Granular cell tumor of the breast: correlations between imaging and pathology findings / Tumor de células granulares da mama: correlação anatomorradiológica

Abstract Objective: To review the imaging features of granular cell tumors of the breast (on mammography, ultrasound, and magnetic resonance imaging), establishing a pathological correlation, in order to familiarize radiologists with this entity and make them aware of the differential diagnoses, other than malignancy, of lesions with spiculated margins. Materials and Methods: We reviewed the medical records (from a clinical-pathology database and picture archiving and communication system) of five patients with a pathologically confirmed diagnosis of granular cell tumor of the breast, treated at the Portuguese Oncology Institute of Lisbon, in the city of Lisbon, Portugal, between January 2012 and December 2018. Results: All five tumors exhibited imaging features highly suggestive of malignancy (BI-RADS 5 lesions), namely spiculated margins, significant depth, and posterior acoustic shadowing (on ultrasound). One tumor showed a kinetic curve indicative of washout on magnetic resonance imaging, two were adherent to the pectoralis muscle, and one was accompanied by skin retraction. Pathology provided the definitive diagnosis in all cases. Conclusion: Granular cell tumors of the breast pose a diagnostic challenge because they can present with clinical and imaging features mimicking malignancy, and the diagnosis is therefore provided by pathology. Radiologists should be familiarized with this entity, so they can be aware of the fact that breast lesions with spiculated margins can be indicative of diagnoses other than malignancy.

Resumo Objetivo: Rever as características de imagem dos tumores de células granulares da mama (mamográficas, ultrassonográficas e de ressonância magnética), estabelecendo uma correlação anatomopatológica, no intuito de proporcionar aos radiologistas uma familiarização com esta entidade e alertar para outros diagnósticos diferenciais de lesões espiculadas além das malignas. Materiais e Métodos: Consulta dos processos clínicos (base de dados clínica, anatomopatológica e sistema de comunicação e arquivamento de imagens) de doentes seguidos no Instituto Português de Oncologia de Lisboa, com diagnóstico anatomopatológico confirmado de tumor de células granulares da mama, de janeiro de 2012 a dezembro de 2018. Resultados: Todos os tumores exibiram características de imagem altamente sugestivas de malignidade (BI-RADS 5), nomeadamente espiculações, crescimento em profundidade e atenuação posterior (ultrassonografia), um mostrou um perfil cinético com washout na ressonância magnética, dois estavam aderentes ao músculo peitoral e um associava retração cutânea. O diagnóstico definitivo foi anatomopatológico. Conclusão: Os tumores de células granulares da mama constituem um desafio diagnóstico, pois podem apresentar características clínicas e de imagem que mimetizam malignidade, pelo que o diagnóstico é anatomopatológico. Os radiologistas devem estar familiarizados com esta entidade de forma a considerá-la nos diagnósticos diferenciais de lesões espiculadas, além das lesões malignas.

Radiation-induced angiosarcoma of the breast: a retrospective analysis of 15 years' experience at an oncology center / Angiossarcoma da mama radioinduzido: 15 anos de análise retrospectiva em um instituto de oncologia

Abstract Objective: To characterize a population of patients with radiation-induced angiosarcoma (RIAS) of the breast treated at an oncology center, focusing mainly on the imaging features, although also on the clinical presentation, diagnosis, and management. Materials and Methods: We performed a retrospective review of patients with histologically proven angiosarcoma of the breast or chest wall, all of whom received radiotherapy, after conservative or radical breast surgery, between 2000 and 2015. Results: Eleven patients met the inclusion criteria. The median age at the time of diagnosis of RIAS of the breast was 71.5 years (range, 58-87 years), and the median latency period was 8.9 years (range, 4-27 years). The rate of local recurrence was 54.4%, RIAS recurring after a median period of 10 months (range, 3-18 months), and distant metastases occurred in three patients (27.3%). All of the tumors were accompanied by skin changes, and a palpable mass was seen in four. Most of the imaging findings were nonspecific. Six patients underwent magnetic resonance imaging, which revealed pronounced skin enhancement in all six. Ultrasound-guided core needle biopsies were negative in three of the eight patients. Conclusion: RIAS of the breast is a rare but recognized complication of radiotherapy for breast carcinoma, with a poor prognosis and high recurrence rate, which requires a high index of suspicion for a prompt diagnosis.

Resumo Objetivo: Caracterizar uma população de pacientes com angiossarcoma da mama induzido por radioterapia em um instituto de oncologia, com foco principalmente nas características de imagem, mas também na apresentação clínica, diagnóstico e gerenciamento. Materiais e Métodos: Efetuamos análise retrospectiva, entre 2000 e 2015, de pacientes com angiossarcoma da mama ou parede torácica histologicamente comprovado que foram previamente irradiadas após cirurgia mamária, conservadora ou radical. Resultados: Onze pacientes preencheram os critérios de inclusão. A mediana da idade na ocasião do diagnóstico de angiossarcoma da mama induzido por radioterapia foi 71,5 anos (variação: 58-87 anos) e o período médio de latência foi 8,9 anos (variação: 4-27 anos). A taxa de recorrência local foi 54,4%, após mediana de 10 meses (variação: 3-18 meses), e metástases a distância ocorreram em três pacientes (27,3%). Todos os tumores apresentaram alterações na pele, e massa palpável observou-se em quatro. Os achados de imagens foram globalmente inespecíficos. Os seis paciente que realizaram ressonância magnética revelaram aumento de captação de contraste cutâneo. As biópsias ecoguiadas foram negativas em três de oito pacientes. Conclusão: Angiossarcoma da mama induzido por radioterapia é complicação rara, mas conhecida, da radioterapia para câncer da mama, com mau prognóstico e alta taxa de recorrência, sendo necessário elevado índice de suspeição para seu diagnóstico imediato.

Primary neuroendocrine breast carcinoma: a case report and literature review / Carcinoma neuroendócrino primário da mama: relato de caso e revisão da literatura

The authors present a case of a neuroendocrine carcinoma in an asymptomatic 75-year-old woman, detected in routine breast screening. The lesion was visible at mammography as a well circumscribed, medium density nodule, with no associated microcalcifications, and at ultrasonography as a hypoechoic nodule, with irregular shape and ill-defined margins. Magnetic resonance imaging revealed findings consistent with malignancy.

Os autores apresentam um caso de carcinoma neuroendócrino numa mulher de 75 anos assintomática detectado em estudo imaginológico mamário de rotina. A lesão apresentava-se na mamografia como nódulo bem circunscrito de média densidade, sem microcalcificações associadas e ecograficamente como nódulo hipoecogênico de morfologia irregular e limites mal definidos. Na ressonância magnética mamária as características da lesão eram concordantes com malignidade.

Validation of the gastroschisis experimental model and the influence of the mother's diet enriched with glutamine in the fetal morphology

To validate the gastroschisis experimental model in female rats and the effects on the glutamine fetal morphology during pregnancy. METHODS: Twelve pregnant rats Wistar were separated in two groups: Group I (n = 6 rats, 71 fetuses) took glutamine and Group II (n = 6 rats, 75 fetuses) took isocaloric supplementation. At the 18th day of pregnancy, female rats were taken to hysterotomy and the fetuses which were selected for the act of gastroschisis were partially removed from the womb and by the laparotomy technique, the exclusion of the intestine was done. After that, fetuses were put in the womb cavity again and the rats' abdomen sutured. At the 21st day of pregnancy, date before delivery, by C-section ordinary animals and the ones with gastroschisis were removed and studied separately. The morphometrical parameters studied were the body weight (PC); the intestine weight (PI); the intestine length (CI) and its relations (PI/PC, PI/CI e PC-PI). RESULTS: The intestine weight (PI) and the intestine length (CI) were different in fetuses with gastroschisis (p<0.05), however no difference between the groups regarding supplementation with glutamine. CONCLUSIONS: The gastroschisis experimental model is valid and reproducible. The nutritional therapy with glutamine did not change the morphometrical parameters.