ABSTRACT
El carcinoma mioepitelial de la mama es un tumor infrecuente, con pocos casos descritos en la literatura, por lo que su diagnóstico es difícil y su tratamiento un desafío que incluye el diseño de colgajos locales. Presentamos un caso clínico de carcinoma mioepitelial de mama con progresión locorregional tras quimioterapia y radioterapia, así como una revisión de la literatura que nos permiten establecer un diagnóstico definitivo y un tratamiento óptimo oncológico y quirúrgico con reconstrucción de este tumor.(AU)
Myoepithelial carcinoma of the breast is an uncommon tumour with few cases reported in the literature. Consequently, it is a diagnostic and therapeutic challenge. Treatment includes the design of local flaps. We present a case of myoepithelial carcinoma of the breast with locoregional progression after chemotherapy and radiotherapy. We also provide a review of the literature, allowing us to establish a definitive diagnosis and optimal oncological and surgical treatment with reconstruction of this tumour.(AU)
Subject(s)
Humans , Female , Breast Neoplasms , Myoepithelioma/diagnosis , Myoepithelioma/surgery , Myoepithelioma/therapy , Review Literature as TopicABSTRACT
ObjetivoEl examen de los costes asociados al diagnóstico y tratamiento quirúrgico en un grupo de pacientes con cáncer de mama.MétodoAnálisis de costes referido a la valoración clínica preoperatoria, tipo de cirugía y hospitalización en una cohorte de 224 pacientes con cáncer de mama en estadios precoces, intervenidas desde junio-2012 a diciembre-2016.ResultadosLa cirugía conservadora en régimen de cirugía mayor ambulatoria versus hospitalización, aplicada a la tumorectomía con biopsia selectiva de ganglio centinela supuso un ahorro de 2.085 por paciente, y total en nuestra serie de pacientes de 289.815 . La aplicación del estudio ACOSOG (American College of Surgeons Oncology Group) a 18 pacientes con ganglio centinela positivo evitó la linfadenectomía axilar y redujo el coste en 37.530 . La RMN preoperatoria en cáncer de mama aportó un beneficio en el tratamiento de 31 pacientes; una selección de pacientes más precisa habría supuesto un ahorro de 37.179 . Las ampliaciones de márgenes quirúrgicos sin hallazgo de tumor residual determinaron un gasto de 11.592 .Conclusiones-La cirugía conservadora de mama con biopsia selectiva de ganglio centinela en régimen de cirugía mayor ambulatoria supuso un ahorro importante de recursos sin comprometer el bienestar y pronóstico de las pacientes.-Los costes asociados a la realización de una RMN preoperatoria sin selección previa de pacientes y las reintervenciones de ampliación de márgenes determinaron un gasto evitable en buena parte de las pacientes.(AU)
ObjectiveThe aim of our study was to identify the costs associated with the diagnosis and surgical procedure in a cohort of patients with early breast cancer.MethodWe performed a costs study, referred to the preoperatory radiological-histological study, surgical procedure and inpatient/outpatient health service in a cohort of 224 patients diagnosed and operated on early-stage breast from June 2012 to December 2016.ResultsBreast conserving surgery in outpatient health service applied to lumpectomy with sentinel lymph node biopsy compared to carrying it out in the inpatient setting, contributed to a saving of 2085 per patient, and total of 289,815. Following the ACOSOG (American College of Surgeons Oncology Group) trial in 18 patients with tumor-involved sentinel node, no further axillary specific treatment (completion of lymphadenectomy) was made, allowing a saving of 37,530. In most patients our study have not showed benefit from diagnostic/preoperative breast MRI, leading to an over cost of 37,179. The surgical rescission without showing the presence of residual tumor burden, led to an additional cost of 11,592.Conclusions-Breast conserving surgery with sentinel lymph node biopsy in outpatient health service supposed an important economical saving of resources, without compromising the well-being and prognosis of our patients.-The diagnostic/preoperative MRI in all the patients and the surgical rescissions led to an over cost that could be avoided in most of the cases.(AU)
Subject(s)
Humans , Female , Health Care Costs , Breast NeoplasmsABSTRACT
Introducción: El objetivo de este estudio fue evaluar qué prueba de imagen de las empleadas para medir el tamaño del cáncer de mama primario preoperatorio (mamografía, ecografía o resonancia magnética [RM]) se correlacionó mejor con el tamaño del tumor en la pieza quirúrgica postoperatoria. Métodos: Análisis retrospectivo de mujeres con diagnóstico de cáncer de mama y con indicación de tratamiento quirúrgico primario operadas desde enero del 2014 hasta diciembre del 2016. Se recogieron variables sociodemográficas, vinculadas a técnicas de imagen e histológicas. Los resultados se presentaron según edad, tamaño tumoral y tipo histológico. Resultados: Se estudió a 224 mujeres. Al comparar el tamaño mamográfico y de la RM con el histológico final no se encontraron diferencias significativas, tanto de forma global como teniendo en cuenta el grupo histológico o la edad, sin embargo, ambas infraestimaron significativamente los tumores grandes y sobrestimaron significativamente los pequeños. La ecografía infraestimó significativamente el tamaño del tumor, especialmente en tumores grandes, pacientes mayores y en los grupos de carcinoma ductal infiltrante (CDI) y CDI con carcinoma ductal in situ asociado (CDI + CDIS). La RM se correlacionó mejor con el tamaño tumoral histológico aunque sin diferencias estadísticamente significativas. Conclusiones: La RM parece ser el mejor predictor del tamaño del tumor en el cáncer de mama. El grupo histológico y el tamaño del tumor fueron claves en la estimación de la medida del tumor, por lo que se deben tener en cuenta en la planificación de la cirugía. La variable edad no interfirió en la interpretación de las imágenes
Introduction: The objective of this study was to determine which image test used to measure the size of pre-operative primary breast cancer (mammography, ultrasound or magnetic resonance imaging [MRI]) correlated best with the size of the tumor in the postoperative surgical specimen. Methods: A retrospective analysis was conducted of women diagnosed with breast cancer for which primary surgical treatment was indicated and who underwent surgical intervention between January 2014 and December 2016. Sociodemographic, imaging and histological variables were collected. The results are presented by age group, tumor size and histological type. Results: In the 224 women studied, mammography and MRI tumor sizes were compared with pathology study tumor measurements, revealing no significant differences, both overall and based on histologic type or age. However, both significantly underestimated large tumors and significantly overestimated small tumors. Ultrasound significantly underestimated tumor size, especially in large tumors, older patients and in infiltrating ductal carcinoma (IDC) and infiltrating ductal carcinoma with associated ductal carcinoma in situ (IDC + DCIS). MRI correlated best with histological tumor size, although with no statistically significant differences. Conclusions: MRI is the best predictor of tumor size in breast cancer. Histologic type and tumor size are key parameters when estimating tumor size and should be taken into account when planning surgery. Patient age does not interfere with the interpretation of imaging tests
Subject(s)
Humans , Female , Adult , Middle Aged , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Age Factors , Breast Neoplasms/surgery , Carcinoma in Situ/diagnostic imaging , Carcinoma in Situ/pathology , Carcinoma in Situ/surgery , Magnetic Resonance Imaging/methods , Mammography/methods , Retrospective Studies , Ultrasonography/methodsABSTRACT
INTRODUCTION: The objective of this study was to determine which image test used to measure the size of pre-operative primary breast cancer (mammography, ultrasound or magnetic resonance imaging [MRI]) correlated best with the size of the tumor in the postoperative surgical specimen. METHODS: A retrospective analysis was conducted of women diagnosed with breast cancer for which primary surgical treatment was indicated and who underwent surgical intervention between January 2014 and December 2016. Sociodemographic, imaging and histological variables were collected. The results are presented by age group, tumor size and histological type. RESULTS: In the 224 women studied, mammography and MRI tumor sizes were compared with pathology study tumor measurements, revealing no significant differences, both overall and based on histologic type or age. However, both significantly underestimated large tumors and significantly overestimated small tumors. Ultrasound significantly underestimated tumor size, especially in large tumors, older patients and in infiltrating ductal carcinoma (IDC) and infiltrating ductal carcinoma with associated ductal carcinoma in situ (IDC+DCIS). MRI correlated best with histological tumor size, although with no statistically significant differences. CONCLUSIONS: MRI is the best predictor of tumor size in breast cancer. Histologic type and tumor size are key parameters when estimating tumor size and should be taken into account when planning surgery. Patient age does not interfere with the interpretation of imaging tests.
Subject(s)
Breast Neoplasms/diagnostic imaging , Breast Neoplasms/pathology , Adult , Age Factors , Breast Neoplasms/surgery , Carcinoma in Situ/diagnostic imaging , Carcinoma in Situ/pathology , Carcinoma in Situ/surgery , Carcinoma, Ductal, Breast/diagnostic imaging , Carcinoma, Ductal, Breast/pathology , Carcinoma, Ductal, Breast/surgery , Female , Humans , Magnetic Resonance Imaging/methods , Mammography/methods , Middle Aged , Retrospective Studies , Ultrasonography/methodsABSTRACT
Hay un riesgo excepcionalmente elevado de cáncer de mama, como segundo tumor, en mujeres que siguen tratamiento para la enfermedad de Hodgkin. Hemos revisado de forma retrospectiva 2 casos de pacientes en remisión completa de su linfoma de Hodgkin, que desarrollaron un cáncer de mama
Women treated for Hodgkin's disease have an exceptionally high risk of breast cancer as a second malignancy. We retrospectively reviewed 2 patients in complete remission from Hodgkin's disease who developed breast cancer
Subject(s)
Female , Adult , Humans , Hodgkin Disease/complications , Breast Neoplasms/pathology , Retrospective Studies , Neoplasms, Multiple Primary/pathologyABSTRACT
El carcinoma neuroendocrino de cérvix uterino (CNCU) es una entidad infrecuente asociada a un comportamiento agresivo. El tratamiento óptimo no está definido claramente. Rara vez se asocia a una gestación. Se presentan 2 casos de CNCU tratados en nuestro departamento, el primero de ellos asociado a un embarazo
Neuroendocrine carcinoma of the uterine cervix is a rare disease with very aggresive behavior. The optimal initial therapeutic approach has not yet been clearly defined. It rarely is complicated by pregnancy. We present 2 cases of this entity treated in our department, the first associated to gestation
