Application of volume replacement techniques in breast conserving surgery for breast cancer treatment / 中华外科杂志

Objective: To examine the application of volume replacement techniques in breast conserving surgery for breast cancer. Methods: The clinic data of 76 breast cancer patients underwent a breast conserving surgery with volume replacement techniques at the Breast Center, Beijing Tongren Hospital, from June 2019 to June 2021 were analyzed retrospectively. All patients were female, aged (42.6±6.4) years (range: 32 to 56 years). Tumor staging inlcuded stage ⅡA in 36 cases, stage ⅡB in 24 cases, stage ⅢA in 12 cases, stage ⅢB in 4 cases. Three types of techniques included the lateral thoracic adipofascial flaps in 47 cases, the upper abdominal wall adipofascial flaps in 22 cases and the latissimus dorsi myocutaneous flap in 7 cases. The specimen volume of tumor expansion resection in breast conserving surgery was measured, while the operative time used for volume replacement techniques, postoperative drainage retention time, postoperative complications and patients' satisfaction with the breast shape were recorded. Results: The specimen volume of tumor was (100.9±24.2) ml (range: 55 to 157 ml) in lateral thoracic adipofascial flap group, (88.4±14.5) ml (67 to 118 ml) in upper abdominal wall adipofascial flap group, (179.7±22.9) ml (range: 155 to 220 ml) in latissimus dorsi myocutaneous flap group. The operative time used to restore the breast shape of the three groups were (52.9±9.0) minutes (range: 45 to 70 minutes), (63.2±8.8) minutes (range: 50 to 70 minutes) and (99.3±3.4) minutes (range: 95 to 105 minutes), respectively. The postoperative drainage retention times of the three groups were (8.6±1.2) days (range: 7 to 10 days), (9.4±0.9) days (range: 8 to 10 days) and (11.4±1.3) days (range: 10 to 13 days), respectively. All the 76 patients were evaluated for their satisfaction with the cosmetic outcomes, 64 patients (84.2%) were strongly satisfied and 12 patients (15.8%) were generally satisfied. The postoperative complications included fat liquefaction in 6 cases (2 cases in the lateral thoracic adipofascial flap group and 4 cases in the upper abdominal adipofascial flap group) and seroma in 4 cases (each 2 cases in the lateral thoracic adipofascial flap group and the latissimus dorsi myocutaneous flap group). Conclusions: For patients with large tissue loss during breast conserving surgery, the corresponding volume replacement techniques, including lateral thoracic adipofascial flaps, upper abdominal wall adpofascial flaps and latissimus dorsi myocutaneous flaps, should be reasonably selected for repair according to the tumor site and the size of the intraoperative breast loss, which can ensure the original volume and shape of the breast, with controllable postoperative complications.

Supervivencia de pacientes con cáncer de mama y cirugía conservadora / Survival in Patients with Breast Cancer and Conservative Surgery

Introducción: En la actualidad la cirugía conservadora, más que una opción en el tratamiento quirúrgico del cáncer de mama, es la técnica quirúrgica de elección. Objetivo: Caracterizar la supervivencia de los pacientes con cáncer de mama operados con cirugía conservadora. Métodos: Se realizó un estudio multicéntrico, retrospectivo descriptivo de corte longitudinal, en el Hospital Universitario Clínico Quirúrgico "Arnaldo Milián Castro" y el oncológico "Celestino Hernández Robau", ambos de la ciudad de Santa Clara provincia Villa Clara, en el período comprendido desde enero del 2011 hasta diciembre del 2020. Resultados: La supervivencia global de los pacientes con cáncer de mama y cirugía conservadora en aquellos que presentaron eventos (fallecidos) fue mayor en los portadores de carcinoma ductal infiltrante con 9,3 años. En el caso del estadio tumoral predominó la supervivencia en aquellos pacientes que estaban en estadios Ia y IIa con 9,8 y 9,1 años, respectivamente. Según la inmunohistoquímica, el subtipo molecular con mejor supervivencia global fue el Luminal B con 9,2 años. En cuanto al tratamiento definitivo aplicado presentaron mayor supervivencia global aquellos pacientes que recibieron esquemas de quimioterapia+ radioterapia+ hormono terapia y quimioterapia+ radioterapia con 9,4 y 8,8 años, respectivamente. Conclusiones: Existe una mayor supervivencia global en aquellos pacientes con carcinoma ductal infiltrantes (NOS), estadios tumorales Ia y IIa, con subtipo molecular Luminal B según inmunohistoquímica y con tratamientos definitivos de quimioterapia+ radioterapia+ hormonoterapia(AU)

Introduction: Nowadays, conservative surgery, rather than an option for the surgical treatment of breast cancer, is the surgical technique of choice. Objective: To characterize the survival of patients with breast cancer operated on with conservative surgery. Methods: A multicenter, retrospective, descriptive and longitudinal study was carried out at Hospital Universitario Clínico Quirúrgico "Arnaldo Milián Castro" and "Celestino Hernández Robau" oncologic hospital, both in the city of Santa Clara, Villa Clara Province, in the period from January 2011 to December 2020. Results: The overall survival of patients with breast cancer and conservative surgery in those who presented events (died) was higher in those with infiltrating ductal carcinoma, accounting for 9.3 years. In the case of tumor stage, survival was predominant in those patients with stages IA and IIA, accounting for 9.8 and 9.1 years, respectively. Concerning immunohistochemistry, the molecular subtype with the best overall survival was Luminal B, accounting for 9.2 years. Regarding the applied definitive treatment, those patients who received chemotherapy-radiotherapy-hormone therapy and chemotherapy-radiotherapy schemes presented better overall survival, accounting for 9.4 and 8.8 years, respectively. Conclusions: Overall survival is higher in patients with infiltrating ductal carcinoma (not otherwise specified), tumor stages IA and IIA, molecular subtype Luminal B according to immunohistochemistry, and definitive treatments with chemotherapy, radiotherapy, hormone therapy scheme(AU)

Oncological Outcomes of Nipple-Sparing Mastectomy in an Unselected Population Evaluated in a Single Center / Desfechos oncológicos da mastectomia poupadora do complexo areolo-mamilar em uma população não selecionada avaliada em um único centro

Abstract Objective Nipple-sparing mastectomy (NSM) has been traditionally used in selected cases with tumor-to-nipple distance > 2 cm and negative frozen section of the base of the nipple. Recommending NSM in unselected populations remains controversial. The present study evaluated the oncological outcomes of patients submitted to NSM in an unselected population seen at a single center. Methods This retrospective cohort study included unselected patients with invasive carcinoma or ductal carcinoma in situ (DCIS) who underwent NSM in 2010 to 2020. The endpoints were locoregional recurrence, disease-free survival (DFS), and overall survival (OS), irrespective of tumor size or tumor-to-nipple distance. Results Seventy-six patients (mean age 46.1 years) (58 invasive carcinomas/18 DCIS) were included. The most invasive carcinomas were hormone-positive (60%) (HER2 overexpression: 24%; triple-negative: 16%), while 39% of DCIS were high-grade. Invasive carcinomas were T2 in 66% of cases, with axillary metastases in 38%. Surgical margins were all negative. All patients with invasive carcinoma received systemic treatment and 38% underwent radiotherapy. After a mean of 34.8 months, 3 patients with invasive carcinoma (5.1%) and 1 with DCIS (5.5%) had local recurrence. Two patients had distant metastasis and died during follow-up. The 5-year OS and DFS rates for invasive carcinoma were 98% and 83%, respectively. Conclusion In unselected cases, the 5-year oncological outcomes following NSM were found to be acceptable and comparable to previous reports. Further studies are required.

Resumo Objetivo A mastectomia poupadora do complexo areolo-mamilar (MPM) tem sido tradicionalmente utilizada em casos selecionados com distância tumor-mamilo > 2 cm e biópsia de congelação da base do mamilo negativa. Recomendar MPM em populações não selecionadas continua controverso. Este estudo avaliou os resultados oncológicos de pacientes submetidas à MPM em uma população não selecionada atendida em um único centro. Métodos Coorte retrospectivo incluindo pacientes não selecionadas com carcinoma invasivo ou carcinoma ductal in situ (CDIS) submetidas à MPM entre 2010 e 2020. Os desfechos incluíram: recorrência locorregional, sobrevida livre de doença (SLD) e sobrevida global (SG), independentemente do tamanho do tumor ou da distância tumor-mamilo. Resultados Setenta e seis pacientes (média: 46,1 anos de idade) (58 carcinomas invasivos/18 CDIS) foram incluídas. A maioria dos carcinomas invasivos era hormônio-positivo (60%) (superexpressão de HER2: 24%; triplo-negativo: 16%), enquanto 39% dos CDIS eram de alto grau histológico. Os carcinomas invasivos foram T2 em 66% dos casos, com metástases axilares em 38%. As margens cirúrgicas foram todas negativas. Todas as pacientes com carcinoma invasivo receberam tratamento sistêmico e 38% receberam radioterapia. Após um período médio de 34,8 meses, 3 pacientes com carcinoma invasivo (5,1%) e 1 com CDIS (5,5%) apresentaram recidiva local. Durante o acompanhamento, duas pacientes tiveram metástase à distância e vieram a óbito. As taxas de SG e SLD aos 5 anos para carcinoma invasivo foram de 98% e 83%, respectivamente. Conclusão Em casos não selecionados, os resultados oncológicos de 5 anos após MPM foram considerados aceitáveis e comparáveis a resultados anteriores. Estudos adicionais são necessários.

Salvage Nipple-sparing Mastectomy for Patients with Breast Cancer Recurrence: A Case Series of Brazilian Patients / Mastectomia preservadora de mamilo para pacientes com recidiva de câncer de mama: Uma série de casos de pacientes brasileiras

Abstract Objective Few studies analyzed the safety of salvage nipple-sparing mastectomy (NSM) for local relapse treatment. We evaluated the outcomes of patients with indications for mastectomy who chose to undergo NSM for ipsilateral breast tumor recurrence (IBTR). Methods Between January 2001 and December 2018, we evaluated 24 women who underwent NSM for local relapse after conservative surgery. Results Thepatientswere followedupfor amean time of132months since thefirst surgery. After the NSM, 5 (20.8%) patients were diagnosed with local recurrence and only 1 (4.2%) patient died. The patients presented 4.8% (2) of partial and 2.4% (1) of total nipple necrosis. Conclusion In this long-term follow-up since the first surgery, we observed low rates of complication and good survival, although associated with high local recurrence in patients diagnosed with IBTR undergoing NSM as salvage surgery.We demonstrated that NSMmay be considered after IBTR for patients who did not want to undergo total mastectomy.

Resumo Objetivo Há poucos estudos sobre a segurança de se realizar adenomastectomia (nipple-sparing mastectomy, NSM, em inglês) para tratamento de recidiva local. O objetivo deste estudo foi avaliar os resultados de pacientes com indicação para mastectomia que optaram por se submeter a NSM para o tratamento de recorrência local. Métodos Foram analisadas 24 pacientes submetidas a NSM para tratamento de recidiva local após tratamento conservador entre janeiro de 2001 e dezembro de 2018. Resultados As pacientes foramacompanhadas por um períodomédio de 132meses a partir da primeira cirurgia. Após a NSM, 5 (20,8%) pacientes foram diagnosticadas com recorrência local, e apenas 1 paciente foi a óbito. As pacientes apresentaram 4,8% de necrose parcial e 2,4% de necrose total do mamilo. Conclusão Em um longo período de acompanhamento desde a primeira cirurgia, foram observadas baixas taxas de complicação pós-operatória e boa sobrevida, porém, associadas comuma alta taxa de recorrência local em pacientes submetidas a NSM para tratamento de recidiva local após cirurgia conservadora. Neste estudo, demonstrou-se que a NSM pode ser considerada uma opção cirúrgica para pacientes que não querem se submeter a mastectomia total.

Hiperplasia estromal pseudoangiomatosa (HEP) de mama: a propósito de un caso / Pseudoangiomatous stromal hyperplasia (PASH) of the breast: about a case

La hiperplasia pseudoangiomatosa estromal de la mama es una patología benigna de rara aparición en mujeres, que hoy en día sigue generando incertidumbre en cuanto a su manifestación y al tratamiento definitivo. Nuestro objetivo será detallar el manejo y los resultados obtenidos luego de tratar a una paciente con esta patología atendida en hospital público durante la pandemia, que presentó gigantomastia bilateral a expensas de crecimiento y simetrización de mama contralateral afectada por HEP durante su estado gravídico.

Pseudoangimatous stromal hyperplasia of the breast, is a pathology of rare appearance, in women, which today continues to generate uncertainty regarding its manifestation and definitive treatment. Our objective will be to detail the management and results obtained after treating a patient with this pathology in a public hospital during a pandemic. who presented bilateral gigantomastia at the expense of growth and symmetrization of the contralateral breast affected by HEP during her pregnancy.

Enfoque oncoplástico en el tratamiento quirúrgico conservador del cáncer de mama. Una revisión bibliográfica / Oncoplastic approach in the conservative surgical treatment of breast cancer. A bibliographic review

Introducción: El cáncer de mama es el más común en el mundo y constituye la principal causa de muerte en mujeres, no obstante, los avances terapéuticos han permitido aumentar sus tasas de supervivencia global, libre de enfermedad. Procurando una mejor calidad de vida surge la cirugía oncoplástica, que combina la cirugía plástica y reconstructiva en el ma-nejo quirúrgico del cáncer de mama localmente avanzado, de mayor tamaño o con ubicación desfavorable, buscando mejorar el resultado estético sin perjuicio del resultado oncológico. Objetivo: Realizar una revisión bibliográfica actualizada del enfoque oncoplástico en el tra-tamiento quirúrgico conservador del cáncer de mama, con el propósito de conocer sus re-sultados oncológicos y estéticos en comparación con los tratamientos quirúrgicos conven-cionales.Material y Métodos: La búsqueda bibliográfica se llevó a cabo en las bases de datos Pub-Med, Elsevier, Hinari, Cochrane y ScienceDirect. Seleccionando los artículos publicados du-rante los últimos 10 años, en inglés o español, que tuvieron relación con información relevan-te en el tratamiento quirúrgico oncoplástico conservador del cáncer de mama.Resultados: Los criterios de búsqueda incluyeron artículos sobre el tratamiento quirúrgico oncoplástico conservador en mujeres con cáncer de mama primario, 99 artículos cumplie-ron los criterios, excluyéndose aquellos publicados hace más de 10 años, con metodología poco clara o no reproducible. Fueron elegibles 35 por ser relevantes al tema, publicados en revistas indexadas entre los años 2011 y 2021, permitiendo determinar los resultados clíni-cos, oncológicos y estéticos de la cirugía oncoplástica conservadora y contrastarlos con las técnicas convencionales. Conclusión: La cirugía oncoplástica conservadora de mama es oncológicamente segura y equiparable a las cirugías convencionales (mastectomía total o parcial), ofreciendo resulta-dos estéticos más satisfactorios y mejorando la calidad de vida de las pacientes.

Background: Breast cancer is the most common cancer in the world and represents the main cause of death in women; nevertheless, therapeutic advances have made it possible to increase overall and disease-free survival rates. Looking for a better quality of life, on-coplastic surgery arises, which combines plastic and reconstructive surgery in the surgical management of locally advanced breast cancer, larger or with unfavorable location, seeking to improve the appearance without affecting the oncologic result.Objective: To perform an updated bibliographic review of the oncoplastic approach in the conservative surgical treatment of breast cancer, with the purpose of knowing its oncologic and esthetic results compared to conventional surgical treatments.Material and Methods: The bibliographic search was carried out in the databases PubMed, Elsevier, Hinari, Cochrane and ScienceDirect. Selecting the articles published during the last 10 years, in either English or Spanish, that were related to relevant information in the conser-vative oncoplastic surgical treatment of breast cancer.Results: The search criteria included articles on conservative oncoplastic surgical treatment in women with primary breast cancer, 99 articles met the criteria, excluding those published more than 10 years ago, with unclear or non-reproducible methodology. 35 were eligible, because they were relevant to the subject, published in indexed journals between 2011 and 2021, allowing to determine the clinical, oncological and aesthetic results of conservative oncoplastic surgery and contrast them with conventional techniques. Conclusion: Oncoplastic breast-conserving surgery is oncologically safe and comparable to conventional surgeries (total or partial mastectomy), offering more satisfactory esthetic results and improving the quality of life in patients.

Malignant Phyllodes Tumor of the Breast: Case Report / Tumor Filoide Maligno de Mama: Relato de Caso / Tumor Phyllodes Maligno de Mama: Reporte de Caso

Introduction: Phyllodes tumors (PT) are rare and account for 0.3% to 0.5% of all breast tumors. PT may be classified as benign, borderline or malignant. The aim of this study was to report a case of malignant PT of the breast. Case report: A 27-year-old woman presented with a mass in the left breast with histopathological features of malignancy (results of US of the breast: an oval, lobulated hypoechogenic lesion, measuring 7.7 cm ­ BI-RADS® 4C). A segmental resection (SR) of the breast was performed and histopathology study of the surgical specimen confirmed a malignant PT. Adjuvant radiotherapy was used for supplemental treatment. One year later, the patient had a local recurrence of the primary tumor and underwent a new SR of the left breast. There was no indication of breast reirradiation. At about 31 months after diagnosis (September 2019 ­ April 2022), the patient is well and adherent to periodical clinical follow-up. Conclusion: This study presents a case of malignant PT that occurred in a young patient and had a more aggressive course

Introdução: Os tumores filoides (TF) são raros e representam entre 0,3% e 0,5% dos tumores de mama, podendo ser classificados como benignos, borderline ou malignos. O objetivo deste estudo foi relatar um caso de TF maligno de mama. Relato do caso: Mulher, 27 anos de idade, apresentando nódulo em mama esquerda com características histopatológicas de malignidade (resultados da ultrassonografia de mamas: lesão hipoecogênica, oval e lobulada, com 7,7 cm ­ BI-RADS® 4C). Foi realizada ressecção segmentar (RS) da mama e o histopatológico da peça cirúrgica mostrou tratar-se de um TF maligno. Como tratamento complementar, foi realizado radioterapia adjuvante. A paciente apresentou recidiva local do tumor primário em cerca de apenas um ano, sendo realizada nova RS da mama esquerda. Não houve indicação de reirradiação da mama. Em 31 meses após o diagnóstico (setembro de 2019 ­ abril de 2022), a paciente encontra-se em bom estado geral e realizando seguimento clínico periódico. Conclusão: Este estudo apresenta um caso de TF maligno que ocorreu em uma paciente jovem e teve um curso mais agressivo

Introducción: Los tumores phyllodes (TP) son poco frecuentes y representan del 0,3% al 0,5% de todos los tumores de mama. Los TP pueden clasificarse como benigno, limítrofe o maligno. El objetivo de este estudio fue reportar un caso de TP maligno de mama. Reporte del caso: Una mujer de 27 años se presentó con una masa en la mama izquierda con características histopatológicas de malignidad (resultados de la ecografía de mama: lesión hipoecogénica ovalada y lobulada, de 7,7 cm ­ BI-RADS® 4C). Se realizó una resección segmentaria (RS) de la mama y el estudio histopatológico de la pieza quirúrgica confirmó un TP maligno. Se utilizó radioterapia adyuvante como tratamiento complementario. Un año después, la paciente presentó una recidiva local del tumor primario y fue sometida a una nueva RS de mama izquierda. No hubo indicación de reirradiación mamaria. Aproximadamente 31 meses después del diagnóstico (septiembre de 2019 ­ abril de 2022), la paciente se encuentra bien y se adhiere al seguimiento clínico periódico. Conclusión: Este estudio presenta un caso de TP maligno que ocurrió en una paciente joven y tuvo un curso más agresivo. Palabras clave: neoplasias de la mama; tumor filoide; mastectomía

Study on Automatic Plan Method for Radiotherapy after Breast-conserving Surgery Based on TiGRT System / 中国医疗器械杂志

To study an automatic plan(AP) method for radiotherapy after breast-conserving surgery based on TiGRT system and and compare with manual plan (MP). The dosimetry parameters of 10 patients and the evaluation of scoring table were analyzed, it was found that the targets dose of AP were better than that of MP, but there was no statistical difference except for CI, The V5, V20 and V30 of affected lungs and whole lungs in AP were lower than all that in MP, the Dmean of hearts was slightly higher than that of MP, but the difference was not statistically significant, the MU of AP was increase by 16.1% compared with MP, the score of AP evaluation was increase by 6.1% compared with MP. So the AP could be programmed and automated while ensuring the quality of the plan, and can be used to design the plans for radiotherapy after breast-conserving surgery.

Factors influencing decisions on contralateral symmetrisation procedure among patients with breast cancer

INTRODUCTION@#Oncoplastic breast-conserving surgery (OBCS) can cause breast asymmetry. Although contralateral breast surgery to achieve symmetry was offered to these patients, the uptake of symmetrisation was variable. We aimed to determine the factors that deter patients with breast cancer undergoing OBCS from opting for symmetrisation.@*METHODS@#All patients with breast cancer who underwent OBCS of displacement type with no symmetrisation were prospectively surveyed to explore the social, economic, psychological and physical reasons against symmetrisation.@*RESULTS@#A total of 28 patients participated in a survey administered at a mean 21.6 (range 2-47) months after OBCS. A combination of factors, such as worry and desire to treat breast cancer first (67.9%), not being overly concerned about breast cosmesis (57.1%) and fear of pain from additional operation (28.6%), deterred patients from immediate symmetrisation. Worry and desire to treat breast cancer first was the most important single factor for 50% of the patients. Reasons for no delayed symmetrisation included not being overly concerned about breast cosmesis (70.4%), fear of breast cancer recurrence (48.1%) and being happy with current breast cosmesis (33.3%), with the former two reasons equally cited as the single most important deterrent by 30% of patients each.@*CONCLUSION@#A combination of factors may deter patients from symmetrisation. The most significant factors deterring OBCS among patients were worry and desire to treat breast cancer first for immediate symmetrisation, and not being overly concerned about breast cosmesis and fear of breast cancer recurrence for delayed symmetrisation. Reassuring these patients may increase their uptake of symmetrisation, thereby improving patient cosmesis and satisfaction.

Mastitis granulomatosa idiopática. Características clínicas, imagenológicas, patológicas y su correlación con la respuesta al tratamiento - Hospital Dr. Cosme Argerich / Idiopathic granulomatous mastitis: clinical, imagenological, pathological characteristics and their correlation with treatment response

Introducción: La mastitis granulomatosa idiopática (MGI) es una patología inflamatoria benigna que se presenta típicamente como tumoración dolorosa. Recientemente, un subconjunto con patrón histológico neutrofilico quístico (MGNQ) fue asociado al corynebacterium. Objetivo: Revisión bibliográfica y evaluación de nuestra casuística. Material y método: Se seleccionaron 24 mujeres con MGI diagnosticada entre 2000-2019. Variables analizadas: demográficas, antecedentes, clínica, imágenes, cultivos, patología, tratamientos y evolución. Resultados: Edad media: 40.7 años. 50% tuvo ≥4 gestas y 91.6% lactó. Presentación clínica: Tumor abscedado palpable 58.33%, Palpable asintomático 25%, Palpable doloroso 12.5%. Lesión no palpable 4.17%. Tamaño promedio de lesión: 3.5 cm. Imágenes BIRADS 4/5: 87.5% Cultivo de corynebacterium 25%. Patología: Polimorfonucleares intraductales (PMNID) 62.5%, Vacuolas quísticas 50% (2 casos con baci- los). Tratamiento: Antibióticoterapia 79.1%, Inmunosupresión 79.1%, Drenaje de abscesos 45.8%. Tumorectomía 41.6%. Tiempo de resolución: 5.5 meses Tiempo libre de enfermedad: 33.6 meses. Recurrencias: 31.%. Conclusiones: Debe sospecharse en toda mujer joven con tumor mamario asociado a abscesos, fistulas y/o úlceras. El diagnóstico de MGNQ y PM- NID tienen asociación estadísticamente significativa con recurrencia. Es esencial el abordaje multidisciplinario y el tratamiento multimodal

Introduction: Idiopathic granulomatous mastitis (IGM) is a benign inflammatory disease that typically presents as a painful mass. Recently, a subset with cystic neutrophilic histological pattern (CNGM) was related to corynebacterium. Objetive: Bibliographic review and evaluation of our casuistry. Material and method: During 2000-2019, 24 women diagnosed with IGM were selected. Variables analyzed: Demographic, background, clinical, images, cultures, pathology, treatment and evolution. Results: Average age: 40.7 years. 50% had ≥ 4 gestations and 91.6% lactated. Clinical presentation: Palpable abscessed tumor 58.33%, Palpable asymptomatic 25%, Palpable painful 12.5%. Non palpable lesion 4.17%. Average lesion size: 3.5 cm. BIRADS images 4/5: 87.5% Corynebacterium culture 25%. Findings: Intraductal polymorphonuclear cells (IDPMNC) (62.5% ), Cystic vacuoles (50%) (With bacilli in 2 cases). Treatment: Antibiotic therapy 79.1%, Immunosuppression 79.1%, Drainage of abscesses 45.8%. Lumpectomy 41.6%. Resolution time: 5.5 months Diseasefree time: 33.6 months. Recurrences: 31.8%. Conclusions: It should be suspected in any young woman with a breast tumor associated with abscesses, fistulas and/or ulcers. The diagnosis of CNGM and IDPMNC has statistically significant association with recurrence. A multidisciplinary approach and multimodal treatment is essential

Potential impact of the z0011 trial on the omission of axillary dissection: a retrospective cohort study / Potencial impacto do estudo Z0011 na omissão da adenectomia axilar: Estudo de coorte retrospectiva

Abstract Objective To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. Methods A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. Results A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded fromthe study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes andmet the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). Conclusion The ACOSOG Z0011 trial criteria can be applied to a select group of SLNpositive patients, reducing the costs and morbidities of breast cancer surgery.

Resumo Objetivo Avaliar o número de pacientes com câncer de mama em estágio inicial que se beneficiariam da omissão da linfadenectomia axilar segundo o protocolo Z0011 da Alliance for Clinical Trials in Oncology (ACOSOG). Métodos Estudo de coorte retrospectiva conduzido no Hospital da Mulher da Universidade Estadual de Campinas. Foram incluídas mulheres diagnosticadas com carcinoma invasivo de mama em estágio inicial, com axila clinicamente negativa, tratadas com cirurgia conservadora e biópsia do linfonodo sentinela, radioterapia, quimioterapia e/ou hormonioterapia, de janeiro de 2005 a dezembro de 2010. Os critérios do estudo da ACOSOG Z0011 foram aplicados a essas mulheres e foi realizada uma análise estatística que comparou ambas as populações dos estudos. Resultados Foram estudadas 384 mulheres submetidas a cirurgia conservadora de mama e biópsia do linfonodo sentinela. Entre elas, 86 mulheres foram submetidas a linfadenectomia axilar por metástase presente no linfonodo sentinela. Uma paciente foi submetida a linfadenectomia axilar por ter um linfonodo palpável suspeito no intraoperatório, não incluída no estudo. Entre essas 86 pacientes, 82 (95,3%) tiveram de 1 a 2 linfonodos sentinela comprometidos e seriam elegíveis para omissão da linfadenectomia axilar pelos critérios do ACOSOG Z0011. Entre as 82 pacientes elegíveis, apenas 13 (15,9%) delas apresentaram tumores com invasão angiolinfática, e 62 (75,6%) dos tumores mediram até 2 cm (T1). Conclusão Os critérios do estudo ACOZOG Z0011 podem ser aplicados a um seleto grupo de pacientes com linfonodo sentinela positivo reduzindo os custos e a morbidade cirúrgica do tratamento do câncer de mama.

Enfermedad de Paget mamaria: revisión de la literatura / Paget's disease of the breast: review of the literature

Resumen La enfermedad de Paget mamaria es una neoplasia infrecuente de la mama, muchas veces de difícil diagnóstico y mal pronóstico. El objetivo es revisar los aspectos fundamentales clínicos, diagnósticos, así como los avances más recientes en su tratamiento. Se realizó una búsqueda bibliográfica a través de PUBMED, GOOGLE SCHOLAR y UPTODATE, de los últimos 20 años. Fueron seleccionados e incluidos en la revisión 38 artículos. La enfermedad de Paget mamaria es una neoplasia maligna infrecuente del complejo areola pezón de características inflamatorias al examen físico, asociado en un 85% de los casos a un cáncer de mama subyacente, en el 50% de los casos no identificable al examen físico, de difícil diagnóstico, cuya sospecha clínica se confirma con imágenes, biopsia e inmunohistoquímica. El tratamiento es mastectomía versus cirugía conservadora y radioterapia. Un mal enfoque clínico, retrasa el diagnóstico y empeora la sobrevida. MÉD.UIS.2021;34(1): 45-53.

Abstract Paget's disease of the breast is an uncommon neoplasm of the breast, many times difficult to diagnose and of poor prognosis. The objective is to review the fundamental clinical and diagnostic aspects, as well as the most recent advances in its treatment. A bibliographic search of the last 20 years was carried out through PUBMED, GOOGLE SCHOLAR and UPTODATE. 38 articles were selected and included in the review. Mammary paget disease is a rare malignant neoplasm of the nipple areola complex with inflammatory features on physical examination, associated in 85% of cases with underlying breast cancer, in 50% of cases not recognizable on physical exam, difficult to diagnose, whose clinical suspicion is confirmed by imaging, biopsy and immunohistochemistry. Treatment is mastectomy versus conservative surgery and radiotherapy. A poor clinical approach delays the diagnosis and worsens survival rate. MÉD.UIS.2021;34(1): 45-53.

New criteria for breast symmetry evaluation after breast conserving surgery for cancer / Novos critérios para avaliação da simetria da mama após cirurgia conservadora de câncer

ABSTRACT Objective: to evaluate symmetry after breast-conserving surgery (BCS) for cancer. Methods: a prospective study of patients undergoing BCS. These patients were photographed using the same criteria of evaluation. The references points used were the nipple height difference (NH), the nipple-manubrium distances (NM), nipple-sternum distances (NS) and the angle between the intramammary fold and the nipple (nipple angle; NA). ImageJ software was used. Three breast symmetry models were evaluated: excellent/others (model 1), excellent-good/others (model 2) and others/poor (model 3). The ROC curve was used to select acceptable criteria for the evaluation of symmetry. Decision tree model analysis was performed. Results: a total of 274 women were evaluated. The BCCT.core result was excellent in 5.8% (16), good in 24.1% (66), fair in 46.4% (127) and poor in 23.7% (65). The difference in NH was associated with good breast area (0.837-0.846); acceptable differences were below 3.1 cm, while unacceptable values were greater than 6.4 cm. Differences in the NM were associated with average breast area (0.709-0.789); a difference in value of less than 4.5 cm was acceptable, while values greater than 6.3 cm were unacceptable. In the decision tree combined model, a good-excellent outcome for patients with differential (d) dNH = 1 (0 to 5.30 cm) and dNM ≠ 3 (<6.28 cm); and for a poor/poor result, values dNM = 3 (> 6.35). Conclusions: the results presented here are simple tools that can assist the surgeon for breast symmetry evaluation.

RESUMO Objetivo: avaliar simetria após a cirurgia conservadora da mama (CCM) para câncer. Métodos: estudo prospectivo de pacientes submetidos à CCM, as quais foram fotografadas segundo os mesmos critérios de avaliação. Os pontos de referência utilizados foram a diferença de altura do mamilo (AM), a distância mamilo-manúbrio (MM), a distância mamilo-esterno (ME) e o ângulo entre o sulco intramamário e o mamilo (ângulo mamilo; AnM). Foi usado o programa ImageJ. Avaliamos três modelos de simetria mamária: excelente/outros (modelo 1), excelente-bom/outros (modelo 2) e outros/ruim (modelo 3). Aplicamos a curva ROC para selecionar os critérios aceitáveis para a avaliação da simetria. Realizamos análise com o modelo de árvore de decisão. Resultados: foram avaliadas 274 mulheres. Os resultados do BCCT.core foram excelentes em 5,8% (16), bons em 24,1% (66), regulares em 46,4% (127) e ruins em 23,7% (65). A diferença de AM (dAM) foi associada a boa área mamária (0,837-0,846); diferenças aceitáveis foram inferiores a 3,1 cm, enquanto os valores inaceitáveis foram superiores a 6,4 cm. As diferenças MM (dMM) foram associadas à área regular das mamas (0,709-0,789); diferença de valor inferior a 4,5 cm foi aceitável, enquanto valores superiores a 6,3 cm foram inaceitáveis. O modelo combinado de árvore de decisão demonstrou resultado bom-excelente para pacientes com diferencial (d) dAM = 1 (0 a 5,30 cm) e dMM ≠ 3 (< 6,28 cm), e resultado ruim/ruim com dMM = 3 (> 6,35 cm). Conclusões: os resultados aqui apresentados são ferramentas simples que podem auxiliar o cirurgião na avaliação da simetria mamária.

Resultado oncológico de cirugía conservadora con adyuvancia en cáncer de mama, Hospital San Felipe, Tegucigalpa / Oncologic outcome of conservative surgery with adjuvancy in breast cancer, Hospital San Felipe, Tegucigalpa

Antecedentes: El cáncer de mama es la malignidad más frecuentemente diagnosticada en mujeres, representando casi 1 de cada 4 casos de cáncer. Objetivo: Describir los resul-tados oncológicos de las pacientes tratadas con cirugía conser-vadora y adyuvancia por cáncer de mama estadios clínicos I-II, Hospital San Felipe, Tegucigalpa, 2017-2019. Métodos: Estudio descriptivo transversal retrospectivo. Extracción de información de expedientes clínicos de pacientes con diagnostico nuevo de cáncer de mama. Se registró datos sociodemográficos, estadio clínico pre- y post-operatorio, tratamiento y sobrevida. Resul-tados: De 49 pacientes, 59.2% (29) >50 años, 71.4% (35) pro-cedencia urbana, 61.2% (30) estadio IIA, las modalidades tera-péuticas fueron radioterapia 73.5% (36), hormonoterapia 69.4% (34), quimioterapia 40.8% (20). La combinación más frecuente fue radioterapia/hormonoterapia 46.9% (23); 26.5% (13) recibió monoterapia. El tiempo promedio de inicio de radioterapia fue 25 semanas (rango 4-90 semanas) y 13 semanas (rango 4-35 sema-nas) para quimioterapia. La sobrevida a 36 meses en estadio IA y IIB con adyuvancia fue 100.0% (5) y 86.0% (12), respectivamen-te. La sobrevida global a 36 meses fue 95.9% (47). Discusión: La sobrevida global identificada es comparable a estudios que si-guen las guías internacionales. Recomendamos implementar las recomendaciones de las guías internacionales para el manejo de cáncer de mama estadios tempranos, donde la adyuvancia debe iniciar en un periodo no mayor a 8 semanas postoperatorias. Este manejo contribuiría a reducir la morbilidad y el impacto psicoso-cial que presentan abordajes terapéuticos más radicales. Es ne-cesario y urgente contar con equipo y medicamentos adyuvantes de acuerdo a los avances científicos y tecnológicos...(AU)

Progress in local treatment of breast cancer: A narrative review / Evolução do tratamento local do câncer de mama: Revisão narrativa

Abstract The present paper reports on the local treatment of breast cancer from a historical perspective. A search for articles written in English was made in the Medline and EMBASE databases, and 40 papers were selected. Over the past 10 years, various randomized, controlled clinical trials on the local treatment of breast cancer indicated that patients with the samemolecular subtypemay receive different individualized surgical treatments aimed atoptimizing systemic adjuvant therapy. With a view to retaining the gainsmade in diseasefree and overall survival, surgical techniques have advanced from radical surgery to conservative mastectomies, thus reducing sequelae, while adjuvant and neoadjuvant therapies have contributed toward controlling the disease, both distant metastases and local recurrence. Current studies evaluate whether future breast cancer therapy may even succeed in eliminating surgery to the breast and axilla altogether.

Resumo Este artigo discute o tratamento local do câncer de mama a partir de uma perspectiva histórica. Uma busca de artigos publicados em inglês foi realizada nas bases de dados Medline e EMBASE, sendo selecionados 40 artigos. Nos últimos 10 anos, vários ensaios clínicos controlados e randomizados sobre o tratamento local do câncer de mama indicaram que pacientes com o mesmo subtipo molecular podem receber diferentes tratamentos cirúrgicos individualizados como objetivo de otimizar a terapia adjuvante sistêmica. Pretendendo reter os ganhos obtidos na sobrevida livre de doença e na sobrevida global, as técnicas cirúrgicas avançaram progressivamente da cirurgia radical para mastectomias conservadoras, reduzindo sequelas, enquanto as terapias adjuvantes e neoadjuvantes contribuíram para o controle da doença, tanto em relação às metástases distantes quanto à recorrência local. Estudos atuais avaliam se a terapia futura contra o câncer de mama poderá até mesmo eliminar a cirurgia da mama e da axila por completo.

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.

A multi-center investigation of breast-conserving surgery based on data from the Chinese Society of Breast Surgery (CSBrS-005) / 中华医学杂志(英文版)

BACKGROUND@#Although breast-conserving surgery is one of the standard treatments for breast cancer, few studies have assessed its recent implementation in China. We aimed to clarify the current real-world status of breast-conserving surgery in China.@*METHODS@#This cross-sectional survey relied on data collected by the Chinese Society of Breast Surgery (CSBrS) to examine patients who underwent this surgery between January 2018 and December 2018. The survey was conducted using a uniform electronic questionnaire to collect information, including clinical and pathological data on these patients.@*RESULTS@#Overall, 4459 breast-conserving surgeries were performed in 34 member units of CSBrS, accounting for 14.6% of all breast cancer surgeries performed in these units during the study period. In patients who underwent breast-conserving surgery with information on tumor size available, more than half (61.2%) of the tumors were smaller than 2 cm in diameter, and only 87 (3.2%) tumors were larger than 4 cm in diameter. Among patients who underwent breast-conserving surgeries, 457 (10.2%) patients received neoadjuvant therapy before the surgery. Among patients with a reported margin width, 34 (2.0%) patients had a margin of ≤2 mm, and 1530 (88.2%) of them had a margin of >5 mm.@*CONCLUSIONS@#This study demonstrated the rates of breast-conserving surgery in member units of the CSBrS, and introduced the characteristics and surgical margins of patients who underwent this surgery. This information helps describe the real-world status of breast-conserving surgery in China.@*TRIAL REGISTRATION@#chictr.org.cn, ChiCTR1900026841; http://www.chictr.org.cn/showproj.aspx?proj=42783.

Estudio transversal: Manejo quirúrgico de Cáncer de Mama en el Hospital José Carrasco Arteaga, Enero 2017- Enero 2018 / Cross-Sectional Study: Surgical Management of Patients with Breast Cancer in José Carrasco Arteaga Hospital January 2017 ­ January 2018

INTRODUCCIÓN: El cáncer de mama ocupa el primer lugar dentro de la patología maligna que afectan a la mujer a nivel mundial, representando el 16% de los cánceres femeninos. El manejo quirúrgico del cáncer de mama ha evolucionado a lo largo de los años, disminuyendo la morbimortalidad y mejorando la calidad de vida de las pacientes. El objetivo del presente estudio es analizar el abordaje quirúrgico de las pacientes tratadas en la unidad de Cirugía Oncológica del Hospital de Especialidades José Carrasco Arteaga. MATERIALES Y MÉTODOS: Estudio observacional transversal para determinar la prevalencia de las cirugías de cáncer de mama realizadas en la Unidad de Cirugía Oncológica del Hospital de Especialidades José Carrasco Arteaga. Se incluyeron variables como edad, diagnóstico, tipo histológico, etapa, localización, tipo de cirugía y márgenes. Se analizaron los datos con estadística descriptiva utilizando el paquete estadístico SPSS versión V24.0. RESULTADOS: Se incluyeron 66 pacientes en el estudio. Los porcentajes de cirugías conservadoras y mastectomías fueron 56.06% versus 43.94% respectivamente. El tipo histológico más frecuente fue el ductal infiltrante (75.74%). Del total de pacientes diagnosticados con cáncer de mama el 46.97% fue en etapa clínica IIB; el cuadrante superior externo estuvo afectado en el 72.7% de pacientes y el lado más frecuentemente con tumor fue el izquierdo en el 50%. CONCLUSIONES: El cáncer de mama es diagnosticado con mayor frecuencia en mujeres posmenopáusicas, el tipo histológico más frecuente es el carcinoma ductal infiltrante, el porcentaje de cirugías conservadoras es mayor a las mastectomíasra de Unidad Técnica de Anatomía Patológica, Hospital de Especialidades José Carrasco Arteaga, Cuenca ­ Ecuador(AU)

BACKGROUND: Breast cancer ranks first among cancers that affect women worldwide, representing 16% of female cancers. The surgical approach to breast cancer has undergone changes over the years, reducing morbidity and mortality and improving life quality for these patients. The purpose of this study is to analyze the surgical approach in patients treated in the Oncologic Surgery unit of José Carrasco Arteaga Hospital. METHODS: Cross-sectional observational study to analyze the prevalence of breast cancer surgeries performed in the Oncologic Surgery Unit of José Carrasco Arteaga Hospital. Variables such as age, diagnosis, histological type, stage, location, type of surgical procedure and surgical margins were included. All the data was analyzed with descriptive statistics using SPSS version 24.0. RESULTS: 66 patients were included in the study. The percentages of conservative surgeries and mastectomies were 56.06% versus 43.94% respectively. The most frequent histological type was infiltrating ductal carcinoma (75.74%). Of the total of patients diagnosed with breast cancer, 46.97% were in clinical stage IIB; the upper external quadrant was affected in 72.7% of patients and the most frequent location was the left side (50%). CONCLUSIONS: Breast cancer occurs most frequently in postmenopausal women, the most frequent histological type is infiltrating ductal carcinoma, and the percentage of conservative surgeries is greater than mastectomies.(AU)

Caso Clínico: Enfermedad de Paget del Pezón / Clinical Case Report: Paget's Disease of the Nipple

INTRODUCCIÓN: La enfermedad de Paget del pezón es infrecuente y representa del 1 al 3 % de las neoplasias de mama. Está asociada con un carcinoma invasivo o in situ en el 82 al 94 % de los casos. Se presenta entre los 55 a 64 años de edad. CASO CLÍNICO: Se presenta el caso de una mujer de 58 años con zona de descamación de 1 cm2 indolora en pezón derecho y tumor de 4 cm2 en mama izquierda, ecografía y mamografía BI-RADS III. Biopsia incisional de pezón derecho que reportó enfermedad de Paget, con ampliación de márgenes. Se completó estudios de extensión con resonancia magnética que reportó lesión retro-areolar sospechosa en mama derecha y lesión nodular maligna en mama izquierda. EVOLUCIÓN: Se realizó cuadrantectomía central más neo-pezón en mama derecha, y en mama izquierda cuadrantectomía superoexterna con vaciamiento ganglionar axilar bilateral, el reporte de patología fue mama derecha negativa para malignidad, mama izquierda hiperplasia intraductal atípica con focos de carcinoma intraductal. Se administró 25 sesiones radioterapia, tras un año de seguimiento se mantiene sin recurrencia. CONCLUSIÓN: La enfermedad de Paget es poco frecuente, pero debe considerarse como diagnóstico diferencial en pacientes sobre los 55 años, su tratamiento estandarizado es quirúrgico, la adyuvancia con radioterapia aún es motivo de discusión. El autoexamen de mama, el acudir a controles periódicos a partir de los 40 años además de realizar una ecografía y mamografía nos lleva a diagnósticos tempranos con un elevado porcentaje de cirugías más conservadoras.(au)

BACKGROUND: Paget's disease of the nipple is uncommon and represents 1 to 3% of breast malignancies. It is associated with invasive or in situ carcinoma in 82 to 94% of cases. It occurs between 55 to 64 years old. CASE REPORT: We present the case of a 58 year old woman with a painless 1cm2 scaling skin lesion in the right nipple and a 4cm2 tumor in the left breast, ultrasound and mammograghy classified as BIRADS III. Incisional biopsy of the right nipple that reported Paget's¬ disease, with extension of surgical margins of resection. MRI extension studies were made; they reported suspicious retroaereolar lesion in the right breast and malignant nodular lesion in the left breast. EVOLUTION: We performed central quadrantectomy with nipple reconstruction in the right breast, and superoexternal quadrantectomy in the left breast, with bilateral axillary lymph node dissection, the pathology report was negative for malignancy in the right breast, in the left breast atypical intraductal hiperplasia with foci of intraductal carcinoma. The patient received 25 radiotherapy sessions. After one year of follow-up there is no recurrence. CONCLUSIONS: Paget's disease is rare, but should be considered as a differential diagnosis in patients over 55 years, its standardized treatment is surgery, adjuvant treatment with radiotherapy is still a matter of discussion. Breast self-exam, regular checkups in people over 40 years old, ultrasound and mammogram lead to early diagnosis with a higher percentage of conservative surgeries.(au)

Whole sequencing of the mitochondrial genome of breast cancer tissue in Mexican-mestizo postmenopausal women with different body mass index

Abstract Background Mitochondrial and oxidative stress has been related to obesity and breast cancer being this cancer more frequent and more aggressive in postmenopausal women with obesity. Objective The objective of this study was to investigate whether Mexican-Mestizo postmenopausal women with breast cancer and obesity present different somatic mutations in the mitochondrial DNA (mtDNA) when compared to women with normal body mass index (BMI). Subjects and Methods We included six Mexican-Mestizo postmenopausal women bearing breast cancer and who underwent mastectomy or breast-conserving surgery. BMI was determined in each case. Patients’ genomic DNA was isolated from blood leukocytes and tumor tissue samples. Whole mtDNA sequence was determined by MitoChip v2.0 mitochondrial resequencing array, and data were analyzed using the GeneChip Sequence Analysis Software. Tumor mtDNA sequence was compared with matched leukocyte mtDNA sequence. Results Three women had a normal BMI and three presented obesity. Overall, we found 64 genetic variants: 53.1% were somatic mutations and 46.9% were polymorphisms; 44.1% were in the non-coding region and 55.9% were in genes that encode for mitochondrial proteins. Among the somatic mutations, 67.7% were in patients with normal BMI and 32.3% in patients with obesity. Conclusions We did not find a higher frequency of mitochondrial somatic mutations in postmenopausal women with breast cancer and obesity compared to those with normal BMI. However, results could be due to the small number of women studied.