ABSTRACT
Resumen ANTECEDENTES: La incidencia de tumores filodes es del 0.3 al 1% de todos los tumores primarios de la mama. Su presentación bilateral puede ser sincrónica o asincrónica y es excepcional. Estos tumores se clasifican (OMS) en fibroepiteliales, benignos, limítrofes o malignos. Aparecen en mujeres con límites muy amplios de edad, aunque lo más frecuente es entre los 35 y 55 años. El diagnóstico definitivo se establece con base en el reporte histopatológico. Su tratamiento es quirúrgico. CASO CLÍNICO: Paciente de 50 años, con antecedentes obstétricos de dos embarazos y dos cesáreas. Acudió a consulta debido a la aparición de una masa palpable en ambas mamas. Carecía de antecedentes relevantes para cáncer de mama. Con base en la mastografía se determinó que se trataba de un tumor categoría BI-RADS 4A. La biopsia excisional, con estudio transoperatorio, determinó que era un tumor filodes de bajo grado (benigno). Se procedió a la extirpación de ambos tumores, con márgenes libres suficientes, a fin de disminuir el riesgo de recidivas. Se determinó un plan de seguimiento con mastografía anual en las que se ha obtenido la categoría BI-RADS 2. Hasta el momento, la paciente permanece libre de enfermedad. CONCLUSIONES: Los tumores filodes son sumamente raros y más aún su aparición bilateral. Es importante integrar un diagnóstico temprano y efectuar un correcto procedimiento quirúrgico que evite las recidivas porque éstas tienden a ser cada vez más agresivas. Sigue siendo motivo de controversia la indicación de radioterapia y quimioterapia en estos tumores, que solo se reservan como tratamiento alternativo ante tumores sumamente agresivos.
Abstract BACKGROUND: The incidence of phyllodes tumors is 0.3% to 1% of all primary breast tumors. Their bilateral presentation may be synchronous or asynchronous and is exceptional. These tumors are classified (WHO) as fibroepithelial, benign, borderline or malignant. They appear in women with very wide age limits, although the most frequent is between 35 and 55 years of age. The definitive diagnosis is established based on the histopathological report. Treatment is surgical. CLINICAL CASE: 50-year-old patient with obstetric history of two pregnancies and two cesarean sections. She came for consultation due to the appearance of a palpable mass in both breasts. She had no relevant history of breast cancer. Based on the mastography it was determined to be a BI-RADS 4A category tumor. The excisional biopsy, with trans-operative study, determined that it was a low-grade (benign) phyllodes tumor. Both tumors were excised, with sufficient free margins, in order to reduce the risk of recurrence. A follow-up plan was determined with annual mastography in which BI-RADS category 2 has been obtained. So far, the patient remains free of disease. CONCLUSIONS: Phyllodes tumors are extremely rare and even more so their bilateral occurrence. It is important to integrate an early diagnosis and to perform a correct surgical procedure to avoid recurrences because they tend to be more and more aggressive. The indication of radiotherapy and chemotherapy in these tumors remains controversial and is only reserved as an alternative treatment for highly aggressive tumors.
ABSTRACT
Human chorionic gonadotropin (hCG) is a placental hormone essential for the maintenance of pregnancy. Previous studies have shown a G to A transition in exon 3 of the hCGbeta gene 5, which changes the naturally occurring valine to methionine in codon 79. The frequency of this transition varies among different ethnic groups, being high in USA women, and less common, or absent, in various European populations. The purpose of the present study was to determine the frequency of the betaV79M allelic variant of the beta-subunit of hCG in a Mexican population, and to compare this frequency with those found in other ethnic groups. Placental DNA from 161 pregnant Mexican women was genotyped for the betaV79M by polymerase chain reaction (PCR)-restriction fragments length polymorphism analysis. No polymorphic betaV79M alleles were identified in the population studied. The allele and genotypic frequencies of betaV79M polymorphism in Mexican Mestizo women were significantly different from those reported for the US population, but not from five different European populations. In contrast to what has been found in women from the USA, it seems that the hCGbeta V79M polymorphism is absent or extremely rare in Mexican Mestizo women.
Subject(s)
Abortion, Spontaneous/genetics , Chorionic Gonadotropin, beta Subunit, Human/genetics , Polymorphism, Single Nucleotide , Amino Acid Substitution/genetics , DNA Mutational Analysis , Female , Gene Frequency , Genetic Predisposition to Disease , Genotype , Humans , Methionine/genetics , Mexico , Pregnancy , Valine/geneticsABSTRACT
BACKGROUND: The characteristics of the infiltrating lobular carcinoma of the breast are not clear, this is caused by special histological and biological features. OBJECTIVE: To identify the clinical stage and correlate it with the radiological and histological features of the disease to make an opportune diagnosis. PATIENTS AND METHODS: From January 1st, 2003 to July 31st, 2004 we identified 68 cases of infiltrating lobular carcinoma at the Luis Castelazo Ayala Hospital. The cases were classified by clinical, radiological and histological features. The results were expressed in media and standard deviation. The difference between the mixed and pure lobular carcinoma types were compared by chi-square test. RESULTS: From 68 patients, 31 had mixed lobular carcinoma, 20 pure, 12 were eliminated because the patient's records were not found and five because the definitive histological report was not lobular carcinoma. The median age for both groups was 50 years old. The most affected region was the upper one (> 80%). The hormonal receptor was more frequently expressed in the pure subtype (p < 0.04), this latter was associated to a delayed diagnosis (p < 0.03). Mammography was considered useful for diagnosis. CONCLUSIONS: The histological behavior of lobular carcinoma is related to non clear characteristics and to delayed diagnosis; however, with a careful evaluation these features can be recognized and make possible an opportune mammography.
