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Autops. Case Rep ; 11: e2021331, 2021. graf
Article in English | LILACS | ID: biblio-1339245


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.

Humans , Female , Adult , Breast Neoplasms , Carcinoma, Ductal, Breast/pathology , Phyllodes Tumor/pathology , Ossification, Heterotopic/pathology
Rev. méd. Chile ; 147(5): 557-567, mayo 2019. tab, graf
Article in English | LILACS | ID: biblio-1014264


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.

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
Rev. bras. ginecol. obstet ; 40(12): 779-786, Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-977811


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.

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
Rev. Assoc. Med. Bras. (1992) ; 64(6): 492-497, June 2018. graf
Article in English | LILACS | ID: biblio-956479


SUMMARY Erysipelatoid Carcinoma (EC), also known as Inflammatory Metastatic Carcinoma, is a rare form of cutaneous metastasis, secondary to an internal malignancy, more often related to breast cancer. Clinically, the lesion has a well-marked, bound erythematous appearance, much like an infectious process, such as erysipelas and cellulitis, these being the most common differential diagnoses. It is characterized by an acute or subacute appearance with an erythematous plaque, sometimes hot and painful, being more often situated in the primary tumor vicinity, especially in the thorax wall in the region of a mastectomy due to breast cancer. Here we present the case of a 75-year-old patient with ductal infiltrated carcinoma for 3 years, who presented an acute erythematous and infiltrated plaque in the region of a previous mastectomy, with a final diagnosis of EC.

Humans , Female , Aged , Skin Neoplasms/secondary , Carcinoma, Ductal, Breast/secondary , Erysipeloid/pathology , Inflammatory Breast Neoplasms/pathology , Skin Neoplasms/diagnosis , Skin Neoplasms/pathology , Thorax , Breast , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Diagnosis, Differential , Erysipeloid/diagnosis , Erythema/pathology
An. bras. dermatol ; 93(2): 289-290, Mar.-Apr. 2018. graf
Article in English | LILACS | ID: biblio-887189


Abstract: Inflammatory breast cancer is an aggressive and infiltrative malignancy that is often misdiagnosed as an infection because of its symptoms and signs of inflammation, delaying proper diagnosis and treatment. We report a case of inflammatory breast cancer showing correlation between dermoscopic and histopathological diagnoses. We highlight the utility of dermoscopy for skin biopsy site selection.

Humans , Female , Middle Aged , Skin/pathology , Carcinoma, Ductal, Breast/pathology , Dermoscopy/methods , Inflammatory Breast Neoplasms/pathology , Biopsy , Carcinoma, Ductal, Breast/diagnosis , Inflammatory Breast Neoplasms/diagnosis
Clinics ; 73: e363, 2018. tab
Article in English | LILACS | ID: biblio-952807


OBJECTIVES: To compare imprint cytology and paraffin section histology for sentinel lymph node detection in women with breast cancer treated with neoadjuvant chemotherapy. METHOD: A cross-sectional study and report of the sentinel lymph node statuses of 64 patients with breast cancer who underwent intraoperative imprint cytology and neoadjuvant chemotherapy in a referral cancer institute in Rio de Janeiro, Brazil, between 2014 and 2016. RESULTS: The mean age was 51 years. The most common histological type was invasive ductal carcinoma (93.75%), and the most common differentiation grade was 2 (62.5%). Overall, 153 lymph nodes were identified, with a mean of 2.39/case. Thirty-four lymph nodes tested positive for malignancy by imprint cytology, and 55 tested positive by histology. Of the 55 positive lymph nodes, 41 (74.5%) involved macrometastases, and 14 (25.5%) involved micrometastases. There were 21 false negatives with imprint cytology, namely, 7 for macrometastases and 14 for micrometastases, resulting in a rate of 17.6%. The sensitivity of imprint cytology was 61.8%, with a specificity and positive predictive value of 100%, a negative predictive value of 82.4% and an accuracy of 86.3%. The method presented null sensitivity for the identification of micrometastases. CONCLUSIONS: The false-negative rate with imprint cytology was associated with the number of sentinel lymph nodes obtained. The rate found for complete response to neoadjuvant chemotherapy was comparable to the rates reported in the literature. The accuracy of imprint cytology was good, and its specificity was excellent for sentinel lymph node detection; however, the method was unable to detect lymph node micrometastases.

Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/drug therapy , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/drug therapy , Neoadjuvant Therapy/methods , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node/pathology , Reference Values , Breast Neoplasms/diagnosis , Immunohistochemistry , Cross-Sectional Studies , Reproducibility of Results , Sensitivity and Specificity , Paraffin Embedding/methods , Carcinoma, Ductal, Breast/diagnosis , False Negative Reactions , Neoplasm Micrometastasis , Neoplasm Grading , Intraoperative Period , Lymphatic Metastasis , Neoplasm Staging
Einstein (Säo Paulo) ; 16(1): eAO4065, 2018. tab, graf
Article in English | LILACS | ID: biblio-891446


ABSTRACT Objective To evaluate the expression of survivin protein in low- and high-grade ductal carcinoma in situ. Methods Breast tissue fragments obtained by incisional biopsy and surgical procedures of 37 women with ductal carcinoma in situ of the breast were subdivided into two groups: Group A, composed of women with low-grade ductal carcinoma in situ, and Group B, women with high-grade ductal carcinoma in situ. Survivin protein expression test was performed by immunohistochemistry, using a monoclonal antibody clone I2C4. The criterion to evaluate survivin immunoexpression was based on the percentage of neoplastic cells that presented brown-gold staining. This criterion was positive when the percentage of stained cells was ≥10%. Results The survivin protein was expressed in 22 out of 24 cases of high-grade ductal carcinoma in situ (78%), whereas, in Group A, of low-grade ductal carcinoma in situ (n=13), it was positive in only 6 cases (21.40%; p=0.004). Conclusion The frequency of expression of survivin was significantly higher in the group of patients with high-grade ductal carcinoma in situ compared to those in the low-grade ductal carcinoma in situ group.

RESUMO Objetivo Avaliar a imunoexpressão da proteína survivina nos carcinomas ductais in situ de mama de baixo e de alto graus. Métodos Fragmentos de tecido mamários obtidos por biópsia incisional e procedimentos cirúrgicos de 37 mulheres acometidas por carcinoma ductal in situ de mama foram subdivididos em dois grupos: Grupo A, formado por mulheres com carcinoma ductal in situ de baixo grau; e Grupo B, por mulheres com carcinoma ductal in situ de alto grau. A pesquisa de expressão da proteína survivina foi realizada pela técnica de imuno-histoquímica, utilizando-se anticorpo monoclonal clone I2C4. O critério de avaliação da imunoexpressão da survivina baseou-se na percentagem de células neoplásicas que apresentava coloração castanho-dourada. Considerouse tal critério positivo quando a percentagem de células apresentasse marcação ≥10%. Resultados A proteína survivina apresentou-se expressa em 22 dos 24 casos de carcinoma ductal in situ de alto grau (78%), enquanto no Grupo A, de carcinoma ductal in situ de baixo grau (n=13), apresentou-se positiva em apenas 6 casos (21,40%; p=0,004). Conclusão O índice de frequência de expressão da survivina foi significativamente mais elevado no grupo de pacientes com carcinoma ductal in situ de alto grau, quando comparado às do grupo com carcinoma ductal in situ de baixo grau.

Humans , Female , Breast Neoplasms/metabolism , Carcinoma in Situ/metabolism , Biomarkers, Tumor/metabolism , Carcinoma, Ductal, Breast/metabolism , Inhibitor of Apoptosis Proteins/metabolism , Breast Neoplasms/pathology , Immunohistochemistry , Carcinoma in Situ/pathology , Carcinoma, Ductal, Breast/pathology , Survivin
Rev. chil. obstet. ginecol. (En línea) ; 82(4): 416-423, oct. 2017. graf
Article in Spanish | LILACS | ID: biblio-899924


El tejido mamario ectópico se desarrolla debido a la involución incompleta de la cresta mamaria, de localización más frecuente en la axila y más común en mujeres. Este tejido sufre cambios fisiopatológicos similares a los de la mama normal, entre los cuales se encuentra la malignización. El carcinoma primario de este tejido es infrecuente, y su manifestación más común es la masa palpable. Al igual que en la mama normal, la histología más frecuente del cáncer de mama ectópica es el Carcinoma Ductal Infiltrante y, por su localización atípica, suele diagnosticarse tardíamente, y tendría un curso más agresivo y de peor pronóstico, dado por la mayor cercanía a ganglios, piel y pared torácica. Debido a los pocos datos publicados, el diagnóstico y tratamiento no están bien establecidos, pero los esquemas disponibles son similares a los utilizados en el cáncer de mama normal. Se presenta el caso de una paciente de 41 años, con diagnóstico de cáncer de mama ectópica en la región axilar derecha, sin invasión a distancia, tratada con cirugía, quimioterapia y radioterapia, que evoluciona favorablemente, sin metástasis ni recidivas durante seguimiento.

Ectopic mammary tissue develops due to the incomplete involution of the mammary crest, which is more frequently located in the axilla and more common in women. This tissue undergoes pathophysiological changes similar to those of the normal breast, among which malignancy is found. The primary carcinoma of this tissue is infrequent and its most common manifestation is the palpable mass. As in the normal breast, the most frequent histology of ectopic breast cancer is the Infiltrating Ductal Carcinoma and, because of its atypical location, it is usually diagnosed late and it would have a more aggressive course and a worse prognosis, due to the greater proximity to lymph nodes, skin and chest wall. Because of the few published data, the diagnosis and treatment are not well established, but the available schemes are similar to those used in normal breast cancer. We present the case of a 41yearsold female patient with a diagnosis of ectopic breast cancer in the right axillary region, without distant invasion, treated with surgery, chemotherapy and radiotherapy, whoevolves favorably, without metastasis or relapses during follow-up.

Humans , Female , Adult , Axilla/abnormalities , Breast Neoplasms/diagnosis , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Breast Neoplasms/therapy , Carcinoma, Ductal, Breast/diagnosis , Carcinoma, Ductal, Breast/therapy
An. bras. dermatol ; 92(2): 239-242, Mar.-Apr. 2017. tab, graf
Article in English | LILACS | ID: biblio-838066


Abstract: Ductal eccrine carcinoma (DEC) is a rare sweat gland carcinoma with ductular differentiation. Clinically, it is characterized by a slowly growing, hardened plaque or nodule predominantly located on the head and neck. Histologically, DEC shares similar features to invasive breast carcinoma, thus causing great diagnostic challenges. We report a 69-year-old woman who presented with a hardened plaque on the axilla. A skin biopsy was performed and metastatic invasive breast carcinoma could not be ruled out. Complete excision and further workup were subsequently conducted, leading to the diagnosis of estrogen receptor positive DEC with associated axillary lymph node metastases. The patient received adjuvant radiotherapy to the left axilla and was started on oral letrozole. She is disease-free 14 months after initial diagnosis.

Humans , Female , Aged , Sweat Gland Neoplasms/pathology , Carcinoma, Skin Appendage/pathology , Carcinoma, Ductal, Breast/pathology , Axilla , Sweat Gland Neoplasms/diagnosis , Sweat Gland Neoplasms/therapy , Carcinoma, Skin Appendage/diagnosis , Carcinoma, Skin Appendage/therapy , Carcinoma, Ductal, Breast/diagnosis , Diagnosis, Differential , Lymph Nodes/pathology , Lymphatic Metastasis
Rev. Assoc. Med. Bras. (1992) ; 62(5): 421-427, Sept.-Oct. 2016. tab, graf
Article in English | LILACS | ID: lil-794905


SUMMARY Objective: The purpose of this study was to evaluate the various morphologies and kinetic characteristics of the ductal carcinoma in situ (DCIS) on breast magnetic resonance imaging (MRI) exam, to establish which are the most prevalent and to determine the effectiveness of the method in the detection of DCIS. Method: A prospective observational study, starting in May 2014. We evaluated 25 consecutive patients with suspicious or highly suspicious microcalcifications on mammography screening, BI-RADS categories 4 and 5, who underwent breast MRI and then surgery with proven diagnosis of pure DCIS. Surgery was considered the gold standard for correlation between histologic findings and radiological findings obtained on MRI. Results: The most frequent morphological characteristic of DCIS on MRI was non-mass-like enhancement (NMLE), p<0.001, observed in 22/25 (88%) patients (95CI 72.5-100). Of these, segmental distribution was the most prevalent, represented by 9/22 (40.91%) cases (95CI 17.4-64.4), p=0.306, and a clumped internal enhancement pattern was most commonly characterized in DCIS, observed in 13/22 (50.09%) cases. Conclusion: DCIS has a wide variety of imaging features on MRI and being able to recognize these lesions is crucial. Its most common morphological presentation is non-mass-like enhancement, while segmental distribution and a clumped internal enhancement pattern are the most common presentations. Faced with the combined analysis of these findings, percutaneous core needle biopsy (core biopsy) or vacuum-assisted biopsy (VAB) should be encouraged.

RESUMO Objetivo: avaliar as várias morfologias e características cinéticas do carcinoma ductal in situ (CDIS) ao exame de ressonância magnética (RM) de mama, estabelecer as mais prevalentes e determinar a eficácia do método na detecção do CDIS. Método: estudo prospectivo e observacional, com início em 2011 e duração de 24 meses. Foram avaliadas 25 pacientes consecutivas que apresentaram microcalcificações suspeitas ou altamente suspeitas ao exame mamográfico de rastreamento, categorias 4 e 5 de BI-RADS, que realizaram RM mamária e, posteriormente, foram submetidas à cirurgia com resultado comprovado de CDIS puro. A cirurgia foi considerada padrão-ouro para correlação entre os resultados histológicos e os achados radiológicos obtidos à RM. Resultados: a característica morfológica do CDIS mais frequente à RM foi o realce não nodular (p<0,001), observada em 22/25 (88%) casos (IC 95% 72,5-100). Dentre estes, a distribuição segmentar foi a mais prevalente, representada por 9/22 (40,91%) casos (IC 95% 17,4-64,4), p=0,306, e o realce interno tipo clumped foi o padrão mais frequentemente caracterizado no CDIS, observado em 13/22 (50,09%) casos. Conclusão: o CDIS tem uma grande variedade de características imaginológicas à RM e é fundamental reconhecê-las. A apresentação morfológica mais comum é o realce não nodular, sendo a distribuição segmentar e o padrão interno de realce tipo clumped as apresentações mais frequentes. Diante da análise combinada desses achados, a biópsia percutânea por agulha grossa (core biopsy) ou assistida a vácuo (mamotomia) deve ser encorajada.

Humans , Female , Adult , Aged , Aged, 80 and over , Breast Neoplasms/pathology , Breast Neoplasms/diagnostic imaging , Carcinoma in Situ/pathology , Carcinoma in Situ/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/diagnostic imaging , Breast Neoplasms/surgery , Calcinosis/pathology , Calcinosis/diagnostic imaging , Magnetic Resonance Imaging/methods , Mammography/methods , Carcinoma in Situ/surgery , Image Enhancement , Prospective Studies , Reproducibility of Results , Carcinoma, Ductal, Breast/surgery , Neoplasm Grading , Biopsy, Large-Core Needle , Middle Aged
Rev. chil. radiol ; 22(4): 158-163, 2016. ilus, tab
Article in Spanish | LILACS | ID: biblio-844622


Abstract: Objective. Assess the performance of digital 2D mammography and tomosynthesis in the characterisation of architectural breast distortion (ABD). Material and method. A retrospective study, approved by the Ethics Committee, was conducted on mammographic studies on cases with a diagnosis of ABD selected from August 2015-August 2016. Cases with imaging modalities available on PACS were included: digital mammography (2D), tomosynthesis (TS), ultrasound (US), magnetic resonance (MR), and with biopsy performed at our institution. ABD cases associated with micro-calcifications and post-surgical changes were excluded. Detection rates and imaging characteristics were analysed, as well as the histopathological concordance. Results. A total of 81 cases of ABD without microcalcifications were detected on the mammographs, but only 52 met the inclusion criteria. According to histopathology, 23 (44%) were malignant, 17 (33%) were benign, and 12 (23%) were high-risk lesions. All were detected by TS and US, and classified as suspicious lesions (BI-RADS 4 or 5). In 2D mammography, 24 cases (46%) were not seen and 8 (33%) of these were malignant. Malignant lesions showed dense centres in 87% of cases. The most frequent lesion on ultrasound was a hypoechogenic area (60%) in 86% of lesions with penetrating vessels. A total of 21 MRI were performed, with mass enhancement being identified in all of them. Conclusion. ABD is better displayed in TS than 2D mammography. Despite its characteristics, histological examination is essential (even when a radiolucent centre is observed). Focused US should be the next procedure to follow, since it allows to visualize the lesion to be visualised, and can direct the percutaneous biopsy in most cases.

Resumen: Objetivo. Determinar en qué método de imagen se logra visualizar y caracterizar mejor una distorsión de la arquitectura mamaria (DAM). Material y método. Estudio retrospectivo, aprobado por el Comité de Ética. Se seleccionaron los estudios mamográficos con diagnóstico de DAM en nuestro servicio entre agosto de 2015 y agosto de 2016. Se incluyeron casos estudiados con al menos 3 de las modalidades de imágenes disponibles en PACS: mamografía digital (2D), tomosíntesis (TS), ecografía (US), resonancia (RM) y que fueron biopsiados en nuestra institución. Se excluyeron casos de DAM asociadas con microcalcificaciones y cambios posquirúrgicos. Se evaluaron la tasa de detección, las características imagenológicas y la concordancia histopatológica. Resultados. En 15 meses se detectaron 81 casos de DAM en mamografía; de estos, 52 cumplieron con los criterios de inclusión. Según la histopatología, 23 (44%) resultaron malignas, 17 (33%) benignas y 12 (23%) lesiones de alto riesgo (LAR). Todas fueron detectadas por TS y US, clasificadas como lesiones sospechosas (BI-RADS 4 o 5). En mamografía 2D, 24 casos (46%) quedaron ocultos, y de estos, 8 (33%) resultaron malignos. Las lesiones malignas presentaron centro denso en el 87% de los casos. La lesión más frecuente en ecografía fue el área hipoecogénica (60%), en el 86% de las lesiones con vasos penetrantes. Se contó con 21 RM, identificándose captación tipo masa en las patologías malignas. Conclusión. La DAM es mejor visualizada en TS que en mamografía 2D. Pese a sus características, un estudio histológico es indispensable (incluso al observar un centro radiolúcido). El US dirigido es el paso a seguir, ya que permite visualizar la lesión y dirigir su biopsia percutánea en la mayoría de los casos.

Humans , Female , Adult , Middle Aged , Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Breast/pathology , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Mammography , Precancerous Conditions/pathology , Retrospective Studies
Einstein (Säo Paulo) ; 13(3): 352-356, July-Sep. 2015. tab, graf
Article in English | LILACS | ID: lil-761958


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

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

Female , Humans , Middle Aged , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , /metabolism , Stress, Psychological/complications , Body Mass Index , Breast Neoplasms/complications , Breast Neoplasms/psychology , Chronic Disease , Cohort Studies , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/psychology , Monitoring, Immunologic , Overweight/complications , Surveys and Questionnaires
Int. braz. j. urol ; 41(2): 279-287, Mar-Apr/2015. tab, graf
Article in English | LILACS | ID: lil-748308


Introductıon Ureteral obstruction is a common pathology and caused kidney fibrosis and dysfunction at late period. In this present, we investigated the antifibrotic and antiinflammatory effects of montelukast which is cysteinyl leukotriene receptor antagonist, on kidney damage after unilateral ureteral obstruction(UUO) in rats. Mateirıals and Methods 32 rats divided four groups. Group 1 was control, group 2 was sham, group 3 was rats with UUO and group 4 was rats with UUO which were given montelukast sodium (oral 10 mg/kg/day). After 14 days, rats were killed and their kidneys were taken and blood analysis was performed. Tubular necrosis, mononuclear cell infiltration and interstitial fibrosis scoring were determined histopathologically in a part of kidneys; nitric oxide(NO), malondialdehyde(MDA) and reduced glutathione(GSH) levels were determined in the other part of kidneys. Urea-creatinine levels were investigated at blood analysis. Statistical analyses were made by the Chi-square test and one-way analysis of variance (ANOVA). Results There was no difference significantly for urea-creatinine levels between groups. Pathologically, there was serious tubular necrosis and fibrosis in group 3 and there was significantly decreasing for tubular necrosis and fibrosis in group 4(p<0.005). Also, there was significantly increasing for NO and MDA levels; decreasing for GSH levels in group 3 compared the other groups(p<0.005). Conclusıon We can say that montelukast prevent kidney damage with antioxidant effect, independently of NO. .

Female , Humans , Middle Aged , Breast Neoplasms/chemistry , Carcinoma, Ductal, Breast/chemistry , DNA-Binding Proteins/analysis , Epithelial-Mesenchymal Transition , Estrogen Receptor alpha/analysis , Transcription Factors/analysis , Biomarkers, Tumor/analysis , Breast Neoplasms/pathology , Cadherins/analysis , Carcinoma, Ductal, Breast/pathology , Immunohistochemistry , Predictive Value of Tests , Prognosis , Tissue Array Analysis , beta Catenin/analysis
Indian J Cancer ; 2014 Jan-Mar; 51(1): 25-28
Article in English | IMSEAR | ID: sea-154278


CONTEXT: As of today, there is no validated standard method to assess clinical response of breast cancer to neo- adjuvant chemotherapy (NACT). Some centers use clinical dimensions while others use radiological measurements to evaluate response according to RECIST criteria. AIMS: The aim was to correlate and compare the clinical, radiological, and pathological parameters for assessing the tumor response in patients of breast cancer receiving NACT. SETTINGS AND DESIGN: Single institution, prospective nonrandomized study conducted over a 2-year period. MATERIALS AND METHODS: Patients with diagnosed breast cancer were assessed for response to NACT prior to surgery using clinical and radiological techniques. This was correlated with pathological reponse which was assessed by measuring gross dimensions and Miller-Payne grading of response to chemotherapy. STATISTICAL ANALYSIS USED: Spearman’s rho nonparametric. RESULTS: Fifty two patients completed the evaluation (out of 313 cases of ca breast treated during the same period) with a median age of 52.5 years. We noted a 26.9% clinical complete response (CR) and 19.2% had pathological CR. Clinical evaluation had a sensitivity and specificity of 73.5% and 88.5% respectively compared to 14.2% and 100% respectively for radiological assessment. CONCLUSIONS: Clinical assessment of response to NACT shows a higher sensitivity compared to radiological assessment. However the overall low sensitivity and specificity rates of clinical assessment mandate a search for a better method of evaluation.

Adult , Aged , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Breast Neoplasms/radiotherapy , Carcinoma, Ductal, Breast/drug therapy , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/radiotherapy , Chemotherapy, Adjuvant , Female , Follow-Up Studies , Humans , Middle Aged , Neoadjuvant Therapy , Neoplasm Staging , Prognosis , Prospective Studies , ROC Curve , Remission Induction
Article in English | WPRIM | ID: wpr-114862


OBJECTIVE: To evaluate the retrieval rate and accuracy of ultrasound (US)-guided 14-G semi-automated core needle biopsy (CNB) for microcalcifications in the breast. MATERIALS AND METHODS: US-guided 14-G semi-automated CNB procedures and specimen radiography were performed for 33 cases of suspicious microcalcifications apparent on sonography. The accuracy of 14-G semi-automated CNB and radiology-pathology concordance were analyzed and the microcalcification characteristics between groups with successful and failed retrieval were compared. RESULTS: Thirty lesions were successfully retrieved and the microcalcification retrieval rate was 90.9% (30/33). Thirty lesions were successfully retrieved. Twenty five were finally diagnosed as malignant (10 invasive ductal carcinoma, 15 ductal carcinoma in situ [DCIS]) and five as benign. After surgery and mammographic follow-up, the 25 malignant lesions comprised 12 invasive ductal carcinoma and 13 DCIS. Three lesions in the failed retrieval group (one DCIS and two benign) were finally diagnosed as two DCIS and one benign after surgery. The accuracy of 14-G semi-automated CNB was 90.9% (30/33) because of two DCIS underestimates and one false-negative diagnosis. The discordance rate was significantly higher in the failed retrieval group than in the successful retrieval group (66.7% vs. 6.7%; p < 0.05). Punctate calcifications were significantly more common in the failed retrieval group than in the successful retrieval group (66.7% vs. 3.7%; p < 0.05). CONCLUSION: US-guided 14-G semi-automated CNB could be a useful procedure for suspicious microcalcifications in the breast those are apparent on sonography.

Adult , Aged , Biopsy, Large-Core Needle/methods , Breast/pathology , Breast Diseases/pathology , Breast Neoplasms/pathology , Calcinosis/pathology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Intraductal, Noninfiltrating/pathology , Female , Humans , Middle Aged , Ultrasonography, Interventional/standards , Young Adult
Rev. méd. Chile ; 141(12): 1534-1540, dic. 2013. graf, tab
Article in Spanish | LILACS | ID: lil-705572


Background: Aging is the main risk factor to acquire breast cancer (BC). Nevertheless BC in elderly patients is sub-represented in clinical trials. Aim: To describe the clinical characteristics and long term treatment results of localized BC in older women. Material and Methods: Review of medical records of 65 women aged 70 to 88 years, with localized BC, treated with surgery, postoperative radiotherapy or systemic therapy at a Clinical Hospital in Chile. Results: The presence of symptoms or abnormal findings on physical examination were the main reasons for consulting in 65% of cases. Compared with tumors detected on physical examination, those detected using screening mammogram were smaller and were in stage 1 with a higher frequency (18 and 59% respectively, p < 0.01). The pathological type was luminal in 80% of cases. Overall survival was better for luminal pathological type. All patients completed radiotherapy without interruptions developing minor acute toxicity. The most common co-morbidity was high blood pressure occurring in 46% of patients. Thirteen percent of patients had three or more co-morbidities. After a median follow up of 7 years, 23 (35%) patients had died and the cause of death was BC in 43% of cases. Two patients died of lung cancer. No patient had a local breast relapse. Conclusions: Screening mammogram in older women detected smaller tumors and it was associated with a better survival. BC is the ultimate cause of death in approximately half of cases.

Aged , Aged, 80 and over , Female , Humans , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Breast Neoplasms/mortality , Breast Neoplasms/surgery , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/surgery , Chile/epidemiology , Follow-Up Studies , Immunohistochemistry , Lung Neoplasms/complications , Mastectomy , Neoplasm Staging , Retrospective Studies , Radiotherapy/adverse effects , Survival Analysis , Tumor Burden
An. bras. dermatol ; 88(4): 608-610, ago. 2013. graf
Article in English | LILACS | ID: lil-686511


Cutaneous metastasis is a phenomenon that results from a tumor spreading via lymphatic or vascular embolization, direct implant during surgery or skin involvement by contiguity. The primary malignant tumor that most commonly metastasizes to the skin in women is breast cancer, which can be manifested through papulonodular lesions, erysipeloid or sclerodermiform infiltration, en cuirasse. We report the case of a female patient, 78 years old, with papular, scaly and confluent lesions in the right breast for one year, progressing to edema and skin infiltration, reduction of breast volume and plaque en cuirasse, and similar lesions in the contralateral breast and abdomen for four months. The pathological diagnosis was invasive ductal breast carcinoma with Paget-like foci, epidermal skin metastases and lymphatic embolization.

A metástase cutânea é conseqüente à disseminação do tumor por embolização linfática, vascular, implantação direta durante cirurgias ou envolvimento da pele por contiguidade. Em mulheres, o tumor maligno primário que mais comumente metastatiza para a pele é o de mama, que tanto pode se expressar por lesões tumorais papulonodulares, infiltração erisipelóide ou esclerodermiforme, em couraça. Relatamos o caso de paciente do sexo feminino, 78 anos, apresentando lesões nodulares, descamativas e confluentes em mama direita, evoluindo com edema e infiltração cutânea, com redução do volume mamário e placa endurecida ilimitada. Invasão da mama contralateral e abdome ocorreram 4 meses após o início dos sinais. O diagnóstico histopatológico foi de adenocarcinoma ductal invasivo de mama com focos pagetóides epidérmicos e embolização linfática.

Aged , Female , Humans , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/secondary , Skin Neoplasms/pathology , Skin Neoplasms/secondary , Lymphatic Metastasis/pathology
Indian J Cancer ; 2013 July-Sept; 50(3): 239-244
Article in English | IMSEAR | ID: sea-148655


BACKGROUND: Aim of this study was to investigate the prognostic significance of CD3+ TILs in infiltrating ductal carcinoma (IDC) of the breast. MATERIALS AND METHODS: Immuno-histochemistry was done with CD3 antibodies in tissue sections of 127 breast cancer patients, and CD3+ intra-tumoral and stromal TILs were counted in relation to clinico-pathological variables. RESULTS: Intra-tumoral and stromal CD3+ TILs were significantly associated with positive lymph node status (P = 0.006, P = 0.043, respectively) without significant association with age, menopausal status, family history, and hormonal status. The higher CD3 intra-tumoral and stromal counts both showed significant association with good prognosis (P = 0.039, P = 0.044, respectively). The intra-tumoral count was higher than stromal count and was independently associated with disease-free survival in stage I and II cancer (P = 0.021). CONCLUSIONS: CD3+ TILs may serve as independent marker of good prognosis in IDC breast. The findings of this study need further validation on a larger sample size.

Adult , Aged , Aged, 80 and over , CD3 Complex/immunology , Breast Neoplasms/immunology , Breast Neoplasms/mortality , Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/immunology , Carcinoma, Ductal, Breast/mortality , Carcinoma, Ductal, Breast/pathology , Disease-Free Survival , Female , Humans , Immunohistochemistry , Kaplan-Meier Estimate , Lymphocytes, Tumor-Infiltrating/immunology , Middle Aged , Prognosis , Proportional Hazards Models