Mastopatía diabética. Revisión sistemática con 93 pacientes / Diabetic mastopathy. A systematic review of 93 patients

Introducción La mastopatía diabética (MD) es una afectación benigna de la mama que aparece en pacientes diabéticas con mal control glucémico de larga evolución. La enfermedad se caracteriza por la aparición de nódulos fibrosos que pueden simular tanto clínica como radiológicamente un cáncer de mama. Su diagnóstico debe realizarse con biopsia con aguja gruesa (BAG) y el tratamiento debe evitar resecciones quirúrgicas. El objetivo de este trabajo es caracterizar con más exactitud esta enfermedad y sus características aportando claridad en su diagnóstico diferencial. Material y métodos Se ha realizado una revisión sistemática de los artículos publicados en los últimos 5 años en las principales bases de datos médicas usando para ello los términos «Mastopatía diabética» y «Diabetic mastopathy». Se incluyeron todo tipo de artículos científicos que aportasen datos sobre la MD, excluyendo aquellos que incluyeran otras enfermedades inflamatorias de la mama. Se seleccionaron finalmente 28 artículos. Para el análisis estadístico se dividió a las pacientes en 2 grupos, diabetes mellitus (DM) tipo 1 (DM1) y DM tipo 2 (DM2), y se compararon la media y la proporción de las diferentes variables analizadas utilizando para ello la prueba t de Student. Se utilizó el programa STATA para realizar el análisis estadístico. Resultados Se analizaron 28 artículos, con un total de 93 pacientes incluidas. En los artículos analizados todos los pacientes eran mujeres. La mayoría de las pacientes presentaron DM1 y el tiempo medio de evolución de la diabetes fue de 20 años. La lesión asociada a la DM que se observó con mayor frecuencia fue la retinopatía diabética (34%). La lesión palpable fue la forma de manifestación más frecuente (53%). Respecto al diagnóstico el hallazgo mamográfico más habitual, fue la hiperdensidad asimétrica y en la ecografía la lesión hipoecoica de bordes irregulares y sombra acústica posterior. El tratamiento más habitual fue conservador. Conclusión ... (AU)

Introduction Diabetic mastopathy is a benign disease of the breast that develops in patients with long-standing diabetes and poor glycemic control. The disease is characterised by fibrous nodules that can be confused with breast cancer both clinically and radiologically. Diagnosis should be made with core needle biopsy (CNB) and treatment should avoid surgical resections. The main objective of this study was to characterise this rare disease in order to improve its differential diagnosis and treatment. Material and methods A systematic review was conducted, including articles published in the last 5 years in the main medical databases using the terms “Mastopatía diabética” and “Diabetic mastopathy”. We included all types of scientific articles providing data on diabetic mastopathy. We excluded articles including other inflammatory breast diseases. Finally 28 articles were selected. For the statistical analysis, patients were divided in 2groups: DM1 patients and DM2 patients. The mean and proportion of the different variables were analysed with the Student t-test. The statistical analysis was performed with the STATA programme. Results We analysed 28 articles, with 93 patients. None of the included articles reported male patients. Most patients had type 1 diabetes and diabetic mastopathy developed at a mean of 20 years after diabetes onset. The most frequent complication of diabetes was diabetic retinopathy (34%). The most common manifestation was a palpable nodule (53%). Regarding diagnosis, the most common mammographic finding was asymmetric hyperdensity and the most common ultrasound finding was a hypoechoic lesion with irregular edges and posterior acoustic shadow. The most frequent treatment was conservative. Conclusion... (AU)

Mammary Paget's disease. Conservative mastectomy / Enfermedad de paget mamaria. Mastectomía conservadora

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[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.

Carcinoma medular quístico de mama / Cystic medullary breast carcinoma

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Seguimiento del cáncer de mama en la mujer joven. Revisión de la bibliografía y propuesta de un protocolo / Breast cancer follow-up in young women. Literature review and proposal of a protocol

Introducción: El cáncer de mama en la mujer joven es poco frecuente, pero presenta unas características propias, como por ejemplo una tasa de recidiva mayor, un peor pronóstico, una dificultad mayor para el control mamográfico, importancia de la fertilidad/gestación, un impacto psico-socio-familiar mayor y una influencia genética mayor, que obligan a replantearse si los protocolos específicos de control postoperatorio para la población general son también aplicables a este grupo de pacientes. Material y métodos: Revisión de la bibliografía científica existente sobre el seguimiento del cáncer de mama en la mujer joven y, en función de la evidencia disponible, proponer un protocolo de seguimiento específico. Resultados: No hay estudios que aborden de manera específica el seguimiento del cáncer de mama en la mujer joven, por lo que la evidencia científica actual es escasa para poder recomendar de manera concluyente uno u otro seguimiento. No obstante, según la revisión efectuada, el seguimiento debe ser especialmente exhaustivo durante los primeros 3-5 años, ya que el número de recidivas en este período es mayor. Conclusión: A partir de esta revisión, como los pilares básicos del seguimiento los autores proponen la autoexploración mamaria mensual, la exploración física cada 3-6 meses por parte de personal sanitario cualificado, la mamografía anual (con o sin ecografía) y la resonancia magnética anual(AU)

Introduction: Breast cancer in young women is relatively uncommon, but it has specific characteristics, such as higher rates of recurrence, worse prognosis, difficulties in mammographic control, the importance of fertility/gestation, higher psycho-social-familial impact, and a higher genetic influence. All this puts into doubt whether the specific protocols for follow-up in the general population are also applicable to this group of patients. Material and methods: Literature review of scientific evidence on the follow-up of breast cancer in young women. According to this evidence the authors propose a specific protocol. Results: There are no studies that specifically analyse the follow-up of young women with breast cancer. Thus, scientific evidence is too low to recommend any specific protocol. Nevertheless, according to the literature review performed, follow-up must be especially exhaustive during the first 3-5 years, as the number of recurrences during this period is higher. Conclusion: According to this review, the authors propose the following protocol: self-examination monthly, physical examination by a qualified health professional every 3-6 months, annual mammogram (with or without ultrasound), and annual magnetic resonance(AU)

Respuesta de los autores: Inyección en la mama de ácido hialurónico: dificultades para el control mamográfico / Authors’ reply: Hyaluronic acid breast injections: difficulties for mammographic monitoring

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[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.

Inyección en la mama de ácido hialurónico: dificultades para el control mamográfico / Hyaluronic acid breast injections. Potential interferences with mammography

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Debating the mathematical model to validate the sentinel lymph biopsy techniques in breast cancer patients. The danger of bias and its practical implications.

BACKGROUND: Sentinel node biopsy (SNB) is an effective alternative to axillary lymph node dissection (ALD) for axillary staging. SNB (test) needs a validation period in which ALD (the gold standard) is always performed. Sensitivity, specificity and predictive values (PV) are used to define the accuracy of the procedure. We hypothesise that, during the period of validation, a bias is produced if the result of SNB is included as a part of the ALD. PATIENTS AND METHODS: A hypothetical population of 350 patients was analysed. First analyses were performed by including the sentinel lymph node as a part of 'the rest of the axilla'. Second analyses were re-done according to our theory, and sentinel lymph node was considered outside 'the rest of the axilla'. Sensitivity, specificity and PV were compared for both models. RESULTS: First group (classic) - sensitivity: 94%; specificity: 100%; positive PV: 100%; negative PV: 97%. Second group (new proposed model) - sensitivity: 87%; specificity: 81%; positive PV: 44%; negative PV: 97%. CONCLUSION: The classic concept of sentinel lymph node to calculate sensitivity, specificity and positive PV can result in a bias. The magnitude of this bias will vary in terms of the obtained values, but its direction is always optimistic.

Disease-free survival and prognostic significance of metastatic lymph node ratio in T1-T2 N positive breast cancer patients. A population registry-based study in a European country.

BACKGROUND: The ratio of positive lymph nodes between the total number of harvested lymph nodes (metastatic lymph node ratio, MLNR) has been proposed as an alternative to the total number of lymph nodes alone in predicting outcomes for patients with breast cancer. Because there can be differences between European and non-European populations, the authors present the first study analyzing MLNR influence over disease-free survival (DFS) by using a population-based cancer registry in a European country. METHODS: Data from 441 patients with T1-2 N1-3 breast cancer included in the Castellon Cancer Registry (Comunidad Valenciana, Spain) were used. Cumulative DFS was determined using the Kaplan-Meier method, with univariate comparisons between groups through the log-rank test. The Cox proportional hazards model was used for multivariate analysis. RESULTS: At univariate analysis, factors influencing the 10-year DFS rate were tumor size, conservative or nonconservative surgery, histologic grade, histologic type, radiotherapy, tamoxifen, estrogen and progesterone receptor status, p53 status, total number of positive lymph nodes, and MLNR. At multivariate analysis, tumor size, MLNR, and progesterone receptor status were revealed to be independent prognostic factors; the metastatic lymph node ratio was the most notably independent factor (hazard ratio 1.02, 5.21, and 0.61, respectively). CONCLUSIONS: MLNR is a stronger prognostic factor for recurrence than the total number of positive lymph nodes in T1-T2 N1-3 breast cancer.

Estudio prospectivo para evaluar la precisión diagnóstica en enfermedad anal benigna en atención primaria / Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care

Objetivo: Analizar el rendimiento diagnóstico del médico de atención primaria (AP) en enfermedad anal benigna.Diseño: Estudio transversal con inclusión de los pacientes remitidos desde AP a nuestra consulta con el diagnóstico de entidades Clínicas englobadas en la enfermedad anal benigna entre el 1 de junio y el 31 de diciembre de 2007. Se comparó el diagnóstico establecido por el médico de AP con el de 2 médicos especialistas en cirugía general y digestiva.EmplazamientoServicio de Cirugía General y del Aparato Digestivo. Hospital General de Castellón.Participantes: Pacientes diagnosticados de enfermedad anal benigna en AP y remitidos a nuestro servicio.Mediciones: Se calcularon, para cada enfermedad, la sensibilidad, la especificidad y los índices kappa.Resultados: Se intervino en un total de 105 pacientes. Los diagnósticos en AP fueron: 65 hemorroides, 13 fisuras, 8 fístulas, 7 abscesos, 4 quistes pilonidales y 8 otros diagnósticos. A 61 pacientes se les había realizado exploración física y a 19, tacto rectal. En atención especializada se diagnosticaron 44 hemorroides, 20 fisuras, 16 fístulas, 9 quistes pilonidales y 16 otros diagnósticos. Para hemorroides, la sensibilidad fue del 90,9%, la especificidad del 59% y el índice kappa, 0,5. Para fístula, el 43,8%, el 98,9% y 0,5, respectivamente, y para fisura, el 15%, el 88,2% y 0,04. La exploración física mejoró todos estos resultados.Conclusiones: El rendimiento diagnóstico de la enfermedad anal benigna en AP es insuficiente. Posiblemente, una buena exploración física y una mejor formación en estas enfermedades conseguirían mejorar estos resultados(AU)

Objective: To analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases.Design: Cross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery.Setting: Department of General Surgery and Digestive Diseases. Castellon General Hospital.Participants: Patients diagnosed with a benign anal disease in PC and referred to our department.MeasurementsThe sensitivity, specificity and kappa index was calculated for each disease.Results: A total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results.Conclusions: The diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results(AU)

[Prospective study to evaluate diagnostic accuracy in benign anal diseases in primary care]. / Estudio prospectivo para evaluar la precisión diagnóstica en enfermedad anal benigna en atención primaria.

OBJECTIVE: To analyse the diagnostic performance of the primary care (PC) doctor in benign anal diseases. DESIGN: Cross-sectional study including patients referred to our clinic from PC with the diagnosis of clinical conditions pertaining to benign anal diseases between 1st June and 31st December 2007. The diagnosis established by the PC doctor was compared with that of 2 medical specialists in general and digestive diseases surgery. SETTING: Department of General Surgery and Digestive Diseases. Castellon General Hospital. PARTICIPANTS: Patients diagnosed with a benign anal disease in PC and referred to our department. MEASUREMENTS: The sensitivity, specificity and kappa index was calculated for each disease. RESULTS: A total of 105 patients were included. The diagnoses were: 65 haemorrhoids, 13 fissures, 8 fistulas, 7 abscesses, 4 pilonidal cysts, and 8 other diagnoses. A physical examination was carried out on 61 patients and 19 had a rectal examination. In AE, 44 haemorrhoids, 20 fissures, 9 pilonidal cysts were diagnosed and there were 16 other diagnoses. For haemorrhoids the sensitivity was 90.9%, the specificity 59%, and the kappa index was 0.5. For a fistula, it was 43.8%, 98.9% and 0.5, respectively and for a fissure, 15%, 88.2% and 0.04. The physical examination improved all these results. CONCLUSIONS: The diagnostic performance of benign anal diseases in PC is insufficient. A good physical examination and improved training in these diseases could possibly improve these results.

[Ileal pouch-anal anastomosis for Crohn's disease. Current status]. / Anastomosis ileoanal con reservorio en pacientes con enfermedad de Crohn. Estado actual.

Ileal pouch-anal anastomosis has become the standard surgical procedure for the treatment of ulcerative colitis and familial polyposis of the colon. Nevertheless, its use in Crohn's disease patients remains controversial. A review was carried out in order to determine the present scientific evidence on the usefulness of ileal pouch-anal anastomosis in Crohn's disease patients. There are no clinical trials analysing this issue. Scientific evidence is based on case series and retrospective studies. Most authors agree that Crohn's disease remains a contraindication for ileal pouch-anal anastomosis, due to the high rate of complications and pouch failure. Nevertheless, a small group of authors consider ileal pouch-anal anastomosis as a good alternative for selected Crohn's disease patients. Both groups agree that if the pouch can be preserved, functional results are good. According to our review, current scientific evidence does not recommend ileal pouch-anal anastomosis for Crohn's disease patients.

Anastomosis ileoanal con reservorio en pacientes con enfermedad de Crohn. Estado actual / Ileal pouch-anal anastomosis for crohn & apos; s disease. Current status

La colectomía subtotal y la anastomosis ileoanal con reservorio son la técnica de elección para el tratamiento quirúrgico de la colitis ulcerosa. Su utilización en la enfermedad de Crohn (EC) es controvertida. Se realiza una revisión de la literatura para determinar la evidencia científica actual sobre la utilidad de los reservorios ileoanales en los pacientes con EC. No existen ensayos clínicos que aborden específicamente este tema. La evidencia científica actual se basa en series de casos y en estudios retrospectivos. La EC debería seguir siendo una contraindicación para la anastomosis ileoanal con reservorio. Un reducido número de autores consideran la anastomosis ileoanal con reservorio una buena alternativa para pacientes con EC seleccionados. Ambos grupos coinciden en que los resultados funcionales son buenos. La evidencia científica actual no recomienda la anastomosis ileoanal con reservorio en pacientes con enfermedad de Crohn (AU)

Ileal pouch-anal anastomosis has become the standard surgical procedure for the treatment of ulcerative colitis and familial polyposis of the colon. Nevertheless, its use in (..) (AU)

[Diabetic mastopathy. Features in four patients]. / Mastopatía diabética. Estudio de 4 pacientes.

Diabetic mastopathy is a clinicopathologic entity that represents less than 1% of benign breast disease and is mainly related to type 1 diabetes. The pathogenesis is unknown but the most convincing hypothesis postulates extracellular collagen deposit and predominantly B-cell inflammation with autoimmune response. The clinical, radiological and pathological features of four patients with diabetic mastopathy are presented.