ABSTRACT
RESUMEN Introducción: El cáncer de mama se conoce desde épocas remotas, el tumor de mama es la neoplasia maligna más importante en la mujer. Se considera la primera causa de muerte por cáncer en las mujeres en el mundo. Objetivo: Evaluar la correlación ecográfica, mamográfica e histopatológica del carcinoma de mama en la provincia de Guantánamo. Método: Se realizó un estudio observacional, descriptivo, retrospectivo en 140 pacientes durante el período de 2010 a 2015 en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. El dato primario se obtuvo del Registro Provincial de Cáncer con diagnóstico de tumor maligno de mama. Resultados: La mayor incidencia de la enfermedad se registró a partir de los 45 años (80 %), el promedio de edad del diagnóstico fue de 57 más menos 15 años. La mama izquierda tuvo una mayor frecuencia a verse afectada con respecto a la mama la derecha (53 % vs. 46 %), fue poco frecuente que ambas mamas se encontrasen afectadas de forma sincrónica (menos del 1 %). El 53 % presentó una lesión de aspecto espiculado en la mamografía, de aspecto sólido en la ecografía y correspondiente a un carcinoma ductal infiltrante por histología. Conclusiones: Existe correlación entre los diagnósticos ecográficos, mamográficos y el diagnóstico definitivo histopatológico del cáncer de mama.
ABSTRACT Introduction: Since ancient times, breast cancer has been studied. It is current the most important invasive neoplasm in women and considered the leading cause of cancer deaths in women worldwide. Objective: To assess the ultrasound, mammographic and histopathological correlation for the diagnosis of breast cancer in Guantanamo province. Method: An observational, descriptive, and retrospective study was conducted in 140 patients during the period 2010-2015 at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo. The primary information was obtained from the Provincial Registry Database of Cancer with the diagnosis of malignant breast tumor. Results: The highest incidence of the disease was recorded in patients 45 plus years of age (80%), the average age at diagnosis was 57 ± 15 years. The left breast was more frequently affected than the right breast (53% vs. 46%), it was not common for both breasts be affected synchronously (less than 1%). The 53% of patients presented a lesion with a speculated appearance on mammography, solid appearance on ultrasound. This lesion, as per histology criteria, it corresponded to an infiltrating ductal carcinoma. Conclusions: There is a correlation between ultrasound, mammographic diagnoses and the breast cancer related definitive histopathological diagnosis.
RESUMO Introdução: O câncer de mama é conhecido desde a antiguidade, sendo o tumor de mama a neoplasia maligna mais importante na mulher. É considerada a principal causa de morte por câncer em mulheres no mundo. Objetivo: Avaliar a correlação ecográfica, mamográfica e histopatológica do carcinoma de mama na província de Guantánamo. Método: Estudo observacional, descritivo, retrospectivo, realizado em 140 pacientes durante o período de 2010 a 2015 no Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. Os dados primários foram obtidos do Registro Provincial de Câncer com diagnóstico de tumor maligno de mama. Resultados: A maior incidência da doença foi registrada após 45 anos (80%), a média de idade do diagnóstico foi de 57 anos mais ou menos 15 anos. A mama esquerda teve maior frequência de acometimento em relação à mama direita (53% vs. 46%), sendo raro que ambas as mamas fossem acometidas de forma síncrona (menos de 1%). 53% apresentavam lesão com aspecto espiculado na mamografia, aspecto sólido na ultrassonografia e correspondendo a carcinoma ductal infiltrante pela histologia. Conclusões: Existe correlação entre os diagnósticos ultrassonográfico e mamográfico e o diagnóstico histopatológico definitivo de câncer de mama.
ABSTRACT
Se presenta una paciente femenina de 69 años de edad, quien acudió en varias ocasiones al consultorio del médico de familia por notar aumento de volumen en la mama izquierda, considerado como resultado del efecto adverso a la ingestión de espironolactona. Se suspende el medicamento sin mejoría clínica. Se indicó ultrasonido de mama y se informa imagen de aspecto tumoral debajo del tejido mamario, que impresiona estar en relación con el músculo pectoral mayor; a esto se asocia una alteración del patrón mamario. Se realizó mamografía diagnóstica, se encuentra asimetría de volumen de la mama izquierda y una zona de aumento de la densidad cerca del pectoral, sin visualizar nódulo definido. Se realizó tomografía axial computarizada simple y contrastada. Se aprecia masa tumoral del músculo pectoral mayor izquierdo que infiltra tejido mamario y mediastino anterior, con diagnóstico imaginológico sugestivo de tumor del músculo pectoral mayor izquierdo. Se realizó biopsia por aguja fina de la lesión, guiada por ultrasonido y el diagnóstico fue carcinoma lobulillar infiltrante de mama. Se concluye que el comportamiento imaginológico puede estar relacionado con las pobres manifestaciones clínicas y, por tanto, con el diagnóstico tardío.
The case of 69 years-old woman, who went several times to the family physician's office because of the increased volume of her left breast, was presented. This problem was considered to result from the adverse effect of the spironolactone intake. The drug consumption ceased but there was no clinical improvement. Breast ultrasound test was indicated in which a tumor-like image below the breast tissue was observed; it seemed to be related to the major pectoralis muscle, additionally, there was altered breast pattern. Diagnostic mammography was performed, asymmetric volume of the left breast was found together with an increased density area located near the pectoralis, without viewing a defined nodule. Simple and contrast computerized tomography were also performed. It was observed that there was tumor mass in the left pectoralis major muscle infiltrating into the breast tissue and the anterior mediastinum, with imaging diagnosis suggestive of left pectoralis major muscle tumor. Ultrasound-guided fine-needle biopsy of the lesion was applied and the resulting diagnosis was infiltrating lobular carcinoma of the breast. It was concluded that the imaging result could be related to poor clinical manifestations and thus, to late diagnosis.
ABSTRACT
PURPOSE: Infiltrating lobular carcinomas (ILC) represent 5-10% of all breast cancers. Compared to infiltrating ductal carcinomas (IDC), ILC has a trend to be a more indistinct and multicentric form of cancer, thus, they are detected later and are less frequently treated using breast conserving surgery. The objective of this study was to determine the difference between ILC and IDC and the utility of using breast conserving surgery for ILC. METHODS: We studied 26 ILC and 319 IDC patients surgically treated at the Department of Surgery, Samsung Medical Center. Age, size of tumor, mammographic findings, operative method and pathologic findings were analysed retrospectively. For the microvessel count, tumor sections were immunohistochemically stained using CD31 monoclonal antibody, and microvessels were counted at 200 magnification in three separate fields selected from areas of highest vascularity. RESULTS: There were no differences between patients with ILC and IDC with respect to the mean age (45.4 and 47), the mean size of the tumors (2.59 cm and 2.63 cm), the malignant findings on mammography (13/15 (86.6%) and 203/237 (85.7%)(p=0.636)), and the number of breast conservaing surgeries (10/26 (38.5%) and 103/311 (33.1%)(p=0.361)). Axillary nodal metastasis was slightly more common in patients with ILC (15/25, 60%) than in those with IDC (141/284, 9.6%)(p=0.217) but there was no difference in TNM staging. More frequent estrogen receptor expression and less frequent P53 mutations were found in ILC than in IDC. Unlike IDC, there was no association between tumor microvessel density and pathologic stagings in ILC. CONCLUSION: ILC was found in patients of similar age, and the size was not different from that of IDC. The mammographic accuracy in diagnosing malignancy was about the same in ILCas in IDC. Breast conserving surgery can be performed in ILC patients at the same rate as in IDC patients. Microvessel density was not a prognostic factor in ILC patients.