Adenoma pleomorfo de la mama. A propósito de un caso / Pleomorphic adenoma of the breast. Apropos of a case

OBJETIVO: El adenoma pleomorfo es un tumor con una gran heterogenicidad arquitectural y citológica, de ahí su denominación como tumor mixto. Compuesto característicamente por células epiteliales y mioepiteliales con estroma mesenquimal, presenta un comportamiento benigno, siendo su localización habitual las glándulas salivares. La mama es una localización muy infrecuente para este tipo de tumores. CASO CLÍNICO: Presentamos el caso clínico de una paciente de 76 años sin antecedentes de patología mamaria, valorada en consultas externas de cirugía por una secreción unilateral de aspecto serosanguinolento desde la mama derecha, asociada a un nódulo de unos 2cm de diámetro mayor. Tras completar su estudio, se decide exéresis de la tumoración, obteniendo como resultado en la anatomía patológica una tumoración heterogénea con predominio de células miopiteliales; descripción compatible con un adenoma pleomorfo. DISCUSIÓN: El adenoma pleomorfo de la mama, es una tumoración epitelial benigna que tiene un patrón histológico similar al del tumor de las glándulas salivares. Los rasgos histológicos más importantes es la metaplasia ósea y mixocondroide, junto con presencia de calcificaciones, tejido epitelial (con o sin diferenciación glandular), y tejido mioepitelial; siendo esta gran variedad estructural lo que le caracteriza. Hay que realizar un diagnóstico diferencial con patología maligna a la cual asemeja. Se presenta de forma poco frecuente a nivel mamario y suele ser una lesión bien delimitada y solitaria, elastica y no adherida. Pese a su comportamiento benigno (no ha presentado en ninguno de los casos documentados metástasis a distancia) el tratamiento es quirúrgico, asegurando buenos margenes de resección para evitar recidivas

OBJECTIVE: Pleomorphic adenoma shows wide architectural and cytological heterogeneity and is consequently classified as a mixed tumour. These benign adenomas are characteristically composed of epithelial and myoepithelial cells with mesenchymal stroma and are usually located in the salivary glands. Localisation in the breast is extremely infrequent for this type of tumour. CASE REPORT: We report the case of a 76-year-old female patient with no prior history of breast disease who was assessed in the surgery outpatient clinic for unilateral serosanguinous secretion from the right breast associated with a nodule of approximately 2cm in diameter. After workup, it was decided to extirpate the tumour. Histological findings indicated a heterogeneous tumour with a predominance of myoepithelial cells, compatible with pleomorphic adenoma. DISCUSSION: Pleomorphic adenoma of the breast is a benign epithelial tumour whose histological pattern is similar to that of pleomorphic adenoma of the salivary glands. The most important histological features are osseous and myxochondroid metaplasia, together with the presence of calcifications, epithelial tissue (with or without glandular differentiation) and myoepithelial tissue. This wide structural variety is what characterises these tumours. The differential diagnosis should be performed with malignant disease, which these adenomas frequently mimic. Pleomorphic adenomas are very infrequent in the breast and are usually well-demarcated, solitary, elastic and non-adherent tumours. Despite their benign behaviour (there have been no reported cases of distant metastases), treatment is surgical, with good resection margins to avoid recurrences

Cirugía mayor ambulatoria en patología mamaria / Major ambulatory surgery in breast diseases

Introducción: El tratamiento quirúrgico de la patología mamaria (PM) ha evolucionado aumentando su manejo como cirugía mayor ambulatoria (CMA). El objetivo de este estudio es analizar una serie de pacientes intervenidas de PM en régimen de CMA durante el año 2017 para evaluar su calidad y seguridad. Métodos: Se realiza análisis retrospectivo de las pacientes intervenidas de PM en el Consorcio Hospital General Universitario de Valencia desde enero hasta diciembre del 2017 incluidos en programa de CMA, estudiando el número de pacientes, los motivos de exclusión, el tipo de procedimientos quirúrgicos realizados, el índice de sustitución (IS), la tasa de ingreso (TI) y las causas de conversión al ingreso, complicaciones postoperatorias y el índice de satisfacción. Se compara con un grupo control del año 2013. Resultados: En 2017 se realizaron 396 intervenciones por PM, siendo de PM benigna (PMB) 170 intervenciones y de PM maligna (PMM) 226 intervenciones. El IS para la PM global es del 72,8% y para PMB fue 93,4%. El IS para PMM fue 57,2%, que ha progresado en los últimos años desde el 45,4% en 2013. La TI inesperado de la PMM fue del 14,1%, mientras que en la PMB fue del 0,6%. La PMM con ingreso presentó más morbilidad (17%) que la PMM sin ingreso (8,5%) y la PMB (6,5%). Conclusiones: En PMM del Consorcio Hospital General Universitario de Valencia el IS ha aumentado y la TI depende de la linfadenectomía tras biopsia peroperatoria del ganglio centinela. La CMA para el tratamiento de la PM es segura y eficiente

Introduction: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. Methods: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. Results: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). Conclusions: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe

Major ambulatory surgery in breast diseases. / Cirugía mayor ambulatoria en patología mamaria.

INTRODUCTION: The use of ambulatory surgery (AS) for breast pathology (BP) has increased. The objective of this study is to analyse a group of patients treated surgically for breast pathology in order to evaluate its quality and security in a MAS setting in 2017. METHODS: A retrospective review of all patients undergoing breast surgery was conducted within an AS programme from January to December 2017 in Consorcio Hospital General Universitario of Valencia (CHGUV). The study analysed the number of patients, exclusion reasons, type of surgical procedures, evolution of substitution rate (SR), rate and causes of conversion to admission, postoperative complications, motives for not being included in the ambulatory programme and the satisfaction rate of the patients treated with ambulatory surgery. This has been compared with a 2013 group. RESULTS: In 2017, 396 procedures for BP were performed: 170 for benign and 226 for malignant disease. The SR for the global mammary pathology was 72.8%. The SR for benign pathology was 93.4% and the SR for malignant pathology was 57.2%, which has increased in recent years from 45.4% in 2013. The unexpected hospitalization rate (HR) of malignant pathologies was 14.1%, while the HR in benign pathologies was 0.6%. Patients hospitalized for malignant pathologies presented higher complications (17%) than ambulatory patients (8.5%) and benign pathologies (6.5%). CONCLUSIONS: At the CHGUV, the SR has steadily increased in malignant pathologies. The unexpected hospitalization rate is determined by perioperative sentinel lymph node biopsy results. AS for the treatment of mammary pathology is efficient and safe.

Miofibroblastoma de mama en el varón: un desafío diagnóstico. A propósito de 2 casos / Myofibroblastoma of the breast in men: a diagnostic challenge. Apropos of two cases

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Lesiones inflamatorias mamarias benignas / Benign inflammatory breast lesions

El proceso diagnóstico de las lesiones inflamatorias mamarias incluye la descripción de su patrón histopatológico. El objetivo del trabajo es identificar los patrones inflamatorios mamarios. Se ha realizado una revisión de la literatura científica. Los patrones identificados son mastitis aguda con galactoforitis infecciosa inespecífica, galactoforitis crónica supurativa recidivante con mastitis periductal y de células plasmáticas, mastitis eosinofílica, lobulillitis linfocítica, mastitis granulomatosas, vasculitis mamaria, pseudotumores inflamatorios y necrosis grasa. Estos patrones y sus subtipos se han diferenciado analizando su composición, localización, mecanismo de producción y diagnóstico diferencial. En las biopsias de las inflamaciones mamarias se pueden identificar patrones histológicos inflamatorios desde los que se definen subtipos de mastitis. Para realizar el diagnóstico debe realizarse un completo estudio histopatológico y microbiológico de la biopsia de una mastitis y completar el diagnóstico con una adecuada correlación clinicopatológica (AU)

The diagnosis of chronic inflammatory breast disease includes the description of the histological pattern and location. The objective of this revision of the literature is to identify breast inflammatory patterns which are: acute mastitis with nonspecific infectious galactoforitis, chronic suppurative galactoforitis with periductal and plasma cell mastitis, eosinophilic mastitis, lymphocytic lobulillitis, granulomatous mastitis, breast vasculitis, inflammatory pseudotumour and fat necrosis. The composition, location, production mechanism and differential diagnosis of all types and subtypes are analyzed. Several inflammatory histological patterns with subtypes can be identified in biopsies of mastitis. A correct diagnosis requires a comprehensive histopathological and microbiological study in correlation with adequate clinicopathological data (AU)

Malignant eccrine breast spiradenoma. A case report and literature review.

INTRODUCTION: Eccrine spiradenomas are rare adnexal tumours of the skin that originate in the sweat glands. There are only three cases, including ours, diagnosed as malignant transformation in the breast. PRESENTATION OF CASE: We present a case of an asymptomatic 48 year old woman in whom the lesion was detected on the basis of breast cancer prevention programme. The metastatic study detection and the sentinel lymph node biopsy were negative so wide excision of the mass was performed with no further treatment. After 32 months of follow-up, there is no evidence of recurrent or metastatic disease in our patient. DISCUSSION: The lesions usually show a typical history of a long-standing unchanged cutaneous solitary nodule that becomes enlarged. The imaging findings of breast eccrine spiradenomas have not been clearly demonstrated. Diagnosis is based in histopathological findings of malignant focus. A large list of uncommon dermatological skin malignancies and breast benign lesions can mimic malignant eccrine spiradenomas (MES); therefore, determination of inmunophenotype allows narrowing differential diagnosis. Distant metastases portend an ominous prognosis. The mainstay of treatment is surgical removal with wide excision margins. Radiation and hyperthermic chemotherapy can also be administered to prevent focal recurrence. Due to the high risk of developing metastases, close follow up of these patients for early detection of recurrence should be carried out. CONCLUSION: Eccrine spiradenomas are rare adnexal tumours of the skin. Intraparenquimatous breast location is especially infrequent. Diagnosis is based on histopathological examination. MES metastasizes (40%), so a close follow up is recommended.