Molecular detection of cancer cells in bone marrow and peripheral blood of patients with operable breast cancer. Comparison of CK19, MUC1 and CEA using RT-PCR.

We have compared three different RT-PCR procedures to measure cytokeratin 19 (CK19), carcinoembryonic antigen (CEA) and mucin MUC1 gene expression in order to determine their diagnostic value in detecting tumour cells in bone marrow aspirates of patients with operable breast cancer. In an experimental model, the best sensitivity was observed for CK19 and MUC1 RT-PCR assays, although only the CEA and CK19 assays showed good specificity. The study of 42 patients showed that a 'CK19 positive/CEA positive' RT-PCR assay in bone marrow correlated positively with a positive axillary lymph node status (N(0) versus N(1-3), P<0.05). Both assays were also positive in 17% of node negative patients. RT-PCR assays were more sensitive in bone marrow than in peripheral blood. Our results suggest that CK19 and CEA RT-PCR assays are powerful methods for detecting disseminated breast cancer cells. A larger study with long-term follow-up is required in order to clarify their clinical usefulness.

Primary lung liposarcoma.

Liposarcoma of the lung is extremely rare with only 11 cases previously reported. A case of a locally advanced pulmonary pleomorphic liposarcoma in a 49-year-old male is presented. Surgery was performed but radical resection was not possible. Post-operative radiotherapy (40 Gy) was given concurrently with cisplatin (12.5 mg daily for 10 days). A partial response of short duration was obtained. The patient died 8 months following surgery with disseminated disease. Based on reports in the literature, liposarcoma of the lung must be classified as an aggressive highly metastatic disease responding poorly to both chemotherapy and radiotherapy.

Cáncer de mama metaplásico: a propósito de un caso / Metaplastic breast cancer: A case report

Introducción: El carcinoma metaplásico de mama (CMM) es un tipo raro y agresivo de cáncer de mama que suele diagnosticarse en etapas avanzadas, con tumores de gran tamaño y grado histológico elevado. En este estudio, presentamos un caso de CMM, y realizamos una revisión y discusión de la literatura relacionada. Principales síntomas o hallazgos clínicos: Paciente de 35 años, sin antecedentes personales ni familiares relevantes, que consulta por tumoración mamaria de 2cm, de crecimiento progresivo, que agrega en la evolución umbilicación del pezón y dolor mamario. Se realiza ecografía mamaria que evidencia masa sólida polilobulada con características sospechosas. En suma: masa en mama izquierda BI-RADS 5. Diagnósticos principales, intervenciones terapéuticas y resultados: Se realiza core biopsia y la anatomía patológica evidencia un carcinoma ductal infiltrante, variedad metaplásico, triple negativo y con expresión PDL1>1%. Se realiza mastectomía radical modificada. En la evolución se diagnostica un secundarismo pulmonar, y la paciente recibió tratamiento sistémico de primera y segunda línea. Conclusiones: Dada la naturaleza agresiva de este tipo de tumor, y las limitadas opciones de tratamiento disponibles, la participación en ensayos clínicos puede considerarse para mejorar los resultados en estas pacientes. Un enfoque multidisciplinario, y la revisión en un comité de tumores son fundamentales para guiar las decisiones terapéuticas y proporcionar la mejor atención posible a estas pacientes(AU)

Introduction: Metaplastic breast carcinoma (MBC) is a rare and aggressive type of breast cancer that is often diagnosed in advanced stages, with large tumors and a high histological grade. In this study, we present a case of MBC, and conduct a review and discussion of the related literature. Main symptoms or clinical findings: A 35-year-old patient with no relevant personal or family history presents with a progressively growing 2 cm breast mass, which, over time, develops into nipple retraction and breast pain. A breast ultrasound reveals a suspicious-looking polilobulated solid mass. In summary: a BI-RADS 5 mass in the left breast. Main diagnoses, therapeutic interventions, and outcomes: A core biopsy is performed, and the pathology report reveals an infiltrating ductal carcinoma, metaplastic variety, triple-negative with PDL1 expression > 1%. A modified radical mastectomy is performed. During follow-up, pulmonary metastasis is diagnosed, and the patient receives first and second-line systemic treatment. Conclusions: Given the aggressive nature of this type of tumor and the limited treatment options available, participation in clinical trials may be considered to improve outcomes in these patients. A multidisciplinary approach, and review in a tumor committee are essential to guide therapeutic decisions and provide the best possible care for these patients.(AU)

[Root cracks and fractures. Clinical diagnosis--prognosis]. / Fêlures et fractures radiculaires. Diagnostic clinique--pronostic.

The diagnosis as well as the therapy of fractured teeth are often a real problem for the general practitioner. Their major etiology is iatrogenic but is sometimes accidental or parafunctional. In order to avoid complications we should as a rule use the least invasive techniques in our therapies. The rapidity and the extent of periodontal destruction induced by these lesions impose a precise diagnosis and in most cases an extraction without any delay.

Linfoma primario del sistema nervioso central en un paciente con sida / Primary central nervous system lymphoma in patient with AIDS

Se presenta una caso clínico de linfoma primario del sistema nervioso central (LPSNC) en una paciente con infección por virus de la inmunodeficiencia humana (VIH) en estadio sida. En este caso particular se destaca la confirmación por histopatología mediante intervención neuroquirúrgica de una lesión ocupante de espacio (LOE), lo que permitió instalar tratamiento oncoespecífico y terapia antirretroviral, lográndose buena evolución clínica. El obejtivo de la presente comunicación es realizar una revisión y actualización bibliográfica del LPSNC en pacintes con VIH destacando principalmente el aporte de los métodos diagnósticos y terapéuticos.

Tumores malignos de las vías biliares / Malignant tumors of the biliary tract

Los tumores de las vías biliares son poco frecuentes. En Estados Unidos los tumores malignos del hígado y de las vías biliares intrahepáticas ocupan el 5to lugar en incidencia y el 3er lugar en mortalidad entre los cánceres digestivos. Desde luego, no podemos precisar cuantos corresponden a hepatocarcinoma, a colangiocarcinoma, o a enfermedad metastásica hepática de primario no diagnosticado. Los tumores malignos de la vesícula biliar y las vías biliares extrhepáticas ocupan el 7mo lugar en incidencia y en mortalidad para el año 2000.