Sequential administration of dose-dense epirubicin/cyclophosphamide followed by docetaxel/capecitabine for patients with HER2-negative and locally advanced or node-positive breast cancer.

PURPOSE: Capecitabine is effective against metastatic breast cancer (MBC). We hypothesized that sequential treatment with dose-dense epirubicin/cyclophosphamide (EC) and docetaxel/capecitabine would be active and tolerable in the adjuvant/neoadjuvant setting. METHODS: In this prospective phase II clinical trial patients with HER2-negative and node-positive or locally advanced tumors were eligible to receive four cycles of EC (100/600 mg/m2) every 2 weeks with G-CSF on days 3-10, followed by four cycles of docetaxel/capecitabine (75/1,000 mg/m2 b.i.d., days 1-14) every 3 weeks. RESULTS: Fifty-five patients were enrolled with median age of 49, and 80% had hormone receptor-positive disease. The median tumor size was 2.5 cm, with a median of two axillary nodes involved. Seventy-five percent of the first 20 patients had grade 2/3 hand-foot syndrome (HFS). Dose reduction of capecitabine to 800 mg/m2 reduced the grade 2/3 HFS incidence to 31% in the remaining patients. No grade 4/5 toxicities were observed. All 20 patients treated preoperatively responded, with 5 (25%) pathologic complete responses and 3 additional pT0N1 tumors. At a median follow-up of 48 (range 28-60) months, the event-free and overall survival rates are 91 and 98%, respectively. CONCLUSIONS: Sequential treatment with dose-dense EC followed by docetaxel/capecitabine, using a lower capecitabine dose than that approved for MBC, has an acceptable toxicity profile and encouraging activity when used as neoadjuvant or adjuvant treatment of breast cancer.

Enfermedad de Paget de la mama: análisis de una serie de 27 casos / Paget's disease of the breast: analysis of a series of 27 patients

Objetivo: Analizar las características de una serie, con especial referencia a su histogénesis y las posibilidades de la cirugía conservadora. Material y métodos: Se revisó a 27 pacientes portadoras con cáncer de mama (CM) y afectación del pezón con características de enfermedad de Paget (EP). Resultados: Las pacientes tenían una media de 56,5 años, los motivos de consulta fueron: eccema de pezón (48,1%), presencia de tumor mamario (26%) y secreción por el pezón (18,5%). El examen físico advirtió la lesión eccematosa en 26/27 casos. En 11 casos la imagen mamográfica se localizó a nivel retroareolar, en 13 casos distal al pezón y en 3 casos la mamografía fue normal. En 15 casos correspondió a un carcinoma intraductal, y en los 12 restantes a carcinoma ductal infiltrante. En uno la EP fue hallazgo del estudio seriado de la pieza de mastectomía. Se practicó una cirugía conservadora en 5 casos y mastectomía en 22 (6 con reconstrucción inmediata). Tras 6,5 años de seguimiento medio, 2 pacientes presentaron diseminación a distancia y una de las pacientes sometida a cirugía conservadora presentó recidiva local. Conclusiones: La EP representa el 1,4 % de los CM en nuestra serie y el signo diagnóstico característico es el eccema de pezón-aréola. La mamografía muestra una baja sensibilidad diagnóstica; se puede recurrir a la resonancia magnética en los casos de EP sin patología mamográfica y se debe realizar biopsia de la lesión ante la menor duda diagnóstica. El tratamiento más utilizado fue la mastectomía, y se recurrió a la cirugía conservadora en casos seleccionados de EP limitada al pezón, o con lesión subareolar circunscrita, conociendo los riesgos de un tumor subyacente inadvertido

Objective: To analyze the characteristics of a series, with special reference to histogenesis and the possibilities of conservative surgery. Material and methods: We reviewed 27 patients with breast cancer, nipple involvement and characteristics of Paget's disease. Results: The mean age of the patients was 56.5 years. Reasons for consulting were eczema of the nipple (48.1%), breast tumor (26%), and nipple secretion (18.5%). Physical examination revealed an eczematous lesion in 26/27 patients. The mammographic image was localized in the retroareolar area in 11 patients, distal to the nipple in 13 patients and was normal in three patients. Intraductal carcinoma was found in 15 patients and invasive ductal carcinoma in the remaining 12 patients. In one patient, Paget's disease was detected on examination of serial sections of the mastectomy specimen. Conservative surgery was performed in five patients and mastectomy in 22 (six with immediate reconstruction). After a mean follow-up of 6.5 years, distant dissemination occurred in two patients and local recurrence occurred in one patient who underwent conservative surgery. Conclusions: Paget's disease represented 1.4% of breast carcinoma in our series and the characteristic diagnostic sign was eczema of the nipple-aureola. Mammography showed low diagnostic sensitivity. Magnetic resonance imaging should be used in patients with Paget's disease without breast abnormalities. Biopsy of the lesion should be performed when there is diagnostic doubt. The most common treatment was mastectomy. Conservative surgery can be used in selected patients with Paget's disease limited to the nipple or with a circumscribed subareolar lesion, although the risk of an underlying tumor must be taken into account

[Sequelae after illegal injection of liquid silicone for breast augmentation: report of two cases]. / Secuelas tras inyección ilegal de silicona líquida como técnica de aumento mamario: presentación de 2 casos.

The use of liquid silicone for breast augmentation was widespread in the 1960s but was abandoned at the end of the decade due to numerous studies describing the development of a large number of local complications, as well as remote migration of small amounts of silicone. The use of liquid silicone also leads to enormous difficulty in the early diagnosis of breast cancer; these patients are precluded from routine screening programs and must undergo exhaustive periodic examinations. Magnetic resonance imaging has become the most effective test for the early detection of breast cancer in these patients. Indications for subcutaneous mastectomy are the presence of local complications, suspicion of a malignant lesion, or the patient's desire to prevent both these potential problems.

Secuelas tras inyección ilegal de silicona líquida como técnica de aumento mamario: presentación de 2 casos / Sequelae after illegal injection of liquid silicone for breast augmentation: report of two cases

La utilización de silicona líquida con el fin de aumentar el volumen mamario tuvo una amplia difusión en la década de los años sesenta del siglo pasado, pero a finales de ésta, tras la publicación de numerosos estudios que describían la aparición de un gran número de complicaciones locales, así como la migración a distancia de pequeñas cantidades de silicona, su práctica se abandonó. Su empleo dificulta posteriormente el diagnóstico temprano del cáncer de mama, por lo que este grupo de pacientes no debe incluirse en los programas habituales de cribado, sino que han de seguir controles periódicos y exhaustivos. En este contexto, la resonancia magnética es la mejor prueba de imagen para la detección temprana de procesos malignos mamarios. La presencia de complicaciones locales, la sospecha de una lesión maligna o el deseo de la paciente por evitar ambas situaciones son indicación de la mastectomía subcutánea (AU)

The use of liquid silicone for breast augmentation was widespread in the 1960s but was abandoned at the end of the decade due to numerous studies describing the development of a large number of local complications, as well as remote migration of small amounts of silicone. The use of liquid silicone also leads to enormous difficulty in the early diagnosis of breast cancer; these patients are precluded from routine screening programs and must undergo exhaustive periodic examinations. Magnetic resonance imaging has become the most effective test for the early detection of breast cancer in these patients. Indications for subcutaneous mastectomy are the presence of local complications, suspicion of a malignant lesion, or the patient's desire to prevent both these potential problems (AU)

Stereotactic-guided excisional biopsy: a new technique for very thin breasts.

Stereotactic biopsies are widely used for the diagnosis of breast lesions. Most biopsy devices require breast thickness of at least 25-30 mm with compression. We describe an alternative technique in order to perform excisional stereotactic-guided biopsies for very thin breasts using the prone stereotactic table. In the outpatient setting and with local anesthesia, this procedure can be performed by a radiologist, a surgeon, and a nurse. After conventional stereotactic localization, a fine needle is placed at the site of the lesion. Once the point is marked with a skin marker, a 25G x 16 mm needle is introduced. Then, a couple of stereotactic views are taken to confirm the correct position of the needle. Later, the surgeon excises the lesion guided by the needle. Additional radiographs of the specimen and the remaining breast tissue are obtained to ensure the accuracy of the procedure.

Fibroadenomas de mama con atipia o carcinoma en su interior: presentación de nuestra experiencia / Fibroadenomas of the breast with atypia or carcinoma in its interior: presentation of our experience

La presencia de atipia o carcinoma en un fibroadenoma es un hallazgo infrecuente. Se ha realizado un estudio retrospectivo de los archivos de nuestro centro desde enero de 1995 hasta junio de 2003. Se encontraron un total de 881 fibroadenomas con confirmación histológica, y siete de ellos con atipia o carcinoma asociados (dos carcinomas ductales in situ, dos carcinomas lobulillares in situ, y tres hiperplasias ductales con atipia). La edad media fue de 44 años (rango: 36-67). Cuatro de los siete fibroadenomas se presentaron como lesiones palpables que habían experimentado crecimiento, que correspondieron a los cuatro casos de carcinoma. Hallazgos mamográficos (tres casos): dos agrupaciones de microcalcificaciones y un nódulo bien delimitado. Hallazgos ecográficos (seis casos): cuatro nódulos ovoideos bien definidos, un nódulo con calcificaciones y un nódulo ovoideo bien definido de ecoestructura heterogénea. El diagnóstico inicial se realizó mediante biopsia escisional en 5 casos y mediante biopsia con aguja gruesa en otros dos casos. Los dos casos de biopsia con aguja gruesa tuvieron un primer resultado de fibroadenoma, pero la cirugía posterior demostró la presencia de carcinoma ductal in situ y un carcinoma lobulillar in situ. En conclusión se puede decir que los fibroadenomas con atipia o carcinoma pueden ser similares a los fibroadenomas habituales en mamografía y ecografía. Sin embargo, el crecimiento de un nódulo palpable, la presentación mamográfica como microcalcificaciones sospechosas o el hallazgo ecográfico de un nódulo heterogéneo, obligan a la realización de una biopsia escisional para un diagnóstico fiable

The pathological finding of atypia or carcinoma in a fibroadenoma is not frequent. We performed a retrospective study at our institution from January 1995 to June 2003. Seven cases with associated atypia or carcinoma (with histological confirmation) were found out of a total of 881 fibroadenomas. Two ductal carcinomas in situ (DCIS), two lobular carcinomas in situ (LCIS) and three ductal hyperplasias with atypia were found among the seven cases. Mean age was 44 years (range from 36 to 67 years). Four lesions were palpable and experienced growth, corresponding with the carcinoma cases. Mammographic findings (3 cases): Two groups of polymorphic microcalcifications and a well-defined ovoid nodule with heterogeneous echostructure. The initial diagnosis was done by excisional biopsy in five cases and by core needle biopsy in two other cases. The first result of the two cases of core biopsy was fibroadenoma, however subsequent surgery demonstrated the presence of DCIS and LCIS. In conclusion fibroadenomas with atypia or carcinoma may be similar to usual fibroadenomas in mammography and ultrasonography. However, growth of a palpable nodule, mammographic presentation as suspicious microcalcifications, or the ultrasonographic findings of heterogeneous nodule make it necessary to conduct an excisional biopsy for reliable diagnosis

Tumores mucocele-like de mama / Mucocele-like breast tumors

Objetivo: Los tumores mucocele-like (TML) de mama son lesiones infrecuentes que se definen anatomo-patológicamente como quistes o conductos dilatados que contienen mucina. Nuestro objetivo es describir los hallazgos clínicos, mamográficos y ecográficos de los TML de mama. Material y métodos: Estudio retrospectivo. En los archivos de nuestro centro se encontraron cuatro casos de TML, todos ellos confirmados mediante biopsia escisional. Se revisó la presentación clínica (edad y palpación), así como los hallazgos mamográficos y ecográficos. Resultados: La edad media de las pacientes fue de 42 años (rango: 35-48). Uno de los casos resultó palpable, se trataba de un nódulo blando de baja sospecha. Los hallazgos mamográficos consistieron en dos casos en una agrupación de microcalcificaciones polimórficas sospechosas, mientras que en los otros dos las mamografías fueron normales. La ecografía mostró la presencia de quistes con ecos internos difusos en los dos casos con mamografías normales. Conclusiones: Los TML son lesiones mamarias que pueden manifestarse como un nódulo palpable de baja sospecha en la exploración física, como microcalcificaciones sospechosas en mamografía o como quistes con ecos internos difusos en ecografía

Objective: Mucocele-like breast tumors (MLT) are uncommon lesions histologically defined as cysts or dilated ducts that contain mucin. We describe the clinical, mammographic, and echographic findings for MLT. Material and methods: Retrospective study of the four cases of MLT found in our archives; all diagnoses were confirmed at histological study of excisional biopsies. We review the clinical presentation (age and palpation), as well as the mammographic and echographic findings. Results: Mean patient age was 42 years (range: 35-48 years). In one case MLT presented as a soft, low-suspicion, palpable lesion. At mammography, two cases showed a set of suspicious polymorphic micro-calcifications and the other two had normal findings. Echography showed cysts with diffuse internal echoes in the two cases with normal findings at mammography. Conclusions: Breast MLT can present as a low-suspicion palpable nodule at physical examination, as suspicious microcalcifications at mammography, or as cysts with diffuse internal at echography

Lesiones malignas con apariencia mamográfica de ganglios intramamarios / Malignant lesions as mammographically appearing intramammary ganglia

Los ganglios intramamarios son hallazgos mamográficos frecuentes, sin trascendencia patológica. Presentamos dos casos de lesiones malignas de mama cuya apariencia mamográfica puede resultar equívoca al comportarse como los ganglios intramamarios. Aunque el aspecto mamográfico de una lesión recuerde a la de un ganglio intramamario, debe ser estudiada detenidamente, tanto si presenta algún borde mal delimitado como si es palpable (AU)