Persistencia de enfermedad metastásica ganglionar de cáncer colorrectal con resección en bloque y colocación de injerto aortoilíaco / Persistence of lymph node metastatic disease from colorectal cancer with bloc resection and biaortoiliac graft placement

Introducción: el pronóstico del cáncer de colon está relacionado con el grado de penetración del tumor a través de la pared intestinal y con la infiltración ganglionar en el momento de la cirugía. Se reporta poca experiencia en cuanto al tratamiento quirúrgico de persistencia o recidivas locorregionales a ganglios paraaórticos con afectación de la aorta abdominal. Caso clínico: mujer que presenta persistencia locorregional del cáncer colorrectal con afectación aortoilíaca. Se plantea una estrategia de tratamiento quirúrgico interdisciplinario con intención curativa, con la colocación de un injerto vascular bifurcado y conseguir la resección R0 con la supervivencia libre de enfermedad. Discusión: los pacientes con persistencia de la enfermedad metastásica requieren un abordaje quirúrgico abierto con el objetivo de lograr una resección R0. En el caso de presentarse infiltración local de estructuras a órganos adyacentes, se recomienda la resección radical en bloque. Estos procedimientos más complejos se asocian con una mayor morbilidad. Sin embargo, los beneficios asociados con la eliminación de la metástasis a ganglios paraaórticos deben considerarse frente al riesgo de morbilidad quirúrgica. (AU)

Introduction: the prognosis of colon cancer is related to the degree of tumor penetration through the intestinal wall and lymph node infiltration at the time of surgery. Little experience is reported regarding the surgical treatment of persistence or locoregional recurrences to para-aortic nodes with involvement of the abdominal aorta. Case report: woman presenting with locoregional persistence of colorectal cancer with aortoiliac involvement. An interdisciplinary surgical treatment strategy with curative intent is proposed, with the placement of a vascular graft bifurcated and achieving R0 resection with disease-free survival. Discussion: patients with persistent metastatic disease require an open surgical approach, with the goal of achieving an R0 resection. In the case of local infiltration of structures to adjacent organs, radical en bloc resection is recommended. These more complex procedures are associated with greater morbidity. However, the benefits associated with removal of para-aortic lymph node metastasis must be weighed against the risk of surgical morbidity. (AU)

Overexpression of MMP-3 and uPA with Diminished PAI-1 Related to Metastasis in Ductal Breast Cancer Patients Attending a Public Hospital in Mexico City.

Extracellular matrix metalloproteases and the fibrinolytic system are important protease systems interacting with each other in charge of remodeling and recycling of tissues. Their role in tumor invasion and metastasis is often discussed. In this study several metalloproteases such as MMP-1, MMP-3, MMP-9, and TIMP-1 together with molecules from the fibrinolytic system like uPA, its receptor uPAR, and its inhibitor, PAI-1, were studied by immune-histochemistry to establish a comparison with and without metastasis. From the (118) primary tumors of Mexican patients with ductal breast cancer studied, 56% were grade II and 69% were size T2; the group with metastatic ganglia included 64 samples (54.3%). In patients with metastasis the estimated expression of MMP-3 and uPA (resp., 28% and 45%) was higher than that from no metastatic tumors; it means there is higher expression of both markers in metastatic tumors (p < 0.05). At the same time, metastatic tumors showed statistically significant lower signal of PAI-1 (24%) than tumors without metastasis (p < 0.05). We concluded that overexpression of MMP-3 and uPA, altogether with diminished expression of PAI-1 from metastatic tumors, might be a crucial step towards metastasis in ductal breast cancer. Nevertheless, additional studies in different populations are necessary to establish a pattern.

Intervención cognitivo-conductual para el control de ansiedad ante la biopsia insicional en pacientes con cáncer de mama / Cognitive-behavioral intervention to control anxiety about incisional biopsy in patients with breast cancer

La atención del enfermo oncológico implica la realización de pruebas médico invasivas para la obtención de un diagnóstico preciso. Cuando los pacientes se someten a estos procedimientos experimentan reacciones desadaptativas como miedo, ansiedad y dolor. En el caso del cáncer de mama, la prueba diagnóstica más utilizada es la biopsia incisional, procedimiento que las pacientes ignoran y que condiciona la presencia de incertidumbre, ansiedad y pensamientos anticipados negativos respecto al procedimiento y al posible resultado. La ansiedad y el dolor pueden provocar complicaciones fisiológicas, conductuales y emocionales, motivo por el cual el psicólogo especialista en medicina conductual participa antes, durante y después de la toma de biopsia. El objetivo de este estudio fue evaluar el efecto de un programa cognitivo-conductual sobre la ansiedad en mujeres que se sometieron a toma de biopsia incisional en mama por primera vez. Participaron 10 pacientes del servicio de Oncología del Hospital Juárez de México las cuales fueron atendidas en la consulta externa. La intervención consistió en proporcionar psicoeducación y entrenamiento en relajación pasiva a través de videos, grabaciones e información impresa. Para evaluar ansiedad se utilizaron el inventario IDARE-Estadoy la Escala de Expresión Facial de la Ansiedad (EEF-A), así como tensión arterial y frecuencia cardíaca antes y después de la intervención. Los datos fueron analizados tanto intrasujeto como entre sujetos mediante la prueba de Wilcoxon (p≤0,05) encontrándose reducción de la ansiedad como grupo en lasescalas de ansiedad-estado (puntajes crudos y rangos) y en la EEF-A

Oncological patients are submitted to invasive exams in order to obtain an accurate diagnosis; these procedures may cause maladaptative reactions (fear, anxiety and pain). Particularly in breast cancer, the most common diagnose technique is the incisional biopsy. Most of the patients are unaware about the procedure and for that reason they may focus their thoughts on possible events such as pain, bleeding, the anesthesia, or the later surgical wound care. Anxiety and pain may provoke physiological, behavioral and emotional complications, and because of this reason, the Behavioral Medicine trained psychologist takes an active role before and after the biopsy. The aim of this study was to evaluate the effect of a cognitive-behavioral program to reduce anxiety in women submitted to incisional biopsy for the first time. There were 10 participants from the Hospital Juárez de México, Oncology service; all of them were treated as external patients. The intervention program focused in psycho-education and passive relaxation training using videos, taperecorded instructions and pamphlets. Anxiety measures were performed using the IDAREState inventory, and a visual-analogue scale of anxiety (EEF-A), and the measurement of blood pressure and heart rate). Data were analyzed both intrasubject and intersubject using the Wilcoxon test (p≤00.05). The results show a reduction in anxiety (as in punctuation as in ranges) besides, a reduction in the EEF-A

[Clear cell adenocarcinoma arising from abdominal wall endometriosis]. / Adenocarcinoma de células claras originado de endometriosis en pared abdominal.

BACKGROUND: Clear cell carcinoma originating in the abdominal wall is a rare event. It is generally associated with endometrial tissue implants left behind after a caesarean section or other gynaecological operations. Its pathophysiology is complex and controversial. CLINICAL CASE: The case is presented of a 45 year-old female with history of three caesarean sections, who was seen due to having a tumour mass of 6 months onset in the anterior abdominal wall. Imaging studies confirmed its location, and due to measuring 9 by 7 cm it was suspected to be an urachal tumour. A resection with wide margins was performed. The histopathology report was of a clear cell adenocarcinoma originated in ectopic endometrial tissue, with negative margins. CONCLUSION: This is a very rare case, with few cases reported in the literature. This diagnosis should be included in tumours of the abdominal wall.

[Medullary carcinoma experience in breast oncology unit of Hospital Juarez Mexico]. / Cáncer de mama de tipo medular. Experiencia en el Hospital Juárez de México.

BACKGROUND: Medullary breast cancer is a rare type, considered of good prognosis. OBJECTIVE: To know the epidemiological and clinical characteristics of the population attended in the Hospital Juarez de Mexico, to know if they are alike to described worldwide and if the treatments proposed internationally are applicable for this hospitable center. METHODS: We performed a retrospective analysis. Reviewing the records with histopathologic diagnosis of medullary breast cancer from February 1993 to February 2011. Finding 41 patients in the oncology unit of the institution. RESULTS: We report an incidence of 3.04%, originating in 11 Mexican States, with a low to middle socioeconomic level in 39.02%. The average age at the time of diagnosis was 50 years. No family history was reported but some patients had medical history for type 2 diabetes, hypertension and previous breast cancer. 63.41% were menopausal. The average clinical size of the tumor was 58 mm. The 63% of the cases were located in the left breast. The 53.1% were clinical stages I and II, 46.3% were clinical stages III and in 9.6% of the cases primary tumor could not be assessed. Only 47% of the patients had positive axillary lynph nodes at diagnosis. The inmunohistochemestry was only reported in 14 of the 41 patients, according to the molecular classification of breast cancer: 8 were triple negative, 2 luminal A, 1 luminal B and 3 Her2neu. CONCLUSIONS: The Mexican population presents epidemiological and clinical characteristics similar to those patients described in other studies worldwide.

Antecedentes: el carcinoma de mama, variante medular, es poco frecuente y de buen pronóstico. Objetivo: conocer las características epidemiológicas y clínicas de la población atendida en el Hosital Juárez de México, saber si se asemejan a las descritas a nivel mundial y si los tratamientos propuestos internacionalmente son aplicables para este centro hospitalario. Material y métodos: estudio retrospectivo y descriptivo de 41 expedientes de pacientes con cáncer de mama tipo medular atendidas entre febrero de 1993 y febrero 2011. Resultados: se encontró que la incidencia de cáncer de mama de tipo medular fue de 3.04% en pacientes originarias de 11 estados mexicanos, con edad promedio de 50 años, nivel socioeconómico medio bajo para 39.02%, sin antecedentes familiares pero sí personales patológicos para: diabetes mellitus tipo 2, hipertensión arterial sistémica y cáncer de mama previo. Eran postmenopáusicas 63.41%. El promedio del tamaño clínico del tumor fue 58 mm, localizado en 63% de los casos en la mama izquierda. Los estadios clínicos fueron: 53.1% en I y II, 46.3% en III y 9.6% no etapificable. El 47% de las pacientes tenía ganglios linfáticos axilares positivos al momento del diagnóstico. La inmunohistoquímica sólo se reportó en 14 de las 41 pacientes; de acuerdo con la clasificación molecular para cáncer de mama: 8 fueron triple negativo, 2 luminal A, 1 luminal B y 3 Her2Neu. Conclusión: la población mexicana tiene características epidemiológicas y clínicas similares a las de las pacientes descritas en estudios internacionales.

[Frequency of cancer in a specialty hospital in Mexico City. Implications for the development of early detection methods]. / Frecuencia de cáncer en un hospital de tercer nivel de la Ciudad de México. Implicaciones para el desarrollo de métodos de detección oportuna.

BACKGROUND: Cancer is the second cause of death in Mexico. The Juarez Hospital of Mexico is a highly specialized general hospital in which the frequency of cancer treated at the Oncology Unit is a representative sample of the frequency of cancer in the country. OBJECTIVE: To learn about the frequency of presentation of tumors diagnosed in a third level hospital. METHODS: We reviewed all the biopsies and surgical specimens diagnosed as cancer or malignant tumors registered in the pathology unit during the years 2006 to 2010. We grouped the cases by age, sex, and anatomic site. RESULTS: We identified the 10 most common cancers for both sexes, age groups and sex affected, raising the chances of early detection campaigns reinforce for the most common cancers and try to increase control and cure rates and improve coverage of the economically weak, for their integration into health systems. CONCLUSIONS: Information obtained reflects the reality of the country to the general population without entitlements. That in our country women suffer more than men of cancer that breast neoplasms and genital tract are the most frequent, and timely detection systems exist and should be strengthened to achieve greater eligible for early identification of cases in our population.

Antecedentes: el cáncer es la segunda causa de muerte en México. El Hospital Juárez de México es una institución general de alta especialidad, por lo que la frecuencia de pacientes con cáncer atendidos en su Unidad de Oncología es una muestra representativa de la frecuencia de cáncer en el país. Objetivo: conocer la estadística de tumores diagnosticados en un hospital de tercer nivel. Material y métodos: estudio retrospectivo efectuado con base en la revisión de los expedientes guardados en los archivos de Anatomía Patológica de pacientes atendidos entre los años 2006 y 2010. Se registraron todos los casos positivos a cáncer de material obtenido mediante biopsia o pieza quirúrgica. Se agruparon por edad, sexo y sitios anatómicos. Resultados: se identificaron las 10 neoplasias más frecuentes en uno y otro sexo, los grupos de edad, y sexo más afectado. Conclusiones: la información obtenida refleja la realidad del país de población abierta no derechohabiente. En México, las mujeres padecen más cáncer que los hombres; las neoplasias de mama y tracto genital son las más frecuentes. Deben reforzarse los sistemas de detección oportuna para que la identificación de casos tempranos sea mayor en nuestra población.

[Study of 14 cases of breast cancer and pregnancy]. / Estudio de 14 casos de cáncer de mama y embarazo.

INTRODUCTION: Breast cancer is diagnosed in pregnant women during pregnancy or the first year after childbirth, and is the second leading cause of death among women of reproductive age. We don't know the frequency of this disease or the characteristics of the women affected at the Juarez Hospital of Mexico. This paper analyzed the cases of pregnant women diagnosed with breast cancer treated in the Oncology Department over a period of 10 years (1990-2000). METHODS: We performed a retrospective descriptive study of pregnant women diagnosed with breast cancer, treated at the hospital. Of the cases found, the following indicators were studied: maternal age, type of cancer, weeks of gestation at the time of diagnosis, resolution of pregnancy and perinatal outcome, and treatment monitoring. Descriptive statistics were performed using measures of central tendency and dispersion. RESULTS: There were 14 cases of pregnant women with breast cancer. The mean age of patients was 28 years, with a mean of 23 weeks gestation at diagnosis. The resolution of pregnancy was favorable in 73% of cases. 78.6% of the patients were treated, 72.7% had follow-up for 2 years that found 62.5% of patients without tumor activity. CONCLUSIONS: The frequency of pregnant women with breast cancer is low, affecting young people. The choice of treatment allowed the resolution of pregnancy and survival of women without tumor activity.

[Initial experience in laparoscopic retroperitoneal lymphadenectomy for the management of nonseminomatous testicular cancer]. / Experiencia inicial en linfadenectomía retroperitoneallaparoscópica para el manejo del cáncerde testículo no seminoma.

BACKGROUND: Germ cell tumors of the testis represent 1% of all cancers in males. The mean age of occurrence is between 15 and 35 years. Early diagnosis and accuracy of staging are factors that have an impact in survival. According with stage I SO in nonseminoma tumors, there are three management options. Choice among them is based on the risk of recurrence, their morbidity and informed consent of the patient. The objective of this paper is to present the first results of retroperitoneal laparoscopic lymphadenectomy (RLL) in testicular germ cell nonseminoma tumors stage I S-0 at the Oncology Unit of Hospital Juarez de México. METHODS: Retrospective study of the data base of patients diagnosed with nonseminomatous testicular cancer Stage I, S-0 and subject to retroperitoneal laparoscopic lymphadenectomy in the period between May 2010 to December 2011. RESULTS: Ten patients underwent transperitoneal retroperitoneal laparoscopic lymphadenectomy with modified limits, ipsilateral to the affected testicle, 70% were stage I-A, showing a nodal count of 15.3 nodes. None suffered from metastases. The followup mean for all patients was 9.6 months. One patient suffered retroperitoneal relapse off lymphadenectomy's reach 10 months after the original surgery. CONCLUSION: Retroperitoneal laparoscopic lymphadenectomy is a safe procedure with reasonable morbidity, hospital stay and nodal count. It requires a surgeon expert in laparoscopic techniques.

Metástasis a pared abdominal por cáncer de vesícula biliar no sospechado después de colecistectomía laparoscópica: informe de dos casos / Abdminal wall metastasis non diagnosed after laparoscopic cholecystectomy for gallbladder carcinoma: report of two cases

La colecistectomía laparoscópica es actualmente el tratamiento de elección para la litiasis biliar sintomática. El hallazgo incidental de un cáncer no sospechado durante la colecistectomía laparoscópica y los implantes en la pared abdominal es un evento poco común que puede alterar la conducta biológica del tumor y empeorar su pronóstico. La frecuencia real de esta complicación no se conoce y sólo se han documentado casos aislados. Se deben examinar las piezas quirúrgicas y realizar estudios transoperatorios de cualquier zona sospechosa. En caso de encontrar un carcinoma de manera incidental, se recomienda reintervenir al paciente y realizar resección amplia de los puertos y del lecho vesicular con linfadenectomía en un intento de mejorar la posibilidad de curación. Presentamos dos casos de pacientes sometidas a colecistectomía laparoscópica quienes desarrollaron metástasis en los puertos por adenocarcinoma de vesícula biliar no sospechado y su evolución

Caso anatomoclínico del Instituto Nacional de Cancerología / Anatomoclinic case of tha Instituto Nacional of Cancerologia

Se describe el caso de una mujer de 77 años que presentó datos cerebrales de un probable carcinoma con primario de origen desconocido. En el estadio final de su evolución clínica presentó datos de abdomen agudo. Se efectúan consideraciones acerca del manejo de las neoplasias de origen desconocido que eventualmente dan metástasis a sistema nervioso central. Así mismo se presenta una revisión bibliográfica de las diferentes extirpes histológicas que metastatizan a cerebro y se comenta acerca de su pronóstico. Finalmente, se efectúan comentarios de los hallazgos histopatológicos.