Gene promoter hypermethylation is found in sentinel lymph nodes of breast cancer patients, in samples identified as positive by one-step nucleic acid amplification of cytokeratin 19 mRNA.

We analysed the promoter methylation status of five genes, involved in adhesion (EPB41L3, TSLC-1), apoptosis (RASSF1, RASSF2) or angiogenesis (TSP-1), in intraoperative sentinel lymph node (SLN) biopsy samples from patients with breast cancer, that had been processed by the one-step nucleic acid amplification (OSNA) technique. SLN resection is performed to estimate the risk of tumour cells in the clinically negative axilla, to avoid unnecessary axillary lymph node dissection. OSNA is currently one of the eligible molecular methods for detecting tumour cells in SLNs. It is based on the quantitative evaluation of cytokeratin 19 mRNA which allows distinguishing between macrometastasis, micrometastasis and isolated tumour cells, on the basis of the quantity of tumour cells present. There have been no prior studies on the question whether or not samples processed by OSNA can be used for further molecular studies, including epigenetic abnormalities which are some of the most important molecular alterations in breast cancer. Genomic DNA was extracted from samples obtained from 50 patients diagnosed with primary breast cancer. The content of tumour cells in SLNs was evaluated by OSNA, and the promoter methylation status of the selected genes was analysed by methylation-specific PCR. All were found to be hypermethylated to a variable degree, and RASSF1 hypermethylation was significantly associated with macrometastasis, micrometastasis and isolated tumour cells (p = 0.002). We show that samples used for OSNA are suitable for molecular studies, including gene promoter methylation. These samples provide a new source of material for the identification of additional biomarkers.

[Gastric necrosis caused by acute gastric distention and superior mesenteric artery syndrome]. / Necrosis gástrica por distensión aguda del estómago y síndrome de la pinza mesentérica.

We report the case of a 14 year-old female patient who was admitted complaining of abdominal pain due to gastric distension after an episode of bulimia. The patient was diagnosed as having gastric intramural necrosis by CT. An emergency laparotomy was performed and a massive gastric necrosis and duodenal compression due to the superior mesenteric artery syndrome was found. The patient did well after total gastrectomy and Roux-en-Y procedure.

[Chylous fistula following lymphadenectomy in breast cancer]. / Fístula quilosa tras linfadenectomía axilar en cáncer de mama.

Axillary lymph node dissection remains an integral part of surgical treatment in patients with invasive breast cancer and axillary lymph node metastases. Chylous leakage after axillary lymph node dissection is infrequent. We report the case of a patient with an advanced local breast cancer that was subsidiary to surgery treatment after neoadjuvant chemotherapy. She had a postoperative chylous leakage; it was successfully treated conservatively in the postoperative course. Chylous leakage an infrequent complication alters axillary lymph node dissection, which has a conservative management in most published studies.

[Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera]. / Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria.

AIM: To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. MATERIAL AND METHODS: A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. RESULTS: The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2-7.2%, P = 0.0037). CONCLUSIONS: The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role.

Fístula quilosa tras linfadenectomía axilar en cáncer de mama / Chylous fistula after lymphadenectomy in breast cancer

La linfadenectomía axilar constituye uno de los pilares en el tratamiento locorregional del cáncer de mama. La fístula quilosa es una complicación infrecuente en el vaciamiento axilar. Se muestra el caso de una paciente con un tumor de mama localmente avanzado, subsidiaria de tratamiento quirúrgico tras la administración de quimioterapia neoadyuvante, que presentó una fístula quilosa en el postoperatorio. La evolución fue satisfactoria con el tratamiento conservador instaurado mediante somatostatina subcutánea y una dieta baja en grasa suplementada con triglicéridos de cadena media. La fístula quilosa es una complicación poco habitual en la linfadenectomía axilar, cuyo manejo es conservador en la gran mayoría de casos descritos (AU)

Axillary lymph node dissection remains an integral part of surgical treatment in patients with invasive breast cancer and axillary lymph node metastases. Chylous leakage after axillary lymph node dissection is infrequent. We report a case patient with an advanced local breast cancer who was treated with neoadjuvant chemotherapy and surgery. She had a postoperative chylous leakage what was successfully treated conservatively in the postoperative course with somatostatin and a fat reduced diet with medium chain triglyceride. Chylous leakage an infrequent complication after axillary lymph node dissection, which has a conservative management in most published studies (AU)

Subtipos moleculares del cáncer de mama: implicaciones pronósticas y características clínicas e inmunohistoquímicas / Molecular subtypes of breast cancer: prognostic implications and clinical and immunohistochemical characteristics

Fundamento. Los carcinomas de mama representan un grupoheterogéneo de tumores, tanto en su comportamiento clínicocomo pronóstico. El objetivo del presente trabajo es clasificarlos carcinomas de mama en subtipos moleculares mediantemarcadores inmunohistoquímicos y analizar las característicasclinicopatológicas e inmunohistoquímicas y los patronesde supervivencia y recaída de los distintos subtipos.Material y métodos. Se han clasificado 272 pacientes condiagnóstico de carcinoma de mama en cinco subtipos: carcinomasde mama de tipo basal, de tipo HER2, de tipo luminalA, de tipo luminal B y normal.Resultados. Los carcinomas de mama más frecuentes fueronlos de tipo luminal A (62,5%), carcinomas de tipo luminal B(18%), carcinomas de tipo HER2 (9,9%), carcinomas de tipobasal (8,4%) y los de fenotipo normal (1,4%). Los carcinomasde mama de tipo luminal mostraron ser, con mayor frecuencia,de forma significativa, tumores bien diferenciados, depequeño tamaño tumoral, con ganglios axilares negativos,estadio precoz en el momento del diagnóstico, niveles altosde BCL-2 y bajo índice de proliferación con Ki-67. En cambio,los carcinomas de mama de tipo basal y HER2 presentabantumores de mayor tamaño, pobremente diferenciados, mayorcompromiso ganglionar y estadios más avanzados en elmomento del diagnóstico. Expresaban con mayor frecuenciaíndices de proliferación altos con Ki 67 y fueron los subtiposque en curvas de supervivencia global y de supervivencia librede progresión mostraron un peor pronóstico.Conclusión. La clasificación del cáncer de mama basada enparámetros inmunohistoquímicos (IHQ) permite una mejordefinición pronóstica. Tanto los carcinomas de mama detipo basal como HER2 presentan características histopatológicase IHQ más desfavorables así como peor supervivenciay menor tiempo de recaída mientras que los carcinomasde mama de tipo luminal manifiestan características másbenignas y mejor pronóstico(AU)

Background. Breast carcinomas are a heterogeneous groupof tumours, in both their clinical behavior and their prognosis.The aim of this article is to classify breast carcinomasaccording to molecular subtypes by means of immunohistochemicalmarkers and to analyse the clinicopathologicaland immunohistochemical characteristics and the patternsof survival and relapse of the different subtypes.Methods. Two hundred and seventy-two patients diagnosedwith breast cancer were classified into five subtypes: breastcarcinomas of the basal type, HER2 type, luminal A type,luminal B type and normal.Results. The most frequent breast carcinomas were: luminalA type carcinomas (62.5%), luminal B type carcinomas(18%), HER2 type carcinomas (9.9%), basal type carcinomas(8.4%) and normal phenotype carcinomas (1.4%). Significantlyand with greater frequency, the luminal type breastcarcinomas proved to be well differentiated tumours, ofsmall tumoral size, with negative axillary lymph nodes, at anearly stage at the time of diagnosis, with high levels of BCL-2 and a low Ki-67 proliferation index. On the contrary, thebasal type and HER2 carcinomas presented larger tumours,poorly differentiated, greater ganglionar involvement andmore advanced stages at the time of diagnosis. They expressedhigh Ki-67 proliferation indexes with greater frequencyand were the subtypes that showed a worse prognosis onglobal survival and progression-free survival curves.Conclusion. Breast cancer classification based on immunohistochemical(IHC) parameters makes a better prognosticdefinition possible. Both the basal type and the HER2 typebreast carcinomas present more unfavourable histopathologicaland IHC characteristics, as well as a worse survivaland less relapse time, while the luminal type breast carcinomasshow more benign characteristics and a better prognosis(AU)

Evaluación de la eficacia en la detección del ganglio centinela en el cáncer de mama: evolución cronológica e influencia de la incorporación de una gammacámara portátil intraoperatoria / Evaluation of the efficacy of sentinel node detection in breast cancer: chronological course and influence of the incorporation of an intra-operative portable gamma camera

Objetivo. Determinar el porcentaje de identificación global del ganglio centinela (GC) en el cáncer de mama, la evolución cronológica de este parámetro y la influencia de la introducción de una gammacámara portátil. Material y métodos. Estudio retrospectivo a partir de una base de datos prospectiva de 754 pacientes a las que se realizó biopsia selectiva del GC de forma consecutiva entre enero de 2003 y diciembre de 2011. La técnica fue mixta en periodo inicial y posteriormente con radiotrazador administrado intra-peritumoralmente. Hasta octubre de 2009 la exéresis del GC fue guiada por sonda y a partir de esta fecha se introdujo una gammacámara portátil para la detección intraoperatoria. Resultados. Se ha biopsiado el GC en 725 de 754 pacientes, siendo por tanto la eficacia global del 96,2%. Según el año de intervención quirúrgica los porcentajes de identificación han sido del 93,5% en 2003, del 88,7% en 2004, del 94,3% en 2005, del 95,7% en 2006, del 93,3% en 2007, del 98,8% en 2008, del 97,1% en 2009 y del 99,1% en 2010 y 2011. Existe una diferencia de proporciones entre el porcentaje de identificación antes y después de la incorporación de la gammacámara portátil del 4,6% que es estadísticamente significativa (IC 95% de la diferencia 2-7,2% con una p asociada de 0,0037). Conclusiones. El porcentaje de identificación global se halla por encima del nivel recomendado por las directrices actuales. Cronológicamente se constata elevación de este parámetro a lo largo del periodo estudiado. Los datos apuntan a que la incorporación de una gammacámara portátil ha tenido un papel en ello (AU)

Aim. To define the sentinel node identification rate in breast cancer, the chronological evolution of this parameter and the influence of the introduction of a portable gamma camera. Material and methods. A retrospective study was conducted using a prospective database of 754 patients who had undergone a sentinel lymph node biopsy between January 2003 and December 2011. The technique was mixed in the starting period and subsequently was performed with radiotracer intra-peritumorally administered the day before of the surgery. Until October 2009, excision of the sentinel node was guided by a probe. After that date, a portable gamma camera was introduced for intrasurgical detection. Results. The SN was biopsied in 725 out of the 754 patients studied. The resulting technique global effectiveness was 96.2%. In accordance with the year of the surgical intervention, the identification percentage was 93.5% in 2003, 88.7% in 2004, 94.3% in 2005, 95.7% in 2006, 93.3% in 2007, 98.8% in 2008, 97.1% in 2009 and 99.1% in 2010 and 2011. There was a significant difference in the proportion of identification before and after the incorporation of the portable gamma camera of 4.6% (95% CI of the difference 2–7.2%, P = 0.0037). Conclusions. The percentage of global identification exceeds the recommended level following the current guidelines. Chronologically, the improvement for this parameter during the study period has been observed. These data suggest that the incorporation of a portable gamma camera had an important role (AU)

Valoración inmunohistoquímica de la expresión de c-erb B2 como variable independiente en el carcinoma mamario T2N1 patológico / Immunohistochemical evaluation of c-erb B2 expression as an independent variable in T2N1 breast carcinoma

Introducción. La incidencia de carcinoma mamario oscila entre 11 y 80 casos por 100.000 mujeres/año. El desarrollo de técnicas de inmunohistoquímica, para la determinación de marcadores tumorales ha posibilitado la realización de trabajos retrospectivos que nos permitan valorar su utilidad como factores pronósticos. Diversos trabajos relacionan la sobreexpresión de c-erb B2 con factores pronósticos. El objeto de nuestro estudio es determinar si la sobreexpresión de c-erb B2 es un factor pronóstico independiente en el grupo de pacientes seleccionado. Pacientes y métodos. Se trata de 83 pacientes intervenidas entre 1980 y 1990 por carcinoma ductal infiltrante de mama,T2N1 patológico. Hemos utilizando el kit Super Sensitive Immunodetection System de Biogenex, para la determinación de c-erb B2. El análisis estadístico de los datos obtenidos se ha realizado mediante las pruebas de 2 para variables cualitativas y la t de Student y análisis de la variancia para variables cuantitativas. Resultados. El 35 por ciento de las pacientes mostró sobreexpresión de c-erb B2. El 48 por ciento de las pacientes prasentó progresión de la enfermedad. No hemos encontrado diferencias significativas al comparar sobreexpresión de c-erb B2 con ningún parámetro estudiado salvo una relación inversa, estadísticamente significativa, entre c-erb B2 y receptores estrogénicos (p = 0,0403). Conclusiones. El c-erb B2 determinado mediante inmunohistoquímica no es un factor independiente de pronóstico en carcinomas ductales infiltrantes de mama T2N1. Los receptores estrogénicos presentan una relación inversa con c-erb B2 con significación estadística (AU)