Nursing care regarding the psycho-emotional aspects of women submitted to mastectomy

Breast cancer, or breast neoplasm, is one of the most frequent types of cancer, and one of the most prevalent among women. The diagnosis and specific treatments, such as mastectomy surgery, lead women to experience different feelings, with the most predominant negative thoughts. In this way, the objective of this study is to describe the importance of nursing care in the face of the psycho-emotional aspects of women after mastectomy. This is an integrative literature review study, developed in electronic Medline and Lilacs databases. The following terms were used: Breast neoplasm; Nursing; Emotions; Mastectomy. A total of 2,314 articles were found, of which eight were selected. The results and discussions were divided into two thematic axes: The first deals with the emotions of women after mastectomy, whose feelings arising from the diagnosis of the disease start to affect different areas, such as personality, sexuality, family, and social relationships. Furthermore, the second deals with nursing care after mastectomy, which must be conducted integrally, aiming at restoring physical and emotional health. Nursing is the vehicle capable of planning and collaborating with these women, promoting humanized treatment and assistance, oriented and aimed at a better quality of life, and stimulating self-help, self-esteem, and acceptance of their body.

Tratamiento quirúrgico de las neoplasias en la glándula parótida / Surgical treatment of the neoplasmsof the parotid gland

Objetivo: Caracterizar a pacientes con diagnóstico de neoplasias en glándula parótida, según el procedimiento quirúrgico efectuado, la técnica de identificación del nervio facial, y la relación de los hallazgos patológicos definitivos con los estudios de muestreo histológico preoperatorio. Métodos: Estudio multidisciplinario, multiinstitucional, descriptivo, cuantitativo y retrospectivo de 26 pacientes con diagnóstico de neoplasias en glándula parótida entre el año 2018 al 2023. Se dividieron de acuerdo a la histología en benignas y malignas. Las distintas frecuencias fueron expresadas en número y porcentaje. Se calculó la sensibilidad y especificidad de la punción con aguja fina como prueba de muestreo histológico. Resultados: Categoría benigna: 16 pacientes (61,5% %). El resto de la serie, diez pacientes, de la categoría de tumores malignos (38,5%). La lobectomía superficial parotídea fue el procedimiento más frecuente en las neoplasias benignas (75%) y malignas (60%). La técnica anterógrada de identificación del nervio facial fue la más común. Entre 25% a 30% de parálisis temporales en ambos grupos. La sensibilidad y especificidad de la punción con aguja fina para el diagnóstico de neoplasias benignas fue de 92,3% y 50%, el porcentaje de falsos negativos de 5,8%. Conclusión: La lobectomía superficial de la glándula parótida y la técnica anterógrada representaron el procedimiento quirúrgico y la técnica de identificación del nervio facial más frecuentemente realizado en ambas categorías. La baja especificidad de la punción con aguja fina y el porcentaje de falsos negativos representaron algunas de las dificultades a afrontar para decidir la extensión del tratamiento quirúrgico(AU)

Objective: To evaluate the surgical procedure, technique identification of nerve facial and correlate the pathological findings withthe preoperative histological sampling studies, in patients with neoplasms parotid underwent surgery. Methods: Study multi-institutiona, multi-disciplinary, descriptive y quantitative of 26 patients with neoplasm parotid between the years 2018 to 2023. We divided in two categories benign and malignant. The frequency was expressed in number and percentage. It was calculated the sensibility and specificity of the fine needle puncture. Results: Category benign: 16 patients (61,5% %). Malignant, ten patients (38,5%). The lobectomy superficial was the surgical procedure more frequent in the neoplasm benign (75%) and malignant (60%). The anterograde technique of identification of nerve facial was the more common. Between 25% and 30% presents facial palsytemporal. The sensibility and specificity of the fine needle puncture were 92,3% y 50%, the percentage of false negatives was 5,8%. Conclusion: In this study the lobectomy superficial and anterograde technique were the surgical procedure and technique of identification of nerve facial more frequent in both categories. The low specificity of fine needle puncture and the percentage of false negatives were some of the difficulties to affront in the decision of the surgery exten(AU)

Estadio, perfil biológico y tendencias de incidencia y mortalidad de cáncer de mama en Uruguay: análisis por franjas etarias

Introducción: el cáncer de mama es el tumor maligno más frecuente y la primera causa de muerte por cáncer en mujeres en Uruguay y en el mundo. La evidencia epidemiológica sugiere que el cáncer de mama en diferentes grupos de edades se comportaría como patologías distintas. El objetivo de este trabajo es caracterizar el cáncer de mama en Uruguay para diferentes estratos de edades. Material y método: se analizaron las tendencias temporales de la incidencia de cáncer de mama en mujeres en Uruguay en el período 2002-2019, y de la mortalidad por esta causa en 1990-2020. Para el quinquenio 2015-2019, se analiza además la distribución de estadios al diagnóstico y de perfiles biológicos (luminales, triple negativos y HER2 positivos). Se analizan tres segmentos de edades: mujeres de 20 a 44 años, de 45 a 69 y de 70 y más años. Resultados: las tasas de incidencia para el conjunto de edades se presentaron estables en el período 2002-2019, mientras que la mortalidad presenta una tendencia decreciente en el período 1990-2020. En las mujeres menores de 45 años se encuentra un aumento en la incidencia, con mortalidad que decrece hasta el 2010, seguido de una estabilización de las tasas; en las mujeres de 45 a 69 años la incidencia se mantiene estable y la mortalidad decrece; en las mayores de 70 años, la incidencia decrece mientras la mortalidad se mantiene estable. Más del 70% de los casos se diagnostican en estadios I y II. Los tumores luminales (receptores hormonales positivos, HER2 negativos) son el subtipo más frecuente para todos los grupos, la proporción de tumores con estas características aumenta con la edad, mientras decrece la proporción de HER2 positivo y triple negativo. Conclusión: en las mujeres uruguayas el cáncer de mama presenta características diferenciales para las tres franjas de edades analizadas.

Introduction: Breast cancer is the most common malignant tumor and the leading cause of cancer death in women in Uruguay and worldwide. Epidemiological evidence suggests that breast cancer in different age groups behaves as distinct pathologies. The objective of this work is to characterize breast cancer in Uruguay for different age groups. Method: Temporal trends in the incidence of breast cancer in women in Uruguay are analyzed for the period 2002-2019, along with mortality trends for this cause from 1990 to 2020. For the five-year period 2015-2019, the distribution of stages at diagnosis and biological profiles (Luminal, Triple-negative, and Her2 positive) is also analyzed. Three age segments are analyzed: women aged 20 to 44 years, 45 to 69 years, and 70 years and older. Results: The incidence rates for all age groups remained stable during the period 2002-2019, while mortality showed a decreasing trend in the period 1990-2020. In women under 45, there is an increase in incidence, with mortality decreasing until 2010, followed by a stabilization of rates; in women aged 45 to 69, incidence remains stable and mortality decreases; in those over 70, incidence decreases while mortality remains stable. More than 70% of cases are diagnosed at stages I and II. Luminal tumors (hormone receptor positive, Her2 negative) are the most frequent subtype for all age groups. The proportion of tumors with these characteristics increases with age, while the proportion of Her2 positive and triple-negative tumors decreases. Conclusions: In Uruguayan women, breast cancer presents differential characteristics for the three age groups analyzed.

Introdução: O câncer de mama é o tumor maligno mais comum e a principal causa de morte por câncer em mulheres no Uruguai e no mundo. Evidências epidemiológicas sugerem que o câncer de mama se comportaria como patologias distintas em diferentes faixas etárias. O objetivo deste trabalho é caracterizar o câncer de mama no Uruguai para diferentes faixas etárias. Materiais e Métodos: São analisadas as tendências temporais da incidência de câncer de mama em mulheres no Uruguai no período 2002-2019 e a mortalidade por esta causa no período 1990-2020. Para o quinquénio 2015-2019 são também analisadas a distribuição dos estádios ao diagnóstico e os perfis biológicos (Luminal, Triplo negativo e Her2 positivo). São analisados três segmentos etários: mulheres dos 20 aos 44 anos, dos 45 aos 69 anos e dos 70 anos ou mais. Resultados: As taxas de incidência para todas as idades permaneceram estáveis no período 2002-2019 enquanto a mortalidade apresentou tendência decrescente no período 1990-2020. Nas mulheres com menos de 45 anos verifica-se um aumento da incidência, com uma redução da mortalidade até 2010, seguida de uma estabilização das taxas; nas mulheres de 45 a 69 anos, a incidência permanece estável e a mortalidade diminui; nas pessoas com mais de 70 anos, a incidência diminui enquanto a mortalidade permanece estável. Mais de 70% dos casos são diagnosticados nos estágios I e II. Os tumores luminais (receptor hormonal positivo, Her2 negativo) são o subtipo mais comum para todos os grupos sem do que a proporção de tumores com essas características aumenta com a idade, enquanto a proporção de (Her2 positivo e triplo negativo) diminui. Conclusão: Nas mulheres uruguaias, o câncer de mama apresenta características diferenciadas para as três faixas etárias analisadas.

Radionecrosis cerebral en un adulto

Se presenta el caso clínico de un paciente de 37 años de edad con el antecedente de haber recibido radioterapia por una lesión tumoral en la región frontal derecha, el cual acudió a consulta en el Instituto de Neurología y Neurocirugía de Cuba por presentar cefalea intensa y hemiparesia izquierda. Luego de realizados los exámenes necesarios, se estableció el diagnóstico clínico-imagenológico de lesión por radionecrosis en el hemisferio contralateral, que fue corroborado en el estudio anatomopatológico una vez que se extirpó el tumor; seguidamente, se indicó inmunoterapia. La evolución del paciente fue satisfactoria, pues se logró el control de la enfermedad y la resolución de los síntomas.

The case report of a 37-year-old patient with history of having received radiotherapy due to a tumor lesion in the right frontal region is presented, who attended to the Institute of Neurology and Neurosurgery in Cuba because of intense headache and left hemiparesis. After carrying out the necessary examinations, the clinical-imaging diagnosis of a radionecrosis lesion in the contralateral hemisphere was established, which was corroborated in the pathological examination once the tumor was removed; then, immunotherapy was indicated. The patient had a favorable clinical course because the control of the disease was achieved as well as the resolution of symptoms.

Acantosis nigricans maligna y carcinoma mamario. Presentación de un caso

Las manifestaciones cutáneas de los tumores malignos comprenden un grupo de dermatosis que pueden ser marcadores de la presencia de neoplasias ocultas y permiten su diagnóstico oportuno. El objetivo de este informe es presentar las características clínicas de una acantosis nigricans asociada a carcinoma de mamario. Para ello, se describe el caso clínico de una paciente de 50 años, color de piel negro, asistida en la consulta de Dermatología del Policlínico Universitario Raúl Sánchez, por tener una placa única eritematosa localizada en la mama izquierda, acompañada de dolor, aumento de la temperatura local y máculas hipercrómicas en las axilas; así como adenopatías axilares múltiples. Los exámenes complementarios mostraron la presencia de acantosis nigricans maligna asociada a un carcinoma inflamatorio de la mama izquierda. Fue intervenida quirúrgicamente, con la consiguiente desaparición de las lesiones cutáneas, pero con un pronóstico reservado. La mayoría de los síndromes paraneoplásicos son inespecíficos; existe una necesidad urgente de sospechar una correlación entre los cambios cutáneos y la posibilidad de una neoplasia interna, por lo que es de suma importancia derivar a estos pacientes para su identificación y el diagnóstico precoz de la enfermedad de base. Esto mejoraría el pronóstico y atenuaría en gran medida las consecuencias.

The skin manifestations of malignant tumors include a group of dermatoses that can be the sign of the occult neoplasms presence and allow their timely diagnosis. The objective of this report is to present the acanthosis nigricans' clinical characteristics associated with breast carcinoma. The clinical case of a 50-years-old black-skinned patient is described, assisted in the Dermatology consultation of the Raúl Sánchez University Polyclinic, for having a single erythematous plaque located in the left breast, accompanied by pain, increased local temperature and hyperchromic macules in the armpits; as well as multiple axillary lymphadenopathy. Complementary examinations showed the presence of malignant acanthosis nigricans associated with an inflammatory carcinoma of the left breast. She underwent surgery, with the consequent disappearance of the skin lesions, but with a reserved prognosis. Most paraneoplastic syndromes are nonspecific; there is an urgent need to suspect a correlation between skin changes and the possibility of an internal neoplasia, so it is of utmost importance to refer these patients for identification and early diagnosis of the underlying disease. This would improve the prognosis and greatly mitigate the consequences.

Tumor metastásico en tejido blando a nivel del sacro secundario a carcinoma de células claras de riñón. Reporte de caso / Metastatic tumor in soft tissue at the level of the sacrum secondary toclear cell carcinoma of the kidney. A case report

Introducción. El cáncer de riñón es la undécima neoplasia maligna más común en los Estados Unidos Mexicanos. El carcinoma de células claras de riñón (CCR) es considerado la estirpe más frecuente y representa el 2-3 % de todos los cánceres a nivel mundial. En el contexto de la enfermedad metastásica, por lo general se identifica un tumor renal primario y las metástasis se localizan en pulmón, hueso, hígado, cerebro y, raramente, en tejidos blandos. Los pacientes con metástasis a tejidos blandos no tienen síntomas en las etapas iniciales y generalmente se identifican sólo cuando las lesiones aumentan de tamaño o durante el estudio de la pieza de resección quirúrgica. Caso clínico. Se presenta el caso de una paciente en la séptima década de la vida, con una metástasis en tejidos blandos de la región sacra, de 10 años de evolución posterior a una nefrectomía secundario a CCR. Resultados. Hallazgos clínicos e imagenológicos de un tumor bien delimitado. Se realizó resección quirúrgica de la lesión, bajo anestesia regional, con extirpación completa. Conclusión. Se recomienda que los pacientes con un sitio metastásico resecable y solitario sean llevados a resección quirúrgica con márgenes libres, como fue el caso de nuestra paciente, por su fácil acceso y ser una lesión única. En el CCR, además de su tratamiento quirúrgico inicial, es indispensable una estrecha vigilancia con examen físico e imágenes transversales, para detectar la presencia de metástasis y con ello evitar tratamientos tardíos.

Introduction. Kidney cancer is the eleventh most common malignancy in the United States of Mexico. Carcinoma renal cell (CRC) is considered the most frequent type and represents 2-3% of all cancers worldwide. In the setting of metastatic disease, a primary renal tumor is usually identified, and metastases are located in the lung, bone, liver, brain, and rarely in soft tissue. Patients with soft tissue metastases do not have symptoms in the initial stages and are generally found only when the lesions increase in size or during the study of the surgical resection piece. Clinical case. In this case, we report a female patient in the seventh decade of life with a soft tissue metastasis located in the sacral region, 10 years after a nephrectomy secondary to CRC. Results. Clinical and radiological findings of a well-defined tumor. Surgical resection of the lesion is performed under regional anesthesia with complete excision. Conclusions. It is recommended that patients with a resectable and solitary metastatic site be candidates for surgical resection with free margins, as was the case with our patient due to its easy access and single lesion. In CRC, in addition to its initial surgical treatment, close surveillance with physical examination and cross-sectional images is essential to monitor the presence of metastases and thus avoid late treatments.

Caracterización histológica del melanoma cutáneo en reportes de patología en la ciudad de Cali, 2016-2021 / Histological characterization of cutaneous melanoma in pathology reports in the city of Cali, 2016-2021

Introducción. El melanoma es la proliferación maligna de melanocitos asociado a un comportamiento agresivo. El objetivo de este estudio fue determinar las variables histológicas del melanoma cutáneo. Métodos. Estudio observacional retrospectivo, transversal descriptivo, realizado con reportes de patologías de pacientes con diagnóstico de melanoma cutáneo en un laboratorio de patología en Cali, Colombia, entre 2016-2021. Se incluyeron las variables edad, sexo, localización, subtipo, espesor de Breslow, ulceración, márgenes, mitosis, invasión linfovascular, neurotrofismo, regresión tumoral, nivel de Clark e infiltración tumoral por linfocitos. Resultados. Se obtuvieron 106 reportes y fueron excluidos 54 por duplicación. Se incluyeron 52 registros, la media de edad fue de 61 años, con una mayor frecuencia de mujeres (55,8 %). De los 33 casos donde se especificó el subtipo histológico, el más frecuente fue el de extensión superficial (66,6 %), seguido del acral lentiginoso (18,1 %) y nodular con (15,2 %). La localización más frecuente fue en extremidades (61,5 %). El espesor de Breslow más común fue IV (34,6 %) y el nivel de Clark más frecuente fue IV (34,6 %). La ulceración estuvo en el 40,4 %. El subtipo nodular fue el de presentación más agresiva, donde el 100 % presentaron espesor de Breslow IV. Conclusiones. El subtipo de melanoma más común en nuestra población fue el de extensión superficial; el segundo en frecuencia fue el subtipo acral lentiginoso, que se localizó siempre en extremidades. Más del 50 % de los melanomas tenían espesor de Breslow mayor o igual a III, lo que impacta en el pronóstico.

Background. Melanoma is the malignant proliferation of melanocytes associated with aggressive behavior. The objective of this study was to determine the histological variables of cutaneous melanoma. Methods. Observational, cross-sectional, descriptive, retrospective study carried out with reports of pathologies with a diagnosis of cutaneous melanoma in a pathology laboratory in Cali between 2016-2021. The variables were age, sex, location, subtype, Breslow thickness, ulceration, margins, mitosis, lymphovascular invasion, neurotropism, tumoral regression, Clark level and tumor infiltration by lymphocytes. Results. One hundred and six reports were obtained and 54 were excluded due to duplication. A descriptive analysis was made on the 52 records that were included, the mean age was 61 years, with a higher frequency in women with 55.8%. Of the 33 cases where the histological subtype was specified, the most frequent was superficial extension with 66.6%, followed by acral lentiginous with 18.1% and nodular with 15.2%. The most frequent location was in the extremities (61.5%); the most common Breslow was IV (34.6%), and the most frequent Clark was IV (34.6%). Ulceration was in 40.4%. The nodular subtype was the most aggressive presentation where 100% presented Breslow IV. Conclusions. The most common subtype of melanoma was that of superficial extension. In our population, the second most frequent was the acral lentiginous subtype, which was always located on the extremities. More than 50% of the melanomas had Breslow greater than or equal to III, which affects the prognosis.

División ganglionar posquirúrgica y su efecto en el recuento ganglionar y la estadificación en pacientes con cáncer gástrico / Postoperative lymph node division and its effect on lymph node count and staging in patients with gastric cancer

Introducción. La gastrectomía y disección ganglionar es el estándar de manejo para los pacientes con cáncer gástrico. Factores como la identificación de ganglios por el patólogo, pueden tener un impacto negativo en la estadificación y el tratamiento. El objetivo de este estudio fue comparar el recuento ganglionar de un espécimen quirúrgico después de una gastrectomía completa (grupo A) y de un espécimen con un fraccionamiento por grupos ganglionares (grupo B). Métodos. Estudio de una base de datos retrospectiva de pacientes sometidos a gastrectomía D2 en el Servicio de Cirugía gastrointestinal de la Liga Contra el Cáncer seccional Risaralda, Pereira, Colombia. Se comparó el recuento ganglionar en especímenes quirúrgicos con y sin división ganglionar por regiones anatómicas previo a su envío a patología. Resultados. De los 94 pacientes intervenidos, 65 pertenecían al grupo A y 29 pacientes al grupo B. El promedio de ganglios fue de 24,4±8,6 y 32,4±14,4 respectivamente (p=0,004). El porcentaje de pacientes con más de 15 y de 25 ganglios fue menor en el grupo A que en el grupo B (27 vs 57, p=0,432 y 19 vs 24, p=0,014). El promedio de pacientes con una relación ganglionar menor 0,2 fue mayor en el grupo B (72,4 % vs 55,4 %, p=0,119). Conclusiones. Los resultados de nuestro estudio mostraron que una división por grupos ganglionares previo a la valoración del espécimen por el servicio de patología incrementa el recuento ganglionar y permite establecer de manera certera el pronóstico de los pacientes, teniendo un impacto positivo en su estadificación, para evitar el sobretratamiento

Introduction. A gastrectomy and lymph node dissection is the standard of management for patients with gastric cancer. Factors such as the identification of nodes by the pathologist can have a negative impact on staging and treatment. The objective of this study was to compare the lymph node count of a surgical specimen after a complete gastrectomy (group A) and of a specimen with lymph node by groups (group B). Methods. Study of a retrospective database of patients undergoing D2 gastrectomy in the Risaralda section of the Liga Contra el Cancer Gastrointestinal surgical service, Pereira, Colombia. The lymph node count was compared in surgical specimens with and without lymph node division by anatomical regions, prior to sending them to pathology. Results. Of the 94 patients who underwent surgery, 65 were from group A and 29 patients were from group B. The average number of nodes was 24.4±8.6 and 32.4±14.4, respectively (p=0.004). The percentage of patients with more than 15 and 25 nodes was lower in group A than in group B (27 vs 57, p=0.432 and 19 vs 24, p=0.014). The average number of patients with a nodal ratio less than 0.2 was higher in group B (72.4% vs 55.4%, p=0.119). Conclusions. The results of our study showed that a division by lymph node groups prior to the evaluation of the specimen by the pathology service increases the lymph node count and allows the prognosis of patients to be accurately established, having a positive impact on their staging, to avoid overtreatment.

Incidence of radiodermatitis and factors associated with its severity in women with breast cancer: a cohort study

Abstract Background: One of the main adverse reactions of adjuvant radiotherapy for breast cancer is radiodermatitis. Objective: To assess the incidence of radiodermatitis in women with breast cancer, identify factors associated with its severity and determine the time at which this event occurs. Methods: Prospective cohort study in 113 women with breast cancer who were evaluated before radiotherapy and at every fifth session until the end of treatment. Logistic regression and Cox proportional regression model were used for the assessment of risk factors; P values < 0.05 were considered significant. Results: The incidence rate of radiodermatitis was 98.2% and it was demonstrated that for each additional point of the Body Mass Index (BMI), the chance of occurrence of grades II to IV radiodermatitis increases by 14% (OR = 1.14 [95% CI 1.04-1.26]; p = 0.004) and statin use increases the risk of more severe skin lesions by four-fold (OR = 4.27 [95% CI 1.11-16.42]; p = 0.035). The exclusive use of hydrogel for skin hydration was an independent factor in delaying the onset of radiodermatitis (HR = 0.55 [95% CI 0.36-0.82]; p = 0.004). Study limitations: The main limitation of this study was its external validity. The identified factors should be considered for services and populations similar to those in this study. Conclusions: There was a high incidence of radiodermatitis and its severity was related to higher BMI, statin use; there was a protective effect of hydrogel use.

Benign cervical schwannoma with tracheal invasion

ABSTRACT Schwannomas commonly develop in the cervical region, 25% - 45% of cases are diagnosed in this anatomical region. Tracheal neurogenic tumors are exceedingly rare and can be misdiagnosed as invasive thyroid carcinomas or other infiltrating malignancies when present at the level of the thyroid gland. Here, we present a case of synchronous benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma in a patient who was initially hospitalized for COVID-19. The patient presented with dyspnea that was later found to be caused by tracheal extension of a cervical tumor. Surgical excision was performed, and the surgical team proceeded with segmental tracheal resection, removal of the cervical mass, and total thyroidectomy. The specimen was sent for pathological analysis, which revealed synchronous findings of a benign cervical schwannoma with tracheal invasion and papillary thyroid carcinoma. The literature on this subject, together with the present case report, suggests that neurogenic tumors should be included in the differential diagnosis of obstructing tracheal cervical masses. Surgical excision is the first-line of treatment for benign cervical schwannomas.

Neoplasia quística mucinosa hepática, reporte de un caso y análisis de la patología / Hepatic mucinous cystic neoplasm, case report and pathology analysis / Neoplasia cística mucinosa hepática, relatório de um caso e análise da patologia

Desde los primeros reportes en la bibliografía, la nomenclatura de las lesiones quísticas hepatobiliares se ha ido modificando, habiéndose descripto dos tipos de lesiones: las serosas y las mucinosas. En 2010 la Organización Mundial de la Salud estableció una nueva clasificación donde los términos cistoadenomas y cistoadenocarcinomas hepatobiliares son reemplazados por entidades más específicas como la neoplasia mucinosa quística y los tumores quísticos intraductales (neoplasia papilar intraductal, neoplasma tubulopapilar intraductal y neoplasma oncocitico papilar). En cuanto a la neoplasia mucinosa quística, la presencia de estroma ovárico le confiere características distintivas en lo patológico y biológico, siendo esto un requisito en la clasificación de la OMS. Esta característica lo diferencia de los hamartomas biliares, los quistes congénitos y la enfermedad de Caroli. Dichas neoplasias son infrecuentes, con una incidencia menor al 5% de las lesiones quísticas hepáticas y ocurren casi exclusivamente en mujeres, frecuentemente perimenopáusicas. Su potencial de malignización ha sido descrito, siendo éste la indicación de tratamiento quirúrgico resectivo. Presentamos el caso clínico de una paciente portadora de una neoplasia quística mucinosa hepática, catalogada como cistoadenoma hepático según la antigua clasificación.

Since the early reports in the literature, the nomenclature of hepatobiliary cystic lesions has been modified, with two types of lesions being described: serous and mucinous. In 2010, the World Health Organization established a new classification in which the terms hepatobiliary cystadenomas and cystadenocarcinomas were replaced by more specific entities such as mucinous cystic neoplasms and intraductal cystic tumors (intraductal papillary neoplasm, intraductal tubulopapillary neoplasm, and intraductal oncocytic papillary neoplasm). Regarding mucinous cystic neoplasms, the presence of ovarian stroma confers distinctive pathological and biological characteristics, which is a requirement in the WHO classification. This characteristic differentiates it from biliary hamartomas, congenital cysts, and Caroli's disease. Such neoplasms are rare, with an incidence of less than 5% of hepatic cystic lesions, and occur almost exclusively in women, often perimenopausal. Their potential for malignancy has been described, and this is the indication for surgical resection treatment. We present a clinical case of a patient with a mucinous cystic hepatic neoplasm, classified as a hepatic cystadenoma according to the old classification.

Desde os primeiros relatos na literatura, a nomenclatura das lesões císticas hepatobiliares tem sido modificada, sendo descritos dois tipos de lesões,asserosas e as mucinosas. Em 2010, a Organização Mundial da Saúdeestabeleceuuma nova classificação, naqual os termos cistoadenomas e cistoadenocarcinomas hepatobiliares foramsubstituídos por entidades mais específicas, como a neoplasia mucinosa cística e os tumores císticos intraductais (neoplasia papilar intraductal, neoplasma tubulopapilar intraductal e neoplasma oncocítico papilar). Em relação à neoplasia mucinosa cística, a presença de estroma ovarianoconfere características distintas do ponto de vista patológico e biológico, sendoesseum requisito naclassificação da OMS. Essa característica a diferencia dos hamartomas biliares, cistoscongênitos e doença de Caroli. Essas neoplasias são raras, comumaincidência menor que 5% das lesões císticas hepáticas, e ocorremquase exclusivamente em mulheres, frequentementeperimenopáusicas. Seu potencial de malignizaçãotem sido descrito, sendoesta a indicação para tratamentocirúrgicoressectivo. Apresentamos o caso clínico de uma paciente portadora de uma neoplasia cística mucinosa hepática, classificada como cistoadenoma hepático de acordocom a antigaclassificação.

Proposal for the applicability of modified Breslow (measured from the basal membrane) as a predictor of survival and sentinel lymph node outcome in patients with cutaneous melanoma

Abstract Background Cutaneous melanoma is a neoplasm with a high mortality rate and risk of metastases to distant organs. The Breslow micrometric measurement is considered the most important factor for evaluating prognosis and management, measured from the granular layer to the deepest portion of the neoplasm. Despite its widespread use, the Breslow thickness measurement has some inaccuracies, such as not considering variations in the thickness of the epidermis in different body locations or when there is ulceration. Objective To evaluate the applicability of a modified Breslow measurement, measured from the basal membrane instead of from the granular layer, in an attempt to predict sentinel lymph node examination outcome and survival of patients with melanoma. Methods A retrospective and cross-sectional analysis was carried out based on the evaluation of slides stained with hematoxylin & eosin from 275 cases of melanoma that underwent sentinel lymph node biopsy from 2008 to 2021 at a reference center in Brazil. Results Analysis of the Cox model to evaluate the impact of the Breslow measurement and the modified Breslow measurement on survival showed that both methods are statistically significant. Logistic regression revealed a significant association between both measurements and the presence of metastasis in sentinel lymph nodes. Conclusion Measuring melanoma depth from the basal membrane (modified Breslow measurement) is capable of predicting survival time and sentinel lymph node outcome, as well as the conventional Breslow measurement.

Angioleiomyoma of the Sinonasal Tract: A Systematic Review of an Uncommon Clinicopathological Entity

Abstract Introduction Angioleiomyoma is a rare neoplasm that represents ∼ 0.2 % of all head and neck benign tumors and ∼ 2% of total cases of tumors of the sinonasal tract. It was once considered a possible subtype of leiomyoma, but, in the 2020 World Health Organization (WHO) classification of soft tissue tumors, it is accepted as a singular entity. Objective To systematically review the existing literature on angioleiomyoma in the light of the new classification of soft tissue tumors. Data Synthesis The present study was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A comprehensive search in the PubMed, Cochrane, Scopus, and Google Scholar databases was performed in January 2022. The search items included the following keywords: nasal angioleiomyoma OR sinonasal angioleiomyoma OR nasal vascular leiomyoma OR sinonasal vascular leiomyoma. A total of 87 patients were evaluated. He age of the patients in the studies ranged from 15 to 88 years (mean age at diagnosis: 55.6 years). The most common site of involvement was the nasal septum (28.4 %), followed by the inferior turbinate (22.5%). The most common symptom was nasal obstruction (66.7%), followed by epistaxis (47.1%). Surgical excision represented the main treatment, and there was recurrence of pathology in only 1 case (0.9%). Conclusion To our knowledge, only 87 cases of sinonasal-tract angioleiomyoma have been previously described. The results of the present review seem to confirm the rarity and the benign nature of this neoplasm, and they seem to confirm the necessity to improve the available data about sinonasal-tract angioleiomyoma.

Predictors of recurrence in breast cancer patients with pathological partial response

SUMMARY OBJECTIVE: Patients with residual disease after neoadjuvant chemotherapy have a relative risk of developing recurrence. This study investigates the risk factors for recurrence in locally advanced breast cancer patients with residual disease and evaluates survival analysis. METHODS: This is a retrospective, single-center study. Breast cancer patients who failed to achieve a pathological complete response after neoadjuvant chemotherapy were included. Demographic, clinicopathological, and treatment characteristics were evaluated to identify predictive factors of recurrence and survival analysis. RESULTS: We included 205 patients in this study. After a median of 31 months of follow-up, 10 patients died, and 20 developed distant metastasis. Disease-free survival and disease-specific survival were 73.8% and 83.1%, respectively. Lymphovascular invasion and non-luminal subtype were independent predictors of locoregional recurrence. In situ carcinoma, lymphovascular invasion, ypTIII stage, and non-luminal molecular subtypes were independent predictors of disease-free survival. The only independent factor affecting disease-specific survival was cNII-III. The number of involved lymph nodes was an independent predictor of disease-free survival in patients without complete axillary response. CONCLUSION: Factors affecting disease-specific survival and disease-free survival were cNII-III and the number of involved lymph nodes, respectively. Patients with non-luminal, large residual tumors with in situ carcinoma, lymphovascular invasion, clinically positive axilla, and residual nodal involvement have a high relative risk for recurrence and may benefit from additional treatments.

Translation and Cross-cultural Adaptation of the SOSG-OQ 2.0 Questionnaire into Brazilian Portuguese / Tradução e adaptação transcultural do questionário SOSG-OQ 2.0 para o português brasileiro

Abstract Objective: To perform the cross-cultural adaptation and translation into Brazilian Portuguese of the Spine Oncology Study Group - Outcomes Questionnaire 2.0 (SOSG-OQ 2.0) to enable its application to Brazilian patients and to allow Brazilian researchers to use a questionnaire that is on trend in the scientific literature. Materials and Methods: The present is a basic, non-randomized, non-comparative study. The translation followed the proposal by Reichenheime and Moraes, mainly for the semantic equivalence and measurement equivalence sessions, as well as the recommendations by Coster and Mancini mainly in the translation stage. The stages were as follows: first - translation into Brazilian Portuguese; second - back-translation; third - semantic comparison; fourth - validation of the final construct. Results: The translations of the SOSG-OQ 2.0 made by three translators presented a high degree of similarity for most questions. The translators kept all question titles and subtitles, as well as their internal and external orders. Two sworn translators, with native proficiency in English, performed the back-translation of the amalgamated text. Both back-translations were quite similar, and any differences were solved through consensus between the main author and the sworn translators, and the translated text was considered the final version. Conclusion: The present study shows a translated version of the SOSG-OQ 2.0 with semantic validity with the original version published in English. As such, researchers can apply the questionnaire to the Brazilian population, adding another tool for spine surgeons to improve the monitoring of this complex group of patients.

Resumo Objetivo: Realizar a adaptação transcultural e a tradução para o português brasileiro da versão 2.0 do Questionário de Desfechos do Spine Oncology Study Group (Spine Oncology Study Group - Outcomes Questionnaire 2.0, SOSG-OQ 2.0, em inglês) para viabilizar sua aplicação em pacientes brasileiros e permitir a utilização deste questionário que está em voga na literatura científica por pesquisadores brasileiros. Materiais e Métodos: Trata-se de uma pesquisa básica, não randomizada, não comparativa. As etapas de tradução foram realizadas conforme propostas por Reichenheime e Moraes, principalmente as sessões de equivalência semântica e equivalência de mensuração, e também foram seguidas as recomendações de Coster e Mancini, principalmente na etapa de tradução. As etapas foram as seguintes: primeira - tradução do questionário para o português brasileiro; segunda - retroversão; terceira - comparação semântica; e quarta - validação final do constructo. Resultados: As traduções do SOSG-OQ 2.0 feitas por três tradutores apresentaram grande similaridade na maioria das questões. Todos os títulos e subtítulos de perguntas foram mantidos pelos tradutores, assim como as ordens interna e externa das perguntas. A retroversão da tradução conciliada foi realizada por dois tradutores juramentados, com fluência nativa na língua inglesa. Ambas as retroversões foram bastante similares, as divergências foram sanadas por consenso entre o autor principal e os tradutores juramentados, e a versão traduzida foi considerada a versão final. Conclusão: Neste estudo, apresenta-se uma versão traduzida do SOSG-OQ 2.0 que tem validade semântica com a versão original publicada em inglês, o que permite a sua aplicação na população brasileira, e acrescenta mais uma ferramenta para que os cirurgiões de coluna possam acompanhar de forma melhor este complexo grupo de pacientes.

Malignant phyllodes tumor of the breast in ayoung patient ­ case report

Phyllodes tumor (PT) is an uncommon form of breast tumor. It occurs most commonly in women aged 35 to 65 years. The benign form represents about 85­90% of cases and only 10­15% of PTs are malignant. Clinically and radiologically, malignant phyllodes tumor (MPT) presents as regular, well-delimited, mobile nodules that are difficult to distinguish from fibroadenomas of the breast. The most important differential diagnoses of MPT include fibroadenoma, metaplastic carcinoma, and sarcoma. The prognosis of MPT exhibits a higher frequency of local recurrence and metastatic rate with larger tumors and inadequate surgical margins. The case presented here refers to a 24-year-old female patient, with a vast tumor in the right breast, with rapid and progressive growth, associated to local pain, and histological diagnosis of MPT. Surgery was the initial treatment, followed by adjuvant chemotherapy and radiotherapy. The purpose of this article was to report an atypical case of MPT of the breast in a very young woman as well as to make a brief literature review on this infrequent and dangerous disease. (AU)

Research advances in second-line therapies for hepatocellular carcinoma after resistance to targeted therapy combined with immunotherapy / 临床肝胆病杂志

In recent years， clinical studies on targeted therapy and immunotherapy for advanced hepatocellular carcinoma used alone or in combination have provided abundant evidence on efficacy and safety for the selection of first-line therapies. However， no consensus has been reached on the selection of second-line therapies in various clinical guidelines for hepatocellular carcinoma， which is caused by the fact that existing evidence is limited to the options after failure of sorafenib and that there is still a lack of high-level evidence for new first-line therapies such as second-line therapies after resistance to targeted therapy and immunotherapy for hepatocellular carcinoma. This article reviews the results of current clinical trials and summarizes the studies on second-line therapies for hepatocellular carcinoma after resistance to first-line targeted therapy and immunotherapy for hepatocellular carcinoma based on the different mechanisms of action of drugs， as well as the research advances in recent years. For hepatocellular carcinoma patients with resistance to first-line targeted therapy and immunotherapy， targeted combination therapy and dual-immune therapy are expected to improve treatment outcome and survival， and more prospective clinical studies are needed in the future to provide effective and safe treatment regimens for hepatocellular carcinoma patients with resistance to targeted therapy and immunotherapy.

Proteomic analysis and validation of DNA repair regulation in the process of hepatocellular carcinoma recurrence / 临床肝胆病杂志

ObjectiveTo investigate the role and mechanism of DNA repair regulation in the process of hepatocellular carcinoma （HCC） recurrence. MethodsHCC tissue samples were collected from the patients with recurrence within two years or the patients with a good prognosis after 5 years， and the Tandem Mass Tag-labeled quantification proteomic study was used to analyze the differentially expressed proteins enriched in the four pathways of DNA replication， mismatch repair， base excision repair， and nucleotide excision repair， and the regulatory pathways and targets that play a key role in the process of HCC recurrence were analyzed to predict the possible regulatory mechanisms. The independent samples t-test was used for comparison of continuous data between two groups； a one-way analysis of variance was used for comparison between multiple groups， and the least significant difference t-test was used for further comparison between two groups. ResultsFor the eukaryotic replication complex pathway， there were significant reductions in the protein expression levels of MCM2 （P=0.018）， MCM3 （P=0.047）， MCM4 （P=0.014）， MCM5 （P=0.008）， MCM6 （P=0.006）， MCM7 （P=0.007）， PCNA （P=0.019）， RFC4 （P=0.002）， RFC5 （P<0.001）， and LIG1 （P=0.042）； for the nucleotide excision repair pathway， there were significant reductions in the protein expression levels of PCNA （P=0.019）， RFC4 （P=0.002）， RFC5 （P<0.001）， and LIG1 （P=0.042）； for the base excision repair pathway， there were significant reductions in the protein expression levels of PCNA （P=0.019） and LIG1 （P=0.042） in the HCC recurrence group； for the mismatch repair pathway， there were significant reductions in the protein expression levels of MSH2 （P=0.026）， MSH6 （P=0.006）， RFC4 （P=0.002）， RFC5 （P<0.001）， PCNA （P=0.019）， and LIG1 （P=0.042） in recurrent HCC tissue. The differentially expressed proteins were involved in the important components of MCM complex， DNA polymerase complex， ligase LIG1， long patch base shear repair complex （long patch BER）， and DNA mismatch repair protein complex. The clinical sample validation analysis of important differentially expressed proteins regulated by DNA repair showed that except for MCM6 with a trend of reduction， the recurrence group also had significant reductions in the relative protein expression levels of MCM5 （P=0.008）， MCM7 （P=0.007）， RCF4 （P=0.002）， RCF5 （P<0.001）， and MSH6 （P=0.006）. ConclusionThere are significant reductions or deletions of multiple complex protein components in the process of DNA repair during HCC recurrence.

Value of a nomogram model in early recurrence of pancreatic ductal adenocarcinoma after laparoscopic pancreaticoduodenectomy / 临床肝胆病杂志

ObjectiveTo investigate the risk factors for early tumor recurrence after laparoscopic pancreaticoduodenectomy （LPD） in patients with pancreatic ductal adenocarcinoma （PDAC）， and to establish a predictive model. MethodsA retrospective analysis was performed for the clinical data of 240 PDAC patients who underwent LPD in The First Hospital of Jilin University from April 2016 to July 2022， with early postoperative tumor recurrence （time to recurrence ≤12 months） as the study outcome. The patients were randomly divided into training group with 168 patients and validation group with 72 patients at a ratio of 7∶3. In the training group， there were 70 patients （41.67%） with early postoperative recurrence and 98 （58.33%） without early recurrence， and in the validation group， there were 32 （44.44%） with early postoperative recurrence and 40 （55.56%） without early recurrence. The chi-square test or the Fisher’s exact test was used for comparison of categorical data between groups； a logistic regression analysis was used to investigate the risk factors for early postoperative recurrence； the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to evaluate the discriminatory ability of the model， with AUC>0.75 indicating that the model had adequate discriminatory ability. The Bootstrap resampling method was used for validation after 1 000 times of random sampling， and the model was validated again in the validation group. The calibration curve and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the degree of calibration， and the decision curve analysis was used to evaluate clinical practicability. ResultsThe univariate and multivariate analyses showed that preoperative CA19-9 level≥37 U/mL （odds ratio ［OR］=6.265， 95% confidence interval ［CI］： 1.938‍ ‍—‍ ‍20.249， P<0.05）， maximum tumor diameter >3 cm （OR=10.878， 95%CI： 4.090‍ ‍—‍ ‍28.932， P<0.05）， poor tumor differentiation （OR=3.679， 95%CI： 1.435‍ ‍—‍ ‍9.433， P<0.05）， lymph node metastasis （OR=0.209， 95%CI： 0.080‍ ‍—‍ ‍0.551， P<0.05）， and absence of adjuvant chemotherapy after surgery （OR=0.167， 95%CI： 0.058‍ ‍—‍ ‍0.480， P<0.05）. A nomogram model was constructed based on these factors； the ROC curve analysis showed that the model had an AUC of 0.895 （95%CI： 0.846‍ ‍—‍ ‍0.943， P<0.001）， and the calibration curve and the Hosmer-Lemeshow test showed that the model had a good degree of calibration （P=0.173）. The decision curve analysis showed that the nomogram had a good clinical application value. ConclusionPreoperative CA19-9 level ≥37 U/mL， maximum tumor diameter >3 cm， poor tumor differentiation， lymph node metastasis， and absence of adjuvant chemotherapy after surgery are independent risk factors for the early recurrence of PDAC after LPD， and the nomogram model established based on these factors can effectively predict early postoperative recurrence.

Bilateral choroidal metastasis of follicular thyroid carcinoma 7 years after total thyroidectomy: a case report

ABSTRACT Follicular thyroid cancers account for 15%-20% of all thyroid tumors. Choroidal metastases secondary to follicular thyroid cancer rarely occur. Herein, we report the case of an 85-year-old woman who presented choroidal metastasis from a follicular thyroid carcinoma in the right eye 7 years after total thyroidectomy and underwent enucleation. To confirm the diagnosis and primary tumor site, histopathological, and immunohistochemical examinations were performed. One year later, she presented metastasis in the contralateral eye. Few similar cases have been described in the literature.