Malformación vascular linfovenular de mama: diagnóstico diferencial a propósito de un caso / Lymphovascular malformation of the breast: differential diagnosis and a case report

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Use of urokinase in percutaneous drainage of large breast abscesses.

OBJECTIVE: The purpose of this study was to evaluate intracavitary urokinase therapy versus irrigation with a saline solution in percutaneous drainage of large breast abscesses. METHODS: A prospective randomized study was conducted in 19 nonlactating women (median age, 35.7 years) with breast abscesses of greater than 3 cm. Percutaneous drainage with an ultrasound-guided catheter was performed in group A patients (saline solution) and group B patients (urokinase). Postdrainage care and ultrasound-guided drainage control were performed on an outpatient basis. The Student t test, Fisher exact test, chi(2) test, and Mann-Whitney U test were used for statistical analysis. RESULTS: Percutaneous drainage with saline or urokinase irrigation was successful in all cases. No statistically significant differences were observed between groups A and B for clinical parameters and sonographic characteristics of the abscesses. However, a statistically significant difference was observed between the two groups for the average drainage times (P < 0.012), which were 3.8 days for the urokinase group and 5.3 days for the saline group. A recurrence was observed in 1 saline group patient who had a diagnosis of a chronic abscess, which was resolved with intracavitary urokinase irrigation. CONCLUSIONS: Percutaneous drainage of large breast abscesses in nonlactating women with intracavitary urokinase irrigation is a simple and safe procedure. It reduces the treatment time and improves the clinical course of patients more than conventional drainage with saline irrigation.

Results of surgical treatment in multinodular goiter with an intrathoracic component.

PURPOSE: (1) To determine the clinical profile of intrathoracic multinodular goiter (IMG); (2) to evaluate the results of surgery, and (3) to analyze the incidence of malignancy and its evolution. METHODS: Two hundred and forty-seven operated cases of IMG were reviewed. These cases of IMG had all been diagnosed according to Eschapse's definition (>3cm below the sternal manubrium). The morbidity and postoperative evolution were analyzed. A comparative study was carried out on a group of 425 cases of nonintrathoracic goiter. We applied the chi(2) test, Student's t-test, and a logistical regression analysis. RESULTS: Intrathoracic MG occurs in patients over 60 years of age, with goiter which has a long evolution time (>12 years), and more than 60% are symptomatic. Oral tracheal intubation was difficult in 10% (n = 24) of the cases, and 7 required the use of a fibrobronchoscope. In 8 cases (3%) a thoracic approach was necessary. Morbidity occurred in 24% (n = 59), most notably 29 recurring lesions (12%), of which 2 were definitive (0.8%), and 31 hypoparathyroidisms (13%), of which 1 was definitive (0.4%). No significant difference was found in the postsurgical morbidity between the intrathoracic MG and the nonintrathoracic cases. Regarding the remission of the symptoms, the results were excellent. In 14 cases (5.7%) thyroid carcinoma was related with, most of these being papillary microcarcinoma. In 10 of the 49 cases of partial surgery (20%) a relapse of the goiter was observed. CONCLUSIONS: Intrathoracic MG is usually asymptomatic and it occurs in goiter with a long time of evolution. Surgery is a good therapeutic option given that the goiter can be removed via the neck, with low morbidity, a remission of the symptoms, malignancy is ruled out, and recurrence can be avoided if a total thyroidectomy is performed.

Surgical treatment of solitary metastasis in the male breast from non-small cell lung cancer.

Detection of metastases in the breast from extramammary neoplasms is rare. We present a case of metastases in breast tissue from surgically treated non-small cell bronchogenic carcinoma. A histologic and immunohistologic study was essential for choosing the appropriate treatment for the patient. The patient is alive and disease-free 18 months after the breast surgery.

Associations of HLA-C alleles with multinodular goiters: study in a population from southeastern Spain.

HYPOTHESIS: Several immunological alterations have been found in patients with multinodular goiter (MG). These alterations, together with the association described between certain autoimmune thyroid diseases and alleles of the major histocompatibility complex (HLA alleles), justify the need for studies of the HLA alleles and MG in an attempt to identify associations. DESIGN: Case-control study. SETTING: Tertiary referral center. PATIENTS: Ninety consecutive patients underwent surgical procedures for MG. The control group comprised 100 unrelated, healthy, white subjects. INTERVENTION: Genotyping for HLA-C alleles was done using the molecular biological technique of polymerase chain reaction using sequence-specific primers and was carried out for all of the patients. MAIN OUTCOME MEASURES: The analyzed variables included age, sex, family history of thyroid pathological abnormalities, clinical features of the patient, clinical grading of the goiter, intrathoracic thyroid component, goiter weight, associated carcinoma, and the HLA-C gene. RESULTS: A significant association was observed between the lower incidence of the HLA-Cw4 allele and the appearance of MG (15.5% vs 8.3%, respectively; P = .001; relative risk [RR] = 0.49). These results suggest that the HLA-Cw4 allele can exert a protective effect against MG. Analysis of the different clinical variables shows the most significant association to be the absence of the HLA-Cw4 allele in patients with goiters with an intrathoracic component (P = .001; RR = 0.19) and in patients with goiters weighing more than 200 g (P = .02; RR = 0.17). Associations between the HLA-C alleles and MG were also observed, such as the presence of the HLA-Cw7 allele and a family history of thyroid pathological abnormalities (P = .03; RR = 3.91) as well as the HLA-Cw1 allele and the presence of goiter-associated thyroid carcinoma (P = .02; RR = 8.60). CONCLUSIONS: The HLA-Cw4 allele can act as a protector against the development of MG, as it occurs less frequently in the population with MG, and those with this allele develop smaller goiters with no intrathoracic component.

Surgical treatment of multinodular goiter in young patients.

The objectives of this study were to analyse the results of surgical treatment of multinodular goiter (MG) in a population with under 30 yr of age; (2) to determine the incidence and evolution of related thyroid carcinomas; and (3) to evaluate the rate of relapse. Eighty-one patients operated for MG and under 30 yr of age were analyzed. The control group used consisted of 510 patients between 30 and 60 yr of age, operated on for MG. Cervical surgery for thyroidectomy was performed in all patients. The main outcome measures were postoperative morbidity and mortality; related thyroid carcinoma (number, type and evolution); remission of symptoms; and relapse of goiter. There were neither cases of hypoparathyroidism nor definitive recurrent lesions. In patients with symptoms, there was total remission of these. Although more than half were treated on suspicion of malignancy, only 9% were related to a carcinoma and most were papillary microcarcinomas. The average follow-up was 124 +/- 68 mo. Of the 48 patients with partial surgery, 40% had relapse (n=19). After 5 yr, the rates of relapse were 11% for the Dunhill technique, 20% for bilateral subtotal thyroidectomy, 17% for hemithyroidectomy, and 50% for unilateral subtotal hemithyroidectomy. These rates increased by 25%, 50%, 44%, and 60% respectively, after 10 yr, and up to 33%, 50%, 62%, and 70% after 15 yr; 89% of the cases of relapse were operated on-there were two hypoparathyroidisms and two recurrent lesions, one of the cases of recurrent lesion becoming definitive. MG in young people is mainly treated because of the suspicion of malignancy, although this occurs in less than 10% of cases. Surgery can be carried out with a low rate of morbidity, although the results are only definitive with total thyroidectomy, with a high level of relapse when partial techniques are used given that these are patients with long life expectancy.