Carcinoma micropapilar infiltrante de la mama. Pronóstico a largo plazo / Invasive micropapillary carcinoma of the breast. Long term outcome

Introducción: el carcinoma micropapilar infiltrante (CMI) es una variante histológica inusual y potencialmente agresiva caracterizada por primera vez en 1993 por Siriangkul et al. y que no formó parte de la clasificación de la Organización Mundial de la Salud (OMS) hasta 2003, como tumor mamario epitelial. Representa menos del 2% del total de carcinomas invasivos de la mama y se presupone que presenta un pronóstico desfavorable en comparación con otros carcinomas convencionales debido a su elevado tropismo vascular y linfático. Material y métodos: hasta la fecha no existe ningún estudio con un número elevado de pacientes procedentes de un único centro (> 100 casos) con un periodo de seguimiento largo (> 20 años) que compare la supervivencia del CMI con otros carcinomas convencionales no micropapilares. Se ha llevado a cabo un estudio retrospectivo, observacional con un total de 401 pacientes: 174 con CMI y 227 con otros carcinomas convencionales. Resultados: el CMI presenta mayor grado histológico, mayor afectación ganglionar y mayor riesgo de metástasis a distancia en comparación con otros carcinomas convencionales de características similares. Sin embargo, en el análisis multivariante considerando factores pronósticos como edad, tamaño tumoral, afectación ganglionar y grado histológico, no se observan diferencias estadísticamente significativas para la supervivencia global y libre de enfermedad entre los CMI diagnosticados en el mismo periodo de tiempo que los casos pareados del grupo control y otros carcinomas convencionales. Conclusión: la supervivencia global y libre de enfermedad es similar entre el CMI y otros carcinomas convencionales a igual edad, tamaño tumoral, grado histológico y afectación ganglionar. (AU)

Introduction: Invasive Micropapillary Carcinoma of the breast (IMPC) is an unusual and aggressive histological variant characterized for the first time in 1993 by Siriangkul et al. and classified by the World Health Organization in 2003 as an epithelial breast tumor. It represents less than 2% of all invasive carcinomas of the breast and is presumed to have an unfavorable prognosis compared to other conventional carcinomas due to its high vascular and lymphatic tropism. Material and methods: Until now, there is no study with a large number of patients from a single center with a long follow-up period that compares the survival of IMPC with other conventional non-micropapillary carcinomas. A retrospective, observational study has been carried out with a total of 401 patients: 174 with IMPC and 227 with other conventional carcinomas. Results: IMPC has a higher histological grade, greater lymph node involvement and a higher risk of distant metastasis compared to other conventional carcinomas. However, in the multivariate analysis considering date of diagnosis, age, tumor size, lymph node involvement and histological grade as variables, no statistically significant differences were observed for overall and disease- free survival between IMPC and other conventional carcinomas. Conclusion: Overall and disease-free survival is similar between IMPC and other conventional carcinomas considering same age, tumor size, histological grade, and lymph node involvement. (AU)

Surgical Management of Vulvar Melanoma: A Case Series.

Vulvar malignant melanoma is the second most common subtype of vulvar cancer, accounting for 5-10% of all vulvar cancers. The prognosis is still very poor, although some advances have been achieved in the last years. One of the most significant changes in its management has been the development of less invasive surgical techniques that diminish the risk of postoperative morbidity and long-lasting sequelae. In this article, we review the surgical management of the pathology, based on the comment of 3 cases with vulvar melanoma treated at our institution.

Rendimiento diagnóstico de la biopsia por punción en tumor filodes de la mama / Diagnostic role of core needle biopsy in phyllodes tumour of the breast

OBJETIVO: Evaluar el rendimiento de la biopsia por punción (BPP) en el diagnóstico de tumor filodes (TF) de la mama. MATERIAL Y MÉTODOS: Se han revisado todos los diagnósticos anatomopatológicos de TF emitidos tanto en BPP como en biopsia quirúrgica (BQ). Se analizan las características clínicas, de imagen y patológicas de los casos y la concordancia diagnóstica entre la BPP y la BQ. RESULTADO: Se han estudiado un total de 87 casos con diagnóstico de TF, 16 en BPP y 71 en BQ. En 18 casos se dispuso de BPP y BQ. Los TFB diagnosticados en BPP fueron: 7 FAD (uno de ellos de la variedad celular), 2 TFB, un TFL, 2TFM y un hamartoma. Dos casos de TFB en BQ habían sido diagnosticados respectivamente en la BPP de fibrosis e hiperplasia. Un TFM en BPP resultó ser un TFL en la BQ. Hubo concordancia diagnóstica en un TFL y un TFM. Se detectaron 5 (27%) falsos negativos y 8 falsos positivos (38%). CONCLUSIONES: El rendimiento de la BPP en el diagnóstico de los TF es bajo con una alta tasa de falsos negativos y falsos positivos. Por ello se aconseja emitir un diagnóstico en la BPP de lesión fibroepitelial con estroma celular dejando pendiente un diagnóstico definitivo a disponer de la BQ

OBJECTIVE: To evaluate the role of core needle biopsy (CNB) in the diagnosis of phyllodes tumour (PT) of the breast. MATERIAL AND METHODS: All pathological diagnoses of PT in both CNB and surgical biopsy (SB) were reviewed. The clinical, imaging and pathological characteristics of the cases and the diagnostic agreement between CNB and SB were analysed. RESULT: A total of 87 cases with a diagnosis of PT, 16 in CNB and 71 in SB, were studied. In 18 cases, CNB and SB were available. Benign PT diagnosed in CNB consisted of: 7 fibroadenomas (one of them cellular), 2 benign PT, 1 borderline PT, 2 malignant PT, and 1 hamartoma. Two cases of benign PT in SB had been diagnosed with CNB as fibrosis and hyperplasia. One PT diagnosed as malignant in CNB was diagnosed as a borderline PT in SB. There was diagnostic agreement in 1 borderline PT and 1 malignant PT. We detected 5 (27%) false negatives and 8 false positives (38%). CONCLUSIONS: The efficiency of CNB in the diagnosis of PT is low, with a high rate of false negatives and false positives. Therefore, it is advisable to suggest a diagnosis of fibroepithelial lesion with cellular stroma in CNB, reserving definitive diagnosis to SB

Preservación de la fertilidad: revisión y análisis de los tiempos oncológicos / Fertility preservation: a review and analysis of cancer treatment times

La incidencia del cáncer de mama (CM) ha aumentado progresivamente y aproximadamente el 15% de las mujeres son diagnosticados antes de los 45 años. Este subgrupo de pacientes suelen tener tumores más agresivos y serán tratadas con terapia sistémica (quimioterapia, terapia hormonal o ambos). Por otra parte, la tendencia a retrasar la edad de maternidad implica que una gran proporción de pacientes con CM jóvenes no han completado su deseo reproductivo. El impacto del tratamiento oncológico en la reserva ovárica depende de la edad de los pacientes, el tipo de esquema y la dosis recibida. El senólogo debería ser sensible al deseo gestacional y realizar una derivación inmediata a la Unidad de Preservación de la Fertilidad. Esta maniobra no implica un retraso en el inicio terapéutico de la enfermedad como demuestran nuestros resultados. En nuestro centro, 40 pacientes fueron sometidas a crioconservación de ovocitos entre 2010 y 2015. La media de días entre el diagnóstico de CM y el inicio del tratamiento oncológico fue de 37,6 días. El tiempo de estimulación (inicio del tratamiento de estimulación hasta la recuperación de los ovocitos) presentó una media de 12 días (7-21). Por lo tanto, consideramos que las pacientes jóvenes deben ser remitidas a una unidad de asesoramiento reproductivo, tal y como aconseja EUSOMA. La preservación de fertilidad requiere de la participación coordinada tanto del equipo de Oncología y el equipo de Reproducción Humana (AU)

The incidence of breast cancer (BC) has progressively increased, and approximately 15% of women will receive a diagnosis before the age of 45 years. This patient subgroup usually has more aggressive tumours and will be treated with systemic therapy (chemotherapy, hormone therapy, or both). In addition, the tendency to delay maternity implies that a many young patients with BC will not have fulfilled their reproductive wishes. The impact of cancer treatment on ovarian reserve depends on patient age, the type of regimen and the doses received. Senologists should be sensitive to their patients’ reproductive wishes and immediately refer them to Fertility Preservation Units. As shown by our results, referral does not imply a delay in treatment initiation. In our centre, 40 patients underwent ovarian tissue cryopreservation between 2010 and 2015. The mean number of days between BC diagnosis and the start of cancer treatment was 37.6 days. The mean time from stimulation (the start of stimulation until oocyte recovery) was 12 days (7-12). Therefore, we believe that young patients should be referred to a reproductive counselling unit, as recommended by EUSOMA. Fertility preservation requires liaison between the oncology and human reproduction teams (AU)

Carcinoma in situ de mama: análisis de los casos y evaluación de las recidivas en nuestro centro, 1999-2012 / Ductal carcinoma in situ: analysis of cases and assessment of recurrences in our center from 1999-2012

Objetivo. Analizar las recidivas de las pacientes diagnosticadas, tratadas y seguidas en nuestro centro por carcinoma ductal in situ de mama, y establecer qué variables se asocian a un mayor riesgo de desarrollarlas. Pacientes y métodos. Se ha realizado un estudio descriptivo retrospectivo de los casos de carcinoma ductal in situ diagnosticados y tratados en nuestro centro desde enero de 1999 hasta enero de 2012. Se excluyeron los casos en que coexistía componente infiltrante y aquellos con antecedente de neoplasia y/o radioterapia previa en la mama afecta. Las variables que se analizaron fueron: la edad de la paciente, el tamaño tumoral, el grado nuclear, el estado de los márgenes quirúrgicos, el tipo de cirugía y el tratamiento complementario (radioterapia y hormonoterapia). Resultados. Se estudiaron 162 casos de carcinomas in situ en el periodo 1999-2012. De estos, 117 (72,2%) fueron tratados con cirugía conservadora y 45 (27,7%) mediante mastectomía. Se produjeron 16 recidivas (9,9%) en el periodo estudiado. No se encuentran diferencias estadísticamente significativas en la tasa de recidivas en función del tamaño tumoral, la distancia quirúrgica al margen, el grado histológico ni la edad de la paciente. En el subgrupo de pacientes tratadas con tumorectomía, la supervivencia libre de enfermedad fue mayor en las que recibieron de forma complementaria radioterapia y hormonoterapia que en aquellas que solo recibieron uno o ninguno de los tratamientos (p=0,001). Conclusión. En el subgrupo de pacientes con carcinoma in situ tratadas con tumorectomía el riesgo de recidiva es 19 veces superior en los casos que no recibieron ningún tratamiento complementario que en aquellos tratados con tumorectomía, radioterapia y hormonoterapia (p=0,001) (AU)

Objective. To analyse recurrences in patients diagnosed, treated and followed up in our centre for ductal carcinoma in situ and to identify the variables associated with an increased risk of their development. Patients and methods. We performed a retrospective study of cases of ductal carcinoma in situ diagnosed and treated in our hospital from January 1999 to January 2012. We excluded cases with coexistence of an infiltrating component, a history of neoplasia, and/or prior radiation to the affected breast. The variables analysed were patient age, tumour size, nuclear grade, surgical margin status, type of surgery, and adjuvant therapy (radiation and hormone therapy). Results. We studied 162 cases of ductal carcinoma in situ occurring between 1999 and 2012. Of these, 117 cases (72.2%) were treated with conservative surgery and 45 (27.7%) by mastectomy. In that period, we found 16 recurrences (9.9%). We found no statistically significant difference in the recurrence rate according to tumour size, surgical distance from the margin, histological grade, or patient age. In the subgroup of patients treated with lumpectomy, disease-free survival was higher in patients receiving radiation therapy and hormone therapy as a complementary treatment than in those who received only one or no treatment at all (P=.001). Conclusion. In the subgroup of patients with ductal carcinoma in situ treated with lumpectomy, the recurrence risk was 19 times higher in patients who received no adjuvant treatment than in those treated with lumpectomy, radiation and hormone therapy (P=.001) (AU)

Breast sarcoma. A case report and review of literature.

INTRODUCTION: Breast sarcomas are rare with an annual incidence of 4.6 cases/1,000,000 women. They can appear as primary forms or secondary to radiation therapy or chronic lymphedema. PRESENTATION OF CASE: A 41 year old woman attended our hospital after having noticed an increase in the size of her fibroadenoma. The examination revealed a 7cm retroareolar nodule. Breast sonography described a hypoechoic bilobulated lesion and MRI showed a large size polinodular image, suggesting a Phyllodes tumor. A core needle biopsy was performed with a histological result of low-grade fusiform cells sarcoma on Phyllodes tumor so we proceeded to surgical treatment with a mastectomy. After two years and a half she noticed a tough nodule over the mastectomy scar, which was resected with a histological result of fusiform cells sarcoma. Considering the diagnosis of recurrence of the disease, surgery was undertaken. DISCUSSION: Breast sarcoma is a rare but aggressive entity. Core biopsy is the procedure of choice for the diagnosis. Lymphatic spread is uncommon so nodal status in breast sarcoma is less informative. Staging study differs from other breast tumors and chest computed tomography is helpful since lungs are the predominant metastatic sites. The use of radiotherapy or chemotherapy is controversial and will depend on the risk of tumor recurrence. CONCLUSION: Surgery represents the only potentially curative therapy for breast sarcoma. Tumor size and adequate resection margin are the most important prognostic factors. Approximately 80% of recurrences appear in the first two years.

Cáncer de mama asociado al embarazo: estudio analítico observacional / Pregnancy-Associated Breast Cancer: An analytical observational study

Fundamento y objetivo: El cáncer de mama asociado al embarazo se define como aquel que aparece durante la gestación o durante el primer año posparto. Pacientes y método: Estudio retrospectivo analítico observacional en el que se comparan 56 cánceres de mama y embarazo (CME) diagnosticados entre 1976-2008 con 73 pacientes con cáncer de mama no asociado al embarazo (CMNE). Se analizan los diversos datos demográficos, los factores pronósticos, el tratamiento y la supervivencia en ambos grupos. Resultados: La prevalencia de CME en nuestro centro es 8,13/10.000 embarazos. La mayor frecuencia (62%) apareció durante el puerperio. Los estadios son mayores en el CME respecto al CMNE, siendo el 31,3% avanzados en el CME frente al 13,3% en el CMNE (p < 0,05). En cuanto a factores pronósticos, el 27,3% de CME eran grado tumoral iii frente al 15,8% del CMNE. En el grupo CME el 33,3% tenían receptores para estrógeno negativos, el 48,7% receptores para progesterona negativos y el 34,5% eran Her2Neu positivo frente al 22,2, 24,1 y 31%, respectivamente, en CMNE. En el 52,8% de CME aparecieron ganglios afectados frente al 33,8% del CMNE (p < 0,05). En el grupo CME la supervivencia global y libre de enfermedad a 5 años fue del 63,7 y del 74,2%, respectivamente. Conclusiones: El peor pronóstico que se observa en el grupo CME es debido posiblemente a la presencia de factores de pronóstico adversos: metástasis ganglionares, receptores hormonales negativos y grado tumoral tipo iii, así como al diagnóstico tardío, con un porcentaje mayor de cánceres avanzados (AU)

Background and objective: Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. Patients and method: A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. Results: The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. Conclusions: The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade III, as well as a delay in diagnosis with a higher rate of advanced stages (AU)

[Pregnancy-Associated Breast Cancer: An analytical observational study]. / Cáncer de mama asociado al embarazo: estudio analítico observacional.

BACKGROUND AND OBJECTIVE: Pregnancy-associated breast cancer is defined as breast cancer diagnosed during pregnancy and up to one year postpartum. PATIENTS AND METHOD: A retrospective, analytical, observational study comparing 56 cases of breast cancer and pregnancy (PABC) diagnosed 1976-2008 with 73 patients with breast cancer not associated with pregnancy (non-PABC) was performed. Demographic data, prognostic factors, treatment and survival were reviewed and compared. RESULTS: The prevalence of PABC in our center is 8.3/10,000. The highest frequency (62%) appeared during the postpartum period. The stages are higher in PABC, being 31.3% advanced (EIII and EIV) in PABC versus 13.3% in non-PABC (P < .05). Regarding prognostic factors, 27.3% in PABC had a tumoral grade 3 versus 15.8% of non-PABC. Among women with PABC, 33.3% had negative estrogen receptors, 48.7% negative progesterone receptors and 34.5% positive Her2Neu compared with 22.2, 24.1 and 31%, respectively of non-PABC patients. Finally, positive lymph nodes were found in 52.8% of PABC, versus 33.8% non-PABC (P < .05). Overall and disease-free survival rate at 5 years for PABC was 63.7 and 74.2%, respectively. CONCLUSIONS: The poorer survival observed is possibly due to the presence of adverse prognostic features such as lymph node metastases, negative hormone receptors, tumoral grade iii, as well as a delay in diagnosis with a higher rate of advanced stages.

Respuesta patológica a la quimioterapia neoadyuvante: correlación entre 2 sistemas de gradación histológica / Pathologic response to neoadjuvant chemotherapy: Correlation between 2 histologic grading systems

Objetivo. Determinar la variabilidad entre 2 sistemas de gradación a la hora de catalogar la respuesta patológica a la quimioterapia neoadyuvante en una misma lesión. Material y métodos. En 8 años se han estudiado 51 pacientes con cáncer infiltrante de la mama sometidas a quimioterapia neoadyuvante de forma consecutiva. Se ha establecido la respuesta patológica de cada caso siguiendo el sistema de Miller y Payne (MyP) y el de la carga tumoral residual (RCB) correlacionando los resultados de ambos sistemas en la misma lesión. Resultados. Según el sistema de gradación de MyP las lesiones se clasificaron en grado 1 (6%), 2 (25%), 3 (27%), 4 (27%) y 5 (14%). La clase RCB fue 0 (13%), I (13%), II (54%) y III (20%). La correlación entre MyP 5 y RCB 0, entre MyP 4 y RCB I, y entre MyP 2 y RCB III fue buena. Se detectaron más discrepancias entre MyP 1, 2, 3 y RCB II. Conclusión. La correlación en la respuesta completa es buena entre los 2 sistemas de gradación. Hay discrepancias en la clasificación en la ausencia de respuesta entre ambos sistemas. Estas discrepancias pueden ser debidas a la inclusión del estado ganglionar en el sistema RCB(AU)

Objective. To determine the variability between 2 grading systems in the classification of pathologic response to neoadjuvant chemotherapy in the same lesion. Material and methods. Fifty-one patients with invasive breast cancer were consecutively treated with neoadjuvant chemotherapy in an 8-year period. Pathologic response in each patient was established according to the Miller and Payne (MP) and the residual cancer burden (RCB) systems and the results were correlated. Results. In the MP system, the lesions were classified in grade 1 (6%), 2 (25%), 3 (27%), 4 (27%) and 5 (14%). RCB class was 0 (13%), I (13%), II (54%) and III (20%). The correlation between MP 5 and RCB 0, between MP 4 and RCB I, and between MP 2 and RCB III was good. There were more discrepancies between MP 1, 2, 3 and RCB II. Conclusions. The correlation between the 2 grading systems is good. There are discrepancies in the assessment of lack of response between the 2 systems. This disagreement could be due to the inclusion of lymph node status in the RCB system(AU)

Skin lesions after prophylactic mastectomy and immediate reconstruction.

SUMMARY: Metastatic breast carcinoma can mimic benign cutaneous lesions. Breast surgeons should be aware of skin manifestations to be able to distinguish them and set a proper therapeutic strategy. A clinical case of cutaneous lesion after breast cancer is presented. A 41-year-old woman with a history of left breast cancer underwent a prophylactic right nipple-sparing mastectomy with immediate breast implant reconstruction. After surgery, she attended our service due to a right periareolar rash resistant to medical treatment, accompanied by cutaneous induration and fixed axillary adenopathy. A differential diagnosis of skin metastases was considered. Cutaneous metastases should be the first diagnosis of skin lesions in oncological patients due to the implications in terms of treatment and prognosis. However, differential diagnoses have to be discussed.