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1.
Med. lab ; 27(1): 25-32, 2023. ilus
Article in Spanish | LILACS | ID: biblio-1412746

ABSTRACT

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


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


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Thyroid Neoplasms/secondary , Breast Neoplasms/pathology , Facial Neoplasms/pathology , Carcinoma, Renal Cell/pathology , Carcinoma, Ductal, Breast/pathology , Upper Extremity/pathology , Kidney Neoplasms/pathology , Melanoma/pathology
2.
Rev. cuba. cir ; 61(4)dic. 2022.
Article in Spanish | LILACS, CUMED | ID: biblio-1441522

ABSTRACT

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)


Subject(s)
Humans , Female , Adult , Breast Neoplasms/drug therapy , Mastectomy, Segmental/methods , Carcinoma, Ductal, Breast/radiotherapy , Epidemiology, Descriptive , Retrospective Studies
3.
Rev. méd. Maule ; 37(1): 8-13, jun. 2022. graf
Article in Spanish | LILACS | ID: biblio-1395908

ABSTRACT

Breast cancer in men is a rare pathology. The most common clinical presentation is a palpable and painless retroareolar nodule. In men, it is a rare pathology, there are few studies on the matter, where breast cancer trials frequently exclude men. Objective: to present the incidence of breast cancer in men from the "Regional Hospital of Talca" Method: Retrospective and descriptive study of cases of breast cancer in men who have been treated and followed up in the Breast Pathology Unit of the Regional Hospital of Talca from January 1, 2011 to December 31, 2021.Results: There were 9 cases of breast cancer in men. Average age at diagnosis was 63 years, all patients were 50 years of age or older. One hundred percent of patients consulted for a self-palpable breast nodule. Average size on physical examination was 30 mm. The most frequent histology was invasive ductal carcinoma (56%), followed by invasive tubular carcinoma (22%) and ductal carcinoma in situ (11%). Immunohistochemistry was 100% positive for estrogen and progesterone receptor. Surgery in 56% of cases was total mastectomy with axillary dissection, and in 33% it was total mastectomy alone. 4 patients underwent adjuvant treatment with chemotherapy, and just one required a combination of chemotherapy and radiotherapy. During follow-up, only 2 patients died. Conclusion. Breast cancer in men is not very prevalent and the management is extrapolated from large studies in women, we believe that it is essential to have studies in male patients, to really have clarity on the behavior and evolution of the disease.


Subject(s)
Humans , Male , Middle Aged , Aged , Carcinoma, Ductal, Breast/therapy , Breast Neoplasms, Male/therapy , Mastectomy/methods , Retrospective Studies , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/epidemiology , Combined Modality Therapy , Breast Neoplasms, Male/pathology , Breast Neoplasms, Male/epidemiology , Histology
4.
Rev. colomb. radiol ; 33(1): 5711-5713, mar. 2022.
Article in English, Spanish | LILACS, COLNAL | ID: biblio-1434238

ABSTRACT

Introducción: El carcinoma de mama bilateral sincrónico se define por la aparición de tumores simultáneos en ambas mamas. Estudios indican que la frecuencia de estos carcinomas oscila entre 1,4 y 11,8 %. Actualmente, la ecografía mamaria y la mamografía constituyen los métodos de cribado aconsejables para detectar lesiones iniciales. Objetivo: Presentar un caso infrecuente de carcinoma bilateral simultáneo. Presentación de caso: Se trata de una mujer de 67 años de edad, sin antecedentes personales ni familiares de cáncer de mama, que acude a consulta de mastología por aumento de volumen focal en la mama derecha. En mamografía digital se identifican imágenes nodulares espiculadas de alta densidad en ambas mamas, con clasificación BIRADS-5. Se completó el estudio con citología por aguja fina y biopsia posoperatoria con el resultado de carcinoma ductal bilateral con metástasis al ganglio axilar derecho. Conclusiones: El carcinoma bilateral de mama, a pesar de ser una entidad de aparición excepcional, se puede identificar en estadios clínicos avanzados en pacientes sin antecedentes familiares, por lo que es importante la evaluación de ambas mamas en los estudios de imagen, para descartar lesiones sincrónicas con las pertinentes biopsias bilaterales para su conclusión histopatológica.


Introduction: Synchronous bilateral breast cancer is defined by some authors as the simultaneous appearance of tumors in both breasts. Studies indicate that the frequency of these carcinomas range from 1.4 to 11.8%. Currently, breast ultrasound and mammography are the recommended screening methods to detect initial lesions. Objective: To describe a rare simultaneous bilateral breast carcinoma case. Case report:We present the case of a 67-year-old woman, with no personal or family history of breast cancer, who attended a mastology consultation due to focal volume increase in the right breast. Digital mammography was performed, identifying high-density spiculated nodular images in both breasts with BIRADS-5 classification. A study was completed with fine-needle cytology and postoperative biopsy, obtaining the result of bilateral ductal carcinoma with metastasis to the right axillary node.Conclusions: Bilateral breast carcinoma, despite being an entity of exceptional appearance, can be identified in advanced clinical stages in patients with no family history, so it is important to evaluate both breasts in imaging studies, to rule out synchronous lesions, requesting the relevant bilateral biopsies for histopathological conclusion.


Subject(s)
Carcinoma, Ductal, Breast , Breast Neoplasms , Mammography
5.
Chinese Journal of Pathology ; (12): 218-223, 2022.
Article in Chinese | WPRIM | ID: wpr-935508

ABSTRACT

Objective: To investigate the clinicopathological features, diagnostic criteria and differential diagnosis of primary salivary gland-type duct carcinoma of lung(LSDC). Methods: Two patients with LSDC after surgical resection in Shanghai Pulmonary Hospital from 2020 to 2021 were included; their clinical parameters as well as pathological, immunohistochemical and molecular characteristics of the tumors were analyzed. The relevant literature was also reviewed. Results: Both patients were male, aged 49(case 1) and 64(case 2) years, respectively, and with a history of smoking. The chest computed tomography scan showed both lesions to be centrally located. Gross examination showed the maximum diameters were 16 mm and 35 mm, respectively. The histomorphology of LSDC resembled ductal carcinoma of breast, with intraductal islands of neoplastic cells, which also formed solid nests, papillary, micropapillary and cribriform structures. There was frequent accompanying comedo-like necrosis. The neoplasm cells were markedly heteromorphic, possessing large irregular nuclei with prominent nucleoli, abundant eosinophilic or clear cytoplasm, and mitotic figures were common. Both cases of LSDC were immunoreactive for CKpan, CK7, AR, HER2 staining was (2+) and were negative for TTF1, Napsin A, p40, GATA3, mammaglobin, GCDFP15, SOX10, PSA, P504S, ER, PR, vimentin, S-100, SMA, CK5/6 and p63. The tumor showed double-layer cell structure of the duct, and some basal cells/myoepithelial cells expressed p40 and CK5/6. Case 1 had no gene mutation while case 2 harbored TP53 and KMT2A gene mutation detected by next generation sequencing. Conclusions: LSDC is a very rare and highly aggressive salivary-type malignant tumor. The postoperative diagnosis mainly depends on histopathology and immunohistochemistry, attention should be paid to differential diagnosis to prevent missed diagnosis.


Subject(s)
Child, Preschool , Humans , Male , Biomarkers, Tumor/analysis , Breast Neoplasms , Carcinoma, Ductal, Breast , China , Lung , Salivary Ducts/chemistry
6.
Chinese Journal of Oncology ; (12): 425-429, 2022.
Article in Chinese | WPRIM | ID: wpr-935231

ABSTRACT

Objective: To investigate the clinicopathological factors and prognostic status of young Mammary Paget's disease (MPD) patients with invasive ductal carcinoma (IDC). Methods: In this study, we defined the age at diagnosis below 40 years old as young patients, and retrospectively analyzed data from 123 MPD-IDC patients who were admitted at the Cancer Hospital Chinese Academy of Medical Sciences from June 2002 to February 2019. Patients were divided into the young group (≤40 years old, 15 cases) and the old group (>40 years old, 108 cases) according to the age of onset, and the clinicopathological characteristics and prognosis of the two groups were compared. Cox regression model analysis was used to analyze the prognosis influencing factors. Results: The proportions of patients in the young group with non-menopausal, axillary lymph node metastasis, and Ki-67 index ≥15% were 93.3% (14/15), 73.3% (11/15), and 86.7% (13/15), respectively, which were higher than those in the old group [45.4% (49/108), 39.8%(43/108), and 60.2% (65/108), respectively] , with statistically significant differences (P<0.05). At an average follow-up of 63.2 months, patients in the young group had a significantly shorter disease-free survival (DFS) compared with that of the old group (P=0.012), while the difference in overall survival (OS) between the two groups was not statistically significant (P=0.161). Multifactorial Cox regression analysis showed that axillary lymph node status was an independent influencing factor on OS (HR=3.339, 95% CI: 1.121-9.943) in patients with MPD-IDC, while age was not. Conclusion: Compared with the old group, young patients with MPD-IDC have a higher incidence of axillary lymph node metastasis, high Ki-67 expression, and a shorter DFS, but age is not an independent influencing factor on DFS or OS in patients with MPD-IDC.


Subject(s)
Adult , Female , Humans , Breast Neoplasms , Carcinoma, Ductal, Breast/surgery , Ki-67 Antigen , Lymphatic Metastasis , Paget's Disease, Mammary/metabolism , Prognosis , Retrospective Studies
7.
An. Fac. Cienc. Méd. (Asunción) ; 54(2): 145-150, 2021.
Article in Spanish | LILACS | ID: biblio-1281112

ABSTRACT

Paciente de sexo femenino de 60 años de edad, con antecedente de carcinoma ductal de mama izquierda, presentó dolor agudo en epigastrio que se acompaña de 6 meses de dispepsia, saciedad precoz y pirosis; con una pérdida de 9 kilogramos en 2 meses. Refirió coluria, negó ictericia y acolia. Las pruebas de función hepática mostraron un patrón de colestasis con elevación de gama glutamiltrasferasa (GGT) y fosfatasa alcalina (FA). Fue diagnosticada con un Colangiocarcinoma perihiliar basado en hallazgos abdominales de tomografía y resonancia, con un nódulo parenquimatoso en el segmento 8 del hígado como un tumor infiltrante periductal. El diagnóstico presuntivo fue el de Tumor de Klatskin, pero la anatomía patológica fue compatible con metástasis de carcinoma ductal de mama (CK7 + / GATA3 +). El informe complementario mostró HER-2 negativo y estrógeno negativo (ER) y progesterona (PR) por lo que el inmunofenotipo final fue ER- / PR-; HER2- con índice de proliferación Ki67 <5%, una metástasis de cáncer de mama triple negativo.


A 60-year-old female, with a medical history of a ductal carcinoma of the left breast, presented with sharp pain in epigastrium with 6 months of dyspepsia, early satiety and pyrosis and with the loss of 9 kilograms in 2 months. She referred choluria and denied jaundice and acholia. Liver function tests showed a cholestasis pattern with only elevated Gama Glutamyl Teransferase and alkaline phosphatase. She was diagnosed with a hilar cholangiocarcinoma based on abdominal CT and MRI findings, with a parenchymal nodule in segment 8 of the liver as a periductal infiltrating tumor. The presumed diagnosis was Klatskin Tumor, but the biopsied site was compatible with breast ductal carcinoma metastasis (CK7 + / GATA3 +). The complementary report showed negative HER-2 and negative estrogen (ER) and progesterone (PR) so the final immunophenotype is ER- / PR-; HER2- with proliferation index Ki67 <5%, a triple-negative breast cancer metastasis.


Subject(s)
Carcinoma , Cholestasis , Carcinoma, Ductal, Breast , Dyspepsia , Alkaline Phosphatase , Acute Pain , Anatomy
8.
Rev. bras. cancerol ; 67(2): e-02785, 2021.
Article in English | LILACS | ID: biblio-1282759

ABSTRACT

Introduction: The inhibition of osteoclastic activity, associated with different treatment modalities in patients with head and neck cancer, make bones unable to respond to repair processes related to physiological traumas or infection and may result in bone necrosis. The present study aims to report a clinical case of osteoradionecrosis in mandible, and how its sequels were controlled by ozonotherapy. Case report: A 73-year-old female patient with infiltrative ductal breast carcinoma with mandibular metastasis was submitted to chemo and radiotherapy at head and neck region associated with bisphosphonate. Three years later, she was diagnosed with hemimandibular osteoradionecrosis that exhibited communication with oral cavity and with a chronic, suppurative and persistent associated infection. It was applied adjuvant therapy with ozone through the cutaneous fistula and the exposed and necrotic bone. Additionally, non-vital bone debridement was proceeded in two surgical steps. The patient is after a 1-year follow-up non-symptomatic. Conclusion: It is supposed that ozonotherapy, due to its antibacterial and immunoregulatory mechanism of action, was an important therapeutic agent for improving the patient's quality of life.


Introdução: A inibição da atividade osteoclástica, associada a diversas modalidades de tratamento utilizadas em pacientes com câncer de cabeça e pescoço, torna o osso incapaz de responder aos processos de reparo relacionados a traumas fisiológicos ou à infecção, e pode resultar em necrose óssea. O presente estudo tem como objetivo relatar um caso clínico de osteonecrose em mandíbula como consequência do uso de bisfosfonato associado à quimioterapia e à radioterapia para tratamento de câncer de mama com metástase para mandíbula, tendo suas sequelas controladas por meio do uso da ozonioterapia. Relato do caso: Paciente do sexo feminino, 73 anos, com história de carcinoma ductal infiltrante de mama com metástase óssea em mandíbula, a qual foi submetida ao tratamento de quimioterapia e radioterapia em região de cabeça e pescoço; três anos depois, foi diagnosticada com osteonecrose da hemimandíbula direita com exposição completa para a cavidade bucal e infecção crônica, supurativa e persistente. Foi realizada terapia adjuvante com aplicação de ozônio nas fístulas cutâneas e no remanescente ósseo exposto e necrosado, além do desbridamento dos sequestros ósseos em duas etapas cirúrgicas. Paciente encontra-se em acompanhamento há 1 ano, sem sintomatologia associada. Conclusão: Observou-se que a ozonioterapia, em razão da sua ação antibacteriana e cicatrizante, foi um importante agente terapêutico para a melhora da qualidade de vida da paciente.


Introducción: La inhibición de la actividad osteoclástica, asociada con las diversas modalidades de tratamiento utilizadas por los pacientes con cáncer de cabeza y cuello, hace que el hueso no pueda responder a los procesos de reparación relacionados con traumas o infecciones fisiológicas y puede provocar necrosis ósea. El presente estudio tiene como objetivo informar un caso clínico de osteonecrosis mandibular como consecuencia del uso de bisfosfonato asociado con quimioterapia y radioterapia para tartar el cáncer de mama con mandíbula metastásica, controlando sus secuelas mediante el uso de la terapia con ozono. Relato del caso: Paciente de 73 años con antecedentes de carcinoma ductal mamario infiltrante con metástasis en la mandíbula ósea fue sometida a quimioterapia y radioterapia en la región de la cabeza y el cuello. Tres años después, le diagnostica con osteonecrosis hemimandibular derecha con exposición completa a la cavidad oral e infección crónica, supurativa y persistente. La terapia adyuvante se realizó con la aplicación de ozono en las fístulas cutáneas y en el remanente óseo expuesto y necrótico, además del desbridamiento de los secuestros óseos en dos etapas quirúrgicas. El paciente ha estado bajo seguimiento durante 1 años in síntomas asociados. Conclusión: Debido a su acción antibacteriana y curativa, la ozonioterapia fue un importante agente terapéutico para mejorar la calidad de vida del paciente.


Subject(s)
Humans , Female , Aged , Ozone/therapeutic use , Bisphosphonate-Associated Osteonecrosis of the Jaw/diagnosis , Bisphosphonate-Associated Osteonecrosis of the Jaw/therapy , Breast Neoplasms , Mandibular Neoplasms/diagnostic imaging , Carcinoma, Ductal, Breast , Bisphosphonate-Associated Osteonecrosis of the Jaw/radiotherapy , Mandible/pathology
9.
Autops. Case Rep ; 11: e2021331, 2021. graf
Article in English | LILACS | ID: biblio-1339245

ABSTRACT

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


Subject(s)
Humans , Female , Adult , Breast Neoplasms , Carcinoma, Ductal, Breast/pathology , Phyllodes Tumor/pathology , Ossification, Heterotopic/pathology
10.
11.
Rev. bras. cancerol ; 66(4): e-15956, 2020.
Article in Portuguese | LILACS | ID: biblio-1140895

ABSTRACT

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.


Subject(s)
Humans , Female , Aged , Breast Neoplasms , Carcinoma, Ductal, Breast , Mastectomy, Segmental , Chemotherapy, Adjuvant , Carcinoma, Intraductal, Noninfiltrating , Radiotherapy, Adjuvant
12.
Journal of Southern Medical University ; (12): 1593-1600, 2020.
Article in Chinese | WPRIM | ID: wpr-880780

ABSTRACT

OBJECTIVE@#To examine the expressions of JMJD3, matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) in invasive ductal breast carcinoma, their association with the clinicopathological features of the patients and the effect of JMJD3 overexpression on proliferation and MMP-2 and VEGF expressions in breast cancer cells.@*METHODS@#The protein and mRNA expressions of JMJD3, MMP-2, and VEGF in invasive ductal breast carcinoma and paired adjacent tissues were detected by immunohistochemistry and RT-PCR, respectively, and their correlation with the clinicopathological characteristics of the patients was analyzed. Kaplan-Meier survival analysis was used to evaluate the correlation of JMJD3, MMP-2 and VEGF expression levels with the survival of the patients. In breast cancer MDA-MB-231 cells transfected with a JMJD3-expression plasmid, the expression of Ki67 was examined immunohistochemically, the cell proliferation was assessed with CCK8 assay, and the mRNA expressions of MMP-2 and VEGF were detected with RT-PCR.@*RESULTS@#Breast cancer tissues had significantly lower JMJD3 expression and higher MMP-2 and VEGF expressions at both the mRNA and protein levels than the adjacent tissue (@*CONCLUSIONS@#The expressions of JMJD3, MMP-2 and VEGF in invasive ductal breast carcinoma are closely correlated to tumor proliferation, invasion, metastasis and prognosis and can be used for prognostic evaluation of breast cancer.


Subject(s)
Humans , Breast Neoplasms/genetics , Carcinoma, Ductal, Breast/genetics , Jumonji Domain-Containing Histone Demethylases , Lymphatic Metastasis , Matrix Metalloproteinase 2 , Prognosis , Vascular Endothelial Growth Factor A
13.
Rev. méd. Hosp. José Carrasco Arteaga ; 11(3): 194-199, 30/11/2019. Tablas, Gráficos
Article in Spanish | LILACS | ID: biblio-1103392

ABSTRACT

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)


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Women , Breast Neoplasms/surgery , Breast Neoplasms/classification , Mastectomy, Segmental/statistics & numerical data , Carcinoma, Ductal, Breast , Mastectomy/statistics & numerical data , Quality of Life , Surgical Procedures, Operative , Prevalence , Methods
15.
Femina ; 47(9): 573-576, 20190930. ilus
Article in Portuguese | LILACS | ID: biblio-1046549

ABSTRACT

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)


Subject(s)
Humans , Female , Pregnancy , Adult , Carcinoma, Ductal, Breast/surgery , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/diagnosis , Pregnancy, High-Risk , Patient Care Planning , Treatment Outcome
16.
São Paulo med. j ; 137(4): 336-342, July-Aug. 2019. graf
Article in English | LILACS | ID: biblio-1043435

ABSTRACT

ABSTRACT BACKGROUND: Use of mammary adenectomy for breast carcinoma treatment remains controversial. OBJECTIVE: This study aimed to verify the oncological safety of mammary adenectomy and immediate breast reconstruction for treating selected patients with infiltrating breast carcinoma and to evaluate patients' satisfaction with the reconstructed breasts. DESIGN AND SETTING: Cohort study conducted among patients treated at Hospital Sírio-Libanês, São Paulo, Brazil. METHODS: This study was based on 152 selected patients (161 operated breasts) with infiltrating breast carcinoma who underwent mammary adenectomy and immediate breast reconstruction. In all patients, the diameter of the largest focus of the tumor was less than 3.0 cm, the imaging tumor-nipple distance was greater than 2.0 cm and the pathological assessment showed clear margins. The cumulative incidence of local recurrence (LR), recurrence-free survival (RFS) and overall survival (OS) curves were estimated using the Kaplan-Meier method. After at least one year of follow-up, 64 patients were asked about their satisfaction with the reconstructed breast(s). RESULTS: At a mean follow-up time of 43.5 months, seven cases of LR (4.4%), four distant metastases (2.6%) and five deaths (3.3%) were recorded. The five-year actuarial LR-free survival, RFS and OS were 97.6%, 98.3% and 98.3%, respectively. No cases of nipple-areolar complex recurrence were reported. Forty-one patients (64%) indicated a high level of satisfaction with the reconstructed breasts. CONCLUSIONS: Mammary adenectomy is a safe and efficacious procedure for selected patients with early-infiltrating breast carcinoma and results in a high rate of patient satisfaction with the reconstructed breasts.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast Neoplasms/surgery , Patient Satisfaction , Mammaplasty/methods , Carcinoma, Ductal, Breast/surgery , Retrospective Studies , Cohort Studies , Follow-Up Studies , Treatment Outcome , Disease-Free Survival , Mastectomy/methods , Neoplasm Recurrence, Local
17.
Rev. méd. Chile ; 147(5): 557-567, mayo 2019. tab, graf
Article in English | LILACS | ID: biblio-1014264

ABSTRACT

ABSTRACT Background: Breast cancer (BC) is the most common malignancy in women. Aim: To assess the impact of HER2 status on axillary lymph node (ALN) involvement in patients with invasive ductal carcinoma of no special type (IDC-NST) both at diagnosis and during the 4-year postoperative period. Patients and Methods: We retrospectively included 375 women with an early clinical stage of non-luminal IDC-NST who between 2007 and 2013 underwent breast surgery at a clinical hospital. They were divided into phenotype-based groups: HR+HER2-, HR+HER2+, HR-HER2+ and HR-HER2-. Only patients with sentinel lymph node (SLN) macrometastases underwent ALN dissection. If > 3 ALNs were positive, radiotherapy was delivered. All patients were treated with chemotherapy, HER2+ BC patients received trastuzumab, and hormone receptor (HR)-positive BC patients received hormonal therapy. Results: Larger tumor size, higher grade, HR+, HER2+ status, and lymphovascular invasion (LVI) were predictive for ALN metastases at diagnosis. The poorest overall, disease-free, and distant recurrence-free survival (OS, DFS, DRFS) were found in the HR-HER2- group, while the poorest locoregional recurrence-free survival (LRFS) was observed in HR-HER2+ and HR-HER2- groups. HER2 status was not predictor of survival. Conclusions: HER2+ status was predictive for ALN involvement at diagnosis but had no effect on 4-year LRFS in these patients.


Antecedentes: El cáncer de mama es el tumor maligno más común en mujeres. Objetivo: Conocer el impacto del estado HER2 sobre el compromiso ganglionar axilar al momento del diagnóstico y durante los primeros cuatro años después de la cirugía en mujeres con carcinoma ductal invasivo de tipo no especial (IDC-NST). Pacientes y Métodos: Incluimos retrospectivamente a 375 mujeres en etapas clínicas iniciales de IDC-NST que fueron operadas en un hospital clínico. Ellas se dividieron en grupos de acuerdo al fenotipo: HR+HER2-, HR+HER2+, HR-HER2+y HR-HER2-. La disección de ganglios axilares se efectuó solo en las pacientes con macrometástasis en el ganglio centinela. Si había más de tres ganglios comprometidos, se efectuó radioterapia. Todas las pacientes se trataron con quimioterapia. Las pacientes HER2+ recibieron trastuzumab y las pacientes HR+ recibieron hormonoterapia. Resultados: Tumores más grandes, de mayor grado de malignidad, HR+, HER2+ y la invasión linfovascular fueron predictivos de la presencia de metástasis axilares al momento del diagnóstico. La sobrevida más baja se observó en pacientes HR-HER2+. La sobrevida libre de recurrencia locorregional más baja, se observó en pacientes HR-HER2+ y HR-HER2-. HER2 no fue predictor de sobrevida. Conclusiones: En estas mujeres, HER2+fue predictor de la presencia de compromiso ganglionar axilar al momento del diagnóstico pero no de la sobrevida a cuatro años.


Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Receptor, ErbB-2/analysis , Sentinel Lymph Node/pathology , Axilla , Time Factors , Breast Neoplasms/mortality , Multivariate Analysis , Retrospective Studies , Carcinoma, Ductal, Breast/mortality , Statistics, Nonparametric , Disease-Free Survival , Ki-67 Antigen/analysis , Tumor Burden , Kaplan-Meier Estimate , Neoplasm Grading , Neoplasm Invasiveness , Neoplasm Recurrence, Local , Neoplasm Staging
18.
Med. leg. Costa Rica ; 36(1): 6-13, ene.-mar. 2019.
Article in Spanish | LILACS | ID: biblio-1002552

ABSTRACT

Resumen Se presenta el caso de una femenina de 69 años con un carcinoma ductal in situ de la mama, el cual presentaba diferenciación apocrina y alto grado nuclear. La forma de presentación clínica se hizo patente en forma de microcalcificaciones detectadas en la mamografía, y corroboradas histológicamente como comedonecrosis. La diferenciación apocrina se comprobó por medio de tinciones de inmunohistoquímica. El diagnóstico se realizó en una biopsia excisional, pero dado a que uno de los márgenes se encontraba comprometido, la paciente se sometió posteriormente a una mastectomía.


Abstract We present the case of a 69 year old female diagnosed with a ductal in situ carcinoma of the breast. The tumor had apocrine differentiation and a high nuclear grade. The clinical presentation corresponded to microcalcifications detected on mammography, which were histologically patent in the form of comedo type necrosis. The aforementioned apocrine differentiation was reassured using the aid of immunohistochemistry. The biopsy was an excisional biopsy, but due to positive quirurgical margins, the patient was later reintervened for total mastectomy.


Subject(s)
Humans , Female , Aged , Breast Neoplasms , Receptors, Androgen , Receptors, Progesterone , Receptors, Estrogen , Carcinoma, Ductal, Breast , Costa Rica
19.
Rev. bras. ginecol. obstet ; 40(12): 779-786, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977811

ABSTRACT

Abstract Objective The use of molecular markers can identify a subgroup of tumors with distinct recurrence patterns. The present study aimed to characterize the immunohistochemical expression of vimentin (VIM), of E-cadherin (CDH1), and of cytokeratin 5 (CK5) in patients with invasive ductal carcinomas (IDCs). Methods We have constructed a tissuemicroarray (TMA) from87 patients with IDC of the breast. Immunohistochemistry (IHC) was performed to study the expression of estrogen and progesterone receptors (ER and PgR), human epidermal growth factor receptor 2 (HER2), VIM, CDH1, CK5, and Ki67. The tumors were classified as luminal A and B (n = 39), HER2 enriched (n = 25), and triple-negative (TNBC) (n = 23), based on the IHC expression. Results We have observed that luminal A and B tumors lack the VIM+/CDH1-/low phenotype. This phenotype was observed in 16.5% of the HER2+ tumors and in 60% of the TNBC tumors (p = 0.0001). Out of a total of 20 TNBC tumors, the CK5 (basal-like marker) was positive in 11 of them. The VIM+/CDH1-/low phenotype was observed in 5 CK5+ TNBC tumors (45%) and in 7 out of 9 CK5- TNBC tumors (78%) (p = 0.02). The median Ki67 index in the VIM+/CDH1-/low tumors was 13.6 (range: 17.8-45.4) compared with 9.8 (range: 4.1-38.1) in other tumors (p = 0.0007). The presence of lymph nodemetastasis was less frequent in patients with VIM+/CDH1-/low tumors (23% versus 61%; X2 test; p = 0.01). Conclusion Our findings suggest that the expression of VIM and CDH1 can identify a subset of IDCs of the breast with a mesenchymal phenotype associated with poor prognosis, high-grade lesion, and high mitotic index.


Resumo Objetivo O uso de marcadores moleculares pode identificar subtipos tumorais com diferentes taxas de recidiva. O objetivo do presente estudo é caracterizar a expressão imunohistoquímica da vimentina (VIM), da E-caderina (CDH1) e de CK5 em pacientes com carcinoma ductal invasivo (CDI) da mama. Métodos Utilizamos uma matriz de amostras teciduais (TMA, na sigla em inglês) de 87 pacientes com CDI da mama. Para avaliar a expressão dos receptores de estrogênio (RE) e receptores de progesterona (RP), HER2, VIM, CDH1, CK5 e Ki67, utilizamos imunohistoquímica. Os tumores foram classificados como luminal A e B (n = 39), HER2+ (n = 25) e triplo negativo (TNBC) (n = 23). Resultados Foi observado que tumores luminais A e B não expressaram o fenótipo VIM+/CDH1-/low. Este fenótipo foi observado em 16,5% dos tumores HER2+ e em 60% dos tumores TNBC (p = 0,0001). Dos 20 tumores TNBC, a CK5 (marcador de tumor basalóide) foi super expressa em 11 amostras. O fenótipo VIM+/CDH1-/low foi observado em 5 tumores CK5+ TNBC (45%) e em 7 dos 9 tumores CK5- TNBC (78%) (p = 0,02). A expressão média de Ki67 nos tumores VIM+/CDH1-/low foi 13.6 (amplitude de 17,8 a 45,4) comparado com 9,8 (amplitude de 4,1 a 38,1) nos outros tumores (p = 0,0007). A presença demetástase linfonodal foimenor em tumores com fenótipo VIM+/CDH1-/low (23% contra 61%; teste X2; p = 0,01). Conclusão Nossos achados sugerem que a expressão de VIM e CDH1 pode identificar um subtipo de CDI da mama com fenótipo mesenquimal associado a pior prognóstico, lesões de alto grau e alto índice mitótico.


Subject(s)
Humans , Female , Vimentin/biosynthesis , Breast Neoplasms/metabolism , Breast Neoplasms/pathology , Cadherins/biosynthesis , Carcinoma, Ductal, Breast/metabolism , Carcinoma, Ductal, Breast/pathology , Keratin-5/biosynthesis , Vimentin/analysis , Breast Neoplasms/classification , Breast Neoplasms/chemistry , Immunohistochemistry , Cadherins/analysis , Carcinoma, Ductal, Breast/classification , Carcinoma, Ductal, Breast/chemistry , Keratin-5/analysis , Middle Aged
20.
Rev. bras. cir. plást ; 33(4): 469-477, out.-dez. 2018. ilus, tab
Article in English, Portuguese | LILACS | ID: biblio-979965

ABSTRACT

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.


Subject(s)
Humans , Female , Adult , Middle Aged , Postoperative Complications/therapy , Thoracic Injuries/therapy , Breast Neoplasms/surgery , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/surgery , Carcinoma, Ductal, Breast/complications , Plastic Surgery Procedures/methods , Thoracic Wall/surgery , Free Tissue Flaps/surgery , Myocutaneous Flap/surgery , Neoplasm Metastasis/therapy
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