Linfoma anaplásico de células grandes asociado a implantes mamarios diagnosticado mediante punción por aguja fina. Caso clínico

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is a rare type of non-Hodgkin T-cell lymphoma, recently defined in the 2016 World Health Organization (WHO) classification of lymphoid neoplasms. It occurs more commonly when textured implants are used and appears clinically as a late seroma. Cytologically, these lesions are composed of large atypical cells with pleomorphic nucleus and an immunophenotype positive for T cell markers and CD30, and negative for ALK1. We report a 56-years-old woman with breast implants who developed a periprosthetic seroma three years after surgery. A fine needle aspiration of the lesion was carried out. Cytology and the immunocytochemical study revealed cells compatible with BIA-ALCL. The flow cytometric study was negative. Excisional biopsy of the capsule was performed, observing that the neoplastic cells were confined to the inner surface of the capsule. Imaging studies did not find evidence of disseminated disease. The present case demonstrates the importance of the study of any late periprosthetic effusion, which can be performed using fine needle aspiration.

Repair of large incisional hernias. To drain or not to drain. Randomized clinical trial

ABSTRACT PURPOSE: To evaluate the occurrence of seroma and surgical wound infection after surgery. METHODS: A total of 42 individuals with large incisional hernias were subjected toonlay mesh repair. Following the mesh placement, the participants were randomly allocated to two groups. In group 1, closed-suction drains were placed in the subcutaneous tissue, while progressive tension sutures were performed in group 2. The participants were subjected to clinical and ultrasound assessment to detect seroma and surgical wound infection at three time-points after surgery. RESULTS: The occurrence of seroma at the early, intermediate or late assessments was respectively 19.0%, 47.6%, 52.4% in group 1 and 28.6%, 57.1%, 42.9% in group 2 and was not significantly different between groups (p 0.469; 0.631; 0.619). Surgical wound infection occurred 19% in group 1 and 23.8% in group 2, without a significant difference between the groups (p>0.999). CONCLUSION: The frequency of seroma and infection did not exhibit significant differences between individuals subjected to onlay mesh repair of large incisional hernias with drains or progressive tension sutures without drainage.

Factores asociados a mayor débito de drenaje tras linfadenectomía axilar por cáncer de mama / Factors associated with greater debit drainage after axillary lymphadenectomy for breast cancer

Introduction: axillary lymph node dissection (ALND) is still a usual procedure in the treatment of breast cancer. A drain is normally placed in the surgical bed and maintained several days until obtaining a daily discharge of 30-50 ml, in order to reduce the appearance of seroma. The aim of this study was to analyze possible factors associated with an increased drainage volume. Patients and Methods: a retrospective study of all the patients undergoing ALND for breasts cancer at our institution between 2011 and 2012 was performed. Results: 40 females were included. There were no complications or mortality. Median hospital stay was 2 days. Median day of drainage removal was the 5th postoperative day. Mean total drainage volume was 298.9 +/- 240.1 ml. High blood pressure associated with an increased drainage volume (550 ml vs 217.5 ml; p = 0.001) and a later removal (8th vs 4th day; p = 0.002). Similar happened with age > 65 years (420.8 ml vs 24.6 ml; p = 0.003) and (7th vs 5th day; p = 0.009). The number of metastatic lymph nodes showed a direct correlation with total drainage volume (Pearson 0.503; p = 0.017) and removal day (Spearman 0.563; p = 0.006), similar to the primary tumour size: total drainage volume (Pearson 0.447; p = 0.042) and removal day (Spearman 0.556; p = 0.009). Conclusion: age over 65 years, high blood pressure, number of metastatic lymph nodes and primary tumour size associated with a higher drainage volume and time to remove the drain.

Introducción: la linfadenectomía axilar (LA) sigue siendo un procedimiento frecuente en el tratamiento del cáncer de mama. Habitualmente se coloca un drenaje en el hueco axilar, que se mantiene varios días, hasta que tiene un débito diario de 30-50 ml, con el fin de reducir la aparición de seroma. El objetivo del presente estudio es analizar posibles factores asociados a un mayor volumen de drenaje. Pacientes y Métodos: realizamos un estudio retrospectivo de todas las pacientes intervenidas de LA por cáncer de mama en nuestro centro durante los años 2011 y 2012. Resultados: incluimos 40 mujeres en el estudio. No hubo complicaciones ni mortalidad. La mediana de estancia hospitalaria fue de 2 días. El día mediano de retirada de drenaje fue el 5° postoperatorio. El volumen medio total del drenaje fue 298,9 +/- 240,1 ml. La hipertensión arterial se asocia a un mayor volumen de drenaje (550 ml vs 217,5 ml; p = 0,001) y a una retirada más tardía del mismo (8° día vs 4° día; p = 0,002). Al igual ocurre con la edad > 65 años (420,8 ml vs 24,6 ml; p = 0,003) y (7° vs 5° día; p = 0,009). El número de ganglios metastásicos también se correlaciona con el volumen total de drenaje (coeficiente de correlación de Pearson 0,503; p = 0,017) y con el día de retirada (Spearman 0,563; p = 0,006), lo mismo que el tamaño del tumor primario: volumen total de drenaje (Pearson 0,447; p = 0,042) y día de retirada (Spearman 0,556; p = 0,009). Conclusión: la edad mayor de 65 años, la hipertensión arterial, el número de ganglios metastásicos y el tamaño del tumor primario se asocian con mayor volumen por el drenaje axilar y días necesarios hasta la retirada.

Postoperative Complications of Thyroid Cancer in a Single Center Experience

The aim of this study was to investigate the complications following surgical treatment of thyroid cancer and the association between the extent of surgery and complication rates. A total of 2,636 patients who underwent surgery due to thyroid cancer were retrospectively reviewed to identify surgical complications. Complication rates were assessed according to the extent of surgery, which was classified as follows; less-than-total thyroidectomy with central compartment node dissection (CCND) (Group I, n=636), total thyroidectomy with CCND (Group II, n=1,390), total thyroidectomy plus ipsilateral neck dissection (Group III, n=513), and total thyroidectomy plus bilateral neck dissection (Group IV, n=97). The most common surgical complication was symptomatic hypoparathyroidism, of which 28.4% of cases were transient and 0.3% permanent. The other surgical complications included vocal cord palsy (0.7% transient, and 0.2% permanent), hematoma (0.5%), seroma (4.7%), chyle fistula (1.8%), and Horner's syndrome (0.2%). The complication rates increased significantly with increasing the extent of surgery from Group I to Group IV. The more extensive surgery makes more complications, such as hypoparathyroidism, seroma, and others.

Los microtraumatismos como etiología del seroma tardío en la mastoplastía de aumento / The etiology of seroma microtrauma as late in augmentation mastoplastia

El seroma tardio es una complicación en la cirugía de los implantes mamarios que aparece habitualmente luego de los tres meses en la mayoría de los casos, aunque puede darse a partir del mes. Es escasa la información con que se cuenta en la actualidad sobre él, especialmente en lo referente a su etiología. Los autores presentan aquí su experiencia en lo relativo a esta patología, atribuyendo su etiología a los microtraumatismos sufridos por la paciente en la cápsula de la zona afectada. Se presentan casos clínicos, su correspondiente tratamiento y resultado final.

Late seroma is a complication of implant surgery for breast augmentation that usually appears, in most cases, after the first three months post-op, although it may also occur a month after the surgery. At he present time, there is little information on the matter, especially regarding its etiology. In this article, the authors present their experience with respect to this pathology, attributing its etiology to micro traumas suffered by the patients in the capsule of the affected area. Clinical cases are presented along with their respective treatment and final result.

Placa axilar compresiva fija para prevenir el seroma persistente postlinfadenectomía: comparación con controles históricos / Compressive axillary plates for persistent seroma after axillary lymphadenectomy

El seroma axilar persistente postlinfadenectomía es una complicación frecuente de la cirugía del cáncer mamario infiltrante, describiéndose diversas técnicas para su control. Para evaluar el beneficio adicional con el uso de placas axilares compresivas fijas se comparó una serie retrospectiva de 30 pacientes en que se usó este dispositivo con una serie histórica seleccionada aleatoriamente y manejada con un tratamiento estándar que consistió en el uso de drenajes aspirativos y compresión axilar con venda elástica. Los dos grupos resultaron homogéneos en las variables edad, estadio clínico y tipo de operación. La serie histórica tuvo una incidencia de seroma persistente de 26,67 por ciento (8/30), mientras que en el grupo con placa fue de un 6,67 por ciento (2/30), diferencia que fue estadísticamente significativa. Concomitantemente, el grupo con placa tuvo una duración del uso de los drenajes significativamente menor. No hubo diferencias en la duración del seroma ni en la aparición de complicaciones locales. No observamos ninguna relación entre la aparición de seroma y la utilización de alguna técnica quirúrgica en particular o de radioterapia preoperatoria.

Background: Persistent axillary post-lymphadenectomy seroma is a frequent complication of breast cancer treatment. Aim: To evaluate the benefit of fixed compressive axillary plates for this complication. Material and methods: Retrospective comparison of 30 patients in whom this technique was used with a randomized historic group of 30 women, handled with a standard technique that included suction drains and external axillary compressive elastic bandages. Results: Both groups had similar age, stage and operation type. Eight patients (27 percent) in the historic group and 2 (7 percent) in the axillary plate group had a persistent axillary seroma (p=0.04). Additionally, the plate group needed drains for a shorter period. There were no differences in the duration of seroma and the appearance of local complications. We did not observe any relationship between seroma appearance and the use of any particular operative technique or preoperative radiotherapy use. Conclusions: The use of fixed compressive axillary plates reduced the incidence of persistent seroma after axillary lymphadenectomy.

Factors predicting seroma formation after mastectomy for Chinese breast cancer patients.

BACKGROUND: Seroma formation after mastectomy typically delays recovery and adds to morbidity. AIMS: This retrospective review was undertaken to identify factors which predict development of seroma after mastectomy for breast cancer patients. SETTING AND DESIGN: 119 consecutive patients intended for mastectomy for the treatment of primary breast cancer were included. Factors taken into consideration were epidemiological, peri-operative in nature and those related to wound drainage output. MATERIALS AND METHODS: Total mastectomy was performed and axillary sampling was taken. All patients were reviewed within two weeks after leaving hospital, unless seroma formation was detected before discharge. The diagnosis of seroma was made clinically when a collection was detected beneath the skin flaps. STATISTICAL ANALYSIS USED : Student's t test was used with continuous variables and the X2 test for categorical situations. Fisher's exact test was applied when small numbers were encountered. A two-tailed test of P< 0.05 was considered significant. Univariate analyses were performed. RESULTS: The incidence of seroma formation was eight per cent. Five factors were identified to be significantly related to seroma formation: i) age over 45 years; ii) hypertension; iii) total drainage output exceeding 500 ml in the first three postoperative days; iv) drainage for more than eight days. Immediate breast reconstruction prevents the formation of seroma. CONCLUSION : The presence of hypertension in a patient over 45 years should alert the surgeon to possible seroma formation, particularly when the post-operative drainage exceeded 500 ml in the first three days. Appropriate preventive measures should then be implemented.

Seroma following modified Blalock-Taussig shunt resulting in subsequent occlusion of the shunt which was opened by balloon angioplasty.

We report the case of a 9-year-old boy with tetralogy of Fallot who had undergone left modified Blalock Taussig shunt. The patient developed seroma around the shunt which was excised surgically. The patient developed total occlusion of the shunt post-operatively with clinical deterioration. We used emergency percutaneous angioplasty to successfully treat the patient.

Seroma formation after surgery for breast cancer

Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy [MRM] or breast preservation [BP] was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument [electrocautery or scalpel], use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years [SD +/- 11.9]. Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy [OR = 2.83, 95% CI 1.01-7.90, P = 0.04]. No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. The findings suggest that the type of surgery is a predicting factor for serorna formation in breast cancer patients