Prognostic significance of sentinel node biopsy status in cutaneous melanoma: a 21-years prospective study from a single institution.

AIM: To analyze the accuracy of the sentinel lymphatic node biopsy (SLNB) and to investigate predictive factors for sentinel node (SN) status and prognostic factors for recurrence-free survival (RFS) and disease-specific survival (DSS) in patients with melanoma. MATERIAL AND METHODS: Between June 1997 and June 2017, 440 consecutive patients, who underwent SLNB by a single surgical team, were prospectively included. Descriptive and survival analysis were performed. RESULTS: 119 of 440 patients (26%) had positive SN. SLNB's false-negative rate was 6.3%. Breslow thickness, Clark´s level, ulceration and histological subtype were statistically significant predictive factors of SN metastases. In a multivariate analysis, positive SN (HR = 2.21, p = 0.01), deeper Breslow thickness (HR = 2.05, p = 0.013), male gender (RR = 2.05, p = 0.02), and higher Clark's level (HR = 2.30, p = 0.043) were significantly associated with decreased RFS; and positive SN (HR = 2.58, p < 0.001), deeper Breslow thickness (HR = 2.57, p = 0.006) and male gender (HR = 1.93, p = 0.006) were associated with lower DSS. CONCLUSION: SLNB is a reliable and reproducible procedure with high sensitivity (93.7%). Positive SN metastases, Breslow thickness and male gender were statistically associated with poorer outcomes. Male gender was an independent prognostic factor of tumor thickness or SN status.

Cambios epidemiológicos en el melanoma cutáneo: estudio retrospectivo de 969 casos (1996-2010) / Epidemiological changes in cutaneous melanoma: retrospective study of 969 cases (1996-2010)

Introducción. La incidencia del melanoma cutáneo ha aumentando durante las últimas décadas en muchos países, pero desconocemos si esto también ha sucedido en Madrid. Hemos analizado los cambios epidemiológicos ocurridos en el melanoma cutáneo durante un período de 15 años. Pacientes y métodos. Se obtuvieron de forma retrospectiva los datos referentes a todos los pacientes con melanoma cutáneo atendidos en el Hospital Gregorio Marañón de Madrid entre los años 1996-2010, dividido en 3 periodos: 1996-2000; 2001-2005, y 2006-2010. Resultados. Se diagnosticaron histológicamente un total de 969 melanomas. La edad media en el momento del diagnóstico fue de 58,5 años. El espesor tumoral medio fue de 1,61mm. El tipo histológico más frecuente fue el melanoma de extensión superficial. Las diferencias estadísticamente significativas (p<0,05) entre los 3 periodos del estudio fueron: mayor edad media al diagnóstico (p<0,001); mayor número de melanomas en cabeza y cuello (p<0,001); mayor número de melanomas en tronco en el sexo femenino (p<0,001); aumento del melanoma tipo lentigo maligno (p<0,001); disminución del espesor medio (índice de Breslow) (p<0,001); mayor número de melanomas intraepidérmicos (p<0,001). Sin embargo, la proporción de melanomas gruesos (>2mm de Breslow) se mantuvo por encima del 20%, siendo más frecuente este subtipo de melanomas en varones y en mayores de 65 años. Conclusiones. El melanoma cutáneo en España se diagnostica con un espesor tumoral medio cada vez más fino, aunque se siguen diagnosticando melanomas de gran espesor especialmente en varones y pacientes de más de 65 años(AU)

Background. The incidence of malignant melanoma has increased over recent decades all over the world; however, we are not aware if this also occurs in Madrid. Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period. Patients and methods. Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Marañón, Madrid, Spain, between 1996 and 2010, divided into three periods: 1996-2000; 2001-2005; 2006-2010, were obtained. Results. In total, 969 melanomas were histologically diagnosed. The mean age at the moment of diagnosis was 58.5 years old. The mean tumor thickness was 1.61mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. There were statistically significant differences (P<.05) between the three periods of the study: Older age at diagnoses (P<.001); larger number of head and neck melanomas (P<.001); more melanomas on trunk in women (P<.001); increase of lentigo maligna melanoma (P<.001); thinner mean tumor thickness (Breslow index) (P<.001); larger number of melanomas in situ (P<.001). However, thick melanomas (tumor thickness over 2mm) ratio was still over 20% in all periods, especially in males and in those over 65 years old. Conclusions. Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness, although thick melanomas are still diagnosed in men and in individuals over 65 years(AU)

Epidemiological changes in cutaneous melanoma: retrospective study of 969 cases (1996-2010).

BACKGROUND: The incidence of malignant melanoma has increased over recent decades all over the world; however, we are not aware if this also occurs in Madrid. Our objective was to analyze epidemiological changes in cutaneous malignant melanomas diagnosed over a 15-year period. PATIENTS AND METHODS: Retrospective analysis of data of patients with primary cutaneous melanomas attended at Hospital Gregorio Marañón, Madrid, Spain, between 1996 and 2010, divided into three periods: 1996-2000; 2001-2005; 2006-2010, was obtained. RESULTS: In total, 969 melanomas were histologically diagnosed. The mean age at the moment of diagnosis was 58.5 years old. The mean tumor thickness was 1.61 mm. The most common histological type was surface-spreading melanoma and the most common site was the trunk. There were statistically significant differences (P < .05) between the three periods of the study: older age at diagnoses (P < .001); larger number of head and neck melanomas (P < .001); more melanomas on trunk in women (P < .001); increase of lentigo maligna melanoma (P < .001); thinner mean tumor thickness (Breslow index) (P < .001); larger number of melanomas in situ (P < .001). However, thick melanomas (tumor thickness over 2 mm) ratio was still over 20% in all periods, especially in males and in those over 65 years old. CONCLUSIONS: Diagnosis of cutaneous melanoma in Spain is made increasingly with a thinner mean tumor thickness, although thick melanomas are still diagnosed in men and in individuals over 65 years.

Tratamiento conservador no quirúrgico de las perforaciones del esófago torácico / Non-surgical convervative treatment of thoracic esophageal perforations

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Linfoma folicular axilar sincrónico con carcinoma mamario. Hallazgo casual al realizar la biopsia del ganglio centinela / Axillary follicular lymphoma synchronic with breast carcinoma. Casual finding during a sentinel node biopsy

Propósito: La biopsia del ganglio centinela en pacientes con carcinoma mamario posee actualmente un elevado índice de falsos negativos. Inicialmente, es aconsejable completar este procedimiento con una linfadenectomía axilar.Material y métodos: Presentamos una paciente de 74 años, con un carcinoma ductal infiltrante TI NOMO localizado en la mama derecha, en la que se llevó a cabo una linfadenectomía axilar tras la biopsia del ganglio centinela.Resultados: La biopsia del ganglio centinela fue negativa al igual que la linfadenectomía axilar, excepto un ganglio donde existía colonización por un linfoma folicular. El estudio de extensión para el linfoma fue negativo y se agregó como único tratamiento adyuvante tamoxifeno 20 mg/día.Conclusiones: No hay una clara relación de riesgo entre linfoma y carcinoma mamario. Sin embargo, gracias a completar la biopsia del ganglio centinela con una linfadenectomía axilar, se diagnosticó de forma fortuita un linfoma folicular localizado, en una paciente con carcinoma mamario (AU)

Leiomiosarcoma mamario en un adulto varón / Mammary leimyosarcoma in an adult male

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[True pancreatic cysts in adults]. / Quistes verdaderos del páncreas en el adulto.

True or congenital cysts of the pancreas in adults are extremely rare entities. We describe two cases of true cysts located in the head of the pancreas, which presented with symptoms of epigastric pain, palpable mass and jaundice. CT scan was useful to demonstrate the location and extent of the lesion and its relation with neighbouring structures, but failed to determine the nature of the cyst. Diagnosis was obtained by the histological study of the cystic wall at surgery.

[Colorectal polyps. Treatment and clinical course]. / Pólipos colorrectales. Tratamiento y evolución.

We report the results of the treatment and follow up of 61 patients with polyps of the colon and rectum, who underwent surgical intervention between 1983 through 1991. The mean age was 56 years (range from 41 to 56 y.) and 53% of the patients were males. The majority of the polyps were located in the anorectal region, n = 32 (52.4%) and sigmoid colon n = 17 (27.8%). Tubular adenomas in n = 38 patients and villous adenoma in n = 19, were the most frequent histological types. We have found polyps with invasive carcinoma in 15 (24.6%) cases. The polyps were resected by transanal resection in 15 patients, by colectomies in 11, and 10 patients underwent colectomy for removal of their polyps. Surgery was indicated when the polyp had a base too wide to be removed by colonoscopy or when malignancy was demonstrated by biopsy. There were 10 (19.6%) recurrences during the first three years of follow up. The histological examination showed malignant changes in 4 polyps. Villous adenomas, n = 7 constituted the histological type with more recurrences. Recurrences were treated by local resection in half of the cases. The morbidity was 9.8% and mortality was 3.3%. Surgery when indicated, allows to obtain free margins from tumor, to determine lymph node involvement and to establish the stage.