ABSTRACT
PURPOSE: To explore the relationship between morphological characteristics and histologic localization of metastasis within sentinel lymph nodes (SLN) and axillary spread in women with breast cancer. METHODS: We selected 119 patients with positive SLN submitted to complete axillary lymph node dissection from July 2002 to March 2007. We retrieved the age of patients and the primary tumor size. In the primary tumor, we evaluated histologic and nuclear grade, and peritumoral vascular invasion (PVI). In SLNs we evaluated the size of metastasis, their localization in the lymph node, number of foci, number of involved lymph nodes, and extranodal extension. RESULTS: Fifty-one (42.8%) patients had confirmed additional metastasis in non-sentinel lymph nodes (NLSN). High histologic grade, PVI, intraparenchymatous metastasis, extranodal neoplastic extension and size of metastasis were associated with positive NLSN. SLN metastasis affecting the capsule were associated to low risk incidence of additional metastasis. After multivariate analysis, PVI and metastasis size in the SLN remained as the most important risk factors for additional metastasis. CONCLUSIONS:The risk of additional involvement of NSLN is higher in patients with PVI and it increases progressively according the histologic localization in the lymph node, from capsule, where the afferent lymphatic channel arrives, to the opposite side of capsule promoting the extranodal extension. Size of metastasis greater than 6.0 mm presents higher risk of additional lymph node metastasis.
OBJETIVO:Explorar a relação entre características morfológicas e localização histológica da metástase dentro dos linfonodos sentinelas (LS) e disseminação axilar em mulheres com câncer de mama. MÉTODOS: Foram selecionados 119 pacientes com LS positivo, submetidas à dissecação completa dos linfonodos axilares entre Julho de 2002 a Março de 2007. Foram recuperados a idade das pacientes e o tamanho do tumor primário. No tumor primário, avaliamos os graus histológico e nuclear e a invasão vascular peritumoral (IVP). Nos LS, avaliamos o tamanho da metástase, sua localização no linfonodo, o número de focos metastáticos, número de linfonodos envolvidos e a extensão extranodal. RESULTADOS: Cinquenta e um (42,8%) pacientes tiveram metástases adicionais confirmadas nos linfonodos não sentinelas (LNS). Alto grau histológico, IVP, metástase intraparenquimatosa, extensão extranodal e tamanho da metástase foram associados com LNS positivos. Metástase afetando a cápsula do LS foi associada com baixo risco de incidência de metástase adicional. Após análise multivariada, IVP e tamanho da metástase no LS foram os fatores de risco mais importantes para metástases adicionais nos LNS. CONCLUSÕES:O risco de envolvimento adicional dos LNS é maior em pacientes com IVP e tal risco aumenta progressivamente de acordo com a localização histológica da metástase no LS, que inicia na cápsula, onde aporta o linfático aferente, e termina no lado oposto, promovendo a extensão extranodal. Tamanho de metástase maior ou igual a 6,0 mm revela maior risco de metástase nos LNS.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Middle Aged , Breast Neoplasms/pathology , Sentinel Lymph Node Biopsy , Axilla , Neoplasm Metastasis , Predictive Value of Tests , Retrospective StudiesABSTRACT
Objective: This study aimed to analyse whether a marker of proliferative activity (PCNA) could provide a prognosis of tumor evolution and to determine whether different interpretation criteria could after the results. Method: The presence of PCNA in 59 patients of state II (T(2) N(0,1) M(0) mammary carcinoma was determined. Result: Numerical proportions of total and intensely stained cells were established. These data were compared with anatomopathological parameters. A significant association between higher cyclin values and worse histological and nuclear grading was encountered, particulaly in patients with a "negative axilla"using the PCNA index. Cyclin values were not significant in relation to any parameters when indices from the intensely stained cells were considered exclusively. Conclusion: Higher nuclear (NG3) and histological (HGIII) grading, associated with a high PCNA index (>50), distinguish high-risk patients, and it is more appropriate considering all the stained cells as representative of PCNA indices, thus reflecting tumor aggressiveness.
Subject(s)
Female , Humans , Breast Neoplasms/pathology , Proliferating Cell Nuclear Antigen/analysis , Lymph Nodes/pathology , Prognosis , Breast Neoplasms/surgery , Analysis of Variance , Statistics, Nonparametric , Disease Progression , Mastectomy , Antibodies, Monoclonal/analysis , Neoplasm StagingABSTRACT
O objetivo deste trabalho é o relato de 4 casos de angioqueratoma vulvar, na Clínica Ginecológica da Faculdade de Medicina da Universidade de Säo Paulo, tumor raramente encontrado na genitária feminina. O angioqueratoma vulvar é semelhante ao angioqueratoma do escroto, tipo Fordyce, e pode ser encontrado como lesäo única ou múltipla, de crescimento popular, globular ou verrucóide, associada muitas vezes a sangramento local intermitente. Os autores comentam o tratamento e a orientaçäo nestes casos