Sentinel lymph node biopsy in selected cases of ductal carcinoma in situ

INTRODUCTION: Axillary lymphadenectomy is nowadays not recommended to treat ductal carcinoma in situ (DCIS), but there is controversy surrounding the indication for sentinel lymph node biopsy (SLNB). MATERIALS AND METHODS: A prospective study of a selected group of patients diagnosed preoperatively with DCIS was performed between 2004 and 2009. Indications for SLNB were histologically determined high-grade tumours, tumour size >2 cm and patients scheduled to undergo a mastectomy. RESULTS: Sixty-five patients were analysed. Surgical technique was mastectomy in 39 patients (60%) and conservative breast surgery in 26 (40%). Definitive histological study of the resected breast tumour revealed 43 cases (66.2%) of DCIS, 15 (23.1%) of ductal invasive carcinoma and seven (10.7%) microinvasive tumours. In confirmed DCIS, only 6.9% of sentinel lymph nodes were positive, in microinvasive carcinoma 28.5% and in invasive carcinoma 40% were positive. Total number of patients with positive sentinel lymph nodes was 11 (16.9%). Of 39 mastectomies, 12 corresponded to microinvasive or invasive carcinoma and six (50%) showed a positive SLNB. CONCLUSIONS: Performing SLNB avoids an unnecessary second surgery to study axillary lymph nodes in invasive carcinoma diagnosed after definitive histological study. In patients undergoing a mastectomy, this study requires an axillary lymphadenectomy that is not useful in up to 50% of cases. We think that in a selected group of patients with DCIS, SLNB improves tumour staging, adapts the treatment and avoids second surgery in this group of patients (AU)

Prognostic and predictive factors and genetic analysis of early breast cancer

The great heterogeneity of breast cancer makes it impossible to firmly predict which patients with early-stage tumours will or will not need systemic treatments according to the conventional prognostic factors currently employed. In fact, a substantial percentage of patients receive medical treatment for a disease that will not relapse, while another proportion of patients regarded as having good prognostic factors according to the classic criteria do not receive treatment and suffer disease relapse. Considering that most oncological treatments have short- and long-term toxic effects, new methods capable of offering a more precise prognosis need to be developed. The individualisation of the diagnosis of patients with breast cancer based on molecular and gene expression studies is bringing about a veritable revolution in our understanding of the biology of the disease. The new molecular classification of breast cancer, based on these profiles, allows us to establish a prognosis according to the genetic characteristics of each tumour. Such individualisation of the diagnosis of patients with breast cancer will lead to the application of more specific treatments, thereby improving patient survival with lesser toxicity and increased economic savings. Of the different genetic analytical tests available, MammaPrint has been shown to be the option offering the most information on the behaviour of early breast cancer; as a result, it is the most useful technique in deciding the need for oncological treatment as a complement to surgery (AU)

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Utilidad de la clasificación TNM para el cáncer de mama en la toma de decisiones quirúrgicas / No disponible

La clasificación TNM (UICC) pretende agrupar en sus diferentesapartados a tumores de características similares enlos que el pronóstico sea parecido y el tratamiento pueda serhomogéneo.En la medida en que los conocimientos sobre el cáncer demama han ido progresando, la clasificación TNM ha sufridodistintas modificaciones y adaptaciones a los mismos. La últimaedición, la sexta, se produce en el año 2002.Sus diferentes modificaciones no han podido dar una respuestasatisfactoria y estable a las distintas situaciones clínicas.Nos preguntamos en qué medida la vigente clasificaciónTNM contribuye a facilitar la planificación quirúrgica en elcáncer de mama, que es uno de sus objetivos, y analizamoscon sentido crítico aquellas circunstancias que puedan tenerun mayor impacto, o planteen más dudas para el cirujano.Reconociendo la extraordinaria aportación de la clasificaciónTNM, debemos aceptar que hoy desempeña un papelmenor en la práctica quirúrgica diaria.La dirección de las investigaciones y del tratamiento seorientan claramente hacia factores biológicos y no en variablesanatómicas e histológicas, que son la base del sistemaTNM.Debe diseñarse un sistema de clasificación más adecuado,que contemple otras variables y que nos ayude mejor en lasdecisiones de tratamiento.Mientras ese nuevo sistema llega, debemos seguir elTNM, complementado por otros factores de los que ya disponemoshoy día (receptores hormonales, grado histológico,P53, índice de proliferación, HER2, perfil genético, etc.).La necesidad de un nuevo sistema de clasificación para elcáncer de mama parece evidente, también para una mejorplanificación quirúrgica(AU)

The TNM staging system (UICC) is used to determine theanatomical extent of malignant disease on the basis of clinicaland pathological criteria. It pretends to group tumors with similarprognosis and therefore treatment would be homogeneous.The TNM system in breast cancer is periodically revisedwith advances in biology, diagnosis and treatment. Significantmodifications were made to the breast cancer staging systemin the sixth edition, published in 2002, with the aim of providingmore reliable prognostic information.The TNM classification system was also designed with theaims of assisting treatment planning, surgical treatment included,providing prognostic guidance and improving understandingof the neoplastic process.How the current TNM staging help to the surgical treatmentdecision? We analyse some confused and polemical surgicalaspects of the breast cancer.We conclude that in current surgical practice, the TNM systemplays a minor part in the management of breast cancerand there are many confusing points.The TNM staging system has failed to fulfil its objectives,and an alternative staging approach that would more suitableto assist treatment decisions should be devised. The limitationsare a reflection of the biological heterogeneity of the breastcancer and new prognostic factors may help improve and adjusttreatments.While the new staging system comes, the TNM is the bestone for the breast cancer, complemented with other prognosticfactors currently in use (hormonal receptors, P53,HER2/neu, etc.).The future for the TNM classification seems brief and surgeonsneed also a new staging system for the best breast cancertreatment choice(AU)

Inflamación y perforación de divertículo solitario de ciego. Presentación de 5 casos y revisión de la literatura / Inflammation and perforation of a solitary diverticulum of the cecum. A report of 5 cases and literature review

El divertículo solitario de ciego es una entidad benigna pocofrecuente en el mundo occidental, pero con alta prevalencia enpoblación asiática. Habitualmente son asintomáticos y sólo se manifiestancuando se complican con inflamación, perforación o hemorragia.Son una causa poco frecuente de abdomen agudo, manifestándoseclínicamente de forma idéntica a una apendicitisaguda con dolor en fosa iliaca derecha, fiebre y leucocitosis. A pesarde la información que aportan ecografía y TC, sigue siendo difícilobtener un diagnóstico preoperatorio de certeza, realizándoseeste habitualmente durante el acto quirúrgico, aunque en ocasioneses también difícil diferenciarlo intraoperatoriamente de unaneoplasia, estando indicado en esos casos la resección quirúrgicaamplia.Presentamos 5 casos de inflamación y perforación de divertículosolitario de ciego y revisamos la literatura

Solitary diverticulum of the cecum is a benign condition uncommonin the Western world, and with a higher incidence inAsian population. They are usually asymptomatic, and manifestclinically only with complications such as inflammation, perforation,or bleeding. They are a rare cause of acute abdominal pain,clinically similar to acute appendicitis, with tenderness in the rightlower quadrant, fever, and leukocytosis. In spite of the informationprovided by ultrasonography or CT scans, a correct preoperativediagnosis is still difficult to reach, and is usually arrived at inthe operating theater; differentiation from a neoplasm may bealso sometimes complicated, and a wide surgical resection is usuallyrequired for such cases.We report on 5 cases of inflammation and perforation of asolitary cecal diverticulum, and perform a literature review

Mammary hamartoma.

INTRODUCTION: Mammary hamartomas are rare benign breast lumps. They are usually painless, wellcircumscribed, mobile and with no adherence to skin or muscle, composed of varying amounts of fat, glandular and fibrous tissue. Mammary hamartoma has been classically considered as an underdiagnosed pathology, but with the increasing use of diagnostic procedures in breast tumours, the number of hamartomas has increased in the last years. Because there is no distinct pathological feature, a correlation with the clinical findings and image techniques is necessary in order to achieve a correct diagnosis of the pathology. MATERIALS AND METHODS: The clinicopathological features of 8 mammary hamartomas are reported here. RESULTS: The patients are ranged in age from 34 to 67 years. The initial manifestation was in all cases a well-circumscribed, soft, palpable breast lump. Mammography was performed in all patients. Other diagnostic procedures used in the diagnosis were Ultrasound, Fine Needle Aspiration Cytology and Needle Core Biopsy. Treatment was tumorectomy. We describe a case of recurrence after excision of the lump in a more aggressive histological form and one patient who presented the coexistence of a mammary hamartoma and an invasive ductal carcinoma. CONCLUSION: Mammary hamartoma is an uncommon breast tumour. It is necessary the correlation between pathology and clinical and radiological findings. We express our management plan for these lesions.

Mammary hamartoma

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Introduction. Mammary hamartomas are rare benignbreast lumps. They are usually painless, wellcircumscribed,mobile and with no adherence toskin or muscle, composed of varying amounts offat, glandular and fibrous tissue. Mammary hamartomahas been classically considered as an underdiagnosedpathology, but with the increasing use ofdiagnostic procedures in breast tumours, the numberof hamartomas has increased in the last years.Because there is no distinct pathological feature, acorrelation with the clinical findings and imagetechniques is necessary in order to achieve a correctdiagnosis of the pathology.Materials and methods. The clinicopathologicalfeatures of 8 mammary hamartomas are reportedhere.Results. The patients are ranged in age from 34 to67 years. The initial manifestation was in all cases awell-circumscribed, soft, palpable breast lump.Mammography was performed in all patients. Otherdiagnostic procedures used in the diagnosis wereUltrasound, Fine Needle Aspiration Cytology andNeedle Core Biopsy. Treatment was tumourectomy.We describe a case of recurrence after excision ofthe lump in a more aggressive histological formand one patient who presented the coexistence of amammary hamartoma and an invasive ductal carcinoma.Conclusion. Mammary hamartoma is an uncommonbreast tumour. It is necessary the correlationbetween pathology and clinical and radiologicalfindings. We express our management plan forthese lesions

Inflammation and perforation of a solitary diverticulum of the cecum. A report of 5 cases and literature review.

Solitary diverticulum of the cecum is a benign condition uncommon in the Western world, and with a higher incidence in Asian population. They are usually asymptomatic, and manifest clinically only with complications such as inflammation, perforation, or bleeding. They are a rare cause of acute abdominal pain, clinically similar to acute appendicitis, with tenderness in the right lower quadrant, fever, and leukocytosis. In spite of the information provided by ultrasonography or CT scans, a correct preoperative diagnosis is still difficult to reach, and is usually arrived at in the operating theater; differentiation from a neoplasm may be also sometimes complicated, and a wide surgical resection is usually required for such cases. We report on 5 cases of inflammation and perforation of a solitary cecal diverticulum, and perform a literature review.

Breast metastasis of primary colon cancer.

Metastatic tumors to the breast from colon adenocarcinoma are very rare. They are usually indicative of disseminated disease, and the prognosis is poor. Generally, radical operation should be avoided unless needed for palliation. This case report described a patient with breast metastasis from colon adenocarcinoma treated by simple mastectomy.

Metástasis en mama de carcinoma primario de colon / Breast metastasis of primary colon cancer

La metástasis en la mama de tumores de colon es una entidad muy poco frecuente. El pronóstico a largo plazo es infausto, pues esta lesión es expresión de enfermedad sistémica. El tratamiento quirúrgico debe ser lo más conservador posible, ya que es un tratamiento paliativo. Presentamos un caso de esta rara entidad, tratada mediante mastectomía. (AU)

[Pancreatic vipoma with bizarre characteristics]. / Vipoma pancreático con características atípicas.

Pancreatic vipoma is an unusual endocrine tumour, with only 5 cases reported in our country. We report a new case in a 41 year-old-male; the diagnosis was made on the basis of increased plasma levels of vasoactive intestinal peptide (VIP) and positive immunohistochemistry for VIP in the tumour. The peculiarities of this case were a strong steatorrhea which was managed with oral pancreatic enzymes and the findings of peritoneal carcinomatosis at the time of diagnosis.

Breast carcinoma in situ in a male. Report of a case diagnosed by nipple discharge cytology.

BACKGROUND: Cytologic evaluation of abnormal nipple secretion is a well-established method for the rapid diagnosis of breast carcinoma in females. However, less attention has been focused on male patients presenting with nipple discharge. CASE: A case of intraductal carcinoma of the male breast was diagnosed by nipple discharge cytology alone. CONCLUSION: This report illustrates the usefulness of nipple discharge cytology in the diagnosis of early breast carcinoma in males.

Lobular carcinoma of the male breast associated with the use of cimetidine.

A case of carcinoma in the breast of a male patient with a chronic gastric ulcer is described. The patient had received cimetidine for 17 years. Histological examination of an excisional biopsy showed lobular in situ and infiltrating carcinoma. In our review of the English literature, this is the 18th case of lobular carcinoma of the male breast to be reported; it is also the first report of lobular carcinoma associated with the use of cimetidine, and the second in a man with documentation of genotype.

Microvessel density, p53 overexpression, and apoptosis in invasive breast carcinoma.

AIM: To investigate the possibility of a correlation among microvessel density, p53 overexpression, and apoptosis in invasive breast carcinoma. METHODS: Microvessel density was analysed in 105 cases of invasive breast carcinoma by immunohistology using antifactor VIII related antibody. The results were correlated with the immunohistochemical expression of p53 and the apoptotic index, detected using the in situ end labelling of fragmented DNA method (TUNEL). Assessment was made with a CAS 200 image analyser. All these studies were performed on formalin fixed, paraffin wax embedded tissue sections of tumour samples. RESULTS: The mean (SD) microvessel count was 47.2 (51.1), with a range from 7 to 250. Thirty five (33%) carcinomas showed overexpression of p53 protein. The apoptotic index of tumours ranged from 0.0 to 28.0, with a mean (SD) of 1.7 (3.2). The results showed that there was a significant inverse correlation between microvessel density and p53 expression (p = 0.04; odds ratio, 0.37). In contrast, no correlation was identified between the microvessel density and apoptotic index. CONCLUSIONS: These results suggest that in invasive breast carcinoma the p53 overexpression phenotype downregulates tumour neoangiogenesis, as does the wild-type of p53 protein. In addition, they suggest that apoptosis and neoangiogenesis in these tumours are independent processes.

Different immunoreactivity of endothelial markers in well and poorly differentiated areas of angiosarcomas.

This study evaluated the immunohistochemical staining of four endothelial cell markers in well differentiated and poorly differentiated areas of angiosarcomas. Formaldehyde-fixed, paraffin-embedded sections from eight angiosarcomas were studied using the antibodies anti-factor VIII-related antigen (FVIII-RA), Ulex europaeus I agglutinin, anti-CD34 (QBEND/10) and anti-CD31 (JC70). The immunostaining of the angiomatous (well differentiated) and solid (poorly differentiated) areas was separately analysed and specificity was evaluated in 20 non-vascular tumours. The antibody anti-CD31 and Ulex europaeus were the most sensitive markers staining well differentiated vasoformative structures and poorly differentiated solid areas. Anti-FVIII-RA and anti-CD34 did not stain undifferentiated malignant endothelial cells from solid areas. Ulex europueus and anti-CD34 showed very low specificity; in contrast, none of the non-vascular tumours expressed CD31 or FVIII-RA. JC70 (anti-CD31) appears to be the most useful marker in elucidating the vascular nature of angiosarcomas. Is important to emphasize the lack of specificity of Ulex europaeus and the low sensitivity of anti-CD34 and anti-FVIII-RA for poorly differentiated lesions.