Myiasis associated with an invasive ductal carcinoma of the left breast: case study

ABSTRACT Most breast cancers originate in the ductal epithelium and are referred to as invasive ductal carcinoma. In this study we report on the clinical procedures adopted to diagnose myiasis in association with infiltrating metastatic breast carcinoma in a female patient. A 41 years old woman came to the Federal Hospital of Andaraí complaining of intense itching, warmth, redness and hardening of the breast, which had acquired the aspect of an orange peel. A lesion in the left breast was cavitated, dimpled, had fetid odor, and had fibrotic and infected air nodules filled with exudate and Dipteran larvae. The tissue was cleaned and 33 larvae were extracted. The patient was hospitalized and received Ivermectin. Eighteen of the larvae extracted from the patient were placed in 70% alcohol, and twelve were placed in a container with sterile wood shavings under controlled conditions until they metamorphosed into adults. The taxonomic identification of the flies revealed that the culprit was Cochliomyia hominivorax. A histopathological exam conducted three months earlier had revealed infiltrating ductal carcinoma. Two months after the myiasis treatment, the breast tissue had healed. The patient had waited ten days from the onset of the myiasis to seek treatment, and that delay interfered negatively in the prognosis of both the neoplasm and the myiasis. This study is relevant to public health in view of the strong social impact of myiasis.

Pacientes portadores de feridas neoplásicas em serviços de cuidados paliativos: contribuições para a elaboração de protocolos de intervenções de enfermagem / Patients carries of neoplastic wounds in palliative care services: contributions to elaboration of nursing protocol interventions

O artigo tem por objetivo sugerir um protocolo de intervenções de enfermagem elaborado para guiar a prática de realização de curativos em pacientes portadores de feridas neoplásicas. Tendo em vista a diversidade de condutas nesse tipo de cuidado, foi realizada revisão de literatura nos tópicos de estadiamento, algoritmo de condutas e protocolos de intervenções nos curativos, bem como na abordagem ao paciente. A partir dos dados da literatura e da prática, no serviço de ambulatório de uma instituição federal especializada em cuidados paliativos, é sugerido um protocolo que leva em consideração a importância dos conceitos de oncogênese e paliação frente à escolha de produtos e técnicas mais favoráveis ao controle dos sinais e sintomas dos quais estas feridas apresentam.

This paper aims to sugest a nursing intervention protocol that was elaborated to guide the wound dressing practice in patients carriers of neoplasic wounds. Given the diversity of conducts possible for this kind of care, a literaturereview was accomplishedon the topics of classification, behavior algorithm and dressing intervention protocols, as well as the approach to patients. From the literature data and based onthe clinic service practice, on a federal institution specialized in oncological palliative care, it is suggested a protocol which takes into account the importance of carcinogenic and palliative concepts to use products and techniques which are more favorable to the control of signs and simptoms presented in such wounds.