Biopsia radioquirúrgica asistida por radioscopia intraoperatoria. Descripción del método y nuestra experiencia en el Hospital Universitario Austral / Intraoperative radioscopy-assisted radiosurgical biopsy. Description of the method and our experience at the Austral University Hospital

Introducción: En la actualidad entre un 25 y 30% de los cánceres de mama se representan por lesiones no palpables. Es por eso que ha aumentado y se nos exige cada vez más en la detección de estas lesiones y posterior tratamiento de las mismas. Presentamos en este trabajo nuestra experiencia desde 2014 a 2020 de la realización de Biopsia radio quirúrgica guiada por radioscopia intraoperatoria. Objetivo: El objetivo de nuestro trabajo es evaluar si la BRQ asistida por radioscopia permitió mejorar ciertos parámetros, como la evaluación de márgenes quirúrgicos, tasas de retumorectomias, volumen de tejido resecado y tiempo quirúrgico empleado. Material y método: Se realizó un estudio observacional retrospectivo de tipo corte transversal, incluyendo las pacientes con lesiones mamarias no palpables a las cuales se les realizó punción biopsia y colocación de clip metálico, y que luego fueron sometidas a BRQ en el Centro Mamario del Hospital Universitario Austral entre noviembre de 2014 a noviembre de 2020. Resultados: Se incluyeron un total de 128 pacientes. En el 100% de las cirugías se logró la extracción del clip, colocado preoperatoriamente. No encontramos diferencias estadísticamente significativas, entre ambos grupos con respecto a la edad de las pacientes, tipo de cirugía, piezas obtenidas, márgenes quirúrgicos y necesidad de re operación. Sí se constató una diferencia estadísticamente significativa en cuanto al volumen total resecado, siendo esta menor en la técnica de BRQ con radioscopia, infiriendo un mejor resultado cosmético. Conclusiones: La biopsia radioquirúrgica asistida por radioscopia es un procedimiento sencillo que permite extirpar las lesiones no palpables de la mama, minimizando la probabilidad de fallo del procedimiento, y con menor volumen de tejido mamario resecado. Con la sistematización de la técnica, se podrían mejorar otros parámetros, inclusive los costos del procedimiento, lo cual creemos que da un gran beneficio en la práctica diaria para la resección de estas lesiones(AU)

Introduction: Currently, between 25 and 30% of breast cancers are represented by non-palpable lesions. That is why it has increased and we are increasingly required to detect these lesions and later treat them. In this study we present our experience from 2014 to 2020 of performing intraoperative fluoroscopy-guided radio-surgical biopsy. Objetive: The objective of our workis to evaluate whether radioscopy-assisted BRQ allowed to improve certain parameters, such as the evaluation of surgical margins, re-lumpectomy rates, volume of resected tissue, and surgical time used. Material and method: A retrospective cross-sectional observational study was carried out, including patients with non-palpable breast lesions who underwent a biopsy puncture and metal clip placement, and who then underwent BRQ at the Breast Center of the Austral University Hospital between November from 2014 to November 2020. Results: A total of 128 patients were included. In 100% of the surgeries, the clip was extracted, placed preoperatively. We did not find statistically significant differences between both groups with respect to the age of the patients, type of surgery, pieces obtained, surgical margins and need for reoperation. A statistically significant difference was found in terms of the total volume resected, this being less in the BRQ technique with fluoroscopy, inferring a better cosmetic result. The aesthetic result is very good. Conclusions: Radioscopy -assisted radio surgical biopsy is a simple procedure that allows the removal of non-palpable breast lesions, minimizing the probability of procedural failure, and with a smaller volume of resected breast tissue. With the systematization of the technique, other parameters could be improved, including the costs of the procedure, which we believe is of great benefit in daily practice for the resection of these lesions(AU)

Nocardia Brain Abscess Mimicking a Metastatic Brain Tumor: A Severe CNS Infection Requiring Aggressive Management

Nocardiosis is an uncommon Gram-positive bacterial infection caused by aerobic actinomycetes in the genus Nocardia. Nocardia spp. have the ability to cause localized or systemic suppurative disease in humans and animals. Nocardiosis is typically regarded as an opportunistic infection, but approximately one-third of infected patients are immunocompetent. We report a rare case of pulmonary nocardiosis and a brain abscess caused by Nocardia asteroides in an elderly woman with a history of Crohn's disease. Radiographic imaging revealed a contrast-enhancing lesion with perilesional parenchymal edema that was preoperatively thought to be a neoplasm. The patient experienced aggressive disease progression simulating a metastatic brain tumor. Early diagnosis of norcadiosis, the absence of underlying disease, and the administration of appropriate antibiotics has a positive impact on prognosis. Familiarity with the magnetic resonance and computed tomography findings associated with CNS nocardiosis, such as those presented here, is essential for making an early diagnosis.

Adiaspiromicose pulmonar humana / Human pulmonary adiaspiromycosis

A adiaspiromicose é uma doença fúngica sistêmica que acomete usualmente roedores e raramente atinge o homem. É causada pelo fungo Emmonsia crescens e ocorre após a inalação da forma contagiante (conídios). Embora estas formas não se multipliquem nem se disseminem no organismo humano, induzem uma reação inflamatória crônica granulomatosa de padrão miliar que pode levar a falência respiratória e morte. Apresentamos aqui um caso de adiaspiromicose pulmonar humana em paciente imunocompetente que exibia infiltrado intersticial pulmonar difuso ao exame de imagem e fora diagnosticado mediante biópsia pulmonar.

Adiaspiromycosis is a systemic fungal disease that usually affects rodents and rarely infects humans. It is caused by the fungus Emmonsia crescens and occurs after inhalation of its contagious form (conidia). Although these forms neither multiply nor spread in the human body, they cause a chronic granulomatous inflammatory reaction of miliary pattern, which may lead to respiratory failure and death. In this study we present a case of human pulmonary adiaspiromycosis in an immunocompetent patient that showed a diffuse pulmonary interstitial infiltrate diagnosed by pulmonary biopsy.

Utilidad de la biopsia de piel en el diagnóstico de enfermedades neurológicas / Skin biopsy for the diagnosis of nervous system diseases

Skin biopsy is a powerful diagnostic tool in Dermatology. Its use has been extended to other medical specialties, aüowing the diagnosis of several diseases that previously required complex and high risk diagnostic procedures. Skin contains numerous cell types, including blood vessels and peripheral nerves and represents a window to the systemic circulation and nervous system. In this review we discuss the use of skin biopsy to diagnose nervous system diseases in which patients do not exhibit any clinical cutaneous manifestations. We review the usefulness of skin biopsy in cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopaty (CADASIL), some lysosomal storage diseases, Lafora disease and in peripheral neuropathies.

Coll: colour occult lesion localization. localização de lesões mamárias não-palpáveis com corante e identificação concomitante do linfonodo sentinela em tumores mamários / Coll: colour occult lesion localization. localization of occult breast lesions with corant and concomitant identification of the sentinel node in breast tumors

A incidência de lesões não-palpáveis da mama vem aumentando através dos tempos, fato intimamente correlacionado à difusão da mamografia de alta resolução. Para tanto, tornam-se necessárias marcações pré-operatórias para localização dessas lesões, por meio de técnicas com fio metálico, material radioativo, carvão ativado ou, como no nosso serviço, a utilização de corante vital (azul patente). Apresentaremos a experiência do Hospital e Maternidade São Cristóvão na utilização do corante azul patente para a marcação de lesões não-palpáveis da mama, abordando em concomitância a localização do linfonodo sentinela em alguns casos. Selecionaram-se as pacientes que haviam sido submetidas à marcação pré-operatória com azul patente no Hospital e Maternidade São Cristóvão, no período de julho de 1999 a março de 2007, totalizando 285 pacientes com lesão (ões) não-palpável (eis) da mama. Foram 332 marcações, por orientação mamográfica, injetando–se 1 mL de azul patente intratumoral, 30 minutos a três horas antes do procedimento cirúrgico. A lesão foi excisada e confirmada por radiografia da peça operatória e/ou congelação intra-operatória. Houve 160 casos que tinham indicação para realização do linfonodo sentinela (LS), sendo realizado, nessas pacientes, um reforço da dose de azul patente na sala operatória, acrescentando-se 1 mL do corante na região subareolar e biópsia do LS com congelação intra-operatória deste. Procedeu-se a dissecção axilar completa somente nos casos em que o LS foi positivo. A idade média das pacientes foi de 60,92 anos (23 a 89 anos). As lesões foram identificadas em todos os casos (100%) e totalmente excisadas sem intercorrências cirúrgicas. Nos casos indicados de linfonodo sentinela, a taxa de localização concomitante do LS foi de 98,13%. O tamanho médio dos tumores foi de 1,3 cm. A avaliação histopatológica em parafina revelou 133 casos malignos (40,1%), 26 lesões precursoras de risco (7,8%) e 173 tumores benignos em geral (52,1%). A localização...

The incidence of non-palpable breast lesions is increasing due to the diffusion of the high resolution mammography. For surgical biopsies orientation there are several techniques, such as the insertion of a metallic hook wire and the injection of radioisotopes or corants. The aim of this paper is to present the of the Hospita and Maternity São Cristóvão experience with blue corant for marking occult breast injuries allowing concomitantly the localization of sentinel node (SN). There were 332 markings under, mammography and/or ultrasonograph orientation, with the injection of 1 ml of bluedye intra-tumoral, from 30 minutes to 3 hours before surgical procedure. The lesion was excised and confirmed by specren radiography.In 160 cases there was indication of SN biopsy. In these patients it was injected, a reinforcement of the dose of the blue patent just in the surgical room, adding more l ml of the blue dye in the subareolar region. There average age of the patients it was 60.9 years (23 – 89). The non-palpable breast lesions were identified in all of the cases (100%) without any surgical complication. In the cases of SN biopsy, the rate of localization of the SN was 98,1%. The average size of tumors was 1.3 cm ou the histopatological evaluation in paraffin sections being the results as follows: 133 malignant (40.1%), 26 pre-malignant injuries of risk (7.8%) and 173 benign lesions (52.1%). The localization of occult lesions using blue patent - COLL (Colour Occult Lesion Localization) - and concomitant sentinel node in breast tumors are practical, safe and confident allowing, treinament with minimum aggression and satisfactory aesthetic result. As the radiocolloids method, this is a methodology of high sensitivity, with the advantage of the low cost, being able to be used in hospitals without nuclear medicine services.

Early detection of breast cancer with microcalcification but without palpable mass / 中国癌症杂志

Purpose:To investigate method of early detection of breast cancer with microcalcification observed by mammograph but without palpable mass clinlcally.Methods:Stereotatic core needle biopsy (SCNB) were performed in 35 patients with calcification observed by mammography,and 29 people received stereotatic needle localized breast biopsies (NLBB).All tissues were routinely processed.Microscopic analysis of calcification and morphologic analysis of calcifica- tion were done,as well as histologic diagnosis.Results:Among the 35 specimens of SCNB,microscopic calcification,in- traductal carcinoma and invasive ductal carcinoma were detected in 24,8,and 4 respectively.Calcification was identified in 25 of the 29 cases of NLBB.Five cases of intraductal carcinoma,six cases of invasive ductal carcinoma as well as one case of invasive lobular carcinoma were diagnosed in these 29 patients.Conclusions:With close cooperation among pathol- ogists,surgeons and radiologists,the application of SCNB and NLBB may benefit the early detection of breast cancer with microcalcification observed by mammograph but without mass being palpable clinically and finaly improve the survival of breast cancer patients.