Carcinoma neuroendocrino primario de mama / Primary neuroendocrine carcinoma of the breast

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Mastitis granulomatosa idiopática. Una rara entidad benigna que puede simular un cáncer de mama / Idiopathic granulomatous mastitis. A rare benign entitiy that can simulate breast cancer

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[Technical features of interest in lymphatic basin localization in breast cancer sentinel lymph node biopsy]. / Aspectos técnicos de interés en la localización de drenajes linfáticos en la biopsia del ganglio centinela del cáncer de mama.

OBJECTIVES: The sentinel node is defined as the node with the highest probability of being involved in the case of lymphatic spread from a tumor. Accurate identification and biopsy of this node can avoid unnecessary lymphadenectomies. The aim of this study was to determine if there are differences in the number of isolated sentinel lymph nodes in breast cancer according to whether a mixed technique (vital dye plus isotopic tracer) or radiotracer alone is used and if there are differences in the detection of more than one lymphatic basin and in the number of lymphatic nodes depending on the site of tracer injection. PATIENTS AND METHOD: A total of 173 sentinel lymph node biopsies in 173 women with breast cancer were studied taking into account the technique (mixed [n = 109] or radiotracer alone [n = 64]) and the location of tracer injection (periareolar [n = 81], intra and/or peritumoral [n = 92]). The number of lymphatic basins and the number of sentinel nodes were compared among the distinct groups resulting from the combination of the 2 parameters. RESULTS: Simultaneous drainage to both the axilla and internal mammary chain was more frequent with the intra-periareolar technique. The number of identified nodes was significantly higher when mixed techniques were compared, and was higher with periareolar injection than with the intra-peritumoral route. CONCLUSIONS: In breast cancer sentinel lymph node biopsy, the number of identified nodes is not influenced by the use of a mixed technique or radiotracer alone. However, the number of identified nodes is higher with the periareolar route than with the intra-peritumoral route. Intra-peritumoral injection of the tracer shows a higher frequency of internal mammary chain drainage than periareolar injection, although this difference was not statistically significant.

Aspectos técnicos de interés en la localización de drenajes linfáticos en la biopsia del ganglio centinela del cáncer de mama / Technical features of interest in lymphatic basin localization in breast cancer sentinel lymph node biopsy

Objetivos. El ganglio centinela es el que tiene más probabilidad de afectarse en caso de extensión linfática de un tumor. Su identificación y biopsia correctas pueden evitar linfadenectomías innecesarias. El objetivo de este trabajo es estudiar si hay diferencias en el número de ganglios centinelas aislados en el cáncer de mama dependiendo de que se utilice la técnica mixta (colorante más trazador isotópico) o únicamente isótopo como trazador, y si las hay en la aparición de más de un drenaje linfático y en el número de ganglios centinela, dependiendo de la localización de la inyección del trazador. Pacientes y método. Se han estudiado de forma prospectiva 173 biopsias selectivas del ganglio centinela en 173 mujeres con carcinoma de mama, considerando la técnica usada (mixta, 109; isótopo, 64) y la localización de la inyección del trazador (periareolar [n = 81], intratumoral y/o peritumoral [n = 92]). Se comparó el número de drenajes y el número de ganglios centinela entre los distintos grupos resultantes de combinar los dos parámetros. Resultados. El drenaje simultáneo a axila y a cadena mamaria interna fue más frecuente en los casos de inyección intratumoral y peritumoral. Con relación al número de ganglios identificados, encontramos que fue significativamente mayor al comparar las técnicas mixtas entre sí, y fue mayor el número de ganglios con la técnica de inyección periareolar que con la intratumoral y peritumoral. Conclusiones. En la biopsia selectiva del ganglio centinela para el cáncer de mama, el número de ganglios centinelas identificados no depende de usar una técnica mixta o sólo isótopo como trazador; sin embargo, es mayor cuando se usa la vía periareolar que la intratumoral y peritumoral. La inyección intratumoral y peritumoral muestra una mayor frecuencia de drenajes hacia la cadena mamaria interna que la periareolar, aunque esta diferencia no es estadísticamente significativa (AU)

Objectives. The sentinel node is defined as the node with the highest probability of being involved in the case of lymphatic spread from a tumor. Accurate identification and biopsy of this node can avoid unnecessary lymphadenectomies. The aim of this study was to determine if there are differences in the number of isolated sentinel lymph nodes in breast cancer according to whether a mixed technique (vital dye plus isotopic tracer) or radiotracer alone is used and if there are differences in the detection of more than one lymphatic basin and in the number of lymphatic nodes depending on the site of tracer injection. Patients and method. A total of 173 sentinel lymph node biopsies in 173 women with breast cancer were studied taking into account the technique (mixed [n = 109] or radiotracer alone [n = 64]) and the location of tracer injection (periareolar [n = 81], intra and/or peritumoral [n = 92]). The number of lymphatic basins and the number of sentinel nodes were compared among the distinct groups resulting from the combination of the 2 parameters. Results. Simultaneous drainage to both the axilla and internal mammary chain was more frequent with the intra-periareolar technique. The number of identified nodes was significantly higher when mixed techniques were compared, and was higher with periareolar injection than with the intra-peritumoral route. Conclusions. In breast cancer sentinel lymph node biopsy, the number of identified nodes is not influenced by the use of a mixed technique or radiotracer alone. However, the number of identified nodes is higher with the periareolar route than with the intra-peritumoral route. Intra-peritumoral injection of the tracer shows a higher frequency of internal mammary chain drainage than periareolar injection, although this difference was not statistically significant (AU)

Utility of frozen-section examination for diagnosis of malignancy associated with multinodular goiter.

BACKGROUND: Frozen-section examination (FSE) has traditionally been used for the intraoperative diagnosis of thyroid cancer. However, the utility of the technique is now controversial, especially in multinodular goiter (MNG), on which there are few studies. The aim of this study was to analyze the utility of FSE for ruling out malignancy in patients undergoing surgery for MNG. PATIENTS AND METHODS: FSE was performed in 197 patients with MNGs undergoing surgery for suspected malignancy, either preoperatively (n = 145; 74%) or intraoperatively (n = 52; 26%), and where the preoperatively planned surgical technique was partial resectional surgery. The FSE diagnosis was classified as benign, suggestive of malignancy, or malignant. The following FSE parameters were calculated for diagnosing MNG-associated carcinoma: true- and false-positives and true- and false-negatives, sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy. The chi2 and Student's t tests were applied. RESULTS: The FSE revealed benignity in 191 cases (97%), suggested malignancy in 3 (1.5%), and were malignant in the remaining 3. The final histology revealed 16 carcinomas (8%), of which only 3 were detected by FSE. Only tumor size was a factor significantly associated with FSE carcinoma detection (p = 0.0012). The sensitivity of the technique for detecting carcinoma was 19%, specificity, 100%; positive predictive value, 100%; negative predictive value, 93%; and diagnostic accuracy, 93%. CONCLUSIONS: FSE should not be used routinely in the management of MNG, and considering its low rate of sensitivity for detecting malignancy, the decision on the extent of the thyroidectomy should be based on other factors and explorations.

[Primary non-lymphoid thymic neoplasms. A study of 58 cases]. / Neoplasias primarias del timo de estirpe no linfoide. Estudio de 58 casos.

BACKGROUND AND OBJECTIVE: Primary non-lymphoid thymus tumors (PNLTT) are an uncommon though quite varied pathology. Our objective was to identify the clinical, therapeutic and histologic variables with a prognostic value in these neoplasms. PATIENTS AND METHOD: We studied 58 PNLTT cases, corresponding to 52 epithelial neoplams (PTEN), 4 thymolipomas (7%) and 2 neuroendocrine tumors (3%). Commonest clinical manifestations were myasthenia gravis (41%) and dyspnea (21%). Three patients were symptom-free (24%). We used Kaplan-Meier survival curves and Cox regression model. RESULTS: All patients underwent surgery which consisted of thymectomy. Four patients underwent a biopsy procedure alone. Perioperative mortality was 3% (n = 2) and morbidity was 31% (n = 18), mainly because of respiratory and wound problems. 24 patients with PTEN, Masaoka degrees III and IV, and a patient with a lymphoepithelial carcinoma received adjuvant chemotherapy and/or radiotherapy. With a follow-up of 13 + 5 years, 12 PTEN patients and one patient with a neuroendrocrine tumor died as a consequence of the evolution of the disease. Cumulative survival was 80% at 5 years, 71% at 7 years and 63% at 10 years. There are currently two local relapses in two PTEN cases after 9 and 8 years of follow-up, respectively. Main prognostic factors are the histologic type and subtype and the clinical stage (p < 0.001). CONCLUSIONS: In PNLTT early diagnosis is crucial in order to administer a correct treatment before the clinical stage is more advanced. Main prognostic factors are the histologic type and subtype and the clinical stage.

Estudio multivariante de los factores de riesgo de lesión del nervio laríngeo recurrente en la cirugía del bocio multinodular / Multivariate study of risk factors for recurrent laryngeal nerve injury in multinodular goiter surgery

Objetivo. La lesión recurrencial es la complicación más grave en la cirugía tiroidea. Sin embargo, existen pocos análisis multivariantes que valoren el impacto de sus factores de riesgo. El objetivo es analizar, mediante un estudio estadístico multivariante, los factores de riesgo para el desarrollo de lesión recurrencial en la cirugía del bocio multinodular (BM).Pacientes y método. Se han revisado de manera retrospectiva 672 BM intervenidos. Se consideró disfonía a la alteración en el tono, timbre o intensidad de la voz a raíz de la intervención quirúrgica y confirmada la parálisis de la cuerda vocal mediante laringoscopia. Si dicha alteración persistía más de 12 meses se consideraba definitiva. Se aplica el test de 2, el de la t de Student, y un análisis de regresión logística, para determinar las variables de riesgo de lesión recurrencial. Resultados. Se confirmaron 76 disfonías (11 por ciento), lo cual supone un riesgo del 6,3 por ciento por nervio recurrente expuesto. La duración media de la disfonía, en los 66 casos (87 por ciento), en los cuales ésta fue transitoria, fue de 2,7 ñ 2,9 meses (1-12 meses). Los factores de riesgo fueron la presencia de sintomatología derivada del bocio (p = 0,0471), el hipertiroidismo (p = 0,0376), la gradación del bocio (p= 0,0425) y la técnica quirúrgica utilizada (p = 0,0195), persistiendo como factores independientes la técnica quirúrgica y el hipertiroidismo. En 10 pacientes (1,5 por ciento) la disfonía persistió como definitiva (0,8 por ciento por recurrente expuesto). Las dos variables que se asociaban a su desarrollo fueron la gradación del bocio (p = 0,0481) y el hipertiroidismo (p = 0,0227), persistiendo como factor de riesgo independiente el hipertiroidismo. Conclusiones. El principal factor de riesgo de lesión recurrencial, tanto transitoria como definitiva, en la cirugía del BM, es que se trate de un bocio tóxico (AU)