Técnica de Puckett en el tratamiento de mamas tuberosas con lipotransferencia complementaria / The Puckett Technique for Treating Tuberous Breasts with Complementary Lipotransfer

Introducción: La mama tuberosa es una anomalía congénita de la mama que se presenta en la pubertad y es relativamente frecuente. Objetivo: El objetivo de este artículo es dar a conocer el resultado estético del tratamiento quirúrgico de esta afección con la técnica de Pukett sin incluir el implante mamario, con lipotransferencia complementaria. Presentación del caso: Se presenta una paciente femenina, de 25 años de edad, con mama tuberosa grado 4. Se le realiza corrección con técnica de Pukett sin implantes mamarios y en su lugar se usa grasa autóloga. Luego de corregir las anomalías que conforman esta malformación se obtuvo una mama armoniosa sin complicaciones. Conclusión: La técnica de Pukett combinada con lipotransferencia ofrece resultados estéticos y estables en el tratamiento de la mama tuberosa(AU)

Introduction: Tuberous breast is a congenital breast anomaly that presents at puberty and is relatively frequent. Objective: The aim of this article is to report the aesthetic outcome after treating this condition surgically using the Puckett technique without breast implant, with complementary lipotransfer instead. Case presentation: The is presented of a 25-year-old female patient with grade-4 tuberous breast. She is performed a correction using the Puckett technique without breast implants; autologous fat is used instead. After correcting the anomalies that make up this malformation, a harmonious breast was obtained without complications. Conclusion: The Puckett technique combined with lipotransfer offers aesthetic and stable outcomes in the treatment of tuberous breast(AU)

Aspectos Morfológicos de la Mama. Una Revisión de la Literatura / Morphological Aspects of the Breast. A Literature Review

La glándula mamaria tiene su origen embriológico, posteriormente se diferencia histológica y anatómicamente; a lo largo del tiempo se han ido descubriendo nuevos hallazgos, además de nueva terminología. El objetivo de este trabajo consistió en describir la actualización en los aspectos morfológicos de la glándula mamaria. Se realizó una búsqueda de artículos en diferentes fuentes primarias y secundarias de la literatura científica como: Pubmed, Embase, WOS, Scopus, Scielo obteniendo 623 publicaciones, seleccionado 53 para su revisión y 17 incluidos. La mama se ha ido actualizando en los aspectos morfológicos; Los conductos se ubican cercanos a la areola y al pezón donde desembocan directamente, las ramificaciones de los conductos se ubican cercanos a la areola; los pezones tienen entre 15 y 20 lóbulos, de los cuales sólo 5-9 son verdaderos orificios del conducto mamario, no existen senos lactíferos por lo que la leche desemboca directamente en el pezón, en cuanto a la inervación de la mama son inervados por las ramas cutáneas anterior y lateral de los nervios intercostales. La evidencia existente demuestra la necesidad de realizar estudios permanentes en el ámbito de la morfología, como fue descrito en este artículo de revisión sobre la mama. En diferentes aspectos, tales como términos, funciones y estructuras. Está información es importante para, la formación de pregrado, post grado, y su utilización en la clínica, identificación de patologías, clínicas de lactancia, entre otros.

SUMMARY: The mammary gland has its embryological origin, later it differentiates histologically and anatomically; over time new findings have been discovered, as well as new terminology. The aim of this work was to describe the update on the morphological aspects of the mammary gland. A search for articles was carried out in different primary and secondary sources of scientific literature such as: Pubmed, Embase, WOS, Scopus, Scielo, obtaining 623 publications, 53 selected for review and 17 included. The breast has been updated in morphological aspects; the ducts are located close to the areola and the nipple where they open directly, the branches of the ducts are located close to the areola; the nipples have between 15 and 20 lobes, of which only 5- 9 are true mammary duct orifices, there are no lactiferous sinuses, so the milk flows directly into the nipple, in terms of innervation of the breast they are innervated by the anterior and lateral cutaneous branches of the intercostal nerves. The existing evidence demonstrates the need for permanent studies in the field of morphology, as described in this review article on the breast. In different aspects, such as terms, functions and structures. This information is important for undergraduate and postgraduate training, and its use in the clinic, identification of pathologies, lactation clinics, among others.

Mama supranumeraria: resección mediante técnica abierta con dren versus sin dren / Supranumerary breast: resection by open technique with drain vs without drain

Introducción. El tejido mamario accesorio es una anomalía congénita que se presenta en el 2-6 % de la población femenina. En este tejido se pueden desarrollar las mismas patologías que en la mama normal. El manejo curativo es la resección quirúrgica. El objetivo de este estudio fue comparar los resultados de la técnica de resección vía abierta de tejido mamario accesorio con dren vs sin dren. Métodos. Se realizó un estudio observacional tipo cohorte retrospectivo, teniendo en cuenta dos grupos de pacientes con tejido mamario accesorio: a uno de ellos se les realizó resección quirúrgica mediante técnica abierta con dren y al otro grupo sin dren. Además, se incluyó un brazo prospectivo donde se evaluó la calidad de vida y la satisfacción de las pacientes con el resultado posoperatorio mediante el uso de la herramienta Breast-Q. Resultados. Se recolectó la información de 82 pacientes, la mayoría mujeres; 22 se intervinieron con técnica con dren y 60 con técnica sin dren. 13,6 % de los pacientes presentaron complicaciones tempranas, siendo la infección de sitio operatorio la más frecuente (36,4 %). En general, las complicaciones fueron más comunes en el grupo con dren (40,9 % vs 3,4 %), con una diferencia estadísticamente significativa (p=0,000). La calidad de vida fue similar en ambos grupos. Conclusiones. Los pacientes a quienes se les realizó resección de mama supernumeraria y se dejó un sistema de drenaje en el lecho de disección presentaron más complicaciones posoperatorias que las pacientes a quienes no se les dejó dren

Introduction. Accessory breast tissue is a congenital anomaly that occurs in 2-6% of the female population. It can develop the same pathologies that in the normal breast. The curative management of this pathology is surgical resection. The objective of this study was to compare the results of the accessory breast tissue open resection technique with a drain vs without a drain. Methods. An observational retrospective cohort study was conducted considering two groups of patients with accessory breast tissue: one of them underwent surgical resection using an open technique with a drain and the other group without a drain. In addition, a prospective arm where the quality of life and satisfaction of the patients with the postoperative result was evaluated by the Breast-Q tool. Results. Eighty-two patients were included, most of them women; 22 were operated with open technique with drain and 60 without drain. 13.6% of patients presented early complications, with surgical site infection being the most frequent (36.4%) and, in general, complications were more common in the group with drain (40.9% vs 3.4%) with a statistically significant difference (p=0.000). Quality of life was similar in both groups.Conclusions. Patients who undergo supernumerary breast resection and leaving drainage in the dissection bed present more postoperative complications compared to those without drain

Recomendações para o rastreamento do câncer de mama no Brasil do Colégio Brasileiro de Radiologia, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia / Recommendations for breast cancer screening in Brazil from the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations

Objetivo: Apresentar a atualização das recomendações do Colégio Brasileiro de Radiologia e Diagnóstico por Imagem, da Sociedade Brasileira de Mastologia e da Federação Brasileira das Associações de Ginecologia e Obstetrícia para o rastreamento do câncer de mama no Brasil. Materiais e Métodos: Foram feitas buscas das evidências científicas publicadas nas bases Medline, EMBASE, Cochrane Library, EBSCO, CINAHL e Lilacs, entre janeiro de 2012 e julho de 2022. As recomendações foram baseadas nessas evidências, mediante consenso da comissão de especialistas das três entidades. Recomendações: O rastreamento mamográfico anual é recomendado para as mulheres de risco habitual entre 40 e 74 anos. Acima de 75 anos, deve ser reservado para as que tenham expectativa de vida maior que sete anos. Mulheres com risco maior que o habitual, entre elas as com mamas densas, com história pessoal de hiperplasia lobular atípica, carcinoma lobular in situ clássico, hiperplasia ductal atípica, tratamento de câncer de mama ou de irradiação no tórax antes dos 30 anos ou, ainda, portadoras de mutação genética ou com forte história familiar, beneficiam-se do rastreamento complementar, sendo consideradas de forma individualizada. A tomossíntese é uma evolução da mamografia e deve ser considerada no rastreamento, sempre que acessível e disponível. (AU)

Objective: To present the update of the recommendations of the Brazilian College of Radiology, the Brazilian Society of Mastology and the Brazilian Federation of Gynecology and Obstetrics Associations for breast cancer screening in Brazil. Materials and Methods: Scientific evidence published in Medline, Embase, Cochrane Library, Ebsco, Cinahl and Lilacs between January 2012 and July 2022 was searched. Recommendations were based on this evidence, by consensus of the expert committee of the three entities. Recommendations: Annual mammographic screening is recommended for women aged between 40 and 74 years old. Above 75 years should be reserved for those with a life expectancy greater than seven years. Women at higher than usual risk, including those with dense breasts, a personal history of atypical lobular hyperplasia, classic lobular carcinoma in situ, atypical ductal hyperplasia, treatment for breast câncer, chest irradiation before age 30, carriers of genetic mutation or with a strong family history, benefit from complementary screening, being considered individually. Tomosynthesis is an evolution of mammography and should be considered in screening, whenever accessible and available. (AU)

Caracterización clínica-epidemiológica de pacientes menores o iguales a 40 años con cáncer de mama / Clinical-epidemiological characterization of patients under or equal to 40 years old with breast cancer

El cáncer de mama se encuentra dentro de los tres primeros cánceres diagnosticados en las mujeres a nivel mundial. En las mujeres menores de 40 años ocupa el primer puesto de incidencia. Alrededor de 146 000 nuevos casos son diagnosticados en mujeres menores de 40 años a nivel global. Objetivo. Identificar las características epidemiológicas y clínicas de las pacientes con edad menor o igual a 40 años con diagnóstico de cáncer de mama en un hospital de tercer nivel especializado en la atención de la mujer. Metodología. Estudio transversal descriptivo. Se recolectó información de 60 expedientes de pacientes con diagnóstico de cáncer de mama con edad menor o igual de 40 años diagnosticados entre enero 2019 y diciembre 2020. Resultados. El mayor número de casos se encontró en las mujeres entre 39 y 40 años (18,3 %, cada uno). El 60 % era del área urbana; el 80 % de las pacientes tenía una paridad entre uno a cuatro hijos; el 40 % de se encontraba con sobrepeso y el 58 % no tenía antecedentes familiares de cáncer de mama. El estadio clínico más frecuente fue IIIA. El diagnóstico histopatológico más común fue carcinoma de mama invasivo de tipo no especial (91,6 %), pobremente diferenciado, con receptores para estrógeno y progesterona positivos. Conclusión. Las mujeres con edad menor o igual a 40 años, con cáncer de mama, son pacientes procedentes del área urbana, con sobrepeso, con uno a cuatro hijos y sin antecedentes familiares de cáncer de mama; con presentación clínica inicial en etapas localmente avanzadas, con diagnóstico de carcinoma de mama invasivo de tipo no especial, pobremente diferenciado y receptores para estrógeno y progesterona positivos

Breast Breast cancer is among the first three cancers diagnosed in women worldwide. In women younger than 40 years old it occupies the first place in incidence. About 146 000 new cases are diagnosed globally in women under 40 years old. Objective. To identify the epidemiological and clinical characteristics of patients under or equal to 40 years old, diagnosed with breast cancer in a tertiary hospital specialized in women's care. Methodology. Descriptive cross-sectional study. Information was collected from 60 clinical records of patients diagnosed with breast cancer with an age less than or equal to 40 years old, between January 2019 and December 2020. Results. The highest number of cases was found in women between 39 and 40 years old (18.3 % each). Sixty percent were from the urban area; 80 % of the patients had parity between one and four children; 40 % were overweight and 58 % had no family history of breast cancer. The most frequent clinical stage was IIIA. The most common histopathological diagnosis was invasive breast carcinoma of non-special type (91.6 %), poorly differentiated with positive estrogen and progesterone receptors. Conclusion. Women aged less than or equal to 40 years old, with breast cancer, are patients from urban areas, overweight, with one to four children and no family history of breast cancer, with initial clinical presentation in locally advanced stages, with a diagnosis of invasive breast carcinoma of non-special type, poorly differentiated and positive estrogen and progesterone receptors

Magnetic resonance differential analysis for different hormone receptor expression status in HER-2-positive breast cancer / 中南大学学报(医学版)

OBJECTIVES@#Currently, it is difficult to assess the expression status of hormone receptor (HR) in breast malignant tumors with human epidermal growth factor receptor 2 (HER-2)-positive in the early preoperative stage, and it is difficult to predict whether it is non-invasively. This study aims to explore the value of MRI on the different HR expression status (HR+/HR-) in HER-2 positive breast cancer.@*METHODS@#Thirty patients with HR+ HER-2-positive breast cancer (HR+ group) and 23 patients with HR-HER-2-positive breast cancer (HR- group) from the First Hospital of Hunan University of Traditional Chinese Medicine between January 7, 2015 and November 26, 2021 were selected as subjects, and all the patients were examined by MRI and all were confirmed by surgery or pathological biopsy puncture. The immunohistochemical staining results were used as the gold standard to analyze the basic clinical conditions, peri-lesion conditions and MRI sign characteristics in the 2 groups.@*RESULTS@#There were all significant differences in terms of mass margins, internal reinforcement features, and apparent diffusion coefficient (ADC) values between the HR+ group and the HR- group (all P<0.05). The logistic multivariate regression model showed that: when the lesion presented as a mass-type breast cancer on MRI, the internal enhancement features of the lesion were an independent predictor for differentiation in the 2 types of breast cancer [odds ratio (OR)=5.95, 95% CI: 1.223 to 28.951, P<0.05], and the mass margin (OR=0.386, 95% CI: 0.137 to 1.082, P>0.05) and ADC value (OR=0.234, 95% CI: 0.001 to 105.293, P>0.05) were not the independent predictors in distinguishing the 2 types of breast cancer.@*CONCLUSIONS@#Multiparametric MRI has good diagnostic value for HR expression status in HER-2-positive breast cancer. Combined logistic regression analysis to construct a predictive model may be helpful to the identical diagnosis.

Application of volume replacement techniques in breast conserving surgery for breast cancer treatment / 中华外科杂志

Objective: To examine the application of volume replacement techniques in breast conserving surgery for breast cancer. Methods: The clinic data of 76 breast cancer patients underwent a breast conserving surgery with volume replacement techniques at the Breast Center, Beijing Tongren Hospital, from June 2019 to June 2021 were analyzed retrospectively. All patients were female, aged (42.6±6.4) years (range: 32 to 56 years). Tumor staging inlcuded stage ⅡA in 36 cases, stage ⅡB in 24 cases, stage ⅢA in 12 cases, stage ⅢB in 4 cases. Three types of techniques included the lateral thoracic adipofascial flaps in 47 cases, the upper abdominal wall adipofascial flaps in 22 cases and the latissimus dorsi myocutaneous flap in 7 cases. The specimen volume of tumor expansion resection in breast conserving surgery was measured, while the operative time used for volume replacement techniques, postoperative drainage retention time, postoperative complications and patients' satisfaction with the breast shape were recorded. Results: The specimen volume of tumor was (100.9±24.2) ml (range: 55 to 157 ml) in lateral thoracic adipofascial flap group, (88.4±14.5) ml (67 to 118 ml) in upper abdominal wall adipofascial flap group, (179.7±22.9) ml (range: 155 to 220 ml) in latissimus dorsi myocutaneous flap group. The operative time used to restore the breast shape of the three groups were (52.9±9.0) minutes (range: 45 to 70 minutes), (63.2±8.8) minutes (range: 50 to 70 minutes) and (99.3±3.4) minutes (range: 95 to 105 minutes), respectively. The postoperative drainage retention times of the three groups were (8.6±1.2) days (range: 7 to 10 days), (9.4±0.9) days (range: 8 to 10 days) and (11.4±1.3) days (range: 10 to 13 days), respectively. All the 76 patients were evaluated for their satisfaction with the cosmetic outcomes, 64 patients (84.2%) were strongly satisfied and 12 patients (15.8%) were generally satisfied. The postoperative complications included fat liquefaction in 6 cases (2 cases in the lateral thoracic adipofascial flap group and 4 cases in the upper abdominal adipofascial flap group) and seroma in 4 cases (each 2 cases in the lateral thoracic adipofascial flap group and the latissimus dorsi myocutaneous flap group). Conclusions: For patients with large tissue loss during breast conserving surgery, the corresponding volume replacement techniques, including lateral thoracic adipofascial flaps, upper abdominal wall adpofascial flaps and latissimus dorsi myocutaneous flaps, should be reasonably selected for repair according to the tumor site and the size of the intraoperative breast loss, which can ensure the original volume and shape of the breast, with controllable postoperative complications.

Development in the last 20 years of anti-HER2 targeted therapy for breast cancer / 中华外科杂志

Since trastuzumab was listed and approved for breast cancer in 2002, China has entered a new epoch of targeted therapy. Over the past 20 years, anti-human epidermal growth factor receptor 2 (HER2) targeted therapy for breast cancer in China has experienced the era of single-target, tyrosine kinase inhibitors, double-target and anti-HER2 plus antibody-drug conjugate. Advancement in the anti-HER2 targeted therapy is continuously changing the treatment mode of patients with HER2 positive status and even HER2 low expression, significantly improved their prognosis. In the past 20 years, Chinese scholars have participated in international clinical researches, completed a series of registration studies of imported drugs, developed new drugs with proprietary intellectual property rights, enriched the evidence of clinical research on HER2-targeted therapy, and formed a treatment system with both international standards and Chinese characteristics. In particular, the formulation of the Chinese Society of Clinical Oncology Breast Cancer Guidelines and the Chinese expert consensus on anti-HER2 targeted treatment in breast cancer are the concentrated embodiments of Chinese wisdom.

Establishment and validation of a multigene model to predict the risk of relapse in hormone receptor-positive early-stage Chinese breast cancer patients / 中华医学杂志(英文版)

BACKGROUND@#Breast cancer patients who are positive for hormone receptor typically exhibit a favorable prognosis. It is controversial whether chemotherapy is necessary for them after surgery. Our study aimed to establish a multigene model to predict the relapse of hormone receptor-positive early-stage Chinese breast cancer after surgery and direct individualized application of chemotherapy in breast cancer patients after surgery.@*METHODS@#In this study, differentially expressed genes (DEGs) were identified between relapse and nonrelapse breast cancer groups based on RNA sequencing. Gene set enrichment analysis (GSEA) was performed to identify potential relapse-relevant pathways. CIBERSORT and Microenvironment Cell Populations-counter algorithms were used to analyze immune infiltration. The least absolute shrinkage and selection operator (LASSO) regression, log-rank tests, and multiple Cox regression were performed to identify prognostic signatures. A predictive model was developed and validated based on Kaplan-Meier analysis, receiver operating characteristic curve (ROC).@*RESULTS@#A total of 234 out of 487 patients were enrolled in this study, and 1588 DEGs were identified between the relapse and nonrelapse groups. GSEA results showed that immune-related pathways were enriched in the nonrelapse group, whereas cell cycle- and metabolism-relevant pathways were enriched in the relapse group. A predictive model was developed using three genes ( CKMT1B , SMR3B , and OR11M1P ) generated from the LASSO regression. The model stratified breast cancer patients into high- and low-risk subgroups with significantly different prognostic statuses, and our model was independent of other clinical factors. Time-dependent ROC showed high predictive performance of the model.@*CONCLUSIONS@#A multigene model was established from RNA-sequencing data to direct risk classification and predict relapse of hormone receptor-positive breast cancer in Chinese patients. Utilization of the model could provide individualized evaluation of chemotherapy after surgery for breast cancer patients.

Malignant Phyllodes Tumor in the male: A case report

@#Phyllodes tumors are breast tumors accounting for about 1% of all breast neoplasms in women and are rare in males. Reported here is a case of a 45-year-old male presenting with a rapidly enlarging right breast mass with invasion of the anterior chest wall. Core Needle Biopsy revealed Malignant Phyllodes Tumor. He underwent wide excision and chest wall resection. Reconstruction was performed using polyropelene mesh, a latissimus dorsi flap and split thickness skin grafting. Patient was discharged on the 33rd post-operative day due to delayed expansion of the right lung from splinting and subsequent near-complete loss of the split thickness skin graft over the latissimus muscle flap. On the recommendation of the plastic surgeon, the wound was allowed to heal by secondary intention. This report draws attention to the rarity of malignant phyllodes tumor in males, and the difficulty of recognizing a malignant pathology in males presenting with breast mass. It also highlights a cost-effective treatment option in the management of these tumors.

Sobrepeso e obesidade entre mulheres e associação com características demográficas e obstétricas entre usuárias de uma unidade de saúde especializada / Overweight and obesity between women and association with demographic and obstetric characteristics among users of a specialized health unit

Resumo Introdução O excesso de peso é um fator de risco para doenças crônicas. Objetivo Estimar a prevalência de sobrepeso e obesidade, e investigar sua associação com variáveis demográficas, socioeconômicas e reprodutivas e com comportamentos relacionados à saúde entre mulheres usuárias de unidade de atenção especializada. Método Estudo transversal com mulheres em atendimento por mastologista. O estado nutricional foi classificado por meio do índice de massa corporal. Foram utilizados modelos de regressão logística multinomial brutos e ajustados, com estimativa de razões de chance (RC) e intervalos de confiança de 95% (IC95%). A eutrofia foi considerada como categoria de referência. Resultados Participaram 182 mulheres com média de idade de 51 anos. A prevalência de sobrepeso foi de 34,1% (IC95% 27,1-41,0) e de obesidade foi de 31,8% (IC95% 25,0-38,7). Apresentaram maiores chances de obesidade as mulheres: com 60 anos ou mais, que exerciam atividade remunerada, que tiveram menarca antes dos 13 anos e com três ou mais gestações. Após análise ajustada, permaneceram associadas à maior chance de obesidade a menarca antes dos 13 anos (RC 4,40; IC95% 1,76-10,99) e três ou mais gestações (RC 8,50; IC95% 2,14-33,70). Conclusão Verificou-se elevada prevalência de sobrepeso e obesidade entre as participantes, associada às características reprodutivas.

Abstract Background Overweight is a risk factor for chronic diseases. Objective To estimate the prevalence of overweight and obesity and to investigate its association with demographic, socioeconomic, reproductive and health behaviors related among women users of specialized care units. Method Cross-sectional study with women in care by a mastologist. Nutritional status was classified by Body Mass Index (BMI). Gross and adjusted multinomial logistic regression models were used, to estimate an Odds Ratios (OR) and 95% Confidence Intervals (95% CI). Eutrophy was considered as a reference category. Results 182 women with a mean age of 51 years. The prevalence of overweight was 34.1% (CI 95% 27.1-41.0) and obesity was 31.8% (CI 95% 25.0-38.7). Women were more likely to be obese: 60 years of age or older, who were gainfully employed, who had menarche before age 13, and with three or more pregnancies. After adjusted analysis, they remained associated with a greater chance of the development of obesity to menarche before 13 years (OR 4.40 CI 95% 1.76-10.99) and three or more pregnancies (OR 8.50 CI 95% 2.14-33.70). Conclusion There was a high prevalence of overweight and obesity among the participants, associated with reproductive characteristics.

Subtipos intrínsecos de cáncer de mama y factores pronósticos en un centro de referencia en Medellín, Colombia. Estudio descriptivo / Intrinsic subtypes of breast cancer and prognostic factors in a reference center in Medellin, Colombia. A descriptive study

Introducción. Entre las mujeres, el cáncer de mama es el más frecuente en el mundo. Representa una enfermedad heterogénea, debido a que un mismo tipo histopatológico puede tener comportamiento biológico distinto según su clasificación molecular, aportando valor pronóstico y como predictor de la respuesta a la quimioterapia neoadyuvante. El objetivo de este estudio fue describir la distribución de los subtipos intrínsecos de cáncer de mama, y su asociación con factores pronósticos, así como las características sociodemográficas y clínicas de pacientes de la Clínica Medellín, entre 2016 y 2019. Metodología. Estudio descriptivo, retrospectivo de una base de datos institucional, en el periodo 2016 a 2019. Se analizaron los datos demográficos y clínicos de los registros médicos utilizando estadística descriptiva. Resultados. Se incluyeron en el estudio 468 historias clínicas, la mediana de edad al diagnóstico fue de 61 años, y 27 % (n=131) eran menores de 50 años. El tipo histológico más frecuente fue el ductal con un 89,1 % (n=417), y el grado histológico 2 fue el de mayor frecuencia con el 44 % (n=206) de los casos. El subtipo intrínseco más frecuente fue el luminal A con un 32,7 % (n=153), seguido por el luminal B HER2- con 30,1 % (n=141), luminal B HER2+ con 17,3 % (n=81), triple negativo con un 13 % (n=61) y, por último, el HER2 enriquecido con 6,8 % (n=32). Conclusión. La distribución de los subtipos intrínsecos del cáncer de mama en la población estudiada mostró que el subtipo luminal A fue el más frecuente, mientras que los subtipos triple negativo y HER2 enriquecido fueron los menos frecuentes

Introduction. Among women, breast cancer is the most common cancer in the world. It represents a heterogeneous disease, because the same histopathological type can have different biological behavior according to its molecular classification, providing prognostic value and as a predictor of response to neoadjuvant chemotherapy. The objective of this study was to describe the distribution of intrinsic subtypes of breast cancer, and their association with prognostic factors, as well as the sociodemographic and clinical characteristics of patients at the Clínica Medellín, between 2016 and 2019. Methodology. Descriptive, retrospective study of an institutional database, in the period 2016 to 2019. Demographic and clinical data from medical records were analyzed using descriptive statistics. Results. A total of 468 medical records were included in the study, the median age at diagnosis was 61 years, and 27% (n=131) were under 50 years of age. The most frequent histological type was ductal with 89.1% (n=417), and histological grade 2 was the most frequent with 44% (n=206) of the cases. The most frequent intrinsic subtype was luminal A with 32.7% (n=153), followed by luminal B HER2- with 30.1% (n=141), luminal B HER2+ with 17.3% (n=81), triple negative with 13% (n=61) and, finally, HER2 enriched with 6.8% (n=32). Conclusion. The distribution of the intrinsic subtypes of breast cancer in the study population showed that the luminal A subtype was the most frequent, while the triple negative and HER2-enriched subtypes were the least frequent

Tumor Desmoide de mama en paciente gestante. A propósito de un caso / Desmoid Tumor in a pregnant pacient´s breast. Case report

El Tumor Desmoide, es un tumor raro de origen mesenquimal con una incidencia aproximada de 0.3% (1) que, si bien es considerado un tumor benigno por no presentar metástasis a distancia, se considera un tumor localmente agresivo con altas tasas de recidiva tras la extirpación quirúrgica de entre el 19 a 28% (2). Se presenta el caso clínico de una mujer de 21 años de edad, gestante de 7 semanas, que acudió a consulta a la Unidad de Mastología del Hospital de Clínicas por percatarse de nódulo en cuadrante superoexterno de mama derecha, que aumenta de tamaño. Se realizó exéresis tumoral con márgenes, cuyo diagnóstico fue un Tumor Desmoide y, posterior resección de márgenes para ampliación. El Tumor Desmoide es poco frecuente de localización mamaria, que fue tratada con cirugía con buena evolución en una mujer gestante, por lo que debe considerarse esta patología en pacientes jóvenes gestantes, como diagnóstico diferencial en nódulos mamarios.

Desmoid tumor is a rare tumor of mesenchymal origin with an approximate incidence of 0.3% (1). Although it is considered a benign tumor because it does not present distant metastases, it is considered a locally aggressive tumor with high rates of recurrence after surgical removal of between 19 to 28% (2). We present the clinical case of a 21-year-old woman, 7 weeks pregnant, who attended the Mastology Unit of the Hospital de Clínicas, after noticing a nodule in the upper outer quadrant of the right breast, which was increasing in size. Tumor excision with margins was performed, whose diagnosis was a Desmoid Tumor, and subsequent resection of margins for amplifying The Desmoid Tumor is rare in the breast and was treated with surgery with a good evolution in a pregnant woman, so this pathology should be considered in young pregnant patients, as a differential diagnosis in breast nodules.

Adenoma tubular gigante de mama, una rara patología benigna: Reporte de Caso / Giant tubular adenoma of the breast, a rare benign pathology: A case report

Introducción: El adenoma tubular de mama una patología benigna que se presenta en mujeres jóvenes como una masa unilateral que genera asimetría mamaria y se tiende a confundir con fibroadenoma gigante juvenil, diferenciándose en el estudio histopatológico. Es una patología muy rara, con excepcionales casos reportados en la literatura de mayor a 10 cm, motivo de presentación de este caso. Caso clínico: Presentamos el caso de una mujer de 21 años de edad con una masa de10 cm aproximadamente en la mama derecha, de 1 año de evolución con crecimiento paulatino, sin síntomas asociados. El examen físico sin hipertrofia de ganglios axilares. Taller diagnóstico: La paciente fue sometida a una exéresis quirúrgica reportando en el estudio patológico definitivo un adenoma tubular de mama. Conclusión: Como conclusión se trata de una patología poco frecuente, pero debemos conocerla y tener un mínimo de sospecha diagnóstica para evitar confusiones con patología mamaria maligna.

Introduction: Tubular adenoma of the breast is a benign pathology in young women as a unilateral mass that generates breast asymmetry and tends to be confused with giant juvenile fibroadenoma, differing in the histopathological study. It is a very rare pathology, with exceptional cases reported in the literature of greater than 10 cm, which is the reason for presenting this case. Clinical case: We present the case of a 21-year-old woman with a mass of approximately 10 cm in the right breast, of 1 year of evolution with gradual growth, without associated symptoms. Physical examination showed no axillary node hypertrophy. Diagnostic workshop: The patient underwent surgical excision, reporting a tubular adenoma of the breast in the definitive pathological study. Conclusion: It is a rare pathology, but we must know it and have a minimum of diagnostic suspicion to avoid confusion with malignant breast pathology.

Angiosarcoma radioinducido de mama: reporte de caso / Radioinduced angiosarcoma of the breast: Case report / Angiossarcoma radioinduzido de mama: reporte de caso

El angiosarcoma es un tumor vascular maligno poco frecuente. Constituye menos del 2% de todos los sarcomas. Existen varias formas clínicas, una es la producida después de radioterapia, en pacientes que fueron tratadas por un cáncer de mama, con cirugía conservadora y radioterapia. Se presenta como un sarcoma de alto grado, localizado en la piel o en el tejido subcutáneo y, ocasionalmente, el parénquima mamario. El único tratamiento curativo es la cirugía, con tendencia a la recurrencia y a hacer metástasis hematógena, el pronóstico es malo, con alta tasa de mortalidad.

Angiosarcoma is a rare malignant vascular tumor. It constitutes less than 2% of all sarcomas. There are several clinical forms; the one produced after radiation therapy is that associated with patients who were treated for breast cancer with conservative surgery and radiation therapy. It presents as a high-grade sarcoma located on the skin or the subcutaneous tissue and, occasionally, the breast parenchyma. The only curative treatment is surgery, with a tendency to recurrence and visceral hematogenous metastasis, with a poor prognosis and a high mortality rate.

El angiossarcoma é um tumor vascular maligno pouco frequente. Constitui menos de 2% de todos os sarcomas. Existem várias formas clínicas, uma é a produzida depois da radioterapia, em pacientes que foram tratadas por um câncer de mama, com cirurgia conservadora e radioterapia. Se apresenta como um sarcoma de alto grau, localizado na pele ou no tecido subcutâneo e, ocasionalmente, o parênquima mamário. O único tratamento curativo é a cirurgia, com tendência à recorrência e a fazer metástasehematogênica, o prognóstico é mau, com alta taxa de mortalidade.

As políticas públicas de saúde e a fragmentação do corpo feminino em útero e peito / Public health policies and the fragmentation of the female body into uterus and breast

Resumo Estudo qualitativo com abordagem de História Oral Temática, com o objetivo de compreender a atenção à saúde da mulher na visão de mulheres sem filhos, considerando as políticas públicas em saúde. Utilizou-se a técnica de snowball para definição das 19 mulheres participantes, sem filhos, idade entre 18 e 90 anos, que conheçam ou utilizem políticas públicas de saúde. As narrativas foram recolhidas por meio de entrevistas, com um roteiro semiestruturado, e submetidas ao método de análise de narrativas. Dentre os achados, encontram-se os discursos e as representações da maternidade, produzidos e veiculados nas políticas públicas de saúde, nas quais estão implícitas as características biológicas femininas na fragmentação do corpo feminino em útero e peito. Destaca-se ainda a percepção das mulheres sem filhos de que os programas e políticas de saúde, ao se concentrarem nos aspectos reprodutivos, reafirmam o ideal feminino de mulher-mãe, negligenciando outros aspectos e desconsiderando a mulher que escolhe a não maternidade. As representações do feminino concentram-se no corpo, alvo do poder, vinculando a condição de ser mulher à maternidade, baseado num determinismo biológico. Faz-se necessário reelaborar essas políticas, considerando as transformações no papel feminino e a liberdade de escolha da mulher na contemporaneidade.

Abstract Qualitative study with a Thematic Oral History approach, aiming to understand women's health care from the point of view of childless women, considering public health policies. The snowball technique was used to define the 19 participating women, without children, aged between 18 and 90 years, who know or use public health policies. The narratives were collected through interviews, with a semi-structured script, and submitted to the narrative analysis method. Among the findings, there are the discourses and representations of motherhood, produced and conveyed in public health policies, in which the biological characteristics of women are implicit in the fragmentation of the female body into uterus and breast. Also noteworthy is the perception of childless women that health programs and policies, by focusing on reproductive aspects, reaffirming the female ideal of a woman-mother, neglecting other aspects and disregarding the woman who chooses no maternity. The representations of the feminine focus on the body, the target of power, linking the condition of being a woman to motherhood, based on biological determinism. It is necessary to re-elaborate these policies, considering the transformations in the female role and women's freedom of choice in contemporary times.

Indução da lactação em mulheres nuligestas: relato de experiência / Inducción de la lactancia en mujeres nuligestas: informe de experiencia / Lactation induction in women who never got pregnant: experience report

Resumo Objetivo relatar a experiência de indução da lactação em nuligestas realizada por enfermeira consultora em aleitamento. Método relato de experiência. O processo de indução láctea foi realizado com três mulheres por motivo de gestação em útero de substituição e relacionamento homoafetivo. Resultados todas perceberam o aumento de tamanho e a sensibilidade nas mamas, bem como apresentaram secreção láctea. No entanto, a continuidade da amamentação foi diferenciada entre elas. A primeira não recebeu apoio de profissionais de saúde no contexto de pós-parto hospitalar, nem em casa, e não deu continuidade à amamentação. A segunda recebeu apoio da equipe do hospital e da parceira, amamentando por três meses. A terceira, com o apoio da parceira, amamentou por dois meses, mas interrompeu por sentir-se inibida por familiares. Conclusão e implicações para a prática a técnica de indução é capaz de desencadear a produção láctea. Já o processo de amamentação só se estabeleceu mediante a associação com a rede de apoio, o acolhimento, o incentivo da equipe de saúde e o olhar integral à mulher e sua família. Dessa forma, o cuidado de Enfermagem na indução láctea não deve focar apenas no manejo da indução, mas transcender o aspecto técnico, o que se mostra como fundamental para a proteção, o estabelecimento e a continuidade da amamentação.

Resumen Objetivo reportar la experiencia de inducir la lactancia en nuligestas realizada por una consultora de enfermería en lactancia materna. Método relato de experiencia. El proceso de inducción de la leche se realizó con tres mujeres por embarazo en útero de reemplazo y relación homoafectiva. Resultados todas notaron el aumento de tamaño y la sensibilidad en las mamas, además de presentar secreción de leche. Sin embargo, la continuidad de la lactancia materna se diferencia entre ellos. La primera no recibió apoyo de los profesionales de la salud en el contexto posparto hospitalario, ni en el domicilio, y no continuó con la lactancia. La segunda recibió apoyo del personal del hospital y su pareja, amamantando durante tres meses. La tercera, con el apoyo de su pareja, amamantó durante dos meses, pero la interrumpió porque se sentía inhibida por familiares. Conclusión e implicaciones para la práctica la técnica de inducción es capaz de desencadenar la producción de leche. El proceso de lactancia materna, en cambio, solo se estableció a través de la asociación con la red de apoyo, la acogida, el estímulo del equipo de salud y la mirada integral a la mujer y su familia. Así, el cuidado de Enfermería en la inducción de la leche no debe enfocarse solo en el manejo de la inducción, sino trascender el aspecto técnico, que se muestra fundamental para la protección, el establecimiento y la continuidad de la lactancia materna.

Abstract Objective to report the experience of lactation induction in women who never got pregnant by a lactation consultant nurse. Method experience report. The process of lactation induction was performed with three women due to surrogate pregnancy and homosexual relationships. Results all noticed an increase in the size and sensitivity of the breasts, as well as milk secretion. However, the continuity of breastfeeding was different between them. The first did not receive support from health professionals in the postpartum hospital setting, nor at home, and did not continue breastfeeding. The second received support from the hospital staff and her partner, breastfeeding for three months. The third, with the support of her partner, breastfed for two months, but stopped because she felt inhibited by family members. Conclusion and implications for practice the induction technique is capable of triggering milk production. However, the breastfeeding process was only established through the association with the support network, the reception, the encouragement of the health team, and the comprehensive view of the woman and her family. Thus, nursing care in lactation induction should not focus only on the management of induction, but transcend the technical aspect, which is essential for the protection, establishment, and continuity of breastfeeding.