Biopsia del ganglio centinela y disección axilar dirigida en mujeres con cáncer de mama y axila positiva en el momento del diagnóstico: caminando hacia el futuro / Sentinel node biopsy and targeted axillary dissection in women with positive axilla breast cancer at diagnosis: walking into the future

Objetivo: conocer la tasa de concordancia del ganglio marcado con semilla Magseed® con el ganglio centinela marcado mediante tecnecio, en las pacientes con enfermedad ganglionar en el momento del diagnóstico que han recibido tratamiento neoadyuvante. Pacientes y métodos: estudio descriptivo retrospectivo de 44 mujeres diagnosticadas de carcinoma de mama estadios cT1-4/cN1/cM0, que recibieron quimioterapia neoadyuvante entre enero 2016 y diciembre 2020, y que tras una reevaluación radiológica se realizaron una cirugía mamaria con ganglio centinela en el Hospital General Universitario de Alicante. En las pacientes cN1 con respuesta radiológica axilar completa, la detección del ganglio centinela se llevó a cabo mediante doble técnica, extrayéndose por lo menos 3 ganglios. Además, se realizó una disección axilar dirigida mediante semilla magnética Magseed®, para su correcta localización y escisión. Resultados: la tasa de concordancia al realizar la disección axilar dirigida fue del 93,2%. La tasa de respuesta completa tras la quimioterapia neoadyuvante fue del 45,45%. Conclusiones: la disección axilar dirigida mejora la estadificación axilar tras la quimioterapia neoadyuvante, ya que reduce la tasa de falsos negativos respecto a la biopsia selectiva del ganglio centinela de manera aislada. (AU)

Objectives:To know the concordance rate of the ganglion marked with Magseed® with the sentinel node marked by technetium, in patients with limph node disease at diagnosis, that had received neoadjuvant treatment. Patients and methods: Retrospective descriptive study of 44 women, diagnosed with stage cT1-4 / cN1 / cM0 breast carcinoma, who received neoadjuvant chemotherapy between January 2016 and December 2020, and who after radiological re-evaluation, have undergone breast surgery with sentinel node at the General University Hospital of Alicante. In cN1 patients with a complete axillary radiological response, detection of the sentinel node is performed using a double technique, removing at least 3 nodes. In addition, axillary dissection directed by Magseed® magnetic seed is performed, for its correct location and excision. Results: The concordance rate when performing targeted axillary dissection was 93.2%. The complete response rate after neoadjuvant chemotherapy was 45.45%. Conclusions: Targeted axillary dissection improves the axillary staging after neoadjuvant chemotherapy, since it improves the false negative rate with respect to sentinel lymph node biopsy in isolation. (AU)

Presence of human papillomavirus DNA in breast cancer: a Spanish case-control study.

BACKGROUND: Breast cancer is one of the most important neoplasia among women. It was recently suggested that biological agents could be the etiological cause, particularly Human Papilloma Virus (HPV). The aim of this study was to explore the presence of HPV DNA in a case-control study. METHODS: We performed our study including 251 cases (breast cancer) and 186 controls (benign breast tumors), using three different molecular techniques with PCR (GP5/GP6, CLART® and DIRECT FLOW CHIP®). RESULTS: HPV DNA was evidenced in 51.8% of the cases and in 26.3% of the controls (p < 0.001). HPV-16 was the most prevalent serotype. The odds ratio (OR) of HPV within a multivariate model, taking into account age and breastfeeding, was 4.034. CONCLUSIONS: Our study, with methodological rigour and a sample size not previously found in the literature, demonstrate a significant presence of HPV DNA in breast cancer samples. A possible causal relationship, or mediation or not as a cofactor, remains to be established by future studies.

Uterine duplicity without communication between both hemiuteri and cervicovaginal atresia: importance of a thorough diagnosis before treatment.

The study described diagnostic and therapeutic processes for an exceptional congenital female genital anomaly involving a 15-year-old girl with progressive dysmenorrhoea and intense abdominal pain, and analyses pathogenesis of embryological anomalies associated with uterine duplicity (UD). Diagnostic methodology is analysed; treatment is described; and recommendations are provided. For the study of anomalies such as UD, we recommend the use of an ultrasound, vaginoscopy, MRI and laparoscopy imaging. Keeping in mind that hemihysterectomy should only be performed in cases with endometriosis or other unusual circumstances, surgical treatment should be avoided. A complete study based on gynaecological examination and ultrasound should be performed in adolescents with severe and progressive dysmenorrhoea. Based on the findings, imaging tests such as MRI and, if necessary, laparoscopy coinciding with menstruation, should be conducted before opting for surgical treatment.

Mastitis granulomatosa crónica idiopática / Chronic idiopathic granulomatous mastitis

La mastitis granulomatosa crónica idiopática (MGCI) es una enfermedad inflamatoria benigna con una baja incidencia. Se ha asociado a una respuesta inmunológica anormal, la utilización de anticonceptivos orales, así como la existencia de algún organismo infeccioso, como posible causante de una reacción alérgica de tipo cuerpo extraño. Afecta principalmente a mujeres en edad fértil. Generalmente es unilateral y se manifiesta por una o más masas inflamatorias. El aspecto mamográfico puede simular el desarrollo de un carcinoma intraductal, enfermedad de Paget o procesos inflamatorios mamarios de origen benigno de diferentes etiologías. Histopatológicamente se caracteriza por una lobulitis crónica, necrotizante, no caseificante, que presenta formación de granulomas. El diagnóstico de MGCI debe fundamentarse en este patrón histológico combinado con la exclusión de otras lesiones granulomatosas de la mama. Aunque se han planteado varias alternativas terapéuticas, tanto quirúrgicas como médicas, el tratamiento ideal de la MGCI no ha sido aún establecido. Las resecciones quirúrgicas del tejido afectado asociado o no con corticoides orales es la terapia más utilizada (AU)

Chronic idiopathic granulomatous mastitis (CIGM) is a benign inflammatory disease with a low incidence. This entity has been associated with an abnormal immune response, oral contraceptive use and the existence of an infectious organism as a possible cause of an allergic reaction to a foreign body. CIGM mainly affects women of childbearing age, is usually unilateral and is manifested by one or more inflammatory masses. The mammographic appearance may mimic the development of intraductal carcinoma, Paget's disease or benign inflammatory processes of the breast of various etiologies. Histopathologically, CIGM is characterized by chronic, necrotizing, non-caseating lobulitis, which shows formation of granulomas. The diagnosis of CIGM should be established on the basis of this pattern, combined with exclusion of other granulomatous lesions of the breast. Although various medical and surgical therapeutic options have been proposed, the optimal treatment of CIGM has not yet been established. The most commonly used treatment is surgical resection of affected tissue with or without oral corticosteroid therapy (AU)