ABSTRACT
Objetivo: Valorar la evolución en el diagnóstico y tratamientodel carcinoma oculto de mama que se presenta comometástasis ganglionar.Pacientes y método: Trece mujeres diagnosticadas y tratadaspor haber presentado metástasis ganglionar de un carcinomade mama, sin localizar el foco primario.Resultados: Las 10 pacientes a las que se pudo aplicar cirugíaconservadora y radioterapia, evolucionaron favorablemente.Las tres que sólo recibieron hormonoterapia presentaronmastitis carcinomatosa a los pocos años.Conclusiones: Aunque la mamografía sigue siendo la exploraciónprincipal, la RNM y el PET ayudan a localizar algunoscarcinomas ocultos. Se confirma que el tratamiento consistenteen una linfadenectomía y radioterapia de la mama, esel de elección en la mayoría de los casos, frente a la cirugía radicalclásica(AU)
Objective: To evaluate the evolution in the diagnosis andtreatment of the occult breast carcinomas presented asmetastatic lymph node.Patients and methods: Thirteen women diagnosed andtreated of lymph node metastasis of breast cancer without primaryfocus localization.Results: Ten patients were treated with conservativesurgery and radiotherapy of the breast, presenting afavourable evolution. The 3 women that were treated onlywith hormonotherapy, had carcinomatous mastitis after fewyears.Conclusions: Mammography is still the gold standard testto study breast cancer. RNM and PET can help to localize occultbreast cancer. Lymphadenectomy and radiotherapy of thebreast is a good treatment in most cases, opposite to the classicalradical mastectomy(AU)
Subject(s)
Humans , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Neoplasms, Unknown Primary/diagnosis , Neoplasms, Unknown Primary/therapy , Neoplasm Metastasis/therapy , Mammography/methods , Ultrasonography, Mammary , Lymph Node Excision/methods , Neoplasms, Unknown Primary/radiotherapy , Neoplasms, Unknown Primary/surgery , Neoplasms, Unknown Primary , Lymph Node Excision/trendsABSTRACT
Analysis of a series of 34 fine-needle aspirations (FNA) from 28 patients with invasive lobular carcinoma (ILC) was undertaken. The false-negative smears were reviewed to reveal the cause of such a relatively frequent error. This was a retrospective study and comparison between the cytological and pathological findings in a series of 34 FNA. Three cases were excluded without sufficient material. Twelve cases were positive, nine suspicious of malignancy, and 10 were considered false-negatives. In a second analysis of this later group, one was reclassified as carcinoma, two reconsidered without sufficient material for diagnosis, and the remaining seven, still considered negatives, constituted the core of this study. Of these seven, there were none with hypercellular smears and in six there was a predominance of fat-tissue fragments. The scarce epithelial component showed honeycomb-flat sheets in four, loose clusters in three, small and tight clusters with irregular limits in six, and more than 10% of isolated epithelial cells (noncohesive cells) in one case. "Staghorns" were undetected and myoepithelial cell nuclei were very scarce in all cases. Some nuclear enlargement was detected in one, angulated nuclear contour in three, and nuclear crowding was present in five. All seven had fine, homogeneous chromatin, without prominent nucleoli. Cytoplasmic limits were undefined in all but one (6/7) and occasional cytoplasmic vacuolization was detected in two. Hypocellular smears with few, small, and dense groups (but always with more than 10 groups in at least one smear) can be related with ILC. In these cases, further studies are recommended to exclude malignancy. The loose cluster and flat sheets identified in four cases represent a benign epithelial hyperplasia mixed with the ILC.
Subject(s)
Breast Neoplasms/pathology , Carcinoma, Lobular/pathology , Biopsy, Needle , Breast/pathology , Cytodiagnosis , Diagnosis, Differential , False Negative Reactions , Female , Humans , Neoplasm Invasiveness , Retrospective StudiesABSTRACT
Littoral cell angioma (LCA) is a recently described splenic vascular tumor. We present a new case in a 62-year-old woman with severe thrombocytopenia and mild bleeding diathesis, but without palpable splenomegaly. Abdominal ultrasound and magnetic resonance showed multiple nodular images, suggesting splenic hemangiomas. A platelet kinetic study revealed a very short platelet survival. As the spleen was the site of platelet destruction, splenectomy was carried out. Histopathological and immunohistochemical data allowed a final diagnosis of LCA. Following splenectomy, the patient showed a transitory normalization of the platelet counts. Thrombocytopenia then reappeared but was moderate, without hemorrhagic diathesis. A second platelet kinetic study, performed 16 months post-splenectomy, showed hepatic platelet destruction. However, there were no macroscopic hepatic lesions in a second abdominal magnetic resonance study. This case illustrates the difficulties involved in determining the etiology of many peripheral thrombocytopenias.
