Carcinoma escamoso con cambios quísticos asociado a embarazo / Pregnancy-associated squamous cell carcinoma with cystic changes

El cáncer de mama asociado al embarazo representa una compleja situación clínica por la dificultad de su diagnóstico. La clínica principal del cáncer de mama gestacional es el nódulo palpable, sin embargo, debido a los cambios fisiológicos que se producen en la glándula durante el embarazo o la lactancia, el diagnóstico es especialmente difícil, lo que provoca un retraso en el diagnóstico. El carcinoma escamoso es un subtipo histológico raro, que representa menos del 0,5% de los cánceres de mama. Se trata de un tipo de tumor que suele presentarse en forma de masa quística y cuyo diagnóstico puede confundirse con una entidad benigna. Se presenta el caso de una mujer de 35 años diagnosticada de un carcinoma escamoso de mama tras múltiples ingresos médicos por sospecha de galactoceles y mastitis. El cáncer de mama debe ser el primer diagnóstico diferencial que tener en cuenta ante un nódulo persistente que no mejora tras tratamiento médico y es importante pensar en el carcinoma escamoso en caso de que se trate de una masa quística o absceso mamario

Pregnancy-associated breast cancer represents a complex clinical situation due to the difficulty of diagnosis. The main clinical feature is a palpable nodule. However, due to the physiological changes that occur in the gland during pregnancy or lactation, diagnosis is especially difficult and sometimes delayed. Squamous cell carcinoma is a rare histological subtype, representing less than 0.5% of breast cancers. It usually presents as a cystic mass that can be mistaken for a benign entity. We present the case of a 35-year-old woman diagnosed with squamous cell carcinoma of the breast after multiple medical admissions due to suspicion of galactoceles and mastitis. Breast cancer should be the first differential diagnosis to consider in the presence of a persistent nodule that does not improve after medical treatment and it is important consider squamous cell carcinoma if there is a cystic mass or breast abscess

Impact of aging on obstetric outcomes: defining advanced maternal age in Barcelona.

BACKGROUND: Women of advanced maternal age (AMA) are a growing population, with higher obstetric risks. The Mediterranean population has specific characteristics different from other areas. Thus, the objective of this study was to establish a cut-off to define AMA in a selected mediterranean population coming from a tertiary referral private/mutual health hospital in Barcelona. METHODS: Retrospective cohort of euploid singleton pregnancies delivered from January 2007 to June 2017. Main maternal outcomes were: gestational diabetes, preeclampsia, placenta previa, c-section and prolonged hospitalization (≥ 7 days). Main adverse perinatal outcomes were: stillbirth, prematurity, preterm prelabor rupture of membranes, low birth weight, need of admission at a neonatal intensive care unit and perinatal mortality. Adjustment for confounding factors (smoking, previous comorbilities, parity, assisted reproductive techniques (ART) and obesity) was performed. RESULTS: A total of 25054 pregnancies were included. Mean maternal age was 34.7 ± 4.2 years, with 2807 patients in the group of age between 40 and 44 years (11.2%) and 280 patients ≥45 years (1.1%). Women at AMA had higher incidence of previous comorbilities (compared to the reference group of women < 30 years): prior c-section, chronic hypertension and obesity. In addition, they were more likely to use ART. After adjusting for confounding factors, maternal age was an independent and statistically significant risk factor for gestational diabetes (OR 1.66/2.80/3.14) for ages 30-39, 40-44 and ≥ 45 years respectively, c-section (OR 1.28/2.41/7.27) and placenta previa (OR 2.56/4.83) for ages 40-44 and ≥ 45 years respectively, but not for preeclampsia (neither early-onset nor late-onset). Risk of emergency c-section was only increased in women ≥45 years (OR, 2.03 (95% CI, 1.50-2.74). In the other groups of age, the increase in c-section rate was because of elective indications. Age ≥ 45 years was associated with iatrogenic prematurity < 37 weeks (OR 2.62, 95% CI 1.30-5.27). No other relevant associations between AMA and maternal or neonatal outcomes were found. CONCLUSIONS: Maternal age is an independent risk factor for adverse obstetric outcomes. Age ≥ 40 years was associated to relevant increased risks and reveals to be an adequate cut-off to define AMA in our population.