Abordaje multidisciplinar de un tumor phyllodes maligno de mama en una mujer de 16 años / Multidisciplinary approach to a malignant phyllodes tumour of the breast in a 16-year-old woman

INTRODUCCIÓN: El tumor phyllodes (TP) es una tumoración fibroepitelial que representa el 0,3-0,9% del total de tumores de mama. Si bien puede aparecer a cualquier edad, acostumbra a presentarse en mujeres jóvenes (edad media 40-45 años) como una masa palpable no dolorosa, de rápido crecimiento y de gran tamaño. Los TP presentan una elevada tasa de recurrencia local y raramente metastatizan. CASO CLÍNICO: Se presenta el caso de una paciente de 16 años, con antecedente de exéresis de un fibroadenoma de 70mm. A los 15 meses presentó reaparición de una masa ipsilateral filiada como TP maligno de mama. Fue sometida a tumorectomía amplia, pero dada la afectación de varios márgenes de resección finalmente se realizó mastectomía con reconstrucción inmediata. RESULTADOS: Los TP suponen un reto en cuanto al diagnóstico, a veces complejo, tanto mediante pruebas de imagen como histológico. El tratamiento principal es quirúrgico mediante resección amplia (cirugía conservadora o mastectomía) de la lesión sin abordaje axilar. La recurrencia local se asocia mayoritariamente a afectación de márgenes de resección. Con frecuencia es necesario recurrir a técnicas de oncoplastia dado el elevado volumen de mama afectado. CONCLUSIONES: El manejo de este tipo de tumores requiere un abordaje completo y multidisciplinar

INTRODUCTION: Phyllodes tumour of the breast (PT) is a fibroepithelial mass representing 0.3-0.9% of all breast tumours. Although it can appear at any age, it usually develops in young women (mean age 40-45 years) as a painless, palpable, large, rapidly-growing mass. These tumours have a high local recurrence rate and rarely metastasize. CASE REPORT: We present the case of a 16-year-old female patient who had undergone extirpation of a 70mm fibroadenoma. Fifteen months later, an ipsilateral mass developed, which was diagnosed as a malignant PT of the breast. She underwent wide local excision, but given the involvement of various resection margins, mastectomy with immediate reconstruction was performed. RESULTS: PT are a diagnostic, and sometimes complex, challenge both through imaging and histological tests. The main treatment is surgical, through wide (breast-conserving surgery or mastectomy) resection of the lesion without axillary clearance. Local recurrence is mainly associated with involvement of the resection margins. It is often necessary to resort to oncoplastic techniques due to the volume of affected breast tissue. CONCLUSIONS: Management of this type of tumour requires a comprehensive and multidisciplinary approach

Factors affecting surgical margins in nonpalpable breast tumors excised with the radioguided occult lesion localization approach.

AIM: Most breast surgeons generally assume that obtaining negative margins in nonpalpable tumors is a matter of concern. The aim of this study was to examine whether it is easier to obtain negative margins in palpable tumors than in nonpalpable tumors excised with the radioguided occult lesion localization (ROLL) technique. METHODS: A retrospective review was made of nonpalpable breast cancers excised with the ROLL technique (ROLL group, n = 83) and palpable breast cancers in which breast conservative therapy was performed (Palpable group, n = 77). The margin status and the size of the minimum margin obtained when it was negative were reviewed. RESULTS: The percentage of resections with negative margins was similar in both groups: 51.9% in the Palpable group and 61.4% in the ROLL group. There was no difference between the two groups in the minimum margin obtained: mean ± SD, 5.53 ± 3.146 mm in the Palpable group and 5.96 ± 3.039 mm in the ROLL group. Risk factors for failing to obtain negative margins were analyzed in both groups and were similar. These risk factors included histological grade, extensive intraductal carcinoma and c-erbB2 status. CONCLUSION: It is concluded that excision of nonpalpable breast tumors with the ROLL approach obtains similar results for margins as conservative surgery performed for palpable tumors.

The depolarized expression of the alpha-6 integrin subunit in the endometria of women with endometriosis.

OBJECTIVE: The current study sought to compare the endometrial localization of the integrin subunit alpha-6 in women with endometriosis and women without the disease. Alpha-6 integrins have an important function, not only in the attachment of cells to the extracellular matrix and laminin, but they also serve as inductors of cell migration and invasion, depending on their pattern of expression in the cell membrane. METHODS: The endometriosis group consisted of 32 women with a confirmed diagnosis of endometriosis by laparoscopy or laparotomy. The control group consisted of 20 women not having endometriosis or any other gynecologic disease at laparoscopy. Endometria were obtained by biopsy. Immunohistochemical techniques were used to assess alpha-6 localization. In each section, the percentage of positive cells and the localization of expression were evaluated. RESULTS: All glandular cells expressed alpha-6 in all of the samples but presented two different patterns, either only in the basal side of the cells (polarized) or also in other sides of the cells (depolarized). The percentage of samples showing depolarized expression was significantly higher in the endometriosis group (66.6% vs 15.8%, chi2 =12.09, P = .001). CONCLUSIONS: The endometria of women with endometriosis more frequently show a depolarized expression of integrin subunit alpha-6, a characteristic usually found in highly proliferating cells with migrating and invasive abilities.

The endometria of patients with endometriosis show higher expression of class I human leukocyte antigen than the endometria of healthy women.

OBJECTIVE: To compare the expression of class I human leukocyte antigen (HLA I) in endometrial samples from patients with and without endometriosis. DESIGN: Cross-sectional study. SETTING: Acute-care teaching hospital in Barcelona, Spain. PATIENT(S): The endometriosis group included 32 patients for whom the only diagnosis during an operation was endometriosis. The control group included 20 women who underwent a laparoscopy and in whom no evidence of endometriosis or any other genital disease was seen. INTERVENTION(S): Samples of endometrium were obtained by curettage and immediately frozen. A pan-HLA I mouse antihuman IgG2a monoclonal antibody was used for immunohistochemical study. MAIN OUTCOME MEASURE(S): Frequency of positive glandular and stromal cells was evaluated in each section. RESULT(S): A significantly higher expression of HLA I in the endometriosis group than in controls, both in the glandular cells (median 100% vs. 80%) and in the stromal cells (median 60% vs. 20%), was observed. CONCLUSION(S): Patients with endometriosis had a significantly higher expression of HLA I molecules in endometrial cells than did the controls. This could be a possible explanation for their higher resistance to natural killer cytolysis.