Papel da imagem na indicação da eletroporação irreversível no manejo terapêutico do adenocarcinoma de pâncreas / Role of imaging in the applicability of irreversible electroporation for the management of pancreatic adenocarcinoma

Resumo O adenocarcinoma ductal de pâncreas é uma das neoplasias malignas mais agressivas, com taxas de sobrevivência anuais inferiores a 20%. Os métodos axiais (tomografia computadorizada e ressonância magnética) têm papel fundamental no diagnóstico e estadiamento da doença, por fornecerem adequada resolução anatômica na avaliação de estruturas-chave, principalmente vasculares. O adenocarcinoma ductal de pâncreas é frequentemente descoberto em estágios avançados e sem viabilidade de ressecção cirúrgica, e nesse cenário o desenvolvimento de alternativas terapêuticas minimamente invasivas tem sido ainda mais importante para a mudança de sua história natural. A eletroporação irreversível, procedimento intervencionista que minimiza efeitos deletérios nos tecidos adjacentes, vem se destacando no tratamento de lesões tradicionalmente consideradas irressecáveis. Essa técnica, apesar de ganhar cada vez mais espaço no manejo terapêutico do adenocarcinoma ductal de pâncreas, ainda é pouco familiar aos radiologistas. Neste estudo, buscamos expor, de forma sucinta e didática, os fundamentos da técnica, as principais características de imagem e os critérios de elegibilidade que devem ser considerados para indicação da eletroporação irreversível nessa doença.

Abstract Pancreatic ductal adenocarcinoma is one of the most aggressive malignant neoplasms, with a one-year survival rate below 20%. Axial methods (computed tomography and magnetic resonance imaging) play a fundamental role in the diagnosis and staging of the disease, because they provide adequate anatomical resolution in the assessment of key structures, mainly vascular structures. Pancreatic ductal adenocarcinoma is most often discovered in advanced stages, when surgical resection is no longer feasible. In that scenario, minimally invasive treatment alternatives have been developed in attempts to change the natural history of the disease. Irreversible electroporation, an interventional procedure that minimizes deleterious effects on adjacent tissues, has proven useful for the treatment of tumors traditionally considered unresectable. Despite the growing acknowledgment of this technique as a tool for the management of pancreatic ductal adenocarcinoma, it is still relatively unknown among radiologists. In this study, we sought to provide an overview of the main characteristics and eligibility criteria that must be considered for the indication of irreversible electroporation in cases of pancreatic ductal adenocarcinoma.

Lesiones metastásicas a glándula tiroides. Una serie de casos / Metastatic lesions to the thyroid gland. Case series

Las lesiones metastásicas representan hasta un 3 % de los tumores malignos de la glándula tiroides. La mayoría de los casos se originan de tumores de células renales y de pulmón. El abordaje diagnóstico implica una alta sospecha clínica en pacientes con primarios conocidos, sin embargo, puede ser la manifestación inicial de una enfermedad maligna extensa no diagnosticada hasta en un 20 % a 40 % de los pacientes. La biopsia por aguja fina ha demostrado buen rendimiento para el diagnóstico de los nódulos metastásicos. El pronóstico y la opción del tratamiento quirúrgico dependen del control local del primario y del estado de la enfermedad sistémica asociada, por lo tanto, debe ser individualizado. Por lo general, hasta un 80 % de los pacientes con compromiso de la tiroides tienen enfermedad metastásica multiorgánica, y la intención del tratamiento quirúrgico es con fines paliativos para prevenir las complicaciones derivadas de la extensión local de la enfermedad a las estructuras del tracto aerodigestivo superior en el cuello. Se presenta a continuación, una serie de seis casos de pacientes con lesiones metastásicas a glándula tiroides con primarios en riñón, mama y de melanomas

Metastatic lesions represent up to 3% of malignant tumors of the thyroid gland. Most cases originate from lung and renal cell tumors. The diagnostic approach implies a high clinical suspicion in patients with known primaries, however, it can be the initial manifestation of an extensive undiagnosed malignant disease in up to 20% to 40% of patients. Fine-needle biopsy has shown good performance for the diagnosis of metastatic nodules. The prognosis and the option of surgical treatment depend on the local control of the primary condition and the state of the associated systemic disease, therefore it must be individualized. In general, up to 80% of patients with thyroid involvement have multi-organ metastatic disease and surgical treatment is intended to be palliative to prevent complications resulting from local extension of the disease to structures of the upper aerodigestive tract in the neck. A case series of six patients with metastatic lesions to the thyroid gland with primaries in the kidney, breast and melanomas is presented below

Carcinoma Intraductal de Glándula Parótida. Reporte de un Caso en Chile

El carcinoma intraductal es una neoplasia maligna de glándulas salivales infrecuente, la cual se caracteriza por un crecimiento predominantemente intraductal, cuyas células poseen un fenotipo con características ductales. Histológicamente se encuentra compuesto por múltiples estructuras quísticas, con arquitectura cribiforme y proliferación celular con fenestraciones flexibles y una apariencia reticular irregular. Se presenta el caso de una paciente, género femenino, de 67 años, con antecedentes de artritis reumatoidea y una neoplasia intraepitelial tratada (NIE I), que consulta en el policlínico de cirugía del Hospital Regional Antofagasta en el año 2017 por aumento de volumen de consistencia firme, en área de glándula parótida izquierda, de aproximadamente un año de evolución, con dolor de intensidad moderada. Mediante pruebas inmunohistoquímicas se logra confirmar el diagnóstico de carcinoma intraductal de parótida.

Intraductal carcinoma is a rare malignant neoplasm of the salivary glands characterized by predominantly intraductal growth, isolated cells a phenotype with ductal characteristics. Histologically, it is composed of multiple cystic structures, with cribiform architecture and cell proliferation which can present floppy fenestrations and an irregular slits appearance. We present the case of a 67-year- old female patient with a history of rheumatoid arthritis and a treated intraepithelial neoplasm (NIE I), who consulted at the surgery polyclinic of the Hospital Regional Antofagasta in 2017 for increased volume of firm consistency, in the left parotid gland area, approximately one year in evolution, with pain of moderate intensity. Immunohistochemical tests confirm the diagnosis of intraductal parotid carcinoma.

Nipple-sparing Mastectomy with Immediate Implant-based Reconstruction for Patients with Pure Ductal Carcinoma in Situ / Mastectomia preservadora demamilo com reconstrução imediata baseada em implante para pacientes com carcinoma ductal puro in situ

Abstract Objective The presence of an extensive intraductal component is associated to an increasing risk of relapse in the nipple-areola complex. The aim of the present study was to evaluate the outcomes of patients diagnosed with ductal carcinoma in situ (DCIS) who underwent nipple-sparing mastectomy (NSM) with immediate breast reconstruction using silicone implants. Methods We retrospectively analyzed the postoperative complications and oncological safety of 67 breast cancer patients diagnosed with pure DCIS who underwent NSM with immediate breast reconstruction using silicone implants between 2004 and 2018. Results Among the 127 NSM procedures performed, 2 hematomas (1.5%) and 1 partial nipple necrosis (0.7%) were observed. After a mean follow-up of 60months, the local recurrence rate was of 8.9%, the disease-free survival rate was of 90%, and 1 of the patients died. Conclusion Despite the local recurrence rate, we showed that NSM with immediate breast reconstruction using silicone implants is a feasible surgical approach, with a low rate of complications and high survival rates for patients with a diagnosis of pure DCIS when breast-conserving surgery is not an option.

Resumo Objetivo A presença de componente intraductal extenso é associada ao risco aumentado de recorrência no complexo aréolo-mamilar. O objetivo deste estudo foi avaliar os resultados de pacientes diagnosticados com carcinoma ductal in situ (CDIS)submetidas a adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) com reconstrução mamária imediata utilizando prótese de silicone. Métodos Restrospectivamente, foramanalisadas as complicações pós-operatórias e a segurança oncológica de 67 pacientes com câncer de mama diagnosticadas com CDIS puro, e submetidas a NSM com reconstrução mamária imediata utilizando prótese de silicone, entre 2004 e 2018. Resultados Entre os 127 procedimentos realizados, 2 hematomas (1,5%) e 1 necrose parcial de mamilo (0,7%) foram observados. Após um período médio de 60 meses de seguimento, a taxa de recorrência local foi de 8,9%, a sobrevida livre de doença, de 90%, e apenas 1 paciente foi a óbito. Conclusão Apesar da taxa de recorrência local, demostrou-se que NSM com reconstrução mamária imediata comprótese de silicone é umprocedimento viável, combaixa taxa de complicação e alta sobrevida para pacientes com diagnóstico de CDIS puro quando a cirurgia conservadora da mama não é uma opção.

HistoBCAD: herramienta de código abierto para detección de cáncer de mama en imágenes histopatológicas

RESUMEN Fundamento: la detección y clasificación precisa del cáncer de mama mediante el diagnóstico histopatológico es de vital importancia para el tratamiento efectivo de la enfermedad. Entre los tipos de cáncer de mama, el carcinoma ductal invasivo es el más frecuente. El análisis visual de las muestras de tejido en el microscopio es un proceso manual que consume tiempo y depende del observador. Sin embargo, en muchos países, incluido Cuba, es escaso el uso de herramientas software para asistir el diagnóstico. Objetivo: desarrollar una herramienta software para detectar tejido de cáncer de mama, del subtipo carcinoma ductal invasivo, en imágenes histopatológicas. Métodos: la herramienta se implementó en Python e incluye métodos de detección de carcinoma ductal invasivo en imágenes histopatológicas, basados en algoritmos de extracción de características de color y textura en combinación con un clasificador de bosques aleatorios. Resultados: la herramienta de código abierto brinda una serie de facilidades para la lectura, escritura y visualización de imágenes histopatológicas, delineación automática y manual de zonas cancerígenas, gestión de los datos diagnósticos del paciente y evaluación colaborativa a distancia. Fue evaluada en una base de datos con 162 imágenes de pacientes diagnosticados con carcinoma ductal invasivo y se obtuvo una exactitud balanceada de 84 % y factor F1 de 75 %. Conclusiones: la herramienta permitió un análisis interactivo, rápido, reproducible y colaborativo mediante una interfaz gráfica sencilla e intuitiva. En versiones futuras se prevé incluir nuevos métodos de aprendizaje automático incremental para el análisis de imágenes histopatológicas digitales.

ABSTRACT Background: the accurate detection and classification of breast cancer through histopathological diagnosis is of vital importance for the effective treatment of the disease. Among the types of breast cancer, invasive ductal carcinoma (IDC) is the most common. Visual analysis of tissue samples under the microscope is a manual, time-consuming and observer-dependent process. However, in many countries, including Cuba, the use of software tools to assist diagnosis is scarce. Objective: to develop a software tool to detect IDC subtype breast cancer tissue in histopathological images. Methods: the tool is implemented in Python and includes IDC detection methods in histopathological images, based on algorithms for extraction of color and texture features in combination with a random forest classifier. Results: the open source tool provides a series of facilities for the reading, writing and visualization of histopathological images, automatic and manual delineation of cancer areas, management of patient diagnostic data and collaborative remote evaluation. It was evaluated in a database with 162 images of patients diagnosed with IDC, obtaining a balanced accuracy of 84 % and a F1 factor of 75 %. Conclusions: the tool allowed an interactive, fast, reproducible, precise and collaborative analysis through a simple and intuitive graphical interface. Future versions are expected to include new incremental machine learning methods for the analysis of digital histopathology images.

Correlación ecográfica, mamográfica e histopatológica en el diagnóstico de cáncer de mama en Guantánamo, 2010-2015

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.

Analysis of clinicopathological features and survival results in secretory breast carcinoma and invasive ductal carcinoma of breast based on SEER database / 中国医师杂志

Objective:To analyze the differences of clinicopathological features and prognosis between secretory breast carcinoma (SBC) and invasive ductal carcinoma (IDC), and to explore the influence of SBC on the prognosis of breast cancer.Methods:We retrieved data of patients diagnosed with SBC and IDC from The National Cancer Institute′s Surveillance, Epidemiology, and End Results (SEER) database between 1990 and 2016. 109 cases of SBC (SBC group) and 558 814 cases of IDC (IDC group) were collected. The clinicopathological features were compared between SBC and IDC groups. The tendency score matching method was used to match the balance confounding factors according to 1∶4 proportion. The breast cancer-specific survival time (BCSS) and overall survival time (OS) of the two histological types of breast cancer before and after matching were analyzed. The survival curve was drawn using the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate Cox regression analysis was used to determine the independent prognostic factors of breast cancer.Results:There were significant difference in diagnostic age, marital status, sex, histological grade, American Joint Committee on Cancer (AJCC) N stage, estrogen receptor (ER) and progesterone receptor (PR) expression between SBC and IDC group (all P<0.05). The BCSS of SBC group was similar to IDC group, and OS was better than IDC ( P<0.05). Univariate and multivariate regression analysis showed that diagnostic age, race, marriage, sex, location, histological grade, AJCC stage, treatment mode and ER, PR expression were all related factors affecting BCSS and OS (all P<0.05). SBC was an independent prognostic factor for OS ( P<0.05). After propensity score matching according to 1∶4, there was no significant difference in BCSS and OS between the two groups ( P<0.05). Cox regression analysis showed that AJCC T stage and PR negative expression were the influencing factors of BCSS (all P<0.05), and diagnostic age and AJCC T stage were the influencing factors of OS (all P<0.05). SBC was no longer an influencing factor of OS in breast cancer. Conclusions:There was no significant difference in prognosis between SBC and IDC. SBC was not an independent risk factor for breast cancer.

A study on the prediction of prognosis of ductal carcinoma in situ at different pathological stages based on deep learning mammography combined with natural language processing / 中华放射学杂志

Objective:To establish the predictive models for the prognosis of ductal carcinoma in situ (DCIS) at different pathological stages, and to evaluate the predictive performance of the models.Methods:Complete data of 273 patients with confirmed DCIS at different pathological stages who underwent mammography examination in Shenzhen People′s Hospital, Peking University Shenzhen Hospital and Shenzhen Luohu People′s Hospital from November 2014 to December 2020 were retrospectively collected, including 110 cases in the DCIS+ductal carcinoma in situ with microinvasion (DCIS-MI) group and 163 cases in the invasive ductal carcinoma (IDC)-DCIS group. The clinical, imaging and pathological features were analyzed. Mammary Mammo AI fusion model and deep learning-based natural language processing (NLP) structured diagnostic report model were used for image feature extraction. Patients in each group were randomly divided into training set and validation set with a ratio of 6∶4, and the predictors were screened by univariate and multivariate logistic regression analysis. The lowest Akaike information criterion value of each group was selected to construct the final predictive model. The receiver operating characteristic (ROC) curve was drawn to evaluate the performance of each model.Results:Taking estrogen receptor (-) or human epidermal growth factor receptor 2 (3+) as the poor prognostic reference, there were 62 cases considered with poor prognosis and 48 cases with good prognosis in DCIS+DCIS-MI group; while in the IDC-DCIS group, taking the Nottingham prognostic index as the reference, 33 cases were considered with poor prognosis, 73 cases with moderate prognosis, and 57 cases with good prognosis. Four predictive factors were screened to construct the DCIS+DCIS-MI-group predictive model, including DCIS nuclear grade, calcification with suspicious morphology in mammography, DCIS pathologic subtype and DCIS with microinvasion. Five predictive factors were screened to construct the IDC-DCIS-group predictive model, including neural or vascular invasion, Ki67 level, DCIS subtype, DCIS component proportion and associated features in mammography. The area under curve (AUC) for predicting poor prognosis of DCIS+DCIS-MI was 0.92 (95%CI 0.84-1.00) in the training set and 0.90 (95%CI 0.82-0.99) in the validation set; while the AUC for predicting poor prognosis of IDC-DCIS was 0.84 (95%CI 0.76-0.93) in the training set and 0.78 (95%CI 0.64-0.91) in the validation set.Conclusion:The developed models based on deep learning combined with NLP can effectively predict the prognosis of DCIS at different pathological stages, which are beneficial to the risk stratification of patients with DCIS, providing a reference for clinical decision.

The prognostic importance of PD-L1, PTEN, PHH3, and KI-67 expressions in invasive breast carcinoma

SUMMARY OBJECTIVE: The aim of this study was to investigate the relationship of PD-L1, PTEN, PHH3, and Ki-67 immunohistochemical stain expressions with prognostic clinicopathological parameters in breast cancer. METHODS: Lumpectomy and mastectomy materials from 85 patients operated at the Department of Pathology, Bolu Abant Izzet Baysal University, Faculty of Medicine between 2014 and 2019 were retrospectively reviewed. PD-L1, PTEN, PHH3, and Ki-67 expressions were examined. Immunohistochemical staining results were compared with clinicopathological parameters and found to be associated with prognosis. RESULTS: A statistically significant correlation was found between PD-L1 and large tumor size, high histological grade, multifocality, and lymphovascular invasion. A statistically significant correlation was found between the loss of PTEN and large tumor size and histological grade. There was a statistically significant correlation between PHH3 and advanced age, large tumor size, and high histological grade. A statistically significant correlation was found between Ki-67 and large tumor size, high histological grade, and lymphovascular invasion. CONCLUSION: PD-L1, PTEN, PHH3, and Ki-67 are regarded as potential biomarkers that can be used to predict the prognosis of breast cancer and to develop targeted therapies.

Existe un rol para la resección quirúrgica en los pacientes con cáncer de páncreas oligometastásicos / There is a role for surgical resection in patients with oligometastatic pancreatic cancer

RESUMEN Objetivo: El objetivo de este trabajo es analizar retrospectivamente la resección en pacientes con adenocarcinoma de páncreas en estadio IV oligometastásicos, luego de quimioterapia de primera línea para cáncer de páncreas metastásico evaluando la sobrevida de estos casos. Materiales y métodos: Entre enero del 2005 hasta diciembre del 2019 se evaluó de manera retrospectiva a 5 pacientes con diagnóstico de cáncer de páncreas oligometastásico sometidos a quimioterapia de primera línea luego de la cual se les efectuó cirugía resectiva. Resultados: La cirugía resectiva realizadas en estos pacientes fueron: Tres pancreatectomias distales con esplenectomía, una duodenopancreatectomia y una pancreatectomia total. Todos recibieron tratamiento con quimioterapia; tres pacientes recibieron tratamiento con Folfurinox, uno recibió 5 fluoruracilo y otro recibió gemcitabina más capecitabina. Los pacientes recibieron en promedio 4 meses de quimioterapia (3-6 meses) y luego de estos se programó la cirugía resectiva. La sobrevida media en estos pacientes fue de 23 meses (11 a 39 meses), solamente un paciente presento recidiva de la enfermedad y falleció a los 28 meses, los 4 restantes se encuentran vivos. Conclusión: La cirugía resectiva en pacientes con estadio IV con cáncer de páncreas se puede hacer de forma segura. Esta se podría considerar en pacientes seleccionados con una buena respuesta radiológica y bioquímica luego de un periodo adecuado de quimioterapia en los cuales no exista enfermedad a distancia evidente.

ABSTRACT Objective: The objective of this work is to retrospectively analyze the resection in patients with oligometastatic stage IV pancreatic adenocarcinoma, after first-line chemotherapy for metastatic pancreatic cancer, evaluating the survival of these cases. Materials and methods: Between January 2005 and December 2019, 5 patients diagnosed with oligometastatic pancreatic cancer undergoing first-line chemotherapy were retrospectively evaluated, after which resective surgery was performed. Results: The resective surgery performed in these patients were: three distal pancreatectomies with splenectomy, one duodenopancreatectomy and one total pancreatectomy. All received chemotherapy treatment; three patients received treatment with Folfurinox, one received 5-fluorouracil, and one received gemcitabine plus capecitabine. The patients received an average of 4 months of chemotherapy (3-6 months) and after this, resective surgery was scheduled. The average survival in these patients was 23 months (11 to 39 months), only one patient presented recurrence of the disease and died at 28 months, the remaining 4 are alive. Conclusion: Resective surgery in patients with stage IV pancreatic cancer can be done safely. This could be considered in selected patients with a good radiological and biochemical response after an adequate period of chemotherapy in whom there is no obvious distant disease.

Características clínico-patológicas del cáncer de mama:un estudio de 1,840 pacientes / Clinicopathological characteristics of breast cancer: a study of 1,840 patients

Resumen Objetivo: Reportar las características clínico-patológicas de mujeres diagnosticadas con cáncer de mama (Cama) que fueron atendidas en el Instituto Jalisciense de Cancerología (IJC), localizado en Guadalajara, Jalisco, durante el quinquenio 2013-2017. Materiales y métodos: Diseño transversal y analítico, cuya fuente de datos fueron los expedientes clínicos y el registro electrónico del IJC. Se incluyeron y analizaron los siguientes datos de mujeres con diagnóstico confirmado de Cama: edad, grado y variedad histológica, estadio clínico reportado por las categorías in situ (0), temprano (I-IIA), localmente avanzado (IIB-IIIC) y metástasis (IV), así como estatus de los receptores hormonales. Las mujeres fueron clasificadas en dos grupos de edad: <40 e ≥40 años, con la finalidad de comparar las características clínico-patológicas mediante pruebas estadísticas. Se presenta análisis descriptivo de los datos. Resultados: Se recolectaron y analizaron datos relacionados a 1,840 diagnósticos de Cama; la edad promedio de las mujeres al momento del diagnóstico fue 53.2 años. Las características clínico-patológicas de mayor frecuencia fueron: localmente avanzado (53.1%), ductal (88.9%), moderadamente diferenciado (60.1%) y Luminal A (31.6%); mientras que el 15% de los casos reportó la clasificación triple negativo, principalmente mujeres <40 años (21.3%). Salvo la variedad histológica (p <0.05), no se encontraron diferencias significativas entre ambos grupos de edad respecto a las características clínico-patológicas analizadas. Conclusiones: En México, raramente han sido reportadas las características clínico- patológicas del Cama en mujeres, cuya importancia radica en el manejo clínico y la toma de decisiones respecto a los diversos tratamientos terapéuticos. Por tanto, la evidencia presentada permitió reconocer cuál es el perfil clínico-patológico de las mujeres que buscaron atención oncológica en el IJC durante el quinquenio 2013-2017; además, puede justificar el diseño de otros estudios epidemiológicos para evaluar la repercusión en la recurrencia del Cama y las posibilidades de supervivencia de las mujeres.

Abstract Objective: To report the clinicopathological characteristics of breast cancer (BC) diagnosed women who were treated at the Instituto Jalisciense de Cancerología (IJC), located in Guadalajara, Jalisco, during 2013-2017. Materials and methods: Cross-sectional and analytical design whose data source was the clinical records and the electronic registry of the IJC. The following data from women with a confirmed BC diagnosis were included and analyzed: age, grade and histological variety, clinical stage reported by in situ (0), early stage (I-IIA), locally advanced (IIB-IIIC) and metastasis (IV) categories, as well as hormone receptor status. The women were classified into two age groups: <40 and ≥40 years, to compare the clinicopathological characteristics through statistical tests. Descriptive analysis of the data is presented. Results: Data related to 1,840 diagnoses of BC were collected and analyzed; the average age of diagnosis was 53.2 years. The most frequent clinicopathological characteristics were: locally advanced (53.1%), ductal (88.9%), moderately differentiated (60.1%) and Luminal A (31.6%); while 15% of the cases reported triple negative classification, mainly <40 years women (21.3%). Except for the histological variety (p <0.05), no significant differences were found between both age groups regarding the clinicopathological characteristics analyzed. Conclusions: In Mexico, clinicopathological characteristics of BC have rarely been reported, which involve important clinical management and decision-making regarding the various therapeutic treatments. Therefore, the evidence presented allowed us to recognize the clinicopathological profile of the women who sought cancer care at the IJC during 2013 2017; in addition, it may justify the design of other epidemiological studies to assess the impact on BC recurrence and the women survival chances.

Periodo intergenésico corto como factor de riesgo para cáncer ductal de la mama en pacientes del norte del Perú

Introducción: El cáncer de mama es el tipo histológico más común y es una causa frecuente de muerte en las mujeres peruanas. Objetivo: Demostrar que el periodo intergenésico corto es un factor de riesgo para cáncer ductal de la mama. Material y Métodos: Estudio de casos y controles que incluyó 304 mujeres peruanas con diagnóstico histológico de carcinoma de mama, las mismas que se dividieron en dos grupos, uno con carcinoma ductal y el otro con carcinoma de tipo no ductal (control). Además del período intergenésico, se evaluaron paridad, edad al primer parto, edad al último parto, edad de diagnóstico histológico, intervalo entre el último parto y el diagnóstico y subtipo molecular. Resultados: La frecuencia de cáncer ductal en pacientes con periodo intergenésico corto fue de 78%. La razón entre la presencia de periodo intergenésico corto versus ausencia de este es 1,86 veces mayor en pacientes con cáncer ductal (IC 95%: 1,12 ­ 3,08). Además, existe asociación significativa con para edad del primer parto ≤ 20 años (p<0,001) e intervalo entre último hijo y diagnóstico > 10 años (p<0,001). Conclusión: El periodo intergenésico corto es un factor de riesgo para cáncer ductal de la mama; que además se puede modificar y utilizar como elemento de prevención, por lo que debería ser incluido en la historia clínica.

Background:Breast cancer is the most common histological type and it is a frequent cause of death in Peruvian women. To demonstrate that Objective:birth interval is a risk factor for ductal breast carcinoma. Material and Methods: This case-control study included 304 Peruvian women with histological diagnosis of breast carcinoma. They were divided into two groups, one with ductal carcinoma and another with non-ductal carcinoma (control). Besides birth interval; parity, age at first delivery, age at last delivery, age at histological diagnosis, interval from last delivery to diagnosis and molecular subtype were also evaluated. The frequency of Ductal breast cancer Results: was 78% in patients with short birth interval. The ratio between presence of short birth interval versus absence of short birth interval is 1.86 times higher in ductal breast cancer patients (CI 95%: 1,12-3,08). Additionally, there was significant association in age at first delivery ≤ 20 years (p<0,001) and interval from last delivery to diagnosis >10 years (p<0,001). short birth Conclusion:interval is a risk factor for ductal breast cancer, which can also be modified and used as a prevention element, so it should be included in the medicalrecord.

Carcinoma ductal in situ associado à fibroadenoma: relato de caso / Carcinoma ductal in situ arising in a fibroadenoma: report of a rare case

Apesar de fibroadenoma ser uma das lesões mais comuns da mama, sua correlação a alteração maligna é rara.1,2,3,5,7 Quando ocorre tem apresentação clínica similar a dos fibroadenomas típicos, diagnóstico anatomopatológico em geral pós-cirúrgico e tratamento conforme do carcinoma do mesmo tipo histológico isolado.1,2,3,4,6 Apresentamos caso de mulher de 52 anos, apresentando em propedêutica investigativa nódulo em mama direita. Core-biopsy sugeriu carcinoma ductal in situ desenvolvido dentro de fibroadenoma, confirmado em análise anatomopatológica pósoperatória. Tratamento e seguimento se deu conforme já estabelecido pela literatura para carcinoma in situ. Devido baixa incidência, há poucas evidências científicas quanto ao diagnóstico, tratamento e prognóstico desse tipo de lesão. Portanto, apresentar à comunidade científica casos de carcinoma inclusos a fibroadenoma se faz relevante.

Although fibroadenoma is one of the most common lesions of the breast, its correlation with malignant changes is rare. When it occurs, the clinical presentation is similar to typical fibroadenomas, anatomopathological diagnosis is after surgery and treatment goes according to the carcinoma histological type. A case of a 52-year-old woman is presented, with an impalpable nodule in the right breast, diagnosed from screening exams. Corebiopsy suggested carcinoma ductal in situ developed within fibroadenoma, confirmed in the postoperative anatomopathological analysis. Treatment and follow-up followed as established in the literature for carcinoma in situ. Due the low incidence, there are poor scientific evidence regarding the diagnosis, treatment and prognosis of this type of injury. Therefore, presenting cases of Carcinoma ductal in situ arising in a fibroadenoma to the scientific community is so relevant.

Clear cell-rich salivary duct carcinoma involving the palate / Carcinoma do ducto salivar rico em células claras envolvendo o palato

ABSTRACT Salivary duct carcinoma (SDC) is a rare and aggressive neoplasm arising from salivary glands. SDC occurs most frequently in major salivary glands, with isolated cases arising from the minor salivary glands. The occurrence of clear cells in salivary gland tumors is uncommon and is rarer in SDC cases. We report the case of a 51-year-old male diagnosed with a clear cell variant of SDC in the minor salivary gland, involving the left hard palate. Immunohistochemical analysis revealed positivity for HER2/neu and GATA-3. The patient was submitted to radical surgical excision, neck dissection, and radiotherapy. Unfortunately, he died 14 months after the cancer diagnosis.

RESUMEN El carcinoma ductal de las glándulas salivales (CDS) es un tumor raro y agresivo que surge de las glándulas salivales. El CDS ocurre con mayor frecuencia en las glándulas salivales mayores, sin embargo, existen casos aislados de afectación en las glándulas salivales menores. La aparición de células claras en los tumores de las glándulas salivales es infrecuente y más rara en los casos de CDS. Presentamos el caso de un varón de 51 años al que se le diagnosticó la variante de células claras del CDS en la glándula salival menor, que afecta al paladar duro izquierdo. El análisis inmunohistoquímica reveló positividad para HER2/neu y GATA-3. El paciente fue sometido a escisión local quirúrgica radical, disección del cuello y la radioterapia. Desafortunadamente, murió 14 meses después del diagnóstico de cáncer.

RESUMO O carcinoma do ducto salivar (CDS) é um tumor raro e agressivo que se origina nas glândulas salivares. O CDS ocorre mais frequentemente nas glândulas salivares maiores, porém, há casos isolados de acometimento nas glândulas salivares menores. A ocorrência de células claras em tumores de glândulas salivares é incomum, sendo ainda mais rara nos casos de CDS. Relatamos o caso de um homem de 51 anos de idade que foi diagnosticado com a variante de células claras de CDS em glândula salivar menor, envolvendo o palato duro do lado esquerdo. A análise imuno-histoquímica revelou positividade para HER2/neu, GATA-3. O paciente foi submetido a excisão cirúrgica radical, esvaziamento cervical e radioterapia. Entretanto, ele faleceu 14 meses após o diagnóstico do câncer.

Metaplastic breast carcinoma with extensive osseous differentiation

Metaplastic breast carcinoma is a rare subtype of invasive breast carcinoma. Metaplastic carcinoma with osseous differentiation is exceptionally uncommon. Because of the heterogenous microscopy of the lesion, various clinical and radiological features are observed, leading to diagnostic difficulty. Herein, we present a case of a 43-year-old female with a recurrent breast lump, who was clinically diagnosed as a phyllodes tumor. However, histopathological examination revealed metaplastic carcinoma with extensive osseous differentiation.

Análisis comparativo del Carcinoma Lobulillar Invasor versus Carcinoma Ductal Invasor: ¿entidades clínica o biológicamente diferentes? / Comparative analysis of Invasive Lobular Carcinoma versus Invasive Ductal Carcinoma: clinically or biologically different entities?

Introducción El Carcinoma Lobulillar Invasor (cli) es el tipo histológico especial más común del cáncer de mama. Presenta características histopatológicas asociadas a buen pronóstico, pero algunos estudios sugieren que los resultados a largo plazo pueden ser peores que los del Carcinoma Ductal Invasor (cdi). Objetivo Los objetivos principales del estudio fueron evaluar las características clínico-patológicas del cli y establecer el valor pronóstico. Material y método Se seleccionaron 244 pacientes con cli y se utilizó como grupo control a 524 pacientes con cdi, comparándolas con relación 2 a 1. Resultados No se observaron diferencias en edad, estado menopáusico, motivo de consulta e invasión linfovascular. Fueron más frecuentemente multifocales, multicéntricos, de mayor tamaño, bajo grado histológico y her2 negativo. La cirugía conservadora se realizó con menos frecuencia. No hubo diferencias significativas en recaída a distancia, cáncer de mama contralateral, sobrevida libre de enfermedad y global. Conclusiones Las pacientes con cli no tuvieron mejores resultados a pesar de un fenotipo biológico más favorable. La histología ductal o lobulillar no debería ser un factor en el manejo de la patología, y no debería considerarse un factor pronóstico o predictivo determinante al momento del diagnóstico

Introduction Invasive Lobular Carcinoma (ilc) is the second most common histologic type of breast cancer. Typically, displays features associated with a good prognosis, but some studies suggest that outcomes of ilc may be worse than for Invasive Ductal Carcinoma (idc). Objective The main purpose of this study was to evaluate the clinical-pathological characteristics of Lobular Breast Carcinoma and establish his prognostic value. Materials and method We selected a group of 244 patients with ilc and compared with 524 patients whit idc in relation 2:1. Results There were no differences in age, menopausal status, symptoms at time of diagnosis, and lymph vascular invasion. ilc were larger, low histological grade and her2 negative, more often mulfifocal and multicentric. Breast-preservation therapy was less frequent for Invasive Lobular Carcinoma. Distant relapse, contralateral cancer, overall survival, disease-free survival, did not differ between idc and ilc. Conclusions Women with ilc do not have better clinical outcomes than patients with idc, despite the fact that the biologic phenotype of ilc is quite favorable. The ductal or lobular histology should not be a factor in the therapeutic decision-making process, and should not be considered an important prognostic or predictive factor at diagnosis

Diagnostic value of high-frequency ultrasonography for Paget disease of breast / 中国介入影像与治疗学

Objective: To investigate the diagnostic value of high-frequency ultrasound for Paget disease of breast (PDB). Methods :High-frequency ultrasound data of 30 patients with pathology approved PDB were retrospectively analyzed, including 13 cases complicated with invasive ductal carcinoma (IDC). Ultrasonic appearances of PDB with or without IDC were compared. Results: Ultrasonic features of PDB included hypo-echogenicity in nipple, thicken areola skin, mammary nodules, calcification, dilated duct and enlarged axillary lymph nodes. Compared with PDB without IDC, PDB complicated with IDC showed more mammary nodules (P=0.001) and enlarged axillary lymph nodes (P=0.002). No significant difference of breast imaging reporting and data system (BI-RADS) classification, hypo-echogenicity in nipple, thicken areola skin, calcification nor dilated duct rate was found between groups (all P>0.05). Conclusion: PDB have certain ultrasonic characteristics. High-frequency ultrasound is helpful to diagnosis and assessment of PDB.

Câncer de Mama Multifocal: Relato de Caso / Multifocal Breast Cancer: Case Report / Cáncer de Mama Multifocal: Relato de caso

Introdução: O câncer de mama é a neoplasia que mais acomete o sexo feminino, sendo a primeira causa de morte por câncer em mulheres.O carcinoma mamário representa um grupo heterogêneo de doenças. Casos individuais diferem uns dos outros na morfologia, fenótipo e prognóstico. As patologias malignas das mamas podem se manifestar como tumores unifocais, multifocais e/ou multicêntricos. A incidência de tumores multifocais e multicêntricos no câncer de mama varia de 13% a 70%. Relato do caso: Paciente L.C., sexo feminino, 65 anos, com relato de nódulo palpável em mama direita em setembro de 2015. O estudo anatomopatológicodo nódulo mostrou carcinoma intraductal. Realizada quadrantectomia, com anatomopatológico que identificou carcinoma papilífero bem diferenciado intracístico e invasivo damama, associado a componente intraductal cribriforme e papilar, com margens e linfonodo sentinela livres e imuno-histoquímica compatível com perfil triplo-negativo. Em fevereiro de 2019, apresentou duas novas lesões em mama contralateral, identificadas como carcinoma ductal invasivo multifocal com papiloma intraductal associado, e carcinoma ductal invasivo associado a componente intraductal in situ dos tipos papilar, sólido e cribriforme, com imuno-histoquímica com perfis moleculares distintos entre si, sendo uma lesão do tipo luminal A e a outra, luminal híbrido. Conclusão: Este estudo relata um caso de uma paciente que apresentou lesões neoplásicas em ambas as mamas, em tempos distintos e com perfis histológicos e imuno-histoquímicos diferentes. Dessa forma, destacam-se a raridade do caso e a relevância da terapia dirigida a alvos específicos, uma vez que a paciente apresentava lesões com perfis moleculares distintos.

Introduction: Breast cancer is the neoplasm that most affects females, being the first cause of death by cancer in women. Breast carcinoma is a heterogeneous group of diseases. Individual cases differ from each other in morphology, phenotype and prognosis. Malignant breast pathologies can manifest as single, multifocal and/or multicentric tumors. The incidence of multifocal and multicentric tumors in breast cancer varies from 13% to 70%. Case report: Patient L.C., female, 65 years old, with a palpable nodule in the right breast in September 2015. The anatomopathological study of the nodule showed intraductal carcinoma. She underwent quadrantectomy, with anatomopathological examination that identified well-differentiated intracystic and invasive papillary carcinoma of the breast, associated with a cribriform and papillary intraductal component, with free sentinel lymph node and margins and immunohistochemistry compatible with triple negative profile. In February 2019, she presented two new lesions in contralateral breast, identified as invasive multifocal ductal carcinoma, with associated intraductal papilloma, and invasive ductal carcinoma, associated with an in situ intraductal component of the papillary, solid and cribriform types, with immunohistochemistry with different molecular profiles, being one lesion classified as luminal A and the other, hybrid luminal. Conclusion: This study reports a case of a patient who had neoplastic lesions in both breasts, at different times and with distinctive histological and immunohistochemical profiles. Thus, the rarity of the case and the relevance of the therapy aimed at specific targets are highlighted, since the patient presented lesions with different molecular profiles.

Introducción: El cáncer de mama es la neoplasia que más afecta a las mujeres, siendo la primera causa de muerte por cáncer en las mujeres. El carcinoma de mama representa un grupo heterogéneo de enfermedades. Los casos individuales difieren entre sí en morfología, fenotipo y pronóstico. Las patologías mamarias malignas pueden manifestarse como tumores únicos, multifocales y/o multicéntricos. La incidencia de tumores multifocales y multicéntricos en el cáncer de mama varía del 13% al 70%. Relato del caso: Paciente L.C., mujer, 65 años, con un nódulo palpable en el seno derecho en septiembre de 2015. El estudio anatomopatológico de la lesión mostró carcinoma intraductal. La paciente se sometió a una cuadrantectomía, con un examen anatomopatológico que identificó un carcinoma papilar invasivo e intraquístico bien diferenciado de mama, asociado con un componente intraductal cribiforme y papilar, con ganglio linfático y márgens libres y inmunohistoquímica compatible con perfil triple negativo. En febrero de 2019, presentó dos nuevas lesiones en el seno contralateral, identificadas como carcinoma ductal multifocal invasivo, con papiloma intraductal asociado y carcinoma ductal invasivo, asociado con un componente intraductal in situ de los tipos papilar, sólido y cribiforme, con inmunohistoquímica con diferentes perfiles moleculares, siendo una lesión del tipo luminal A y la otra, luminal híbrida. Conclusión: Este estudio reporta un caso de una paciente que tenía lesiones neoplásicas en ambos senos, en diferentes momentos y con diferentes perfiles histológicos e inmunohistoquímicos. Por lo tanto, se destaca la rareza del caso y la relevancia de la terapia dirigida a objetivos específicos, una vez que la paciente presentó lesiones con diferentes perfiles moleculares.

Fatores prognósticos pré-operatórios em pacientes com adenocarcinoma ductal da cabeça do pâncreas / Preoperative prognostic factors in patients with ductal adenocarcinoma of the head of the pancreas

RESUMO Objetivos: Identificar fatores prognósticos pré-operatórios relacionados à sobrevida de pacientes com adenocarcinoma ductal da cabeça de pâncreas (ADCP) submetidos a tratamento cirúrgico com intenção curativa em uma única instituição brasileira. Método: No período de 2005 a 2018, dados clinicodemográficos e laboratoriais pré-operatórios foram prospectivamente coletados. A análise de sobrevida foi feita pelo método de Kaplan-Meier e a comparação entre as curvas pelo teste de log-rank. Para a análise multivariada utilizou-se o modelo de regressão de Cox. Resultados: Os fatores pré-operatórios com impacto significativo na sobrevida à análise univariada foram a idade maior ou igual a 70 anos (p=0,012) e história pessoal prévia positiva para câncer (p=0,026). A análise multivariada, pacientes com níveis séricos pré-operatórios de CA 19.9 de 38 a 554 U/ml apresentaram 3,15 vezes maior chance de óbito (HR 3,15; IC 95% 1,01 - 9,82; p=0,047), enquanto que os pacientes com o marcador acima de 554 U/ml evoluíram com chance 3,96 vezes maior de óbito que aqueles com a dosagem normal (HR 3,96; IC 95% 1,19 - 13,10; p=0,024). Pacientes com comorbidades prévias evoluíram com chance 2,90 vezes superior de óbito que doentes sem condições associadas (HR 2,90; IC 95% 1,10 - 7,67; p=0,032). Conclusão: O ADCP mostrou ser doença agressiva para a qual os fatores pré-operatórios de pior prognóstico foram idade avançada, presença de comorbidades, história prévia de câncer e nível sérico de CA 19.9 elevado no pré-operatório.

ABSTRACT Objective: To identify the preoperative prognostic factors influencing pancreatic cancer survival following curative resection in a single Brazilian institution. Methods: From 2005 to 2018, preoperative clinic, demographic and laboratory data were prospectively collected. Survival analysis was performed by the Kaplan-Meier method and the comparison between curves by the log-rank test. For multivariate analysis, the Cox regression model was used. Results: advanced age (p = 0.012) and previous history of cancer (p = 0.026) were the preoperative factors, according to the univariate analysis, that significantly impacted survival. Patients with preoperative serum levels of CA 19.9 from 38 to 554 U/mL had a 3.15 times higher chances of death (HR 3.15; 95% CI 1.01-9.82; p = 0.047), whereas patients with the marker above 554 U/mL were 3.96 times more likely than those with the normal level (HR 3.96; 95% CI 1.19-13.10; p = 0.024), by using the multivariate analysis. Patients with previous comorbidities had a 2.90 times higher chance of death than those without associated conditions (HR 2.90; 95% CI 1.10-7.67; p = 0.032). Conclusion: Preoperative factors related to the worst prognosis after pancreatic ductal adenocarcinoma resection were advanced age, presence of comorbidities, previous history of cancer and elevated preoperative serum CA 19.9.