Manejo Nutricional em Paciente com Metástase Gástrica de Câncer de Mama: um Relato de Caso / Nutritional Management in a Patient with Breast Cancer Metastasis to the Stomach: a Case Report / Manejo Nutricional en Paciente con Metástasis Gástrica del Cáncer de Mama: un Informe de Caso

Introdução: O surgimento de metástase gástrica oriunda de neoplasia da mama é raro. Entretanto, o suporte nutricional nesses casos é imprescindível, já que tumores gástricos estão relacionados a complicações nutricionais, favorecendo desfechos clínicos negativos. Relato do caso: Paciente com diagnóstico de adenocarcinoma de mama, com progressão para ossos, ovário e estômago, internada em razão das complicações clínicas. Apresentou perda de peso grave durante a internação, além de diagnóstico de risco de desnutrição pela avaliação subjetiva global produzida pelo paciente. Em virtude do quadro de odinofagia severa, a alimentação via oral tornou-se impossibilitada, sendo optado pelo uso de sonda nasoentérica após discussão com equipe interdisciplinar. Conclusão: A terapia nutricional em pacientes com câncer avançado ainda é um dilema entre os profissionais e sua execução deve ser discutida e decidida por uma equipe interdisciplinar, com participação indispensável do nutricionista, do paciente e de seus familiares. Para isso, os serviços de saúde devem estar preparados para o correto manejo da conduta nutricional, a fim de promover qualidade de vida para esses pacientes.

Introduction: It is uncommon for breast cancer to metastasize to the stomach. However, when it does occur, nutritional support is indispensable, because gastric tumors are associated with nutritional complications, which worsen clinical outcomes. Case report: We report the case of a female patient diagnosed with breast adenocarcinoma that had metastasized to the bones, ovary, and stomach, who was hospitalized because of clinical complications. During hospitalization, she presented severe weight loss and was classified as being at nutritional risk, as determined by the Patient-Generated Subjective Global Assessment. Due to severe odynophagia, oral intake was not possible. Therefore, after consultation with the multidisciplinary team, the decision was made to insert a nasogastric tube. Conclusion: Nutritional therapy in patients with advanced cancer still constitutes a dilemma facing professionals and needs to be discussed by a multidisciplinary team, the participation of the nutritionist, patient, and family being indispensable. Therefore, health care services must be prepared to manage nutritional therapy correctly, in order to promote better quality of life for such patients.

Introducción: El surgimiento de metástasis gástrica proveniente de neoplasia de mama es raro. Sin embargo, el soporte nutricional en estos casos es imprescindible, ya que los tumores gástricos están relacionados a complicaciones nutricionales, favoreciendo los resultados clínicos negativos. Informe de caso: Paciente con diagnóstico de adenocarcinoma de mama, con progresión para huesos, ovario y estómago, internada debido a complicaciones clínicas. Se presentó una pérdida de peso grave durante la internación, además de diagnóstico de riesgo de desnutrición por la evaluación subjetiva global producida por el paciente. Debido a un cuadro de odinofagia severa, la alimentación oral se volvió imposibilitada, siendo optado por el uso de sonda nasoentérica después de la discusión con el equipo interdisciplinario. Conclusión: La terapia nutricional en pacientes con cáncer avanzado sigue siendo un dilema entre los profesionales y su ejecución debe ser discutida y decidida por un equipo interdisciplinario, con participación indispensable del nutricionista, del paciente y de sus familiares. Para ello, los servicios de salud deben estar preparados para el correcto manejo de la co

Bilateral multiple extraocular muscle metastasis from breast carcinoma.

We report a rare presentation of an initially misdiagnosed case of a pseudotumor, which on histopathology was diagnosed as bilateral breast metastases of lobular carcinoma involving multiple extraocular muscles. A 61-year-old lady presented with external ophthalmoplegia and diplopia. Incisional biopsy was performed using a lid crease approach and the patient received radiotherapy and hormonal therapy. Following prolonged hormonal therapy, complete remission was achieved, with improvement in ocular motility and resolution of diplopia, about 18 months after the initial presentation. Multiple extraocular muscle involvement by breast carcinoma metastasis is very rare and should be considered in the differential diagnosis, especially in patients with a prior history of breast carcinoma.

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.

A multivariate analysis on prognostic factors for lobular carcinoma of the breast / Uma análise multivariada de fatores prognósticos para o carcinoma lobular de mama

CONTEXT AND OBJECTIVE: Lobular carcinoma is the second most common type of breast neoplasia and has unique clinical and pathological features. Our aim was to evaluate prognostic factors for this type of breast cancer. DESIGN AND SETTING:Retrospective study at a tertiary oncological institution. METHODS: 162 patients diagnosed and treated between January 1985 and January 2002 were included. The inclusion criteria were: absence of previous treatment, histological diagnosis of lobular carcinoma, no previous history of breast cancer and minimum follow-up of 36 months. RESULTS: In univariate analysis, the following factors were statistically significant: clinical stage T (P = 0.0005), clinical stage N (P = 0.0014), neoadjuvant chemotherapy (P = 0.0008), primary tumor size (P < 0.0001), vascular invasion (P < 0.0001), lymphatic invasion (P = 0.0004), neural invasion (P = 0.0004), skin invasion (P < 0.0001), capsular transposition (P = 0.0008), lymph node ratio (P < 0.0001), estrogen receptor expression (P = 0.0186), progesterone receptor expression (P = 0.0286), pathological stage T (P < 0.0001), pathological stage N (P < 0.0001), adjuvant chemotherapy (P < 0.0001) and postoperative hormone therapy (P = 0.0367). After grouping the variables, multivariate analysis was performed. Presence of lymph node metastases, capsular transposition, lymph node ratio and postoperative hormone therapy remained significant. CONCLUSION: In this series, the most important prognostic factors for lobular carcinoma of the breast seemed to relate to lymph node status and presence of capsular transposition. Factors relating to axillary involvement, capsular transposition and hormone therapy were significant for survival.

CONTEXTO E OBJETIVO: O carcinoma lobular é o segundo tipo de neoplasia mais frequente na mama e tem características clínicas e patológicas próprias. Nosso objetivo foi avaliar fatores prognósticos para esse tipo de câncer de mama. TIPO DE ESTUDO E LOCAL: Estudo retrospectivo em instituição terciária oncológica. MÉTODOS: 162 pacientes diagnosticadas e tratadas entre janeiro de 1985 e janeiro de 2002 foram incluídas. Os critérios de inclusão foram: ausência de tratamento prévio, diagnóstico histológico de carcinoma lobular, ausência de história prévia de câncer de mama e acompanhamento mínimo de 36 meses. RESULTADOS: Em análise univariada, os seguintes fatores foram estatisticamente significativos: estágio T clínico (P = 0,0005), estágio N clínico (P = 0,0014), quimioterapia neoadjuvante (P = 0,0008), tamanho do tumor primário (P < 0,0001), invasão vascular (P < 0,0001), invasão linfática (P = 0.0004), invasão neural (P = 0,0004), invasão de pele (P < 0,0001), transposição capsular (P = 0,0008), relação linfonodal (P < 0,0001), expressão de receptor estrogênico (P = 0,0168), expressão de receptor de progesterona (P = 0,0286), estágio T patológico (P < 0,0001), estágio N patológico (P < 0,0001), quimioterapia adjuvante (P < 0,0001) e hormonioterapia pós-operatória (P = 0.0367). Agrupando-se as variáveis, realizou-se análise multivariada. Presença de metástases linfonodais, transposição capsular, razão linfonodal e hormonioterapia pós-operatória permaneceram significantes. CONCLUSÃO: Nesta série, os fatores prognósticos mais importantes para carcinoma lobular de mama parecem ser aqueles relacionados com status linfonodal e presença de transposição capsular. Fatores relacionados ao comprometimento axilar, transposição capsular e terapia hormonal foram significativos para sobrevida.

Carcinoma lobular invasivo de mama com pólipo endometrial metastático / Breast invasive lobular carcinoma with metastatic endometrial polyp

Tumores extragenitais com metástase para o útero são raros, e destes o mais comum é o da mama. O tamoxifeno é uma droga utilizada como terapia adjuvante em mulheres com câncer de mama. Trata-se de droga antiestrogênica; no entanto, no endométrio sua ação é agonista para receptores de estrogênio. Esta descrição de caso relata rara associação do uso do tamoxifeno em paciente com câncer de mama que apresentou metástase para pólipo endometrial. Trata-se de paciente de 70 anos, em hormonioterapia com tamoxifeno há 19 meses, com queixa de sangramento vaginal. Em histeroscopia, evidenciaram-se pólipo endometrial e sua exérese, com diagnóstico de adenocarcinoma metastático, com provável sítio primário em mama. A paciente havia sido submetida à mastectomia radical modificada há três anos, seguida de adjuvância. Pólipos endometriais são achados comuns em mulheres menopausadas e também são complicações da terapia com tamoxifeno. A metástase de carcinoma mamário em pólipo endometrial é rara. Na literatura, foram descritas as seguintes metástases em pólipos endometriais: cinco casos por carcinoma lobular invasivo, três casos por carcinoma ductal e um caso do carcinoma apócrino. Portanto, existe dificuldade em determinar o prognóstico para essas pacientes.

Extragenital tumors metastasizing to the uterine corpus is uncommon; out of those, the most common primary site is the breast. Tamoxifen is used as adjuvant treatment for breast carcinoma. It is an antiestrogenic drug; however has a partial agonist effect on estrogen receptor in the endometrium. This case report relates rare association between the use of tamoxifen in patient with breast cancer which presented metastasis to endometrial polyps. A 10 years old woman received tamoxifen for 19 months after surgery treatment and presented vaginal bleeding. She underwent hysteroscopy with biopsy, which showed endometrial polyp. The polyp was taken out and the pathological diagnosis was metastasis from breast adenocarcinoma. Endometrial polyps are found relatively common in postmenopausal women and they are also related complications to the tamoxifen therapy. Breast carcinoma metastasis to endometrial polyp is rare. There were some descriptions in the literature: five cases of invasive lobular carcinoma, three cases of ductal carcinoma and one case of the apocrine carcinoma. There are few cases shown in the literature and, therefore, there are difficulties in determining the prognosis of these patients.

Carcinoma lobular invasivo no homem / Invasive lobular carcinoma in men

Os autores relatam um caso de carcinoma lobular invasivo em homem, ocorrência extremamente rara nesse sexo, enquanto corresponde a aproximadamente 10% dos carcinomas mamários femininos. Revisamos a literatura e encontramos 22 casos, apenas 1 publicado no Brasil, em 1997.

The authors report a case of invasive lobular carcinoma in man, which is extremely rare, while accord approximately 10% of breast cancers in women. We reviewed literature and found 22 cases, which of just one published in Brazil in 1997.

Carcinoma lobular de mama em homem / Lobular carcinoma of the male breast

Os autores relatam raro caso de carcinoma lobular invasivo diagnosticado em homem no Setor de Mastologia na Disciplina de Ginecologia da UNIFESP - Escola Paulista de Medicina. Discutem vários aspectos relativos a essa neoplasia, em particular, sua etiologia, histopatologia e conduta.