Breast cancer features in women under the age of 40 years / Perfil do câncer de mama em mulheres com idade inferior a 40 anos

Summary Objective: To describe the clinical features, imaging findings and pathological aspects of breast cancer diagnosed in women under the age of 40 years. Method: A retrospective, descriptive study was performed through analysis of medical records between November 2008 and August 2012. One hundred and twenty (120) patients were included, of whom 112 underwent mammography, 113 underwent ultrasonography, and 105 underwent magnetic resonance imaging (MRI). The histopathological data was obtained in most cases from post-surgical analysis, which was available for 113 patients. Results: The mean age at diagnosis of primary breast cancer was 34 years. Only 11 patients (9.0%) had a family history of breast or ovarian cancer in first-degree relative. Ninety-two (92) patients sought medical attention after showing breast symptoms, and the presence of a palpable nodule was the main complaint. One hundred and twenty-two (122) primary tumors were diagnosed, of which 112 were invasive (95%). The most common histological type was invasive ductal carcinoma (73.8%). Luminal B was the predominant molecular subtype (42.6%). Ultrasonography was positive in 94.5% of the cases and the most common finding were nodules (94.8%). At mammography, the malignancy was observed in 92.8% and the presence of suggestive calcifications was the dominant feature. The MRI was positive in 98% of patients, and mass lesions were the most common. Conclusion: Most cases of breast cancer diagnosed in patients under the age of 40 years, in our population, had symptoms at diagnosis and tumor with more aggressive biological behavior. Despite the ultrasound has been the most widely used method, we found improved characterization of breast lesions when also used mammography and MRI.

Resumo Objetivo: descrever o perfil clínico, os achados de imagem e os aspectos anatomopatológicos do câncer de mama em mulheres com idade inferior a 40 anos. Método: estudo retrospectivo, descritivo, com análise de prontuários de novembro de 2008 a agosto de 2012. Foram estudadas 120 pacientes, das quais 112 realizaram mamografia, 113 ultrassonografia e 105 ressonância magnética (RM). A coleta dos dados histopatológicos foi realizada com informações pós-cirúrgicas, disponíveis para 113 pacientes. Resultados: a idade média ao diagnóstico da neoplasia da mama foi 34 anos. Apenas 11 pacientes (9,0%) apresentaram história familiar positiva para câncer de mama/ovário em parente de primeiro grau. Noventa e duas pacientes (92) procuraram atendimento médico após apresentarem sintomas mamários, sendo nódulo palpável a principal queixa referida. Foram diagnosticados 122 tumores primários, dos quais 112 eram invasivos (95%). O tipo histológico mais encontrado foi o carcinoma ductal invasivo (73,8%). Em relação ao subtipo molecular, o luminal B foi predominante (42,6%). A ultrassonografia foi positiva em 94,5% dos casos e o achado mais comum foi nódulo (94,8%). Na mamografia, a lesão maligna foi evidenciada em 92,8% e a presença de calcificações suspeitas foi o padrão dominante. O exame de RM foi positivo em 98% dos pacientes, sendo lesões tipo massa as mais comuns. Conclusão: a maioria dos casos de câncer de mama em pacientes com idade inferior a 40 anos apresentavam sintomas ao diagnóstico e tumores de comportamento biológico mais agressivo. Apesar de a ultrassonografia ter sido o método mais utilizado, observamos uma melhora da caracterização das lesões mamárias quando utilizadas também a mamografia e a RM.

Analysis of risk factors and association between the bi-rads classification and anatomical-pathological findings in nonpalpable breast lesions

OBJECTIVE: To assess the performance of mammography in the detection of nonpalpable breast lesions according to the BI-RADS categories, to analyse the risk factors for breast cancer and to discuss the importance of clinical data on mammography assessment. MATERIAL AND METHODS: Retrospective study with 650 women who underwent preoperative lesion localization, followed by surgical removal of the suspect lesion. The mammography results for these patients, classified according to BI-RADS (fourth edition), were correlated with the anatomical-pathological findings, evaluating the positive predictive value for each category. The risk factors to breast cancer were analiyzed and discussed toghether with BI-RADS classification. RESULTS: Of the total of 650 cases, 59 percent (n = 384) had benign lesions, 10.46 percent (n = 68) had atypical lesions and 30 percent (n = 198) had malignant lesions in the histological study. Microcalcifications were the most frequent finding in the mammograms, observed in 436 patients (67 percent). The positive predictive values for categories 3, 4 and 5 were 13.88 percent, 26.76 percent and 82.35 percent, respectively. On multivariate analysis, only older age and lymph node enlargement on physical examination were associated with malignant results on histology. CONCLUSION: The study showed that the BI-RADS category is a very important tool in the diagnosis of breast cancer. There was a high frequency of malignant findings on lesions classified in BI-RADS category 3, which is problably related to the high prevalence of breast cancer risk factors in our population.

Prevalence of anxiety in women undergoing mammography

Objective:The aim of this study was to evaluate the frequency and possible causes of anxiety in women undergoing mammography and verify the impact of prior information as a tool to reduce anxiety. Material and Methods: The sample consisted of female patients who underwent mammography at an oncology reference center in Brazil. Total sample was divided into two groups and only one group received an explanatory folder with information regarding the mammography and its follow-up. All patients received a questionnaire containing demographic and clinical data, questions about the mammographic exam and the State-Trait Anxiety Inventory (STAI). Results: Two hundred and seventy-four patients were included, aged between 21 and 89 years. Exam purpose was screening in 48.3%. Self-perception of anxiety was reported in 52.2% and most frequent causes of anxiety referred by patients were worry over results (35.3%) and fear of having pain or discomfort during the procedure (26.6%). The levels of anxiety according to the STAI were moderate or high on 52.6% on the state component, and 82.1% on the trait component. There was no statistically significant difference on anxiety levels according to any of the demographic or clinical variables, or between patients who received and did not receive the educational folder prior to the exam. Conclusion: Anxiety is a common feature of women undergoing mammography, mainly caused by fear of the results and lack of knowledge of the exam. According to the results of this and other studies, there was no impact on reducing levels of anxiety with information measures immediately before the exam.

Fatores desencadeantes da instabilização da placa aterosclerótica / Precipitating factors for the unstabilization of the atherosclerotic plaque

A doença aterosclerótica e suas complicações trombóticas ainda permanecem como as principais causas de morbidade e mortalidade no Brasil. Embora a aterosclerose (definida como espessamento da parede arterial, com acúmulo de lipídios, macrófagos, linfócitos T, células musculares lisas, matriz extracelular, cálcio e material necrótico) seja mais prevalente, por si só raramente é fatal. O processo final comum para a transformação de uma lesão não-oclusiva, freqüentemente lesão aterosclerótica clinicamente silenciosa, em uma condição potencialmente fatal é a rotura da placa. A mortalidade associada à doença aterosclerótica relaciona-se com as síndromes coronarianas agudas, incluindo infarto agudo do miocárdio, angina instável e morte súbita cardíaca. Substanciais evidências clínicas, experimentais e "post mortem" demonstram o papel central que a trombose aguda sobreposta à rotura da placa tem como desencadeante das síndromes coronarianas agudas. Assim, o manejo terapêutico visa à redução dessas complicações trombóticas na placa aterosclerótica (como antiagregantes plaquetários, anticoagulantes e terapias trombolíticas), para diminuição da morbidade e da mortalidade. Nesta revisão, foram focalizadas as teorias atuais sobre a aterogênese e como elas interferem em nosso entendimento das síndromes coronarianas agudas.

Frequency of 2, 3, 5-triphenyltetrazolium chloride (TTC) non-reducing bacteria in pasteurized milk

2, 3, 5-triphenyltetrazolium chloride (TTC) is a dye largely used for enumeration of microbial colonies in solid culture media, being a key component of the dry rehydratable film system used for microbiological analysis of food. This dye is colorless in the oxidized form and red when reduced by microorganisms, due to formation of formazan. In this study, TTC was added to Plate Count Agar (PCA) for enumeration of microorganisms in thirty four pasteurized milk samples, with the aim to verify the frequency of microorganisms that are unable to reduce TTC. Milk samples were decimally diluted in saline and pour-plated in PCA plus 0.015(per cent) TTC. Colonies were counted after 24h and 48 h of incubation at 35(degree)C. From a total of 50,574 colonies 19,665(38.88 per cent) did not reduce TTC in 48h. It was observed that 571(6.36 per cent) colonies that were colorless in 24h became red in 48h. From those that didn't reduce TTC in 48h, 233 were purified and Gram stained. 229(98.71 per cent) of them were Gram positive cocci and bacilli. The results show that there is a high percentage of microorganisms unable to reduce TTC in pasteurized milk, which cannot be detected by laboratory procedures based on the formation of red colonies.