Metastatic Occult Primary Lobular Breast Cancer: A Case Report.

Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after invasive ductal carcinoma. Metastatic occult primary breast cancer, although rare, is a well-known clinical entity that usually presents with axillary lymphadenopathy without a detectable breast tumour. A perimenopausal woman in her 50s presented with abdominal pain, fatigue, and weight loss. Imaging showed peritoneal carcinomatosis with ascites, ovarian masses, and a lesion in the ascending colon. Gastric and colon biopsies showed infiltration from lobular breast cancer. Diagnostic workup, including mammography, breast ultrasound, and breast MRI, showed no evidence of breast pathology or axillary lymphadenopathy. First-line treatment with goserelin, letrozole, and palbociclib commenced with clinical improvement and radiological response. This case illustrates the challenges faced by clinicians in the diagnosis and treatment of lobular breast cancer without an identifiable primary lesion or axillary lymphadenopathy.

Evaluación de la sensibilidad de cepas de Pseudomonas aeruginosa multi-resistentes frente a ceftolozano/tazobactam / Evaluation of susceptibility of multidrug-resistant Pseudomonas aeruginosa strains against ceftolozane/tazobactam

Resumen Introducción: Pseudomonas aeruginosa es un patógeno oportunista asociado a alta morbi-mortalidad. Para cepas multi-resistentes (MDR), ceftolozano/tazobactam (CTZ) se ha autorizado por la Agencia Europea del Medicamento (EMA) para infecciones del tracto urinario complicadas, pielonefritis aguda e infecciones intra-abdominales complicadas. Objetivo: Determinar la sensibilidad a CTZ de P. aeruginosa MDR en muestras clínicas aisladas en el Hospital Universitario Puerto Real. Material y Métodos: Se estudió la sensibilidad según criterios EUCAST a CTZ de cepas de P. aeruginosa MDR, entre enero de 2015 y agosto de 2017. Los criterios de multi-resistencia fueron definidos por el Centers for Disease Control and Prevention. La sensibilidad antimicrobiana se obtuvo mediante sistema MicroScan® (Beckman Coulter). La sensibilidad a CTZ se determinó mediante tiras de gradiente (Liofilchem®, Werfen). Resultados: De 1253 cepas, 7% fueron MDR. Se estudió la sensibilidad de 78 cepas de P. aeruginosa MDR, de las cuales cinco (6,4%) resultaron resistentes a CTZ según criterios EUCAST. Conclusiones: En nuestro medio la resistencia in vitro a CTZ en cepas de P. aeruginosa MDR es aproximadamente 6%; CTZ es una opción de tratamiento de infecciones por cepas de P. aeruginosa MDR cuando no exista otra alternativa y se haya comprobado su sensibilidad in vitro.

Background: Pseudomonas aeruginosa is an opportunistic pathogen associated with high morbidity and mortality. For multidrug-resistant strains (MDR), ceftolozane/tazobactam (CTZ) has been authorized by the European Medicines Agency (EMA) for complicated urinary tract infections, acute pyelonephritis, and complicated intraabdominal infections. Aim: To determine the susceptibility to CTZ of P. aeruginosa MDR in isolated clinical samples at the University Hospital Puerto Real. Methods: The susceptibility according to the EUCAST to CTZ criteria of strains of P. aeruginosa MDR, between January 2015 and August 2017 has been studied. The multiresistance criteria were those defined by the Centers for Disease Control and Prevention. The antibiotic susceptibility was obtained by automated MicroScan® system (Beckman Coulter). Susceptibility to CTZ was determined using gradient strips (Liofilchem®, Werfen). Results: Of 1253 strains isolated, 7% presented MDR. We studied the susceptibility of a total of 78 strains of MDR P. aeruginosa, of which 5 (6.4%) were resistant to CTZ according to the EUCAST criteria. Conclusions: In our environment, the in vitro resistance to CTZ in MDR P. aeruginosa strains is approximately 6%. CTZ is an option for the treatment of infections by MDR P. aeruginosa when there is no other alternative and its in-vitro susceptibility has been proven.

Cirugía guiada con radiotrazadores de lesiones de mama no palpables y del ganglio centinela / Radioguided localization with radiotracer of non palpable breast lesions and sentinel node

Objetivo. Evaluar nuestra experiencia en el procedimiento de localización prequirúrgica de lesiones de mama no palpables (LMNP) y del ganglio centinela (GC) con radiotrazadores. Material y métodos. Se incluyeron las LMNP localizadas prequirúrgicamente durante el período comprendido desde enero de 2001 a diciembre de 2011. La inyección del radiotrazador se realizó guiada con ecografía o mamografía. Se obtuvo comprobación con gammagrafía prequirúrgica en todos los casos. El cirujano localizaba en quirófano las LMNP y el GC axilar con una sonda detectora portátil. El estudio histológico del GC se realizó intraoperatorio para evitar reintervenciones si estaba indicada la linfadenectomía axilar. Resultados. Se incluyeron 881 pacientes, de las cuales 226 presentaban lesiones benignas en las que estaba indicada la tumorectomía, y 655 presentaban lesiones malignas en las que estaba indicado el tratamiento quirúrgico conservador. La tasa de detección de las LMNP fue del 99,4%, consiguiendo reducir las reintervenciones por bordes afectos hasta un 7,4%. Conclusión. En nuestra experiencia la cirugía radioguiada de LMNP con radiotrazadores es una técnica sencilla y rápida que permite la extirpación con márgenes quirúrgicos suficientes y resultado estético óptimo, así como la biopsia del GC en la misma intervención ((AU)

Objective. To evaluate our experience with preoperative localization of non-palpable breast lesions (NPBL) with the injection of a radiotracer, or radioguided occult lesion localization technique, and with localization of NPBL and sentinel node (SN) with a single injection of radiotracer, or SN and occult lesion localization technique. Material and methods. We included NPBL in which excision was indicated during the period from January 2001 to December 2011. The radiotracer was injected under stereotactic or ultrasound guidance. Scintigraphy was carried out in all patients before surgery. The surgeon in the operating room had a hand-held gamma probe to locate the lesions in the breast and in the axilla. Intraoperative pathological examination of the SN was done to avoid reinterventions if there were indications for axillary lymphadenectomy. Results. We included 881 patients: 226 benign lesions were localized in patients with indications for lumpectomy and 655 malignant lesions in patients scheduled for breast conserving treatment. The detection rate of NPBL was 99.4%. Reoperations were reduced to 7.4%. Conclusion. In our experience, radioguided surgery of NPBL with radioguided occult lesion localization-SN and occult lesion localization is a quick and simple technique that allows tumor excision with adequate surgical margins and optimal cosmetic results, as well as SN biopsy during the same operation ((AU)