RESUMO
ABSTRACT Breast sebaceous carcinoma is one of the rarest breast neoplasms, with less than 30 cases reported worldwide. Due to the rarity, the new WHO classification of breast tumors grouped these tumors among the ductal carcinoma. A detailed description of these cases is relevant due to the insufficient knowledge about the prognosis of this neoplasm. We report the clinical, histological, and immunohistochemical characteristics of a case of sebaceous carcinoma of the breast in an 81-year-old woman with a right breast nodule. The tumor was composed of nests of a varying mixture of sebaceous cells with abundant slightly vacuolated cytoplasm, surrounded by smaller oval-to-fusiform cells with eosinophilic cytoplasm without vacuolization. No lymph node metastases were present. The immunohistochemical reactions were positive for GATA3, EMA, CD15, and GCDFP15 (focal staining), and negative for RE, RP, and HER-2. The tumor was classified as triple-negative. Morphologically, the differential diagnoses included skin sebaceous carcinoma, lipid-rich carcinoma, apocrine carcinoma, and glycogen-rich clear cell carcinoma. Most of the previously reported cases were positive for RE and RP, which generally was associated with a better prognosis. However, some cases presented a more aggressive behavior with distant and lymph node metastases.
RESUMO
OBJETIVO: Analisar a concordância entre os diagnósticos clínicos e os achados anatomopatológicos obtidos por meio do exame necroscópico, a fim de determinar a frequência com que a necropsia revela diagnósticos principais inesperados, que são relevantes para a causa do óbito. MÉTODOS: Foram analisadas retrospectivamente 680 necropsias realizadas no Hospital de Base do Distrito Federal (HBDF), de janeiro de 1997 a dezembro de 2002. Para a comparação entre os achados clínicos e anatomopatológicos utilizou-se a classificação de Goldman, e fez-se a correlação segundo o sexo, a idade do paciente, a unidade de internação e o tempo de permanência hospitalar. Foram utilizados, como fonte de dados, os pedidos de necropsia, preenchidos pelos médicos-assistentes, e os laudos finais de necropsia. RESULTADOS: A necropsia confirmou os diagnóticos principais formulados pela clínica em 69 por cento das amostras. Em relação aos casos discordantes, 18% foram classificados como classe I (com potencial impacto na sobrevida do paciente) e 13% como classe II (sem o questionável impacto na sobrevida do paciente). Os principais diagnósticos discordantes mais frequentes foram doenças do aparelho circulatório (acidente vascular cerebral, insuficiência cardíaca congestiva e miocardiopatia hipertrófica), moléstias infecciosas (meningite bacteriana, tuberculose miliar e neurotoxoplasmose) e neoplasias (linfomas). CONCLUSõES: Evidenciou-se significativa discordância entre os diagnóticos clínicos e anatomopatológicos post mortem, mostrando que a necropsia ainda é um procedimento importante para o esclarecimento diagnóstico, bem como para a melhoria dos serviços de saúde.
OBJECTIVE: To analyze the discrepancies between clinical and postmortem diagnoses in order to determine the frequency of relevant missed diagnoses detected at autopsy. METHOD: Six hundred and eighty patients autopsied at the Hospital de Base do Distrito Federal, Brazil, between January 1997 and December 2002 were retrospectively investigated. Agreement between clinical and postmortem findings was compared using Goldman's system. Medical records and final autopsy reports were reviewed. RESULTS: Major clinical diagnoses were confirmed in 69 percent of analyzed autopsies. Eighteen percent of cases were classified as Goldman class I missed diagnosis (if known before death, might have led to prolonged survival) and 13 percent as class II (clinically missed major diagnosis for which survival would not have been changed). Most frequent missed major diagnoses were cardiovascular diseases (cerebral hemorrhagic infarction, congestive heart failure and hypertrophic cardiomyopathy), infectious diseases (purulent meningitis, miliar tuberculosis and neurotoxoplasmosis) and neoplasia (lymphoma). CONCLUSION: This study has found significant disagreement between clinical and postmortem examinations and reinforces the importance of autopsy in improving clinical diagnosis and in providing data that could be integrated in quality assurance programs.