A Nonpalpable Nodule in Ectopic Axillary Breast Tissue: Consider Phyllodes Tumor.

Benign and malignant pathology can develop in ectopic axillary breast tissue, such as fibroadenomas, phyllodes tumors, and breast cancer. We present a rare case of an asymptomatic 43-year-old woman with an axillary nodule which was identified during screening mammography within ectopic axillary breast tissue, initially considered as a suspicious lymph node. Radiologic studies were considered as Breast Imaging-Reporting Data System (BI-RADS) 4. A hyperdense, lobular, and well-circumscribed nodule was identified in mammogram while the nodule by ultrasound (US) was hypoechoic with indistinct microlobular margins, without vascularity by Doppler, and measuring 1.26 × 1 cm. Core-needle biopsy reported a fibroepithelial neoplasm. The patient was submitted to local wide-needle excision located in intraoperative radiography of the surgical specimen and margin evaluation. Final histopathological study reported a 1.8 × 1.2 cm benign phyllodes tumor, with irregular, pushing, and clear wide margins within normal ectopic breast tissue. The patient without surgical complications continued annual screening without recurrence during a follow-up that took place 24 months later.

Phyllodes Tumor of the Breast: 307 Treated Cases, the Largest Mexican Experience at a Single Breast Disease Institution.

BACKGROUND: Phyllodes tumor (PT) of the breast in Hispanic patients is more frequently reported with large tumors and with more borderline/malignant subtypes compared with other populations. The objective of this study was to describe characteristics of patients with PT and to identify differences among subtypes in a Mexican population. METHODS: A retrospective study was conducted on patients with PT. Sociodemographic, histopathologic, and treatment characteristics were compared among subtypes, including only surgically treated cases due the complete surgical-specimen study requirement for appropriate WHO classification. RESULTS: During 10 years, 346 PT were diagnosed; only 307 were included (305 patients), with a mean age of 41.7 yr. Self-detected lump took place in 91.8%, usually discovered 6 months previously, with median tumor size of 4.5 cm. Local wide excisions were done in 213 (69.8%) and mastectomies in 92 (30.1%). Immediate breast reconstruction took place in 38% and oncoplastic procedures in 23%. PT were classified as benign in 222 (72.3%) cases, borderline in 50 (16.2%), and malignant in 35 (11.4%), with pathological tumor size of 4.2, 5.4, and 8.7 cm, respectively (P<0.001). Patients with malignant PT were older (48 yr), with more diabetics (14.3%), less breastfeeding (37.1%), more smokers (17.1%), with more postmenopausal cases (42.9%), and older age at menopause (51.5 years) compared with the remaining subtypes (P<0.05). Relapse occurred in 8.2% of patients with follow-up. CONCLUSION: In comparison with other Hispanic publications, these Mexican patients had similar age, with smaller tumors, modestly higher benign PT, fewer malignant PT, and lower documented relapse cases.

[Fibromatosis of the breast. Report of two cases and review of the literature].

BACKGROUND: Fibromatosis is a term used to describe a group of lesions characterized by well-differentiated fibroblast proliferation with an usually benign biological behavior but with an infiltrative pattern of growth, frequently recurrent and locally invasive. It is generally localized in the retroperitoneal area, neck and extremities. The presence of this entity in breast tissue is an uncommon clinical situation, comprising approximately 0.2% of breast tumors and very often misdiagnosed as malignant disease or phyllodes tumor. In this rare condition, immunohistochemistry is an important diagnostic tool in anatomopathological differential diagnosis with other spindle cell tumors of the breast. The purpose of this paper is to report the experience with two cases of this rare condition. CLINICAL CASES: We present two cases of breast fibromatosis confirmed immunohistochemically and also by biopsy. One case had the clinical and imaging appearance of breast carcinoma with the classic irregular mass presentation and the other case was misdiagnosed as phyllodes tumor because of the size and density of the tumor and the cytology. CONCLUSIONS: Approximately 83 cases of breast fibromatosis have been reported during the last 30 years, including one male patient. We reviewed clinicopathological features of two cases of fibromatosis of the breast treated at our institute.

Fibromatosis mamaria: informe de dos casos y revisión de la literatura / Fibromatosis of the breast: report of two cases and review of the literature

Introducción: El término fibromatosis describe un grupo de lesiones caracterizadas por proliferación benigna de fibroblastos bien diferenciados, con un patrón de crecimiento infiltrativo, frecuentemente recidivantes y localmente invasivas, que por lo general se localizan en retroperitoneo, cuello y extremidades. En la mama esta entidad es poco común y constituye solo 0.2 % de los tumores de la mama, y con relativa frecuencia es confundida con cáncer o tumor phyllodes. El propósito de este trabajo es ilustrar nuestra experiencia clínica en dos pacientes y llevar a cabo revisión de la literatura correspondiente. Casos clínicos: Dos pacientes, una con manifestación clínica y en quien mediante mastografía se observó masa irregular que orientaba hacia el diagnóstico de cáncer; en la otra, por el tamaño y densidad de la lesión, así como por su aspecto citológico, se determinó tumor phyllodes. En las dos, el estudio histopatológico indicó fibromatosis primaria de la mama, diagnóstico confirmado con inmunohistoquímica. Conclusiones: En los últimos 30 años solo se han informado 83 casos de fibromatosis de la mama, incluyendo uno del sexo masculino. La inmunohistoquímica desempeña un papel preponderante en el diagnóstico diferencial con otros tumores de células fusiformes de la mama.

BACKGROUND: Fibromatosis is a term used to describe a group of lesions characterized by well-differentiated fibroblast proliferation with an usually benign biological behavior but with an infiltrative pattern of growth, frequently recurrent and locally invasive. It is generally localized in the retroperitoneal area, neck and extremities. The presence of this entity in breast tissue is an uncommon clinical situation, comprising approximately 0.2% of breast tumors and very often misdiagnosed as malignant disease or phyllodes tumor. In this rare condition, immunohistochemistry is an important diagnostic tool in anatomopathological differential diagnosis with other spindle cell tumors of the breast. The purpose of this paper is to report the experience with two cases of this rare condition. CLINICAL CASES: We present two cases of breast fibromatosis confirmed immunohistochemically and also by biopsy. One case had the clinical and imaging appearance of breast carcinoma with the classic irregular mass presentation and the other case was misdiagnosed as phyllodes tumor because of the size and density of the tumor and the cytology. CONCLUSIONS: Approximately 83 cases of breast fibromatosis have been reported during the last 30 years, including one male patient. We reviewed clinicopathological features of two cases of fibromatosis of the breast treated at our institute.

[Surgical practice in the Mexican Empire]. / El ejercicio de la cirugía en el imperio mexica.

The prehispanic medicines of Mexico are considered as testimony of the splendor of the Meso-American cultures; their great scientific advance and technical allowed them to accumulate a vast collection of clinical and pathological data based on the observation and experimentation. They integrated a nomenclature medical surgical that reflected their advance in those fields of the knowledge, where the anatomy and surgery occupied a preponderant paper. The medicine was known generically as ticiotl, of where it derives the term tícitl for the doctor. In their concept health-illness the limits among the magic, religion and the empiricism for natural causes were not clear, therefore they considered that the divine, human or natural origin of the illnesses influenced in an important way in its nature. Inside this complex causal system, the illnesses caused by the gods, spirits and celestial beings were considered as hot, while those caused by beings of the other realm were cold. The practice of the medicine had a very established organization designing a very advanced system of specialties that allowed them to accumulate a vast experience for the handling of chronic and acute illnesses in different progression phases, which managed with an integral therapy that had a plurality of resources of vegetable origin, animal, and mineral. The surgery was designated as texoxotlaliztli and its cures tepatiliztli. The surgeon was designated as texoxotlaticitl and it developed advanced techniques in the handling of sutures, wounded, drainage of abscesses, fractures and joint dislocations, pterygium, tonsillitis, circumcision, and amputations.

[Distinguished doctors of the University of Padua and their works: 16th to 18th centuries]. / Médicos notables de la Universidad de Padua y sus obras. Siglos XVI a XVIII.

Italian universities have been distinguished since their beginnings, within different specialties. One of them, if not the most important, is the teaching of medicine. One of the leaders is the University of Padua, founded in 1222, establishing itself as the second most important institution after the University of Bologna. In spite of the difficulties faced by this university, as with most other universities during the medieval period, it continued to perform and consolidate once again during the Renaissance as one of the most outstanding universities in Europe. The University of Bologna and the University of Padua shared the leadership in teaching during this period. At the University of Padua, the lectures were always full with teachers and students of great fame, such as Andreas Vesalio, Gabriele Falopio, William Harvey, Giovanni Battista Morgagni, Antonio Scarpa, to name just a few. In this article we discuss the rights the University had since it beginnings, from its establishment to the Renaissance, and the great influence of some of the teachers and students in the art and science of medicine.

[Clear cell sarcoma and sentinel lymph node biopsy. Case report and literature review]. / Sarcoma de células claras y ganglio centinela. Reporte de un caso y revisión de la literatura.

The procedure of sentinel node biopsy has been used previously in clear cell sarcoma. There are few studies reported. Due to the similar biological features with melanoma, this procedure can be effective. Sentinel biopsy is an option to detect nodal subclinical metastases. A 19-year-old man presented with ulcerated lesion in the fifth finger of the left hand. The biopsy reported clear cell sarcoma. Immunohistochemistry was positive for Vimentin and S-100. There was no evidence of regional disease. The sentinel lymph node biopsy, using patent blue and Tc-99 rhenium, was positive for metastases. Axillar dissection was carried out. The final report confirmed three metastasic nodes and the patient received adjuvant chemotherapy.

[Teaching of medicine of the University of Bologna in the Reinaissance]. / La enseñanza de la Medicina en la Universidad de Bolonia en el Renacimiento.

The foundation date of the University of Bologna was 1150, was the first European University and set the pattern. The combination of structured teaching and students association marked the origin of the studium generale. The presence of teaching legists encouraged teachers in others fields to come to Bologna. Ars dictaminis, grammar, logic, philosophy, mathematical arts and especially medicine were taught there by the middle of the thirteenth century. The university had to offer advanced instruction in law, medicine, and theology, had a minimum of six to eight professors teaching civil law, canon law, medicine, logic, natural philosophy and usually rhetoric. Many professors bearing local names were able scholars and commanding figures in medicine and surgery. Taddeo Alderotti (1210-95) began to teach medicine in Bologna about 1260. He soon raised medicine to a prestigious position in the university. The geographical distribution demonstrates the international character of the student body 73% were Italians and 26% non Italians. The decision of the commune of Bologna to wrest control of the university from the students by paying professors was probably the most important decision in the history of Italian universities. Examination of the distribution of professors offers a detailed picture of the faculty. In 1370 the university had 11 professors of civil law, seven professors of canon law, three professors of medical theory, two of medical practice (the specific of diagnosis and treatment), and one professor of surgery. After growing steadily the numbers of teachers stabilized at 85 to 110 until 1530.

La enseñanza de la Medicina en la Universidad de Bolonia en el Renacimiento / Teaching of medicine of the University of Bologna in the Renaissance

The foundation date of the University of Bologna was 1150, was the first European University and set the pattern. The combination of structured teaching and students association marked the origin of the studium genérale. The presence of teaching legists encouraged teachers in others fields to come to Bologna. Ars dictaminis, grammar, logic, philosophy, mathematical arts and especially medicine were taught there by the middle of the thirteenth century. The university had to offer advanced instruction in law, medicine, and theology, had a minimum of six to eight professors teaching civil law, canon law, medicine, logic, natural philosophy and usually rhetoric. Many professors bearing local names were able scholars and commanding figures in medicine and surgery. Taddeo Alderotti (1210-95) began to teach medicine in Bologna about 1260. He soon raised medicine to a prestigious position in the university. The geographical distribution demonstrates the international character of the student body 73% were italians and 26% non Italians. The decision of the commune of Bologna to wrest control of the university from the students by paying professors was probably the most important decision in the history of Italian universities. Examination of the distribution of professors offers a detailed picture of the faculty. In 1370 the university had 11 professors of civil law, seven professors of canon law, three professors of medical theory, two of medical practice (the specific of diagnosis and treatment), and one professor of surgery. After growing steadily the numbers of teachers stabilized at 85 to 110 until 1530.

La enseñanza organizada proporcionada por juristas y las asociaciones estudiantiles da inicio a la Universidad de Bolonia en 1150. Su prestigio como centro de excelencia en el estudio del derecho, alentó a otros profesores eruditos a desplazarse a esa ciudad de modo que Ars dictaminis, gramática, lógica, filosofía aristotélica, matemáticas y medicina eran enseñadas en el siglo XIII. Esta universidad fue la más grande de Italia durante el Renacimiento; tuvo un crecimiento continuo, la matrícula se estabilizó entre 95 y 100 profesores en 1530. En la universidad había un mínimo de ocho catedráticos que enseñaban derecho civil, derecho canónico, medicina, lógica, filosofía natural y retórica. La enseñanza de la medicina fue iniciada por Tadeo Alderotti. La Facultad de Medicina en 1400 comprendía un curriculum de cuatro años cursando medicina teórica, medicina práctica, y cirugía, permaneciendo estable hasta 1600 donde se agregan botánica médica, anatomía y cirugía, y medicina clínica. Cada una dividida en primo lectione y secunda lectione, los libros de Galeno, Avicena e Hipócrates eran los más usados. La población estudiantil tenía un carácter internacional, 73% correspondía a estudiantes extranjeros dentro del territorio italiano y 26% procedían de otras naciones transalpinas. En la matrícula de profesores y alumnos destacan figuras de renombre que gracias a la naturaleza de sus investigaciones en anatomía general y especial, embriología y cirugía, elaboraron obras cimeras que sentaron las bases científicas para la enseñanza y evolución de la cirugía.

[Maffucci's syndrome. Case reports and literature review]. / Síndrome de Maffucci. Informe de dos pacientes y revisión de la literatura.

Maffucci syndrome is a rare, congenital disease, which is associated with the appearance of multiple enchondromas (possibility of malignant transformation in 20 to 100%), soft tissue hemangiomas and other mesenchymatous injuries. Case 1 is a 33-year-old female who presented with multiple nodules predominantly in upper extremities. Upon examination, there was deformity in articulation and nodules on the hands, which were soft and moveable. There were bony shavings in the second and fourth fingers of the left hand (enchondromas and atypical cells associated with hemangioma esclerosante). Maffucci syndrome was diagnosed. Later, excision of subcutaneous nodules in superior extremities was performed along with excision of nodules in both hands and hypochondrium (enchondroma injuries of left hand and hypochondrium, hemangioma in right hand). There was dysarticulation of the second finger at the metacarpal level of the phalanges of the left hand (chondrosarcoma). The patient is being followed up currently. Case 2 is a 26-year-old female. The patient had a history of subcutaneous abdominal tumor, exostosis, nodules and nodule in right breast. Upon examination, a tumor was found in the right breast, exostosis of right tibia, injury to the right wrist and left thyroid nodule. A simple mastectomy and axillary dissection was performed (fibroadenoma to intracanalicular and 14 negative lymph nodes). Later, left thyroidectomy and lumpectomy in right wrist were performed (hyperplasia to nodular thyroid and hemangioma cavernous). There was injury in the carpus of the right hand and elbow (hemangioma cavernous and synovial tissue with fibrosis and enchondroma). A diagnosis was made of Marffucci syndrome associated with mesenchymatous tumors. The patient was in poor general health and did not survive this hospitalization.

[Surgery and anatomy in the Renaissance]. / La cátedra de cirugía y anatomía en el Renacimiento.

The interest in the physical perfection and the corporal forms brings as a result the creation of new anatomical studies. The anatomical knowledge progressed in the second half of the XV century, conceiving the knowledge of the human body as a basic reality of Medicine. One of the greater contributions of the Italian Universities to medicine was the teaching of anatomy. The Universities of Padua, Bologna, and Pisa educated in their classrooms great physicians like Andres Vesalio, Gabriel Fallopio, Realdo Colombo, Mondino de Luzzi, Julio Ceasar Aranzio, and Gaspare Tagliacozzi, among others. The teaching of anatomy during the Renaissance was characterized by the development of dissection techniques and autopsy practice, which was recognized as an extremely valuable skill for anatomical study. The dissections were made in circular amphitheatres in the following way: a Medicine professor read the text book, another one made the dissection, and a third one indicated the structures referred.

Schwannomas medaastinales: comunicación de casos y revisión de la literatura

Introducción: Los tumores del mediastino comprenden un grupo heterogéneo de neoplasias raras con comportamiento biológico muy variable. En México, las estadísticas reportan que corresponde al 0.88% de todas las neoplasias. En general, del 30 al 76% de todos estos tumores son malignos. De éstos el 53% corresponden a tumores neurógenos. Objetivo del estudio: Conocer la frecuencia del Schwannoma mediastinal, en el Instituto Nacional de Cancerología (INCan), así como el manejo de esta patología. Material y métodos: Se revisaron expedientes del archivo clínico de 1980 a 2003 con diagnóstico de tumor mediastinal. Se registraron edad, sexo, presentación clínica, presentación radiológica, métodos diagnósticos, tratamientos previos, histología, tratamiento y resultados. Resultados: 109 pacientes con diagnóstico de tumor mediastinal fueron tratados en el INCan entre 1980 al 2003; 9 casos correspondían a tumores de origen neuroepitelial; 4 pacientes fueron llevados a cirugía. Se realizaron 3 resecciones y una tumorectomía. La histología y el tamaño son factores que influyen en el resultado. La resección completa es curativa y la adyuvancia con radioterapia posoperatoria puede ser útil.

Introduction: Mediastinal tumors include an heterogenous group of neoplasms with variable biological behavior. In Mexico they represent 0.88% of all neoplasms. Thirty to 76% of these tumors are malignant; of these, 53% are neurogenic. Objectives: To study the frequency of mediastinal Schwannomas at our institute. Material and methods: A chart review of mediastinal tumors from 1980 to 2003 was done. Age, sex, clinical presentation, radiological features, previous diagnoses and treatments, histology, treatment and results were recorded. Results: 109 patients with mediastinal tumors were treated in the National Institute of Cancer from 1980 to 2003; 9 cases were tumors of neuroepithelial origin, 4 patients were taken to surgery. Histology and size were factors that influenced the result. Complete resection is the standard of care; adjuvant radiotherapy is useful.

[Contributions of Herodotus to surgery within the historiographic analysis of his Histories]. / Contribuciones de Herodoto a la cirugía en el análisis historiográfico de sus Historias.

During the splendor of Athens, Herodotus of Helicarnasus develops his life and work in the V century B.C. that led him to be considered the father of history. The available knowledge of ancient medicine and surgery is based on the descriptions of authors such as Homer, Herodotus, Hippocrates, and Plinius. Herodotus, a contemporary of Hippocrates, in his Histories, defines the limit between the epic narratives of Homer and the beginning of scientific history based on observation, reflection, and analysis. He develops an erudite, objective, and clear narrative of facts that allow him to discover the causes in order to determine their consequences in society. He describes the magic-religious model of the health-disease process, etiology, diagnostic methods, and treatment for diseases in ancient towns. He makes a description of Egyptian medicine, particularly about medical specialization, embalmment, and common diseases. He emphasizes surgical procedures: circumcision, castration, amputations of ears, nose and hands, ocular evisceration and mastectomies (punishments) and describes traumatic wounds, their prognosis and treatment. He also mentions the names and actions of the most famous physicians of the time. Herodotus lived the cultural decadence of Ionia, his native land, at the time of economic and intellectual hegemony of Athens. His work is universal and has the purposes of projection to the future and to seek causes.

[Medical care at the Royal Hospital of Natives]. / La atención médica en el Hospital Real de Naturales.

After the Conquest, the indigenous populations of New Spain were left unprotected by the new government. Thus the Royal Hospital of Naturals (RHN) was created, offering care to the indigenous population for health and with hospitality, as well as religious aid. However, later solely care was provided. The RHN had great support from the Spanish Crown and became a suitable place for clinical investigation that on the peninsula and in all of Europe was forbidden: the autopsies, that in indigenous population are carried out without sanction, only needing authorization of local authorities for their accomplishment, considering the indigenous as inferior to Spaniards. In addition, the RHN was the best place for foundation of the Royal Surgery School of Mexico in the XVIII century. The contribution of the RHN was the fusion of indigenous medicine with European medicine, increasing the therapeutic resource array, as well as the opportunity of carrying clinic investigation through autopsy's for better clinic correlation, and matchless learning for the era in the art of out surgery, this being an important point in the development of the medicine and surgery of Mexico.

[Preliminary report. Usefulness of computed tomographic angiography in the protocol of a kidney donor]. / Reporte preliminar. Utilidad de la angiotomografía renal en el protocolo del donador renal.

OBJECTIVE: To determine clinical correlation of reports of computed tomographic angiography renal (CT-AR) and surgical findings of the kidney donor patient. MATERIAL AND METHODS: Patients were submitted nephrectomy in the related live donor renal transplant program between January and December 2002 as paut of life to which he is made as he CT-AR study protocol. Statistical analysis was carried out by descriptive statistics. RESULTS: Anatomical characteristics of 35 kidneys of the same number of live donors (AD) submitted CT-AR were evaluated and comparison with report of surgical technique was made. Incidence of accessory renal arteries was 23%. As reported by CT-AR, the were 39 renal arteries (91%) compared with 43 arteries found during surgery. CT-AR identified four supernumerary renal arteries (50%) of eight identified during surgical technique; 36 hiliar arteries (90%) and three polar arteries were identified by CT-AR (100%). Only one a case report of early bifurcation of renal artery (20%) by CT-AR was recorded. Anatomical characteristics of veins were described in their totality. CT-AR is a useful instrument to identify alterations in anatomical structure of the renal vasculature, with results similar to other studies for description of renal arteries and veins. We propose ATR as the initial study for evaluation of the renal architecture of the live kidney (LKD).