patients weobserved a bilateral cancer (1 out of 3 were synchronous tumour).The size half size tumour was of 1,4 cm and 81,8% theywere tumours pT1. Metastatic axillary disease was observed in13,1% of cases. We found a high rate of tumours was with positivehormonal receivers, low KI-67) and very low expressionof p53 and c-erb-2. The 79% of patient were treated with breastconservation therapy. With a median follow-up of 10 yearsthe survival was 97,4%.Discusion: TC is a rare breast cancer that can be discoveredin screening. TC can appear in mammography as a spiculatedabnormality and therefore it can be difficult to distinguishfrom radial scar or sclerosing adenosis. TC usually presents asa small tumour that can be treated with conservative surgery.Maxillary nodal metastases are uncommon. Because it is goodprognosis, adjuvant postoperative treatment and even any axillarysurgical procedure are controversial in TC(AU)