Chyle fistula in right cervical area after thyroid surgery

Thoracic duct injury is an infrequent (1-2.5%) but severe complication after neck surgery, leading to nutritional, metabolic and immunologic deficiencies. We report a case of a 34-year-old woman with a right thoracic duct injury after surgery of a thyroid medullar cancer effectively treated with conservative management (parenteral nutrition and intravenous somatostatin). Optimal treatment of these patients is unclear, without a clear limit between conservative and surgical treatment (AU)

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Conservative treatment for infiltrating breast cancer. Ten years follow-up experience

INTRODUCTION: We retrospectively analyze our experience in conservative treatment for infiltrating advanced breast cancer before implementation of selective sentinel node biopsy, specially focusing on characteristics, incidence, treatment and evolution of local-regional recurrences, disease-free survival time, overall survival and patient's satisfaction. MATERIAL AND METHODS: From January 1984 to 31st December 1998, 739 female patients were operated in our institution, diagnosed as having infiltrating breast cancer. One hundred and eighty-eight patients (25.43%) received conservative treatment and they were followed up until December 2003. RESULTS: Average age when diagnosed was 50.42 years old (24-87 years). 53.19% of the patients were premenopausal. After a median follow-up of 129 months (60-198 months), 13 women (6.91%) presented local -regional recurrence and the disease-free time was 48.4 months (8-108 months). Global survival rate was 83.5% and disease free survival rate was 80.85%. CONCLUSIONS: The management of choice for early stage (I and II) infiltrating breast cancer is nowadays conservative, with a low local-regional recurrence rate and survival rate that are comparable to radical mastectomy, according to the literature. It's a safe and efficient method that let us preserve the breast with a good esthetical result. In selected cases, when a regional recurrence occurs, a second conservative management is possible with a good control of the disease, although the most widely accepted treatment in these cases is total mastectomy (AU)

Mammary hamartoma.

INTRODUCTION: Mammary hamartomas are rare benign breast lumps. They are usually painless, wellcircumscribed, mobile and with no adherence to skin or muscle, composed of varying amounts of fat, glandular and fibrous tissue. Mammary hamartoma has been classically considered as an underdiagnosed pathology, but with the increasing use of diagnostic procedures in breast tumours, the number of hamartomas has increased in the last years. Because there is no distinct pathological feature, a correlation with the clinical findings and image techniques is necessary in order to achieve a correct diagnosis of the pathology. MATERIALS AND METHODS: The clinicopathological features of 8 mammary hamartomas are reported here. RESULTS: The patients are ranged in age from 34 to 67 years. The initial manifestation was in all cases a well-circumscribed, soft, palpable breast lump. Mammography was performed in all patients. Other diagnostic procedures used in the diagnosis were Ultrasound, Fine Needle Aspiration Cytology and Needle Core Biopsy. Treatment was tumorectomy. We describe a case of recurrence after excision of the lump in a more aggressive histological form and one patient who presented the coexistence of a mammary hamartoma and an invasive ductal carcinoma. CONCLUSION: Mammary hamartoma is an uncommon breast tumour. It is necessary the correlation between pathology and clinical and radiological findings. We express our management plan for these lesions.

Mammary hamartoma

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Introduction. Mammary hamartomas are rare benignbreast lumps. They are usually painless, wellcircumscribed,mobile and with no adherence toskin or muscle, composed of varying amounts offat, glandular and fibrous tissue. Mammary hamartomahas been classically considered as an underdiagnosedpathology, but with the increasing use ofdiagnostic procedures in breast tumours, the numberof hamartomas has increased in the last years.Because there is no distinct pathological feature, acorrelation with the clinical findings and imagetechniques is necessary in order to achieve a correctdiagnosis of the pathology.Materials and methods. The clinicopathologicalfeatures of 8 mammary hamartomas are reportedhere.Results. The patients are ranged in age from 34 to67 years. The initial manifestation was in all cases awell-circumscribed, soft, palpable breast lump.Mammography was performed in all patients. Otherdiagnostic procedures used in the diagnosis wereUltrasound, Fine Needle Aspiration Cytology andNeedle Core Biopsy. Treatment was tumourectomy.We describe a case of recurrence after excision ofthe lump in a more aggressive histological formand one patient who presented the coexistence of amammary hamartoma and an invasive ductal carcinoma.Conclusion. Mammary hamartoma is an uncommonbreast tumour. It is necessary the correlationbetween pathology and clinical and radiologicalfindings. We express our management plan forthese lesions

Tratamiento quirúrgico conservador del cáncer infiltrante de mama, en régimen de cirugía mayor ambulatoria / Conservative treatment of infiltrating breast cancer in the ambulatory surgery setting

Introducción. La cirugía mayor ambulatoria (CMA) tiene un desarrollo evidente en España. Destaca la escasa referencia que existe respecto al tratamiento del cáncer de mama sin ingreso, a pesar de la tendencia creciente en este sentido en otros países. Comunicamos nuestra experiencia en el tratamiento conservador del cáncer infiltrante de mama sin ingreso hospitalario. Material y método. Estudio retrospectivo de 21 pacientes diagnosticadas de cáncer infiltrante de mama, tratadas de modo conservador (extirpación amplia más linfadenectomía axilar), en la Unidad de CMA del Hospital Ramón y Cajal. Resultados. Dieciséis pacientes (76,1 por ciento) tuvieron carcinoma ductal infiltrante; 2 (9,5 por ciento), lobulillar infiltrante; 2 (9,5 por ciento), tubular puro y uno, presentó patrón mixto. En 10 pacientes (47,6 por ciento) se realizó extirpación amplia del tumor y linfadenectomía; en 9 (42,8 por ciento), ampliación de márgenes y linfadenectomía, y en 2 (9,5 por ciento), sólo linfadenectomía. Los tumores fueron T1 en 14 casos (66 por ciento); T2 en 4 (19 por ciento) y Tx en 3 (14,2 por ciento). El número de ganglios aislados osciló entre 12 y 38, con una media de 22,7. El 66 por ciento fue N0, y el 33,3 por ciento N+.Salvo en un caso, se drenó la axila. Fueron dadas de alta el día de la operación 19 de las 21 pacientes; no hubo reingresos, morbilidad quirúrgica destacable (19 por ciento de seromas de la axila que precisaron evacuación) ni incidencias domiciliarias, y el grado de satisfacción que mostraron las pacientes y sus familiares en la entrevista personal fue excelente. Conclusiones. Aunque nuestra experiencia es corta, deducimos que es posible realizar el tratamiento conservador del cáncer infiltrante de mama de modo ambulatorio con seguridad, con una morbilidad baja similar a la de las pacientes con ingreso, buen control del dolor, de las náuseas y los vómitos postoperatorios, y con un alto grado de satisfacción para las pacientes y su entorno familiar. Debe contemplarse como una opción de tratamiento, que la mujer debe conocer, y sobre la cual debe decidir tras una información adecuada. Para aquellas que libremente elijan el sistema, la CMA puede representar una aportación importante que matice positivamente su trayectoria en el tratamiento del cáncer de mama. Las tendencias en el diagnóstico y el tratamiento del cáncer de mama deberían representar un estímulo para el desarrollo creciente en nuestro país de la CMA en el campo de la patología maligna de la mama. (AU)