Metástasis vulvar de carcinoma lobulillar de mama: reporte de un caso / Vulvar metastases of lobulillar carcinoma of breast: a case report

El objetivo del presente trabajo es el de presentar un caso de metástasis a vulva de primario de mama derecha carcinoma lobulillar estadio IIB, en paciente de 46 años con tratamiento quirúrgico y adyuvancia con quimioterapia, radioterapia y hormonoterapia, vista y tratada en el servicio de patología mamaria del Instituto de Oncología “Dr. Luis Razetti” Caracas, Venezuela. Se revisa la literatura. Se describe una lesión metastásica en labio mayor de hemivulva izquierda de 1,5 cm de diámetro en una paciente con carcinoma lobulillar de mama derecha estadio IIB con intervalo libre de enfermedad de 5 meses después de tratamiento quirúrgico y adyuvante completo. Las metástasis a vulva del cáncer de mama son infrecuentes. La vigilancia ginecológica cuidadosa en pacientes con cáncer de mama permite evidenciar sitios infrecuentes de metástasis, para poder ser diagnosticados precozmente y tratados apropiadamente.

The objective of this present work is to report a case of metastases to vulva of primary of right breast lobulillar carcinoma classified as stadium IIB, in 46 years old patient with surgical and adjuvant treatment with complete chemotherapy, radiotherapy and hormonal therapy she was seen and treated in breast pathology service of Oncology Institute “Dr. Luis Razetti”, Caracas, Venezuela. We review the literature. Describe a metastatic tumor in left lip bigger of the vulva of 1.5 cm primary of the right breast lobular cancer, stadium IIB, with 5 months interval free of illness, after surgical and adjuvant complete treatment. The metastases to vulva of breast cancer are less frequent. The careful gynecological surveillance in patient with breast cancer allows us to evidence an unusual place of metastasis, to be able to be diagnosed precociously and tried appropriately.

Regression of the fibrous disease of the breast in a non-diabetic woman after pregnancy and breastfeeding

Fibrous mastopathy, also known as diabetic mastopathy and lymphocytic mastopathy, may mimic breast cancer at the physical examination, mammography, and ultrasound. We report a case of a woman who presented a non-tender mass clinically suggestive of breast carcinoma; however, the fine-needle aspiration cytology indicated atypia and the core needle biopsy revealed lymphocytic mastopathy. The magnetic resonance imaging of the breast showed a lesion with benign features. It was not demonstrated diabetics mellitus and autoimmune diseases. The patient got pregnant, breastfed, and it was observed the progressive regression of the lesion, with complete disappearance of the solid mass. Three years and three months later, there was no palpable mass at the clinical examination and ultrasound. In conclusion, fibrous mastopathy shall be considered for all breast lesions, regardless of the diagnosis of diabetes mellitus. Once a definitive diagnosis of this pathology is reached, it is recommended clinical, imaging studies and fine-needle aspiration biopsy follow-up of the patient, avoiding unnecessary surgical procedures.

A mastopatia fibrótica, também conhecida como mastopatia diabética e mastopatia linfocítica, pode, ao exame clínico, mamografia e ultra-som, simular um carcinoma mamário. Descrevemos o relato de uma mulher na qual o nódulo foi inicialmente suspeito de carcinoma mamário, mas o diagnóstico pela punção aspirativa com agulha fina foi de atipia, e o com biópsia com agulha grossa foi de mastopatia linfocítica. A ressonância magnética da mama mostrou a lesão com características de benignidade. Não foram demonstradas diabetes mellitus e doenças auto-imunes. A paciente engravidou, amamentou e foi observada regressão progressiva da lesão, com desaparecimento da mesma. A paciente persiste sem lesão na mama ao exame clínico e de ultra-som após acompanhamento de três anos e três meses. Em conclusão, a mastopatia fibrótica deve ser considerada para todas as lesões de mama, mesmo em pacientes sem diabetes mellitus. Quando o diagnóstico definitivo da patologia for realizado, é recomendável o acompanhamento da paciente com estudos clínicos e de imagem e biópsia com agulha fina, evitando-se procedimentos cirúrgicos desnecessários.

Manejo conservador de la axila en cáncer de mama operable / Conservative management of the axillary nodes in operable breast cancer

El tratamiento del cáncer de mama (CM), tumor mas frecuente en la mujer, sufrió diferentes modificaciones a lo largo de los dos últimos siglos. Se describe una reseña de las mismas, como así también los cambios en el manejo de la terapéutica axilar. Durante el siglo pasado, se trabajó fundamentalmente en las opcionesterapéuticas para la conservación de la glándula mamaria. Recién en las últimas décadas comienza el planteo de conductas dirigidas al manejo conservador de la axila, sobre todo para minimizar los efectos adversos secundarios a la linfadenectomía axilar completa. La técnica del Ganglio Centinela cobra importancia ya que los canceres de mama, cada vez con mayor frecuencia, son diagnosticados en estadios iniciales, por lo que las probabilidades de tener ganglios axilares negativos son cada vez mayores. Concluimos que la información que brinda el conocimiento del estado de los ganglios axilares es muy importante en la toma de decisiones terapéuticas en pacientes con cáncer de mama, y que la técnica del ganglio centinela podría, en algunos casos, ser un test que predice el status ganglionar axilar, sin necesidad de realizar una linfadenectomía axilar clásica.

Over the years, the treatment of breast cancer has changed dramatically. We briefly describe those changes and also the different therapeutic approaches to the axillary nodes. Over the last century, the primary goal was to avoid radical surgery of the breast. However, during the last decades, the interest was mainly focused on the possibility of treating the axilla in a conservative way, in an effort to minimize the adverse effects of linfadenectomy. The sentinel node technique is of key importance, because nowadays it is possible to diagnose breast cancer at early stages when most of the times the axilla is negative. The early diagnoses of breast cancer make the sentinel node technique a relevant tool at the time of making therapeutic decisions. We believe that the sentinel node technique could predict in many cases the lymph node status without the need of a complete axillary dissection of the axilla in patients with breast cancer.