Neoadjuvant chemotherapy in pregnant patients with cervical cancer: a Latin-American multicenter study.

OBJECTIVE: To describe oncologic and obstetric outcomes in patients diagnosed with cervical cancer during pregnancy who had a successful delivery after neoadjuvant chemotherapy. METHODS: A multicenter retrospective review was conducted in 12 institutions from six Latin American countries, between January 2007 and December 2018. Data collected included clinical characteristics, neoadjuvant chemotherapy agents, treatment, obstetric and oncologic outcomes. RESULTS: Thirty-three patients were included. Median age was 34 years (range 31-36). Twenty (60.6%) women were diagnosed at early stage (IB), and 13 (39.4%) with locally advanced stage (IIA-IIIB) according to FIGO 2009 classification. Carboplatin and paclitaxel was the most frequent combination used (60.6%). Partial and complete response rates were 27.3% and 9.1%, respectively. Median gestational age at delivery was 35 weeks (range 34-36). All patients had live births delivered by cesarean section. Obstetric pathology: pre-term labor, placenta percreta or intra-uterine growth restriction, was documented in seven patients (21.2%). Two (6.1%) neonates had low birth weight. Definitive treatment was primary chemo-radiation in 19 (57.6%) patients, radical hysterectomy in 11 (33.3%), abandoned radical hysterectomy with para-aortic lymphadenectomy and ovarian transposition in 1 patient (3.0%), and no further treatment in 2 (6.1%) patients. After a median follow-up of 16.3 months (range 2.0-36.9), 8 (26.7%) patients had recurrent disease. Of these, four (13.3%) died due to disease. CONCLUSION: Neoadjuvant chemotherapy may be offered to patients wishing to preserve an ongoing pregnancy in order to achieve fetal maturity. Long-term consequences of chemotherapy in the child are yet to be determined.

Carcinoma papilar encapsulado de mama / Encapsulated papillarycarcinoma of the breast

El carcinoma papilar encapsulado es un tumor mamario infrecuente, de diagnóstico histopatológico, de buen pronóstico, rodeado por una cápsula fibrosa y que forma parte del espectro de lesiones papilares mamarias. Es una entidad clinicopatológica rara y representa un desafío diagnóstico. La negatividad de marcadores de la membrana basal y la ausencia de células mioepiteliales puede llevar a sobrediagnóstico y sobretratamiento. Si la relación mama-tumor lo permite, el tratamiento es la resección sectorial, siendo el estudio del ganglio centinela discutido. Se presenta el caso de una mujer postmenopáusica con un nódulo palpable en la mama izquierda, clasificada imagenológicamente como BI-RADS 4c. El estudio anatomopatológico de la core-biopsia informó un carcinoma ductal infiltrante con patrón papilar. Se realizó una resección sectorial del tumor con márgenes oncológicos y estudio del ganglio centinela. La anatomía patológica definitiva informó el diagnóstico de carcinoma papilar encapsulado, con microinvasión, asociando un foco de carcinoma ductal in situ de bajo grado. Se completó el tratamiento con radioterapia y hormonoterapia adyuvante. El carcinoma papilar encapsulado representa el 0,2 al 2% de los neoplasmas de mama. El diagnóstico anatomopatológico presenta dificultades tanto con muestras citológicas como histológicas, basándose en la ausencia de células mioepiteliales tanto en la periferia, como en el interior del tumor. El tratamiento es quirúrgico y no hay acuerdo sobre la indicación de adyuvancia, aunque la mayoría de los autores aseguran que presenta una buena respuesta a la radioterapia. (AU)

Encapsulated carcinoma is an infrequent tumour of the breast, which is surrounded by a fibrous capsule and forms part of the spectrum of papillary breast lesions. Diagnosis is histopathological and these tumours have a favourable prognosis. These tumours are a rare clinicopathological entity and represent a diagnostic challenge. Negative basal membrane markers and the absence of myoepithelial cells may lead to over-diagnosis and over-treatment. If allowed by the breast-tumour ratio, treatment consists of sectoral resection. Sentinel node analysis is controversial. We present the case of a postmenopausal woman with a palpable nodule in the left breast, immunogeneologically classified as BI-RADS 4 c. Histological study of the core biopsy specimen showed invasive ductal papillary carcinoma. (AU)