Triple negative breast cancer originating from a cystic lesion

Malignant neoplasm diagnosed after radiological evaluation of a simple breast cyst is rare. This report described the case of a young patient with an initial simple cystic lesion, whom, in 18-month follow-up examinations, showed a change in the imaging pattern of the cyst, and underwent biopsy, where a triple negative carcinoma was identified. In addition, the diagnosis occurred during pregnancy, which makes the present report even rarer.

Biodireito e legislação na reprodução assistida / Biolaw and legislation on assisted reproduction

O biodireito é um ramo da ciência jurídica, e por essa lente podemos analisar os princípios e normas que influenciam e modificam as relações com o Estado e entre os próprios indivíduos, quando tratarem sobre a vida e dos direitos fundamentais dos indivíduos envolvidos. Os principais princípios analisados da bioética são: beneficência, autonomia, justiça, respeito pela pessoa e do consentimento informado. As pesquisas buscam trazer foco na legislação brasileira a respeito do assunto, a fim de propor uma maior abordagem para facilitar a compreensão das pessoas envolvidas no processo de Reprodução Assistida, tanto pacientes como profissionais. As normas analisadas foram a Constituição Federal, o Código Civil Brasileiro e as Resoluções do Conselho Federal de Medicina (CFM). O texto trata de assuntos polêmicos que envolvem pacientes, equipe multiprofissional e sociedade, pois ao analisar as técnicas de Reprodução Assistida há inúmeras indagações como por exemplo quais os direitos e deveres envolvidos, qual o limite do uso dessas técnicas para ter como resultado a gravidez e quais os direitos fundamentais que estão sendo preservados. Alguns pontos discutidos no trabalho são da cessão temporária do útero, doação de material genético, criopreservação e Reprodução Assistida post-mortem, entre outros. Assim, o desenvolvimento do tema exposto se dá em três momentos, sendo o primeiro o biodireito e os direitos humanos do ponto de vista da Reprodução Assistida, bem como as técnicas utilizadas, em seguida o estudo da legislação brasileira e por fim os aspectos polêmicos e discussões a respeito do tema. (AU)

Biolaw is a branch of legal science, through which it's possible to analyze the principles and regulations that influence and modify the relation with the State and among individuals themselves when it comes to the life and fundamental rights of the individuals involved. The main bioethics principles analyzed are: beneficence, autonomy, justice, respect for the person and the informed consent. Research aims to focus on the Brazilian legislation on the subject in order to propose a wider approach to promote the comprehension of people involved in the process of Assisted Reproduction, both patients and professionals. The regulations analyzed were the Brazilian Constitution, the Brazilian Civil Code and the Brazilian Federal Medical Council. The text brings up polemical subjects involving patients, a multiprofessional team and the society, as the Assisted Reproduction techniques are analyzed, numerous questions come up, as what are the rights and obligations involved, what is the limit of using these techniques to achieve pregnancy and what are the fundamental rights which are being preserved. Some of the topics discussed in this research are surrogacy, genetic material donation, cryopreservation and posthumous assisted reproduction. Therefore, the development of the exposed topic happens in three phases, the first one is Biolaw and Human Rights from the Assisted Reproduction point of view and the techniques that are used, then the study of the Brazilian legislation and finally the polemical aspects and discussions on the topic. (AU)

Rapid on-site cytopathological examination (ROSE) performed by endosonagraphers and its improvement in the diagnosis of pancreatic solid lesions

PURPOSE: To evaluate the diagnosis improvement of EUS-FNA when using ROSE performed by the endosonographer. METHODS: A retrospective study was conducted. A total of 48 pancreatic solid masses EUS-FNA were divided into two groups according to the availability of on-site cytology (ROSE) - the first 24 patients (group A-without ROSE) and the latter 24 cases (group B-with ROSE). Sensitivity, specificity, positive predictive value, negative predictive value, accuracy, complications and inadequacy rate of EUS-FNA were determined and compared. RESULTS: Among the 48 EUS-FNA, the overall performance was: sensitivity 82%; specificity 100%; positive predictive value (PPV) 100%; negative predictive value (NPV) 70% and accuracy 87%. The sensitivity of the Group A was 71%, versus 94% in-group B (p=0.61). Moreover, the negative predictive value was 58% versus 87% (p=0.72). The accuracy rate increased from 79% to 96% (p=0.67) in the ROSE group. The number of punctures was similar between the groups. No major complications were reported. CONCLUSION: Rapid on-site cytopathological examination, even when performed by the endosonographer, may improve the diagnostic performance in the diagnosis of solid pancreatic lesions, regardless of the slight increase in the number of punctures. .

INITIAL EXPERIENCE OF ENDOSCOPIC SUBMUCOSAL DISSECTION IN BRAZIL TO TREAT EARLY GASTRIC AND ESOPHAGHEAL CANCER: a multi-institutional analysis

Objective This study aimed to evaluate the feasibility and clinicopathological characteristics of early gastric and esophageal cancers treated with endoscopic submucosal dissection (ESD) at five centers in Brazil. Methods Five centers in Brazil reported their initial experience with ESD. The cases reported had already been collected by each center before pooled analysis. Results Were resected 62 gastric lesions; 52(83,8%) of the gastric lesions were well-differentiated adenocarcinoma, 31(50%) from the antrum, 24 (38.7%) type IIa. 51 (82.2%) lesions had en-block resection with three showing lateral margin compromise. Concerning invasion, 25 (40.3%) tumors were M1. Mean tumor diameter was 18.9 mm (range, 0.6-5.0 cm) and mean procedure duration was 119.45 minutes. Gastric perforation occurred in three (4.8%) patients. Mean follow-up duration was 11.3 months, with two local recurrences and one death from pneumonia Seven months after treatment. Of the 16 esophageal lesions resected, 14 (87.4%) were squamous cell carcinoma, 10 (62.5%) were located proximally and 8 (50.0%) type IIa. Mean tumor diameter was 23.8 mm (range, 6-60 mm). Thirteen (81.2%) lesions had en-block resection with five cases of lateral margin compromise. Eight (50.0%) lesions were M1. Mean procedure duration was 78 minutes (range, 20-150 min). Complications included pneumomediastinum in two (12.5%) patients and stenosis in one (6.2%). Mean duration of follow-up was 8.6 months, with no local recurrence despite the presence of lateral margin compromise. Conclusion Different centers in Brazil feasibly perform ESD with a high success rate. .

Objectivo Este estudo tem como objetivo avaliar a viabilidade da técnica de dissecção endoscópica da submucosa (DES) no tratamento do câncer precoce do estômago e do esôfago, assim como as características clinicopatológicas dos pacientes tratados em diferentes centros no Brasil. Métodos Cinco centros no Brasil relataram sua experiência inicial com a técnica de DES. Os casos relatados vinham sendo coletados em cada serviço antes da análise agrupada dos dados. Resultados Foram ressecadas 62 lesões gástricas, sedo 52 (83,8%) adenocarcinoma bem diferenciado, 31 (50%) localizadas no antro e 24 (38.7%) do tipo macroscópico IIa. Foram ressecadas em monobloco 51 (82.2%) lesões, com 3 apresentando margem lateral comprometida. Quanto ao grau de invasão, 25 (40.3%) eram restritas ao epitélio da mucosa (M1). O diâmetro médio das lesões foi de 18.9 (6-50) mm, o tempo médio dos procedimentos foi de 119.45 minutos. A incidência de perfuração gástrica foi de 4,8% (três casos). O tempo médio de seguimento foi de 11.3 meses, com duas recorrências locais e uma morte por pneumonia 7 meses após o tratamento. Das 16 lesões esofágicas ressecadas, 14 (87.4%) eram carcinoma epidermóide, 10 (62.5%) localizados na porção proximal, 8 (50.0%) do tipo macroscópico IIa. O diâmetro médio das lesões foi de 23.8 (6-60) mm. Foram ressecadas em monobloco 13 (81.2%) lesões, sendo que 5 apresentaram margem lateral comprometida e 8 (50.0%) com invasão restrita a camada epitelial (M1). A duração média dos procedimentos foi de 78 (20-150) minutos. Dois (12.5%) pacientes tiveram pequeno pneumomediastino e um (6.2%) evoluiu com estenose esofágica. O tempo médio de seguimento foi de 8.6 meses, ...