Ablación por radiofrecuencia de carcinomas de mama: resultados preliminares de un ensayo clínico / Radiofrequency ablation of breast carcinomas: preliminary results of a clinical trial

Objetivo: Entre las alternativas a la cirugía conservadora del cáncer de mama, la ablación por radiofrecuencia (ARF) es la que ha alcanzado mayor difusión. Nuestro objetivo es determinar la factibilidad, seguridad y eficacia de esta técnica en nuestro medio. Material y métodos: Se realiza ARF de carcinomas de mama con anestesia local y en la sala de ecografía, tratamiento quirúrgico y comprobación histológica posterior, evaluando los efectos de la ARF sobre el tumor y los tejidos circundantes. Material y métodos: Se incluyeron 35 pacientes con edad media de 61,2±8,25 años, todas con carcinoma infiltrante confirmado percutáneamente,<2cm, alejado de la piel y la pared torácica. Tamaño tumoral medio 8,9±2,9mm. Se realizó linfadenectomía selectiva antes de la ARF. A las 2–4 semanas de ésta se llevó a cabo el tratamiento quirúrgico. Material y métodos: El grado de necrosis de coagulación y la afectación de márgenes se evaluaron con tinción de hematoxilina-eosina, y la viabilidad celular o efectividad de la ARF mediante NADH-diaforasa. Resultados: El 85,7% de pacientes no sintió molestias. El 11,4% refirió dolor ligero que pudo ser controlado. El dolor intenso obligó a detener el procedimiento en 1 paciente. No se produjeron otras complicaciones. Resultados: Se encontraron cambios de necrosis coagulativa en todos los casos, catalogada como completa en 32/35 (91,4%). La NADH-diaforasa resultó negativa en 27/32 casos en que se realizó. Una fue ligeramente positiva y 4 no valorables. Conclusión: La ARF es una técnica factible, bien tolerada, segura y eficaz en casi el 90% de los tumores infiltrantes de mama. La confirmación de su eficacia deberá hacerse mediante seguimiento prolongado de pacientes no intervenidas, con ensayos clínicos en fase III cuidadosamente diseñados y monitorizados (AU)

Objective: Among the alternatives to breast conserving surgery in breast cancer, radiofrequency ablation is the most widespread. We aimed to determine the feasibility, safety, and efficacy of this technique in our environment. Material and methods: We performed radiofrequency ablation of breast carcinomas under local anesthesia in the ultrasonography examination room. We included 35 patients (mean age = 61.2 ± 8.25 years) with invasive carcinomas measuring less than 2 cm (mean diameter = 8.9 ± 2.9mm) and located far from the skin and chest wall. Prior to radiofrequency treatment, all patients underwent core biopsy to confirm that the tumors were invasive carcinomas and selective lymphadenectomy. Carcinomas were excised 2 to 4 weeks after radiofrequency treatment and analyzed histologically to evaluate the effects of radiofrequency treatment on the tumor and surrounding tissue. The degree of coagulation necrosis and involvement of the margins was evaluated using hematoxylin and eosin staining. Cellular viability or effectiveness of the radiofrequency treatment was evaluated using NADH diaphorase. Results: In total, 85.7% of patients reported no discomfort; 11.4% reported mild, controllable pain. Intense pain required the procedure to be discontinued in one patient. No other complications occurred. Results: Signs of coagulation necrosis were observed in all cases; coagulation necrosis was classified as complete in 32/35 (91.4%). NADH diaphorase was negative in 27 of the 32 cases in which it was performed; one case was slightly positive and the other four were impossible to evaluate. Conclusion: Radiofrequency ablation of breast carcinomas is feasible, well tolerated, safe, and efficacious in nearly 90% of invasive tumors. The efficacy of the technique should be confirmed through extended follow-up of patients without subsequent surgical intervention in carefully designed and monitored phase III trials (AU)

[Radiofrequency ablation of breast carcinomas: preliminary results of a clinical trial]. / Ablación por radiofrecuencia de carcinomas de mama: resultados preliminares de un ensayo clínico.

OBJECTIVE: Among the alternatives to breast conserving surgery in breast cancer, radiofrequency ablation is the most widespread. We aimed to determine the feasibility, safety, and efficacy of this technique in our environment. MATERIAL AND METHODS: We performed radiofrequency ablation of breast carcinomas under local anesthesia in the ultrasonography examination room. We included 35 patients (mean age=61.2+/-8.25 years) with invasive carcinomas measuring less than 2cm (mean diameter=8.9+/-2.9mm) and located far from the skin and chest wall. Prior to radiofrequency treatment, all patients underwent core biopsy to confirm that the tumors were invasive carcinomas and selective lymphadenectomy. Carcinomas were excised 2 to 4 weeks after radiofrequency treatment and analyzed histologically to evaluate the effects of radiofrequency treatment on the tumor and surrounding tissue. The degree of coagulation necrosis and involvement of the margins was evaluated using hematoxylin and eosin staining. Cellular viability or effectiveness of the radiofrequency treatment was evaluated using NADH diaphorase. RESULTS: In total, 85.7% of patients reported no discomfort; 11.4% reported mild, controllable pain. Intense pain required the procedure to be discontinued in one patient. No other complications occurred. Signs of coagulation necrosis were observed in all cases; coagulation necrosis was classified as complete in 32/35 (91.4%). NADH diaphorase was negative in 27 of the 32 cases in which it was performed; one case was slightly positive and the other four were impossible to evaluate. CONCLUSION: Radiofrequency ablation of breast carcinomas is feasible, well tolerated, safe, and efficacious in nearly 90% of invasive tumors. The efficacy of the technique should be confirmed through extended follow-up of patients without subsequent surgical intervention in carefully designed and monitored phase III trials.

Primary gallbladder carcinoma: imaging findings in 50 patients with pathologic correlation.

Different diagnostic imaging modalities [contrast cholangiography, ultrasonography, and computed tomography (CT)] in a large group of patients with proven gallbladder carcinoma are reviewed. Noninvasive cross-sectional imaging methods strongly correlated with the different gross pathologic types of gallbladder carcinoma. The most common observed type was a mass replacing the gallbladder (39%). Other types observed either by sonography and/or CT were a focal/diffuse gallbladder wall thickening and the presence of an intraluminal polypoid mass. Despite the improvement in several imaging modalities, most of the preoperatively diagnosed gallbladder carcinomas were in advanced stage (84%). A combined approach using noninvasive diagnostic methods and percutaneous aspirative biopsies may reduce the number of explorative laparotomies in the final diagnosis of gallbladder carcinoma.

[Melanotic medulloblastoma. Ultrastructural and histochemical study of a case]. / Meduloblastoma melanótico. Estudio ultraestructural e inmunohistoquímico de un caso.

A electron microscopic and immunohistochemical study of a Melanotic medulloblastoma is reported. The cerebellar tumor was located in the vermis of a 6-year-old boy, dead 11 months after diagnosis. The tumor consisted of medulloblastoma-like areas with focal differentiation and pseudoepithelial structures pigmented with melanin. Electron microscopy showed melanosomes and tight junctions in pigmented areas. On immunohistochemistry, the cytoplasm of melanotic cells were positive to S-100 protein and the differentiated glial cells to GFAP. The tumor histogenesis, its relationship with other pigmented tumors of the CNS and their low frequency is commented on.

Inflammatory pseudotumor of the spleen: ultrasound and computed tomographic findings.

Inflammatory pseudotumor of the spleen is an extremely rare benign lesion characterized by a wide spectrum of nonspecific inflammatory and reparative changes. The ultrasound and computed tomographic (CT) findings of inflammatory pseudotumor affecting the spleen in an asymptomatic patient are reported. The CT scanning revealed a partially calcified mass showing a nonhomogeneous enhancement after contrast injection. After 3 min of bolus administration, an unenhanced central area, which corresponds to a focal area of fibrosis, was demonstrated.

[Giant axonal neuropathy. Presentation of 2 familial cases]. / Neuropatía axonal gigante. Aportación de dos nuevos casos familiares.

A review of 20 cases of giant axonal neuropathy (4 of them familial) described in the literature, and two new cases in brothers whose parents had no consanguinity is reported. A recessive autosomic pattern of inheritance is suggested. Curly hair, a typical phenotypic feature, was not initially present in our cases. This feature developed, however, later in the older brother. Clinical manifestations include an early predominantly motor polyneuropathy, subsequently involving the central nervous system. Clinical course is progressive and gait becomes impaired by the age of 10 to 13 years. Electrophysiologic studies show an axonal polyneuropathy with decreased evoked potential amplitude in motor and sensitive conduction speed. Diagnosis is achieved through a sural nerve biopsy showing an axonal thickening. Electron microscopy shows this to be related to a neurofibrillar accumulation.