A case report of an intramedullary cervical teratoma in an adult patient with cervical spondylotic radiculopathy / Teratoma intramedular cervical en un paciente adulto con radiculopatía espondilótica. Reporte de caso

Spinal cord teratomas are rare. There are few reports of teratomas affecting the cervical spine and their association with spondylotic radiculopathy has not been described. A 59-year-old woman with history of fecal incontinence attended with cervical radicular pain radiating to upper limbs. Physical examination showed distal muscle hypotrophy and abolishment of bicipital, tricipital, and brachioradialis reflexes of the right arm, preserving proximal strength. Also, hiporreflexia and loss of proprioception in the right lower limb was observed. Magnetic resonance imaging showed an intramedullary mass at C7-T1, accompanied by intervertebral disk protrusions and dural sac compressions at the same level. One-stage posterior-anterior operative approach for tumor resection, decompression of the radiculopathy and replacement of intervertebral discs was performed. The histopathological diagnosis was for a mature teratoma. We described the first case of an intramedullary cervical teratoma associated with radiculopathy in an adult, providing evidence of rare long-lasting teratomas affecting the cervical spine

Los teratomas medulares son raros. La asociación de teratomas cervicales con radiculopatía espondilótica no ha sido descrita. Una mujer de 59 años con historia de incontinencia fecal acudió con dolor radicular cervical irradiado a miembros superiores. La exploración física reveló hipotrofia distal, arreflexia bicipital, tricipital y braquiorradial del brazo derecho, conservando la fuerza proximal. Se observó hiporreflexia y pérdida de la propiocepción en el miembro inferior derecho. La resonancia magnética reveló una masa intramedular en C7-T1, así como hernias discales y compresión del saco dural en dichos segmentos. Se realizó un doble abordaje posterior-anterior en un solo tiempo para resecar el tumor, descomprimir la radiculopatía y reemplazar los discos afectados. El diagnóstico histopatológico fue de un teratoma maduro. Describimos el primer caso de un teratoma intramedular cervical con radiculopatía espondilótica en un adulto, aportando evidencia sobre los teratomas raros de larga evolución que afectan a la columna cervical

Tumores papilares mucinosos intraductales y cistoadenomas mucinosos: postura actual y recomendaciones / Intraductal papillary mucinous neoplasms and mucinous cystadenomas: current status and recommendations

La prevalencia real de las lesiones quísticas de páncreas sigue siendo una incógnita. El potencial de malignidad de algunas de estas lesiones supone una causa de preocupación significativa en la práctica clínica diaria. Por lo tanto, es necesario determinar una estrategia para poder discriminar claramente los quistes potencialmente malignos de aquellos que no suponen ningún tipo de riesgo. Los tumores papilares mucinosos intraductales y los cistoadenomas mucinosos son neoplasias quísticas mucinosas potencialmente malignas que han ido ganando mayor importancia y reconocimiento en los últimos años. Sin embargo, pese a los múltiples estudios que se han realizado hasta la fecha, su diagnóstico diferencial respecto a otros subtipos de quistes, así como su manejo terapéutico, continúan suponiendo un reto. Este manuscrito contiene una revisión crítica de las recomendaciones actuales y de las estrategias en el manejo de los tumores papilares mucinosos intraductales y los cistoadenomas mucinosos, así como hace hincapié en las limitaciones de las guías actuales (AU)

The real prevalence of pancreatic cystic lesions remains unknown. The malignant potential of some of these lesions remains a cause for significant concern. Thus, it is mandatory to develop a strategy to clearly discriminate those cysts with a potential for malignant transformation from those that do not carry any significant risk. Intraductal papillary mucinous neoplasms and mucinous cystadenomas are mucinous cystic neoplasms with a known malignant potential that have gained greater recognition in recent years. However, despite the numerous studies that have been carried out, their differential diagnosis among other cysts subtypes and their therapeutic approach continue to be a challenge for clinicians. This review contains a critical approach of the current recommendations and management strategies regarding intraductal papillary mucinous neoplasms and mucinous cystadenomas, as well as highlighting the limitations exposed in current guidelines (AU)

18F FDOPA uptake in brain metastasis of breast cancer / Captación de 18F FDOPA en metástasis cerebral de un cáncer de mama

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Descripción de un caso de adenocarcinoma gástrico sincrónico con adenocarcinoma ductal de páncreas / Synchronic gastric and pancreatic ductal adenocarcinoma. A case report

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Características de los tumores adicionales detectados en tomosíntesis de mama: nuestra experiencia / Characteristics of additional tumors detected by tomosynthesis: our experience

Objetivo. Evaluar las características semiológicas radiológicas e histológicas de los tumores adicionales detectados por tomosíntesis comparativamente con los detectados por mamografía convencional. Material y métodos. Sobre una muestra de 166 pacientes se analizaron retrospectivamente los hallazgos radiológicos y anatomopatológicos de los tumores detectados únicamente por mamografía (105 casos) y de los tumores adicionales detectados por tomosíntesis (61 casos). Resultados. Se encontraron diferencias en la semiología radiológica de los 2 grupos (p < 0,01). En los 105 tumores detectados mediante mamografía, los patrones de presentación más frecuente fueron los nódulos (40%) y el patrón mixto (29,4%), destacando también los detectados por microcalcificaciones (21%). En los 61 tumores adicionales detectados por la tomosíntesis, la forma de presentación más frecuente fueron las distorsiones (44,3%) y los nódulos (34,4%). En este grupo no se detectó ningún tumor adicional por la presencia de microcalcificaciones no detectadas en la mamografía previa. En cuanto a la histología, se detectó una mayor proporción (p < 0,001) de carcinomas tubulares en el grupo de tomosíntesis. No se encontraron diferencias significativas entre los 2 grupos respecto de la proporción de carcinomas infiltrantes-carcinomas in situ, carcinomas ductales infiltrantes o carcinomas lobulillares infiltrantes. Conclusión. La manifestación radiológica más frecuente de los tumores adicionales fue la distorsión arquitectural. La tomosíntesis conllevó una mayor detección de distorsiones arquitecturales y de carcinomas tubulares (AU)

Objective. To evaluate the radiological and histological features of additional tumors detected by tomosynthesis compared with those detected by conventional mammography. Material and methods. Radiological and histological findings were retrospectively analyzed in a sample of 166 patients. A total of 105 tumors were detected by mammography alone and 61 additional tumors were detected by tomosynthesis. Results. Differences were observed in the radiological findings in both groups (P < .01). The most frequent presentation of the 105 tumors detected by conventional mammography were nodules (40%), mixed pattern (29.4%), and microcalcifications (21%). The most frequent presentation of the 61 additional tumors detected by tomosynthesis were distortions (44.3%) and nodules (34.4%). In this group, no additional tumors were detected by the presence of microcalcifications not detected previously with conventional mammography. A higher proportion of tubular carcinomas was detected in the tomosynthesis group (P < .001). There were no differences in the proportion of invasive carcinomas-carcinomas in situ, invasive ductal carcinomas, and invasive lobular carcinomas between the 2 groups. Conclusion. The most frequent radiological feature of additional tumors was distortions. Tomosynthesis detected more distortions and tubular carcinomas (AU)

Carcinoma medular quístico de mama / Cystic medullary breast carcinoma

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Multicentric study on 18F-FDG-PET/CT breast incidental uptake in patients studied for non-breast malignant purposes / Estudio multicéntrico sobre la captación incidental en la mama con 18F-FDG-PET/TAC en pacientes evaluados con fines oncológicos no relacionados con la patología mamaria

Aim. Our study has aimed to establish the prevalence and pathological nature of fluorine-18-fluorodeoxyglucose (18F-FDG) breast incidental uptake (BIU) in patients studied for non-malignant breast tumours and then to compare our data obtained in three Italian nuclear medicine centres with those available in literature. Material and methods. We retrospectively evaluated 42,927 18F-FDG-PET/CT scans performed on patients studied in three Italian Nuclear Medicine Centres. All patients underwent 18F-FDG-PET/CT for oncologic purposes not related to breast disease. Results. Among 42,927 scans, a BIU was identified in 79 (0.18%) patients, 75 (95%) female and 4 (5%) male with an average age of 62 ± 17 years. Twenty-five out of 35 (71.5%) BIUs were malignant and 10/35 (28.5%) benign. Among the 25/35 incidentalomas that were malignant, 12/25 (48%) were infiltrating ductal carcinoma, 5/25 (20%) ductal carcinoma (infiltrating and in situ), 4/25 (16%) lobular carcinoma, 2/25 (8%) ductal carcinoma in situ and 2/25 (8%) were metastases from the primary tumour under investigation. Of the 10 BIUs that were benign in the histological examination, after further investigations it was found that 9/10 (90%) were fibroadenomas and 1/10 (10%) was a benign lesion not better specified. The lesion to liver or to blood-pool SUVmax ratio in malignant lesions is significantly higher than in benign ones. Conclusions. Our multicenter study demonstrates that, although they are uncommon, BIUs show a high percentage of malignancy and therefore requires further research (AU)

Objetivo. Objetivo de nuestro estudio fue establecer la prevalencia y el carácter patológico de la captación incidental en la mama (CIM) de 18F-FDG en pacientes evaluados para tumores malignos de origen no-mamario y luego comparar nuestros datos obtenido en tres centros Italianos de Medicina Nuclear con los que están disponibles en literatura. Material y métodos. Hemos evaluado retrospectivamente 42.927 estudios 18F-FDG-PET/TAC de pacientes en tres centros Italianos de Medicina Nuclear; todos los pacientes se han sometidos a una exploración 18F-FDG-PET/TAC por fines oncológicos no relacionados con la patología mamaria. Resultados. Entre 42.927 exploraciones, una CIM fue identificada en 79 (0.18%) pacientes, 75 (95%) mujeres y 4 (5%) hombres, con una edad media de 62 ± 17 años. Veinticinco de 35 (71.5%) CIM fueron malignas y 10/35 (28.5%) benignas. Entre los incidentalomas malignos, 12/25 (48%) eran carcinomas ductales infiltrantes, 5/25 (20%) carcinomas ductales (infiltrantes e in situ), 4/25 (16%) carcinomas lobulares, 2/25 (8%) carcinomas ductales in situ y 2/25 (8%) eran metástasis de tumour primario objeto de investigación. Entre 10 CIM que fueron identificados como benignos en el examen histológico después de investigación adicional, 9/10 (90%) fueron fibroadenomas y 1/10 (10%) fue una lesión benigna no mejor especificada. El ratio del SUVmáx de la lesión en comparación con el hígado o con el pool vascular es significativamente mayor en las lesiones malignas que en las benignas. Conclusiones. Nuestro estudio multicéntrico demuestra que, aunque son poco frecuentes, las CIM muestran un alto porcentaje de malignidad, por lo tanto las CIM necesitan investigación adicional (AU)

Pseudoaneurisma de la arteria mamaria interna como complicación de una biopsia selectiva de ganglio centinela / Internal mammary artery pseudoaneurysm as a complication of sentinel node biopsy

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Carcinoma metaplásico condrosarcomatoide de mama, una entidad inusual / Chondrosarcomatous metaplastic carcinoma of the breast, a rare tumor

El carcinoma metaplásico de mama es una entidad infrecuente (menos del 0,2% de todos los cánceres de mama), que se caracteriza por presentar un componente mixto epitelial y mesenquimal. Este último componente es el que establece su clasificación histológica. Así, su diagnóstico es puramente histológico, pues clínica y radiológicamente no se diferencia de un carcinoma ductal típico. Presentamos un caso de carcinoma metaplásico de mama tipo condrosarcomatoide, cuyo diagnóstico definitivo requirió un estudio mediante técnicas de inmunohistoquímica para confirmar el componente epitelial maligno del tumor. Diagnosticarlo es importante porque su comportamiento es diferente, suelen diseminarse por vía hematógena (el carcinoma epitelial típico lo hace por vía linfática), las metástasis no se presentan en el momento del diagnóstico, sino durante el seguimiento, y su supervivencia a los 5 años es del 35% (AU)

Metaplastic carcinomas of the breast are uncommon, accounting for less than 0.2% of all breast cancers. Clinically and radiologically, metaplastic carcinomas are indistinguishable from typical ductal carcinomas, and the diagnosis is made histologically by the finding of a mesenchymal component. We present a case of chondrosarcomatous metaplastic breast carcinoma whose definitive diagnosis required immunohistochemical techniques to confirm the malignant epithelial component of the tumor. Accurate diagnosis is important because this tumor behaves differently: it usually spreads through the blood (whereas typical epithelial carcinomas spread through the lymph vessels), metastases present during follow-up rather than before diagnosis, and the five-year survival rate is 35% (AU)

Mammary hamartoma in a male / Hamartoma mamario en el varón

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Tumor de células granulares de mama. Un diagnóstico que se debe considerar / Granular cell tumour of the breast. A diagnosis to consider

El tumor de células granulares es un tumor poco frecuente y generalmente benigno que se origina en las células de Schwann. Su localización habitual es en la cabeza y el cuello y su aparición en la mama es infrecuente. Aun siendo un tumor infrecuente, el tumor de células granulares de la mama tiene una prevalencia mayor de lo que anteriormente se ha reconocido. Este tumor habitualmente imita al carcinoma de mama por la clínica y datos de imagen y su diagnóstico es anatomopatológico. El tratamiento es escisión local amplia y su pronóstico es bueno con escasa tasa de recidivas. Presentamos dos casos de tumores de células granulares de mama en mujeres posmenopáusicas que simulaban un carcinoma de mama en ecografía y mamografía. La primera se detectó en el programa de cribado de cáncer de mama y la segunda durante el seguimiento después de un carcinoma ductal infiltrante (AU)

The granular cell tumour is a very rare tumour which originates in the Schwann cells, and is generally benign. It is usually located in the head and neck, and its appearance in the breast is uncommon. Although it is rare tumour, granular cell tumours of the breast have a higher prevalence than previously recognised. This tumour usually imitates breast cancer due to its clinical and imaging data, with its diagnosis being by histopathology. The treatment is a wide local excision, and its prognosis is good with a low recurrence rate. We present two cases of granular tumours of the breast in post-menopausal women that simulated a breast carcinoma in the ultrasound and mammography. The first was detected in the breast cancer screening program, and the second during follow up of an invasive ductal carcinoma (AU)

Role of sentinel lymph node biopsy in early breast cancer.

Current literature has suggested that sentinel lymph node biopsy may replace axillary dissection as the nodal staging procedure of choice in early breast cancer. The aim of this study is to evaluate the effectiveness and accuracy of sentinel lymph node biopsy using methylene blue dye in predicting axillary nodal status in early breast cancer with clinically impalpable axillary lymph nodes. In the period between June 2005 and May 2009, 50 patients with early breast cancer and clinically impalpable axillary lymph nodes, underwent sentinel lymph node biopsy using methylene blue dye followed by completion of axillary dissection in the same setting after taking a written consent from the patients. Of the included 50 patients, sentinel lymph node biopsy was successful in 48 patients (96.0%). Accuracy of sentinel lymph node biopsy was 95.8%, sensitivity was 90.0%, false negative rate was 6.7%, negative predictive value was 93.3%.

Carcinoma de glándulas anales: criterios diagnósticos. Descripción de un caso y revisión de la literatura / The diagnostic criteria of anal gland carcinoma: a case report and review of the literature

El adenocarcinoma de glándulas anales es una entidad poco frecuente. Según la Organización Mundial de la Salud (OMS), la demostración de la continuidad entre las glándulas anales normales y las displásicas es el criterio más importante para el diagnóstico de dicha lesión, aunque hay pocos casos descritos en la literatura que cumplan este requisito. Describimos un caso de una mujer de 63 años con una masa anal indurada de 2 cm. El examen histológico reveló una neoformación de morfología ductal que afectaba predominantemente los estratos submucoso y muscular, en la que fue posible demostrar la continuidad entre glándulas anales normales y displásicas. Dicha lesión presentó intensa expresión de citoqueratina 7, mientras que CDX2 y citoqueratina 20 fueron negativos. El objetivo de este estudio es revisar la literatura para definir criterios útiles para el diagnóstico de esta inusual lesión (AU)

Anal gland carcinoma is a very rare entity. According to the World Health Organiza- tion (WHO), the most important criterion in its diagnosis is the continuity between normal and dysplastic anal glands. However, there are very few reported cases that fulfill this requirement. We report a case of a 63 year old woman with a 2 cm anal mass of hardened consistency. Histo- logically, a ductal neoplasm predominately in the submucosal and muscular layers was present in which it was possible to demonstrate the continuity between the normal and dysplastic anal glands. Immunohistochemistry revealed a strong positivity for cytokeratin 7 whilst CDX2 and cytokeratin 20 were negative. The aim of this study is to revise the literature in order to define useful diagnostic criteria for this unusual lesion (AU)

Clasificación y características del cáncer de intervalo en el programa de detección precoz de cáncer de mama en el Principado de Asturias / Classification and characteristics of interval cancers in the Principality of Asturias's breast cancer screening program

Objetivo. Revisar y clasificar los carcinomas de intervalo ( CI ) del programa de detección precoz de cáncer de mama del Principado de Asturias (PDPCM). Como objetivo secundario se plantea la descripción de sus características anatomopatológicas, así como de su tamaño y estadio en el momento del diagnóstico. Material y métodos. Se incluyeron los CI del PDPCM correspondientes al período 2003-2007. Se clasificaron según el protocolo de los programas de detección precoz de cáncer de mama, mediante doble lectura sin consenso ni enmascaramiento, con arbitrio. Hubo 10 lectores diferentes, todos ellos radiólogos del PDPCM. Resultados. No pudo ser clasificado el 33,7% del total de CI; del resto, el 40,67% se etiquetaron de intervalos verdaderos, el 31,4% como falsos negativos, el 23,7% como signos mínimos y el 4,23% se consideraron ocultos. El 70% de los CI se diagnosticaron en el segundo año del período entre cribados y un 71,7% tras un cribado subsiguiente. El 76,9% resultaron carcinomas ductales infiltrantes, el 61,1% se detectó en estadio II , y el 78,7% eran mayores de 10 mm cuando fueron diagnosticados. Conclusiones. La tasa de CI y la proporción de falsos negativos son superiores a las recomendadas por las guías europeas de calidad. El diagnóstico del CI es más tardío que el de los tumores detectados dentro del PDPCM. El estudio de los CI conlleva una importante labor formativa para los radiólogos del PDPCM(AU)

Objective. To review and classify the interval cancers found in the Principality of Asturias's Breast Cancer Screening Program (PDPCM). A secondary objective was to determine the histological characteristics, size, and stage of the interval cancers at the time of diagnosis. Material and methods. We included the interval cancers in the PDPCM in the period 2003-2007. Interval cancers were classified according to the breast cancer screening program protocol, with double reading without consensus, without blinding, with arbitration. Mammograms were interpreted by 10 radiologists in the PDPCM. Results. A total of 33.7% of the interval cancers could not be classified; of the interval cancers that could be classified, 40.67% were labeled true interval cancers, 31.4% were labeled false negatives on screening, 23.7% had minimal signs, and 4.23% were considered occult. A total of 70% of the interval cancers were diagnosed in the year of the period between screening examinations and 71.7% were diagnosed after subsequent screening. A total of 76.9% were invasive ductal carcinomas, 61.1% were stage II when detected, and 78.7% were larger than 10 mm when detected. Conclusions. The rate of interval cancers and the rate of false negatives in the PDPCM are higher than those recommended in the European guidelines. Interval cancers are diagnosed later than the tumors detected at screening. Studying interval cancers provides significant training for the radiologists in the PDPCM(AU)

Breast cancer in women aged 25 years and younger.

OBJECTIVE: To evaluate breast cancer characteristics in women aged 25 years and younger. METHODS: This was a retrospective, nested, within-cases matched study. The study design was based on a two-phase protocol. In the first phase, stage, grade, histologic subtype, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 status were compared between 28 patients (aged 25 years and younger) and 685 older premenopausal women (aged older than 25 years) with breast cancer. The second phase aimed to determine whether young patients exhibited worse prognosis when compared with older premenopausal women. RESULTS: Young patients presented at a more advanced stage (P=.012) and exhibited a higher grade (P=.018). No significant differences were noted regarding histologic subtype, estrogen receptor, and progesterone receptor status. Genetic testing for BRCA1 and BRCA2 mutations was performed in 12 of 28 young patients and mutations were found in 25% of them. Moreover, young women presented poorer overall survival (hazard ratio [HR] 4.30, 95% confidence interval [CI] 1.09-17.03) than their older counterparts, matched by histologic subtype, stage, and grade; a similar pattern was noted regarding relapse-free survival (HR 8.28, 95% CI 2.24-30.60). CONCLUSION: Breast cancer diagnosis in women aged 25 years and younger is uncommon; however, these patients present at a more advanced stage, with a higher grade, and exhibit poorer survival.

Pathology of invasive breast disease.

Invasive breast cancers constitute a heterogeneous group of lesions. Although the most common types are ductal and lobular, this distinction is not meant to indicate the site of origin within the mammary ductal system. The main purpose of the identification of specific types of invasive breast carcinoma is to refine the prediction of likely behavior and response to treatment also offered by the other major prognostic factors, including lymph node stage, histologic grade, tumor size, and lymphovascular invasion.

Degeneración cerebelosa paraneoplásica como presentación de un carcinoma de mama oculto / Paraneoplastic cerebellar degeneration as the form of presentation of an occult breast carcinoma

La degeneración cerebelosa paraneoplásica (DCP) es un síndrome poco frecuente y de difícil diagnóstico. Suele presentarse meses o años antes de la aparición de una neoplasia curable y, menos frecuentemente, ocurre en pacientes con una neoplasia conocida o como forma de recidiva. Su asociación con el cáncer de mama es poco frecuente. Presentamos el caso de una paciente de 59 años que desarrolló una DCP, sin identificación del tumor primario. Tras casi año y medio de seguimiento y estudio, se diagnosticó un carcinoma ductal infiltrante de mama, mediante pruebas de imagen, que hasta el momento habían sido rigurosamente normales(AU)

Paraneoplastic cerebellar degeneration (PCD) is an uncommon and difficult-to-diagnose syndrome. This syndrome usually presents months or years before a curable neoplasm develops and, less frequently, in patients with a known or recurrent tumor. The association of PCD with breast cancer is very rare. We present the case of a 59-year-old woman who developed a PCD, without identification of the primary tumor. After almost a year and a half of follow-up, an infiltrating ductal breast carcinoma was diagnosed with imaging tests, which had previously been strictly normal(AU)

The role of endoscopic ultrasound (EUS) in relation to other imaging modalities in the differential diagnosis between mass forming chronic pancreatitis, autoimmune pancreatitis and ductal pancreatic adenocarcinoma / Papel de la endoscopia en relación con otras modalidades de imagen en el diagnóstico diferencial entre pancreatitis crónica en forma de masa, pancreatitis autoinmune y adenocarcinoma pancreático

Differential diagnosis of solid pancreatic lesions remains as an important clinical challenge, mainly for the differentiation between mass forming chronic pancreatitis, autoimmune pancreatitis and pancreatic adenocarcinoma. Endoscopic ultrasound (EUS), computed tomography (CT) and magnetic resonance imaging (MRI) can all provide valuable and complementary information in this setting. Among them, EUS has the unique ability to obtain specimens for histopathological diagnosis and can therefore play a crucial role in the evaluation patients with inconclusive findings on initial examinations. Nowadays, new developed techniques associated to EUS, like elastography and contrast enhancement, have shown promising results for the differential diagnosis of these pancreatic lesions(AU)