Estudio comparativo de la supervivencia del cáncer de mama según diagnóstico asistencial versus programa de detección precoz / Comparison of breast cancer survival by diagnosis in the clinical setting versus screening

Objetivo. Comparar la supervivencia del cáncer de mama en mujeres que han sido cribadas en el programa de Detección Precoz del Cáncer de Mama (DPCM) y en las que no han participado en él. Pacientes y métodos. Es un estudio descriptivo y longitudinal en el que se han estudiado todos los cánceres de mama registrados en el servicio de Anatomía Patológica del Hospital de Tortosa Verge de la Cinta (Tarragona) de mujeres de 50-65 años, que se habían detectado la enfermedad ellas mismas o que la había detectado el programa DPCM, desde junio de 1999 hasta junio de 2003. Se registraron 101 pacientes con cáncer de mama, de las que en 84 se pudieron recoger todos los datos relativos al tumor, la cirugía y el tratamiento. En el 2014, tras un seguimiento de 11,6 ± 1,8 años, se anotó el estado actual. Resultados. No hay diferencia estadísticamente significativa en la supervivencia de los 2 grupos. Pacientes con carcinoma in situ y sin ganglios metastásicos se encuentran entre las fallecidas, mientras que ninguna paciente con carcinoma bien diferenciado falleció. Conclusiones. En nuestro estudio, el cribado del cáncer de mama no mejora la supervivencia y determinados factores en los que se apoyan los programas de cribado, como la detección de carcinomas no infiltrantes y/o de ganglios no metastásicos, no aseguran la curación (AU)

Objective. To compare survival in breast cancer between women diagnosed in an early breast cancer detection programme and those not attending this programme. Patients and methods. We conducted a descriptive and longitudinal study that analysed all types of breast cancer registered in the Pathology Service of the Hospital de Tortosa Verge de la Cinta (Tarragona, Spain). Tumour samples were obtained from 50-65-year-old women who had detected alterations on self-examination and from those attending the early breast cancer detection programme from June 1999 to June 2003. All the information relating to the tumour, surgery or treatment was registered. In 2014, after a follow-up of 11.6 ± 1.8 years, the current status of each patient was recorded. Results. There was no significant statistical difference in survival between the two groups of patients. Non-survivors included patients with in situ carcinoma and without lymph node metastases. Survival was 100% in patients with well differentiated carcinoma. Conclusions. Breast cancer screening did not improve survival in our study. The elements on which screening programs are based, such as non-invasive carcinoma detection and/or non- metastatic lymph nodes, do not ensure recovery (AU)

Endocarditis infecciosa y muerte súbita / Infective endocarditis and sudden death

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Utilidad de la eco-Doppler en la consulta de ginecología / Utility of echo Doppler in gynecology

En los últimos 30-40 años el diagnóstico enginecología ha dado un vuelco importante desdela utilización generalizada de la ecografíaabdominal y, sobre todo, de la ecografía vaginal.En el presente caso comprobamos comoimágenes sospechosas obligan a un control másminucioso para descartar un proceso maligno debase. En nuestro caso la ecografía y más aún elDoppler fue el único dato sugerente deneoformación. Por ello consideramosrecomendable disponer en toda consultaginecológica de ecógrafo con eco-Doppler colorincorporado que representa una herramienta conuna eficacia comprobada, reproducible e inocuade cara al paciente, del que se obtiene una granrentabilidad y que precisa un tiempo mínimopara su realización. Su incorporación al controlrutinario de las pacientes podría ayudarnos adetectar procesos neoformativos en fases muyiniciales, con el consiguiente beneficio para laspacientes.En la actualidad, la ecografía 3D se abre caminocomo técnica diagnóstica en la ginecologíamoderna, pero esta herramienta, dado su elevadocoste y la necesidad de un entrenamientoespecífico, se encuentra reservada hoy día a unospocos

In the last 30-40 years, diagnosis in gynecology hasbeen radically changed by the widespread use ofabdominal – and especially vaginal – ultrasonography.The present case illustrates how suspicious imagesnecessitate more detailed investigation and follow-upto rule out an underlying malignancy. In the presentcase, ultrasonography – and especially Doppler – wasthe only procedure suggesting neoformation.Therefore, we believe that an echo-Doppler-colorultrasound system should be available in allgynecology consulting rooms. This non-invasivetechnique has demonstrated effectiveness andreproducibility, provides a high diagnostic yield, andrequires minimal time to perform. The use of thisprocedure in the routine follow-up of patients couldhelp in the early diagnosis of neoformative processes,with clear benefits

Fibroma ovárico torsionado / Torsion of ovarian fibroma

Se presenta un caso de una paciente de 80 años con una tumoración abdominal orientada erróneamente como neoplasia de ovario. La paciente acudió a nuestro servicio médico por presentar dolor en la fosa ilíaca derecha y pérdida de 5 kg de peso en 1 mes. En las exploraciones efectuadas se detectó una tumoración de 17 x 10 cm de diámetro y una pequeña cantidad de ascitis. Se intentó realizar una paracentesis sin obtener resultados positivos. Analíticamente, destacamos Ca125: 484 U/ml. Se decide realizar un intervención quirúrgica, tras la cual se detectó un fibroma de ovario torsionado, sin criterios de malignidad e implantes de fibrina en Douglas

We present the case of an 80-year-old patient with a large abdominal tumor erroneously interpreted as ovarian cancer. The patient presented with pain in the right iliac fossa and weight loss of 5 kg in the previous month. Investigations revealed a 17 x 10 cm tumor and a small quantity of ascites. An attempt at paracentesis was unsuccessful. A notable laboratory finding was Ca125: 484 U/ml. Surgical intervention was performed, revealing a twisted ovarian fibroma, without criteria for malignancy, and fibrin implants in Douglas's pouch

Tumor-infiltrating cells as a prognostic factor in Hodgkin's lymphoma: a quantitative tissue microarray study in a large retrospective cohort of 267 patients.

The present study aimed to describe the general tissular composition of the immune infiltrate observed in Hodgkin's lymphoma (HL) and its possible relationship with clinical and survival prognostic factors. In this retrospective study of 267 HL patients, the relative proportions of infiltrating T lymphocytes (CD4+, CD8+), natural killer cells (CD 56+, CD 57+), cytotoxic cells (Granzyme B+, TIA-1+) and dendritic cells (CD 21+, S-100+) were quantified immunohistochemically with tissue microarray technology. Our results confirm the predominance of CD4 + T lymphocytes in the background of tumoral cells, in addition to a high number of cytotoxic lymphocytes (CD8, CD 57 and TIA-1). Patients with low numbers of infiltrating CD8, CD 56, CD 57+cells and high numbers of Granzyme B and TIA-1+cells presented a significantly unfavourable clinical course (presence of leukocytosis, B symptoms, advanced clinical stage (III/IV), non-responding patients). A reduced infiltration of CD4+T lymphocytes was related with the presence of Epstein - Barr virus. Significantly longer survival times were observed in patients with a high level of infiltrating CD 57, as well as a low level of Granzyme B and TIA-1+cells (log-rank test). When evaluated in a multivariate model, high levels of infiltrating TIA-1 and Granzyme B+cells were shown to be independent prognostic factors that negatively influenced overall survival. The presence of TIA-1+cells was found to be the only unfavorable prognostic factor of event-free survival and disease-free survival. The overall detection of tumor-infiltrating cells in HL confirms the importance of cytotoxic T lymphocyte infiltration (Granzyme B and TIA-1+cells) in these patients. Independently of the classical clinical and pathological features, these cells appear to be an unfavourable prognostic factor in HL and, more particularly, the presence of cytotoxic TIA-1+cells.

Decreased number of granzyme B+ activated CD8+ cytotoxic T lymphocytes in the inflammatory background of HIV-associated Hodgkin's lymphoma.

This study aimed to assess the differences in the cellular composition of the inflammatory reactive background around tumoral cells of classical Hodgkin's lymphomas (cHL) inside and outside the HIV settings. This retrospective study evaluates the infiltrating T lymphocytes (CD4 and CD8), natural killer cells (CD57+ cells), and more especially cytotoxic cells [granzyme B (GrB) and TIA-1+ cells] in the background of 99 EBV+ cHL. Sections from paraffin-embedded tumor samples from nine HIV-infected cHL patients were immunostained, using standard immunohistochemical protocols and were compared to a control group of 90 HIV-noninfected cHL patients. Our clinical and histological data indicate that HIV-infected cHL patients present a higher frequency of mixed cellularity (MC) histological subtypes, more advanced disease stages, a poor response to treatment, and a poor overall survival compared to control patients. In controls, CD4/CD8 and GrB/TIA-1 ratios were determined as 2:1 and 1:2, respectively. The inflammatory infiltrate of HIV-infected patients had a significant reduction of CD4+ T lymphocytes (CD4/CD8 ratio 1:23), a decrease in infiltrating GrB+ cells (activated cytotoxic cells) and an increase in infiltrating TIA+ T cells (mainly nonactivated cytotoxic cells) in these patients (GrB/TIA-1 ratio 1:12). In conclusion, this study highlights an important intratumoral loss of CD4+ T cells (striking inversion in the CD4/CD8 ratio) and a decrease in intratumoral activated cytotoxic T lymphocytes in HIV-associated cHL patients. Further studies are required to confirm these results and to determine the role of these findings on the antitumoral immune response observed in HIV-associated cHL.