Cáncer de mama en hombres: revisión de casos en el Hospital Regional de Talca / Breast cancer in men: review of cases at "Hospital Regional de Talca"

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.

Cáncer en mama axilar: revisión de la literatura a propósito de un caso / Axillary breast cancer: clinical case and literature review

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.

Cáncer de mama y sexualidad: ¿una discapacidad emergente? / Breast cancer and sexuality: an emerging disability?

Fundamentos: Ante la relevancia del cáncer de mama y su impacto en la salud pública, sumado a las pocas referencias bibliográficas sobre estudios psicosociales en la materia y la necesidad de comprender la situación desde una perspectiva cultural y situada de las personas, surgió la interrogante de conocer las vivencias en la sexualidad de las mujeres tratadas por carcinoma ductal invasor en la Unidad de Patología Mamaria (UPM) del Hospital Regional de Concepción, Chile. Método: Estudio cualitativo exploratorio con usuarias de una Unidad de Patología Mamaria y tratadas por carcinoma ductal invasor (noviembre 2014 ­ junio 2015). Muestreo intencional con entrevista en profundidad semiestructurada, análisis de contenido semánticamente orientado. Resultados: Se encontraron principalmente dificultades en la interacción y comunicación con sus parejas debido a la transformación física como consecuencia de la cirugía de mamas y de la quimioterapia. Al mismo tiempo se evidenció distanciamiento entre las parejas debido al impacto que genera el tratamiento. Sin embargo, se observaron algunos casos en los cuales sus parejas manifestaron apoyo y compañía durante el proceso, lo cual impactó significativamente en las vidas de las usuarias y de éstas. Conclusión: Las mujeres manifiestan conflictos íntimos con sus parejas principalmente como consecuencia del estigma y cambio corporal que existe en el tratamiento de cáncer de mama, generando restricciones y limitaciones en la participación social que enfrentan en su vida personal y comunitaria, gatillando una emergente expresión de discapacidad.

Background: In light of the relevance of breast cancer and its impact on public health, along with the limited number of psychosocial studies on the subject and the need to understand the situation from a cultural perspective, focused on individuals' experiencse, an investigation of the sexual experiences of women treated for invasive ductal carcinoma in the Breast Pathology Unit (BPU) of the Hospital Regional de Concepción, Chile was conducted. Method: Qualitative exploratory study with users of the Breast Pathology Unit who were treated for invasive ductal carcinoma (November 2014 - June 2015). Purposive sampling with semi-structured in-depth interviews, with posterior semantically-oriented content analysis. Results: The principal difficulty expressed involved the interaction and communication with their partners, due to the physical transformation as a result of breast surgery and chemotherapy. Additionally, the woman exerienced distancing with their partner due to the impact of the treatment. However, there were some experiences in which the partners expressed support and companionship during the process, which significantly impacted the users' and their partners' lives. Conclusion: The women expressed intimate conflicts with their partners mainly due to stigma and body changes as a results of breast cancer treatment, which also leads to limited social participation their personal and community life, triggering an emerging type of disability.

Adjuvant treatment delay in breast cancer patients / Atraso no tratamento adjuvante em pacientes com câncer de mama

Summary Background: to evaluate if time between surgery and the first adjuvant treatment (chemotherapy, radiotherapy or hormone therapy) in patients with breast cancer is a risk factor for lower overall survival (OS). Method: data from a five-year retrospective cohort study of all women diagnosed with invasive breast cancer at an academic oncology service were collected and analyzed. Results: three hundred forty-eight consecutive women were included. Time between surgery and the first adjuvant treatment was a risk factor for shorter overall survival (HR=1.3, 95CI 1.06-1.71, p=0.015), along with negative estrogen receptor, the presence of lymphovascular invasion and greater tumor size. A delay longer than 4 months between surgery and the first adjuvant treatment was also associated with shorter overall survival (cumulative survival of 80.9% for delays ≤ 4 months vs. 72.6% for delays > 4 months; p=0.041, log rank test). Conclusion: each month of delay between surgery and the first adjuvant treatment in women with invasive breast cancer increases the risk of death in 1.3-fold, and this effect is independent of all other well-established risk factors. Based on these results, we recommend further public strategies to decrease this interval.

Resumo Objetivo: avaliar se o tempo da cirurgia até o primeiro tratamento adjuvante (quimioterapia, radioterapia ou hormonioterapia) em pacientes com câncer de mama é um fator de risco para pior sobrevivência global (SG). Métodos: estudo retrospectivo em que foram coletados dados dos prontuários de todas as mulheres com câncer de mama invasivo, diagnosticadas entre janeiro de 2005 e dezembro de 2010, atendidas consecutivamente em um serviço acadêmico de oncologia. Resultados: foram incluídas 348 mulheres, com mediana de tempo entre a cirurgia e o primeiro tratamento adjuvante de 2 meses. A sobrevivência global foi pior entre as mulheres com maior tempo entre a cirurgia e o primeiro tratamento adjuvante. Após análise multivariada, essa variável permaneceu como fator de risco independente para SG, juntamente com receptor de estrógeno negativo, presença de invasão angiolinfática e maior tamanho tumoral. Conclusão: o tempo entre a cirurgia e o primeiro tratamento adjuvante é um fator de risco independente para a sobrevivência global de mulheres com câncer de mama invasivo.

Carcinoma papilar intraquístico asociado a adenocarcinoma ductual infiltrante en un hombre: reporte de un caso / Papillary intra cyst carcinoma associated with ductal adenocarcinoma in a man: case report

El carcinoma papilar intraquístico es un subtipo de carcinoma ductal no invasivo, puede estar asociado o no acarcinoma in situ y a carcinoma infiltrante, es una patología poco frecuente por lo tanto su aparición en hombres es extremadamente rara. El tratamiento en estos casos es equivalente al carcinoma de mama en mujeres, se debate entre mastectomía simple o mastectomía parcial más radioterapia. Presentamos el caso de un hombre a quien se diagnostica preoperatoriamente con un carcinoma papilar y se realiza mastectomía simple más ganglio centinela.

The papillary intra cyst carcinoma is a sub type of ductal no invasive carcinoma, it can be or not associated to in situ carcinoma and to infiltrant carcinoma, is a pathology less frequent, for these reason his apparition in men is extremely rare. The treatment is equivalent to the breast carcinoma in women, debated between simple mastectomy and partial mastectomy with radiation therapy. We present a clinical case of a man with pre operative diagnostic with a papillary carcinoma and realized simple mastectomy with sentinel node.

A long-term survival pattern for breast cancer treated in a single institution.

Aim: This paper presents a 14-year retrospective study evaluating the survival rates and prognostic factors of breast carcinoma patients treated in private treatment center in the west coast of Turkey. Materials and Methods: The survival rates of breast cancer patients (n = 1746) who have been treated from 1995 until 2008 were analyzed. The clinical data include age, menopausal stage, oestrogen (ER) and progesterone (PR) receptor status, and C-erbB-2 status as well as histopathological evaluation. AJCC (2002) was used for clinical tumor staging. Survival rates were computed using standard Kaplan-Meier methods, and the difference in survival curves was analyzed with the log-rank test. Results: The 14-year overall survival, disease-free survival, local failure-free survival, and distant failure-free survival rates were 77%, 95%, 77%, and 94%, respectively. Early-stage patients had higher overall survival rates compared to advanced-stage patients (stage IIIb and IIIc, AJCC 2002), and early-stage patients had higher survival rates than advanced-stage patients for disease-free survival, local failure-free survival, and distant failure-free survival. The risk for cancer development increases significantly for advanced-stage patients with positive ER and PR receptor as well as C-erbB-2 receptor. Conclusions: The incidence of breast cancer in Turkey is smaller compared to other European countries. Low advanced-stage patient numbers compared to high early-stage patient numbers; and very high median survival times could possibly be the result of the improvement of detection and treatment of breast cancer over the years.

¿Es curable el cáncer de mama en etapa precoz?: Resultados del tratamiento combinado con cirugía, radioterapia y quimioterapia / Treatment results of early breast cancer: A retrospective review

Background: Breast cancer will develop in one out of ten women during their lifetime. Early diagnosis has increased in recent years. Aim: To describe a population of women with breast cancer stage T1N0M0. To analyze radiation therapy toxicity and to evaluate treatment results. Material and methods: Retrospective review of the medical records of 125 women (aged 35 to 80 years) with breast cancer T1N0M0, that were treated between January 1997 and May 2004, with breast conserving surgery and postoperative radiation therapy at an oncology center. Patients lost from follow up were contacted by telephone. Results: An abnormal screening mammography was the reason for consult in 62 percent of cases. The average tumor size was 11.6 mm. Tumors detected with screening mammogram were smaller than those detected on physical exam. The most common radiotherapy toxicity was erithema, which was severe in 2.5 percent of cases. No patient had to stop the radiation treatment due to toxicity. One patient developed arm edema. Tamoxifen was prescribed for 5 years to 80 percent of patients and 17 patients received chemotherapy. After an average follow up of 40 months, no patient has developed local breast relapse, three patients developed contralateral breast cancer and three developed distant metastasis. Two patients died from breast cancer. Disease free survival was 95 percent. Conclusions: Radiotherapy was well tolerated and had excellent local control. Screening mammography detects small tumors. Survival is excellent for early stage breast cancer.

Cancer de mama oculto: dos casos clínicos analizados según el concepto actual / Occult breast cancer: Report of two cases

Occult breast cancer is expressed as a metastatic axillary lymph node without clinical or imaging evidence of a primary tumor in the breast. The old concept involved non palpable tumors. Its incidence is low, representing only 0.3 to 1 percent of all breast cancer cases. The search for the primary tumors is performed with mammography, whose sensitivity is low, ranging from 0 to 56 percent. Several studies have shown a higher sensitivity of magnetic resonance imaging, ranging from 85 to 100 percent, to detect occult lesions. The treatment of isolated axillary metastases of breast cancer is controversial. An axillary dissection is recommended. If there is a suspicious image, a radiosurgical or stereotaxic biopsy should be done. However, in patients without radiological lesions in the breast, the tendency is not to perform a radical mastectomy as previously recommended, since the primary tumor will not be found in the surgical specimen in two thirds of cases. A superior and external quadrantectomy or exclusive radiotherapy should suffice. An expecting behavior is not recommended as a therapeutic alternative. Treatment should be complemented with hormonal therapy or chemotherapy. The literature suggests that prognosis is better than stage II, with a ten years survival ranging from 50 to 71 percent. We report two patients with a well defined occult breast cancer and based on them, a review of the subject is attempted. Considering its prognosis, physicians should be aware of this uncommon and difficult to diagnose disease.

Therapy-related acute promyelocytic leukemia after treatment of carcinoma breast--a case report.

We report a 43-year-old female, with acute promyelocytic leukemia occurring after 9 months of treatment for carcinoma breast. The diagnosis of APL was made on morphology, cytogenetics and molecular studies. In contrast to other published report of therapy related APL (tAPL) the present case presented early after the primary malignancy and underwent a rapid, downhill course.

Ductal carcinoma in situ of the breast; review of calssification schemes and their clinical significance

The increasing use of screening mammography over the past two decades has led to five-fold increase in the diagnosis of ductal carcinoma in situ [DCIS]1. Thus pathologists are being increasingly faced with the challenge of diagnosing cancer in its early stage. The challenge faced by pathologists today is not just to detect pre-invasive conditions but to be able to further classify them into the various subgroups that may potentially have different biological behaviors. The interest in this area was heightened after the widespread use of breast conservation therapy. The aim of this review is to highlight this controversial area of pathology, clarify the existing classification schemes, emphasize the clinical significance of its different subtypes and identify the minimum required data to be recorded in any pathology report describing DCIS

Metástase ocular de carcinoma de mama: relato de cinco casos / Ocular metastasis of breast cancer: five cases report

Os autores documentam cinco casos de pacientes femininas portadoras de câncer de mama com disseminação ocular. Na série, quatro pacientes já apresentavam doença sistêmica no momento da comprovação de metástase ocular, enquanto uma apresentou lesão orbitária como manifestação inicial de tumor mamário não identificado previamente. A idade na época do diagnóstico de carcinoma de mama variou de 36 a 48 anos. O intervalo entre o diagnóstico de câncer de mama e o surgimento dos sinais e sintomas oculares variou de zero a 128 meses, com média de 60 meses. O intervalo entre o diagnóstico e a recidiva da doença variou de 13 a 132 meses e entre esta e o óbito variou de 4 a 50 meses. Neste estudo duas pacientes receberam quimioterapia; e as demais, a associação de quimioterapia e radioterapia. É importante assinalar que duas mulheres desenvolveram metástases oculares em vigência de quimioterapia. Embora a sensibilidade da metástase à radioterapia esteja bem documentada em vários estudos, há poucas publicações que comprovam a eficácia da quimioterapia.

Hormone receptors: association with prognostic factors for breast cancer

Os tumores de mama positivos para receptores de estrogênio (RE) e/ou de progesterona (RP), além de apresentarem um prognóstico mais favorável, mostram associações com outras variáveis de bom prognóstico. A partir de um estudo com 306 carcinomas ductais infiltrantes de mama, foram construidos modelos preditivos para a positividade dos RE e dos RP. Foram estudadas variáveis relacionadas às pacientes e ao tumor (características macro e microscópicas e marcadores tumorais processados por imuno-histoquímica). Na análise bivariada, algumas variáveis se associaram estatisticamente com a positividade dos RE e RP, porém, na regressâo logística não condicional somente as seguintes variáveis foram fatores preditivos independentes: idade da paciente (RE e RP), idade da menarca (RP), grau histológico (RE e RP), RP (RE) e p53 (RE). De acordo com os resultados deste estudo as variáveis idade da paciente ao diagnóstico, grau histológico, RP e p53 foram fatores preditivos para a positividade dos RE, enquanto que a idade da paciente, a idade da menarca e o grau histológico o foram para os RP.

Metastatic tumors in the sellar and parasellar regions: clinical review of four cases

Metastatic tumors in the sellar and parasellar regions are uncommon and rarely detected in clinical practice. We present four cases of sellar and parasellar metastatic tumors, which metastasized from distant organ in one case and extended directly from adjacent structures in three. Common presenting symptoms were cranial neuropathies, headache and facial pain. Invasion into the cavernous sinus was noted in all cases. We report rare cases of sellar and parasellar metastases. Also, we should consider the possibility of metastasis in these regions for patients who showed the above clinical presentations in systemic cancer patients. In extensive diseases, transient symptomatic relief could be obtained by direct surgical management, even in restricted degree.

Indicadores de riesgo de recidiva local en el tratamiento conservador del cáncer de mama / Risk indicators of local relapse in the conservative treatment of the breast cancer

Fueron evaluados los posibles factores de riesgo para recidiva mamaria en pacientes con estadio I y II de adenocarcinoma ductal invasor, sometidas a tratamiento conservador. Luego de un seguimiento promedio de 60 meses, se registraron 20 recidivas en 211 pacientes con tratamiento conservador. Sobre un total de 152 pacientes se realizó un análisis estadístico, uni y multivariado, para hallar los factores de significación respecto al riesgo de recidiva. Igual metodología de análisis fue implementada en pacientes pre y postmenopáusicas por separado. Se identificaron dos tipos de factores, aquellos asociados con la agresividad tumoral y los relacionados con la enfermedad residual. Tanto para pacientes premenopáusicas como postmenopáusicas, el factor de riesgo más significativo del primer tipo, fue la invasión vascular. Entre los factores asociados a enfermedad residual. Tanto para pacientes premenopáusicas como postmenopáusicas, el factor de riesgo más significativo del primer tipo, fue la invasión vascular. Entre los factores asociados a enfermedad residual, resultó significativo la presencia de componente intraductal extenso. Los bordes quirúrgicos comprometidos resultaron estadísticamente significativos sólo en pacientes postmenopáusicas.

Receptores a estradiol, progesterona y dexametazona en carcinoma ductal infiltrante / Reseptors to estradiol, progesterone and dexamethazone in infiltrating ductal carcinoma

Se estudió el contenido de receptores a estradiol (RE), progesterona (RPg) y dexametazona (RG) por la técnica del carbón cubierto con dextrán en citosol del tejido de la glandula mamaria de pacientes con carcinoma ductal infiltrante. Estudio en cien casos. El 45 por ciento de estas pacientes cursaban la postmenopausia y 55 por ciento la premenopausia, con una edad promedio de 66 y 37 años respectivamente. Su primer embarazo fue a la edad promedio de 24 años y tuvieron 2-4 hijos. El 45 por ciento los amamantó por un periodo mínimo de seis meses. La unión específica encontrada en los tumores considerados "receptor positivo" estuvieron en el rango de 10 a 181 fentomolas/mg prot. "Receptor negativo" se consideró al tumor con unión específica menor a 10 fentomolas/mg prot. En este estudio al utilizar el RE como marcador para predecir el tratamiento hormonal se encontró que el 56 por ciento de estas pacientes mostraron RE+ y 44 por ciento no lo manifestaron, al determinar simultáneamente RE y RPg el número de pacientes que los presentaron aumentó hasta 70 por ciento, y al determinar en el mismo tumor RE y RPg y RG también como marcadores de la hormono-dependencia, el número de pacientes que los contienen se incrementó a 77 por ciento. Finalmente, 23 por ciento de estas pacientes no contienen RE, RPg y RG. Cuando se agruparon los valores de RE+ conforme al estado menstrual de la paciente, se encontró que los valores elevados de RE corresponden a las pacientes postmenopáusicas. No se halló relación alguna entre la concentración de RPg+ y RG+ con el estado menstrual de la paciente

Carcinoma ductal in situ: diagnóstico e tratamento / Ductual carcinoa in situ: diagnostic and treatment

Säo apresentados nove casos de carcinoma intraductal da mama, atendidos entre 1985 e 1988. Oito pacientes eram sintomáticas (cinco com nódulos, duas com mastalgia e uma com descarga capilar) e com exame físico positivo. A punçäo-biópsia aspirativa com agulha fina foi positiva em um caso e a citologia do derrame papilar foi negativa nos dois casos em que foi feita. a mamografia revelou microcalcificaçöes em 25% dos casos e a termografia foi suspeita ou positiva em 83%. O tratamento foi mastectomia radical modificada em seis casos e quadrantectomia com esvaziamento axilar mais radioterapia em três casos. O seguimento foi de cinco a 41 meses, sem recidiva