Carcinoma ductal infiltrante na gestação, desafio diagnóstico e terapêutico: relato de caso / Infiltrating ductal carcinoma during pregnancy, diagnostic and therapeutic challenge: a case report

Introdução: O câncer de mama é a neoplasia mais frequentemente diagnosticada no mundo, sendo a segunda que mais afeta a mulher no ciclo gravídico-puerperal e a principal causa de morte por câncer em mulheres. O câncer de mama associado à gravidez refere-se àquele diagnosticado durante a gravidez ou no primeiro ano pós-parto. A incidência está aumentando à medida que as mulheres atrasam a primeira gestação. Descrição: O artigo traz o relato do caso de uma gestante com câncer de mama na cidade de Juiz de Fora, MG. Discussão: A gestação deve ser considerada como agravante do câncer de mama, sendo o tratamento semelhante ao da população geral. Prematuridade e baixo peso ao nascer são os eventos indesejáveis mais comuns. Conclusão: A abordagem multidisciplinar é fundamental para estabelecer um plano de tratamento individualizado e a paciente ser acolhida, orientada e participar de todo o processo de decisão terapêutica.(AU)

Introduction: Breast cancer is the most frequently diagnosed cancer in the world, being the second that most affects women in the pregnancy-puerperal cycle and the leading cause of cancer death in women. Pregnancy-associated breast cancer refers to cancer diagnosed during pregnancy or in the first year postpartum. The incidence is increasing as women delay first pregnancy. Description: The article reports the case of a pregnant woman with breast cancer in the city of Juiz de Fora, MG. Discussion: Pregnancy should be considered as aggravating breast cancer, being the treatment similar to the general population. Prematurity and low birth weight are the most common undesirable events. Conclusion: The multidisciplinary approach is fundamental to establish an individualized treatment plan and the patient to be welcomed, guided and to participate in the whole therapeutic decision process.(AU)

Reconstrução de parede torácica com retalhos musculocutâneos e fasciocutâneos em pacientes com câncer de mama localmente avançado e metastático / Thoracic wall reconstruction using myocutaneous and fasciocutaneous flaps in patients with locally advanced and metastatic breast cancer

Introdução: Câncer de mama localmente avançado é caracterizado pelos estádios clínicos IIIb ou IV e representam de 20 a 25% de todos os casos. A reconstrução dos defeitos é feita com retalhos musculocutâneos e fasciocutâneos, sendo os mais utilizados o latíssimo do dorso e o reto abdominal. O objetivo é avaliar resultados das reconstruções de parede torácica em câncer de mama localmente avançados com retalhos musculocutâneos e fasciocutâneos. Métodos: Estudo retrospectivo, observacional descritivo, em único centro. Variáveis estudadas: dimensões do defeito e do retalho, tipo de retalho utilizado para a reconstrução, metástases cutâneas e viscerais, evolução pós-operatória e complicações. Resultados: 11 pacientes, com média de idade de 49 anos, com o lado esquerdo mais acometido. O tipo tumoral mais encontrado foi o carcinoma ductal invasivo. Os retalhos realizados foram: 2 latíssimos do dorso com desenho VY (LDVY), 2 latíssimos do dorso associados a retalho toracoabdominal (LDVYTA), 4 verticais do músculo reto do abdome (VRAM) e 3 toracoabdominais (TA). A área média dos defeitos foi 421,72cm2 e a área média dos retalhos utilizados foi de 451cm2. A complicação mais frequente foi deiscência parcial da ferida operatória, presente em 7 pacientes. Da amostra, 6 pacientes atingiram êxito letal. VRAM foi o retalho que apresentou mais complicações. A sobrevida média para VRAM foi de 25,5 meses, para LDVY de 17 meses, TA de 17 meses e LDVYTA de 20,5 meses. Conclusão: Os retalhos musculocutâneos e fasciocutâneos são eficazes para a reconstrução da parede torácica após a ressecção de neoplasias mamárias localmente avançadas.

Introduction: Breast cancer is the most common cancer among women worldwide. Locally advanced breast cancer is characterized by clinical stage IIIb or IV and accounts for 20­25% of all cases. Defects are reconstructed using myocutaneous and fasciocutaneous flaps, primarily from the latissimus dorsi and rectus abdominis muscles. The objective is to evaluate the results of thoracic wall reconstructions in cases of locally advanced breast cancer using fasciocutaneous and myocutaneous flaps. Methods: This was a retrospective, observational, and descriptive single-center study. Variables studied included defect size and flap dimensions, myocutaneous flap type, presence of cutaneous and visceral metastasis, postoperative evolution, and complications. Results: We selected 11 patients with a mean age of 49 years; the left side was the most commonly affected. The most common tumor type was invasive ductal carcinoma. The flaps were made of latissimus dorsi VY (LDVY) in two patients, latissimus dorsi associated with thoracoabdominal flaps (LDVYTA) in two, vertical rectus abdominus myocutaneous flap (VRAM) in four, and thoracoabdominal flaps (TA) in three. The mean defect area was 421.72 cm2, while the mean flap area was 451 cm2. The most frequent complication was partial dehiscence (seven patients). Six patients achieved lethal exit. VRAM flaps presented more complications. The mean survival for VRAM was 25.5 months, LDVY was 17 months, TA was 17 months, LDVYTA was 20.5 months. Conclusion: Myocutaneous and fasciocutaneous flaps are effective for chest wall reconstruction after locally advanced breast cancer resection.

Syndrome in question

Abstract: Dermatomyositis is a rare inflammatory disease, autoimmune, with proximal myopathy associated with characteristic dermatological manifestations. In adults, 20-50% of the cases are paraneoplastic manifestation, being mandatory the workup for malignancy Herein we report a case of a woman with classic dermatological presentation of dermatomyositis and newly diagnosed breast cancer. In general, the clinical presentation of paraneoplastic dermatomyositis is more exuberant and manifestations may precede, concur or succeed the diagnosis of neoplasia. The prognosis of cases associated with breast cancer is worse than the idiopathic form. Treatment is based mainly on the resolution of the underlying disease, beyond immunosuppressants.

Chronic psychological stress and its impact on the development of aggressive breast cancer / Estresse psicológico crônico e seu impacto no desenvolvimento de neoplasia mamária agressiva

Objective To investigate the clinicopathological findings of women diagnosed with breast cancer and study the impact of chronic psychological stress on the pathological characteristics of these tumors.Methods We investigated a cohort composed of women diagnosed with breast cancer and divided into two groups. One group was categorized as presenting with chronic psychological stress (by using the Self-Reporting Questionnaire − SRQ-20). Another group of women with breast cancer, but with no previous history of chronic psychological stress, comprised the Control Group. Clinical and pathological data were assessed.Results Women presenting with a history of chronic distress were significantly overweight when compared to the Control Group. Furthermore, it was observed that these stressed women also had a significant percentage of aggressive breast cancer subtype, the HER2 amplified tumor, which could be putatively associated with the loss of immunosurveillance.Conclusion Our findings suggested an interaction among chronic psychological stress, overweight, and the development of more aggressive breast tumors.

Objetivo Investigar os achados clínico-patológicos de mulheres diagnosticadas com câncer de mama e estudar o impacto do estresse psicológico crônico nas características patológicas desses tumores.Métodos Investigamos uma coorte composta por mulheres diagnosticadas com câncer de mama divididas em dois grupos. O primeiro foi classificado pela apresentação de estresse psicológico crônico (por meio do Self-Reporting Questionnaire− SRQ-20). Outro grupo de mulheres com câncer de mama, mas sem história prévia de estresse psicológico crônico, foi denominado Grupo Controle. Os dados clínicos e patológicos foram avaliados.Resultados As mulheres com histórico de estresse crônico apresentaram-se significativamente acima do peso quando comparadas com o Grupo Controle. Além disso, verificou-se que estas mulheres estressadas apresentaram um porcentual significativo de um subtipo de câncer de mama agressivo, o HER2, o que poderia estar associado à possível perda da imunovigilância.Conclusão Nossos resultados sugeriram uma ligação entre o estresse psicológico crônico, o excesso de peso e o desenvolvimento de tumores de mama com maior agressividade.

Tuberculosis axillary lymph node coexistent breast cancer in adjuvant treatment: case report / Tuberculose linfonodal axilar coexistente com carcinoma mamário em tratamento adjuvante: relato de caso

Coexistence of breast cancer and tuberculosis is rare. In most cases, involvement by tuberculosis occurs in axillary lymph nodes. We report a case of a 43-years-old patient who had undergone adenomastectomy and left sentinel lymph node biopsy due to a triple negative ductal carcinoma. At the end of adjuvant treatment, the patient had an atypical lymph node in the left axilla. Lymph node was excised, and after laboratory analysis, the diagnosis was ganglion tuberculosis. The patient underwent treatment for primary tuberculosis. The development of these two pathologies can lead to problems in diagnosis and treatment. An accurate diagnosis is important to avoid unnecessary surgical procedures.

A coexistência de câncer de mama e tuberculose é rara. Na maioria das vezes, o acometimento pela tuberculose ocorre nos linfonodos axilares. Relatamos caso clínico de paciente de 43 anos submetida à adenomastectomia e à biópsia de linfonodo sentinela à esquerda devido a um carcinoma ductal triplo negativo. Ao final do tratamento adjuvante, a paciente apresentou linfonodomegalia atípica em axila esquerda. Foi realizado exérese do linfonodo e, após análises laboratoriais, diagnosticou-se tuberculose ganglionar. A paciente foi submetida a tratamento para tuberculose primária. O desenvolvimento dessas duas patologias pode acarretar problemas quanto ao diagnóstico e ao tratamento. O diagnóstico acurado é importante para evitar procedimentos cirúrgicos desnecessários.

Quilopericardio y quilotórax bilateral en una mujer con cáncer de mama / Chylopericardium and bilateral chylothorax in a breast cancer patient

El quilopericardio no traumático suele deberse a enfermedades infecciosas, congénitas o neoplásicas que infiltran los ganglios mediastinales, alteran el flujo linfático normal y acumulan quilo en la cavidad pericárdica. Se asocia a quilotórax en, aproximadamente, un 3% de los casos. Se presenta el caso de una paciente de 52 años con cáncer de mama avanzado que ingresa con derrame pleural bilateral y signos ecocardiográficos de taponamiento cardíaco. La TC mostró múltiples adenopatías en mediastino. El dosaje de triglicéridos en líquido pleural fue 372 mg/ dl. Por pericardiocentesis se obtuvo un líquido lechoso con triglicéridos de 984 mg/dl y colesterol 90 mg/dl. Se modificó el esquema terapéutico. Se revisan la fisiopatología, los criterios diagnósticos y el tratamiento de esta rara entidad.

Non traumatic chylopericar dium is mostly secondary to infection, congenital or neoplastic disease that invade mediastinal lymph nodes and modify the normal lymphatic flow. It is associated to chylothorax in approximately 3% of cases. We report the case of a 52 years old woman with diagnosis of advanced breast cancer. She was admitted with bilateral pleural effusion and echocardiographic signs of cardiac tamponade. A CT scan disclosed multiple mediastinal lymphadenopathy. The level of tryglicerides in pleural effusion was 372 mg/dl. A percutaneous pericardiocentesis was performed, obtaining chyle, with 984 mg/dl of tryglicerides and cholesterol 90 mg/dl levels. Treatment strategy was modified. We reviewed pathophysiology, diagnostic criteria and treatment of this rare entity.

Neoplasia Lobular da mama: revisão / Lobular neoplasia of the breast: review

A neoplasia lobular da mama se refere às lesões caracterizadas pela hiperplasia lobular atípica e pelo carcinoma lobular in situ. A neoplasia lobular não é apenas um fator de risco, mas um precursor não obrigatório para desenvolvimento de carcinoma invasivo. O carcinoma lobular in situ do tipo pleomórfico é subtipo de neoplasia lobular com comportamento agressivo, com alto grau nuclear e pode mimetizar o carcinoma ductal in situ de alto grau. O manejo e o seguimento das pacientes portadoras de neoplasia lobular é controverso, especialmente, quando o diagnóstico é feito através da core biopsy. Os estudos moleculares e genômicos têm sido capazes de identificar genes que podem ser dirimir dúvidas quanto à sua patogênese e permitir abordagem que permite abordagens terapêuticas mais seguras e adequadas. Esta revisão procura estabelecer o conceito mais atual sobre a abordagem da neoplasia lobular da mama.

Lobular neoplasia of the breast refers to lesions featuring atypical lobular hyperplasia and lobular carcinoma in situ. Recent evidence suggests that lobular neoplasia is not only a risk factor, but is also a non-obligate precursor for invasive carcinoma. Pleomorphic lobular carcinoma in situ is a subtype of lobular neoplasia with agressive behaviour, that has high-grade nuclei and may simulate high-grade ductal carcinoma in situ. The management and follow-up of patients diagnosed with lobular neoplasia is a current issue of debate, specially when the diagnostic is given by core biopsy. Molecular and genomic studies have identified genes that may be important in understanding its pathogenesis and may lead to news therapeutic interventions.

Embolismo pulmonar tumoral: Reporte de dos casos / Pulmonary tumor embolism: Report of two cases

Dyspnea and hypoxemia in a patient with cancer may have several causes, including infections, thromboembolism, metastases, and pulmonary injuries by drugs. We report a 47-year-old female with breast cancer and a 70-year-old male with urinary bladder cancer who were admitted for dyspnea, hypoxemia and pulmonary hypertension. Chest X rays and CT scans were normal. The ventilation-perfusion scintigram was highly suspicions of thromboembolism in the female. The male died 16 hours after admission and the post mortem examination revealed the presence of tumor cells in the pulmonary vasculature.

Câncer de mama em homem: relato de caso e revisão da literatura / Male breast cancer: a case report and review of the literature

O câncer de mama em homens é uma patologia relativamente incomum. Atinge um homem para cada 1.000 mulheres, representa menos de 1 por cento de todos os cânceres em homens e é responsável por 0,1 por cento da mortalidade por câncer no sexo masculino. Como nas mulheres, o subtipo mais comum é o ductal infiltrativo. No presente trabalho é relatado o caso de um paciente masculino, 67 anos, com nódulo em mama direita com diagnóstico de carcinoma ductal sólido. Apesar de ser incomum, alguns estudos vêm demonstrando um aumento na incidência desses tumores. O exame físico talvez seja a principal ferramenta para o diagnóstico desse tumor. Contudo, a confirmação histopatológica é necessária para avaliação definitiva. Devido à raridade da doença, muitas das atuais modalidades de tratamento são baseadas na experiência com câncer de mama feminino. Este caso evidencia a relevância da conscientização da população sobre essa patologia e ao profissional da saúde em considerar este diagnóstico possível.

Male breast cancer is a fairly uncommon disorder. Affecting only one for a thousand women, it represents less than 1 percent of all male cancers and accounts for 0.1 percent of the male cancer mortality. Just like in women, the most common subtype is the infiltrative ductal. Here we report the case of a 67-year-old male patient with a nodule in the right breast with a diagnosis of solid ductal carcinoma. Although uncommon, a few studies show an increase in the incidence of this tumor. However, histopathologic confirmation is necessary for a definite evaluation. Due to the rarity of the disease, many of the current treatment modalities are based on the experience with female cancer. This case highlights the relevance of raising the awareness of the disease among the general population and health professionals in considering this a potential diagnosis.

Fusión PET-RNM en recidiva de carcinoma de mama / PET-MRI fusion in recurrent breast carcinoma

Presentamos una paciente de 35 años, intervenida de carcinoma ductal infiltrante de mama con vaciamiento axilar y tratamiento radioterápico, 7 años antes; con posterior afectación nodular paraesternal derecha tratada con quimioterapia 4 meses antes. Ante nueva nodulación paraesternal derecha, se decide intervenir quirúrgicamente y realizar PET de cuerpo completo para ver extensión de la enfermedad. La anatomía patológica concluye que se trata de un fibroma. En estudio PET se aprecia foco hipermetabolico sugestivo de malignidad, en área de localización aproximada de dicho fibroma, a 2 cm de profundidad. Para localizar con exactitud el hallazgo PET, se realiza RNM que tras fusionar con PET nos permite la localización exacta de la lesión. Consideramos de importancia la optimización de la prueba diagnostica por la imagen, más adecuada según las características o sospecha de extensión de la enfermedad oncológica.

Peutz-Jeghers Syndrome with Multiple Genital Tract Tumors and Breast Cancer: A Case Report with a Review of Literatures

We report here on the multiple genital tract neoplasms in a 41-yr-old Korean woman with Peutz-Jeghers Syndrome (PJS). The patient presented with lower abdominal pain. Her previous medical history was PJS and breast cancer. Pelvic ultrasound showed a multilocular cyst at the right adnexal region, diagnosed as bilateral ovarian mucinous borderline tumors. An ovarian sex cord tumor with annular tubules was incidentally diagnosed together with a minimal deviation adenocarcinoma of the uterine cervix and mucinous metaplasia of both the Fallopian tubal mucosa and the endometrium. Although the cases of multiple genital tract tumors with PJS has rarely been reported, the present case appears to be the first in Korea in which the PJS syndrome was complicated by multiple genital tract tumors and infiltrating carcinoma of the breast. The clinical significance of the multiple genital tract tumors and breast cancer associated with PJS is reviewed.

Carcinoma mamario papilar intraquístico / Mammary intracystic papillary carcinoma

Los carcinomas papilares de la mama son neoplasias malignas que presentan un conjunto de características especiales, tanto en su morfología como en su conducta biológica. Entre los subtipos no invasores se encuentra la forma localizada, el carcinoma papilar intraquístico. Este tipo de cáncer es de aparición poco habitual destacando por su genio biológico indolente y excelente sobrevida. En esta actualización se destacan aspectos generales de esta enfermedad con especial énfasis en sus características clínicas, criterios diagnósticos actuales y se propone pautas de tratamiento de acuerdo a los resultados publicados en la literatura.

5-Fluorouracil-induced leukoencephalopathy in patients with breast cancer

The purpose of this study is to determine the characteristic clinical features, radiologic findings, and precipitating and prognostic factors in the patients with breast cancer and with 5-Fluorouracil (5-FU)-induced leukoencephalopathy. We reviewed the medical records of six breast cancer patients who developed leukoencephalopathy after chemotherapy which included 5-FU and also evaluated thorough neurological examinations including mini-mental status examination, cerebrospinal fluid studies, brain images and brain biopsies. Six patients exhibited slowly progressing neurologic symptoms characterized by the impairment of cognitive function, abulia, ataxic gait, and/or akinetic mutism. None of the patients had any specific causes or etiologic factors for leukoencephalopathy. Brain MRI in all patients showed diffuse periventricular white matter changes in the T2-weighted MR image. Brain biopsy in Patient 1 showed fragmented axonal fiber and minimally deprived myelination with many scattered macrophages. Five patients who treated with steroids at the onset of neurological symptoms showed clinical improvement, regardless of their age, sex, the pathology and stage of breast cancer, or the total dosage of chemotherapeutic agents. We conclude that leukoencephalopathy in these cases could be attributable to 5-FU neurotoxicity and suggest that the administration of steroids might be the treatment of choice.

Progressive systemic sclerosis (scleroderma), carcinoma breast and valvular heart disease: an unusual combination.

Systemic sclerosis is a multi system disorder characterised by fibrosis of skin and internal organs. There are reports of relation between cancer and polymyositis/dermatomyositis, but no overall association with systemic sclerosis. Reports of the coexistence of cancer and systemic sclerosis, however, emphasise a close temporal relation in their occurrence. Cardiac involvement in the form of myocardial fibrosis and pericarditis occurs frequently in systemic sclerosis, while valvular involvement has been reported only sporadically. We report a patient, admitted for adenocarcinoma of left breast who was found to have features of systemic sclerosis, pulmonary hypertension, gangrene of toes, and stenotic mitral valve disease. The possible mechanisms of the coincidence of the three disorders are discussed.

Carcinoma of the axillary breast

Axillary breast is one of the varieties of polymastia which is characterized by the presence of more than 2 breasts. It may cause symptoms during pregnancy, lactation, or in the premenopausal period. Unless there are obvious symptoms of lactation or the assistance of further imaging studies such as mammography and breast ultrasound, the diagnosis is often confused with subcutaneous lipoma. The incidence of axillary breast cancer is low but it should be investigated and treated properly in view of another breast cancer in the embryonic milk-line. In this paper we reviewed 4 cases of axillary breast cancer and documented some articles regarding aberrant breast and carcinoma arising from it. It is suggested that subcutaneous nodules of uncertain origin around the periphery of the breast should be viewed with suspicion and treated properly.