Subject(s)
Humans , Female , Middle Aged , False Positive Reactions , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy/trends , Lymph Nodes/radiation effects , Lymph Nodes , /methods , Neoplasms, Ductal, Lobular, and Medullary , Carcinoma, Ductal, Breast , Sensitivity and Specificity , Lymph Nodes/physiopathology , Lymph Nodes , Breast/pathology , Breast/ultrastructure , RadiopharmaceuticalsSubject(s)
Breast Neoplasms/pathology , Carcinoma, Ductal, Breast/secondary , Lymphatic Metastasis/diagnostic imaging , Sentinel Lymph Node Biopsy , Axilla , Breast Neoplasms/complications , Breast Neoplasms/diagnostic imaging , Carcinoma, Ductal, Breast/complications , Carcinoma, Ductal, Breast/diagnostic imaging , False Positive Reactions , Female , Fibrocystic Breast Disease/complications , Fibrocystic Breast Disease/diagnostic imaging , Fibrocystic Breast Disease/pathology , Humans , Lymph Node Excision , Mastectomy, Segmental , Middle Aged , Radionuclide Imaging , Radiopharmaceuticals , Technetium Tc 99m Aggregated Albumin , UltrasonographyABSTRACT
La utilización de las vías de administración profunda (intratumoral, peritumoral) y superficial (subdérmica, subareolar) están reconocidas como válidas en la biopsia del ganglio centinela en el cáncer de mama. Presentamos un caso clínico en donde la individualización de la metodología fue determinante en la estadificación axilar. Inicialmente se administra el radiotrazador por vía intratumoral guiada por ecografía. En dicha exploración se identifica una adenopatía axilar no conocida previamente, con engrosamiento cortical focal, hallazgo ecográfico inespecífico, pero subsidiario de biopsia. La linfogammagrafía no mostró captación en dicho ganglio, por lo que se decide reinyección de una 2.ª dosis por vía subareolar. En esta ocasión la linfogammagrafía detecta drenaje a dicho ganglio centinela, siendo el único de los analizados que resultó positivo para micrometástasis(AU)
The use of deep (intratumoral, peritumoral) and superficial (subdermal, subareolar) administration is recognized as valid in sentinel lymph node biopsy for breast cancer. Herein, we are presenting a clinical case in which a personalized methodology was a determining factor in axillary staging. Initially, the radiotracer was injected intratumorally guided by ultrasound. The ultrasound scan identified a previously unknown axillary lymphadenopathy, with focal cortical thickening, this being a non-specific ultrasound finding, but with possibility of biopsy. The lymphoscintigraphy did not show uptake in the mentioned node, hence, a second subareolar dose was administered. On this occasion, the lymphoscintigraphy detected drainage to the sentinel node, which was the only one positive for micrometastases(AU)
Subject(s)
Humans , Female , Middle Aged , Sentinel Lymph Node Biopsy/methods , Sentinel Lymph Node Biopsy , Breast Neoplasms/complications , Breast Neoplasms/diagnosis , Neoplasm Staging/instrumentation , Neoplasm Staging/methods , Sentinel Lymph Node Biopsy/instrumentation , Sentinel Lymph Node Biopsy/trends , Neoplasm StagingABSTRACT
The use of deep (intratumoral, peritumoral) and superficial (subdermal, subareolar) administration is recognized as valid in sentinel lymph node biopsy for breast cancer. Herein, we are presenting a clinical case in which a personalized methodology was a determining factor in axillary staging. Initially, the radiotracer was injected intratumorally guided by ultrasound. The ultrasound scan identified a previously unknown axillary lymphadenopathy, with focal cortical thickening, this being a non-specific ultrasound finding, but with possibility of biopsy. The lymphoscintigraphy did not show uptake in the mentioned node, hence, a second subareolar dose was administered. On this occasion, the lymphoscintigraphy detected drainage to the sentinel node, which was the only one positive for micrometastases.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Radiopharmaceuticals/administration & dosage , Sentinel Lymph Node Biopsy/methods , Technetium Tc 99m Aggregated Albumin/administration & dosage , Axilla , Female , Humans , Injections, Intralesional , Lymphatic Metastasis/diagnostic imaging , Middle Aged , Neoplasm Staging , Nipples , Radionuclide ImagingABSTRACT
Lymphangiomatosis is a rare syndrome that can affect different organs, although simultaneous splenic and adrenal involvement is exceptional. We report the case of a young female with a symptomatic massive splenomegaly and no-nhypersecreating bilateral adrenal masses incidentally discovered that represented a diagnostic challenge. The management of adrenal incidentalomas is controversial, as the presence of large sized bilateral masses are highly indicative of malignancy. Despite the different diagnostic techniques available, it is sometimes impossible to reach an accurate preoperative diagnosis. Elective splenectomy and left adrenalectomy were performed, preserving the functioning of the right adrenal gland, radiologically similar to the left one, to prevent the development of definitive adrenal insufficiency. Postoperative evolution has been favourable without initial increase of the size of the right adrenal lesion. However, the persistence of this mass obligated long-term follow-up and shall assist us in better understanding the behavior of this bening lesion.
Subject(s)
Adrenal Gland Neoplasms/pathology , Lymphangioma/pathology , Spleen/pathology , Splenic Neoplasms/pathology , Adrenal Gland Neoplasms/diagnostic imaging , Adrenal Gland Neoplasms/surgery , Adrenalectomy/methods , Adult , Female , Humans , Lymphangioma/diagnostic imaging , Lymphangioma/surgery , Spleen/diagnostic imaging , Spleen/surgery , Splenectomy/methods , Splenic Neoplasms/diagnostic imaging , Splenic Neoplasms/surgery , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
El hiperaldosteronismo primario (HA1.º) es una forma secundaria de hipertensión arterial (HTA) de fácil diagnóstico, provocado por la secreción inadecuada de aldosterona por la corteza suprarrenal. Con el objeto de establecer las principales características clínicas y bioquímicas de estos pacientes revisamos la base de datos de los últimos 20 años de la consulta monográfica de HTA del Servicio de Nefrología del Hospital San Pedro de Alcántara. De los 937 pacientes con HTA de origen no renal, 16 fueron diagnosticados de HA1.º (1,7 por ciento). No encontramos diferencias en cuanto al sexo. La media de edad fue de 45,8 +/- 9,28 años. Sólo 10 de los 16 presentaban clínica sugerente de HA1.º La tensión arterial (TA) media en la primera consulta fue de 161 +/- 19/101 +/- 13 mmHg. La repercusión orgánica en el momento del diagnóstico era grado II en el 50 por ciento de los casos y grado I en el 50 por ciento restante. Se constató hipopotasemia en 10 pacientes; los 6 restantes presentaban niveles de potasio normales. En todos encontramos niveles elevados de aldosterona basal; en 2 casos la renina no se encontraba suprimida. La gammagrafía con yodo-colesterol permitió localizar la lesión en 13 de los 16 pacientes; la tomografía axial computarizada y la resonancia magnética identificaron 2 casos confirmados por el test postural y la respuesta quirúrgica; en un caso no pudo establecerse la localización. Se diagnosticaron 8 adenomas y 7 hiperplasias bilaterales. Se intervinieron quirúrgicamente 5 de los adenomas, permaneciendo 3 pacientes normotensos son tratamiento y dos con buena respuesta ( cifras de TA normales con dosis bajas de espironolactona). Las hiperplasias, los adenomas no intervenidos y el caso no localizado presentan cifras de TA normales con dosis bajas de espironolactona (AU)
