Câncer de mama masculino: análise de 12 casos em uma única instituição / Male breast cancer: a 12 cases analysis in a single institution

O câncer de mama em homens é raro, correspondendo na Europa e nos Estados Unidos a menos de 1% dos casos. No Brasil, não estão disponíveis estatísticas sobre o assunto, o que dificulta a identificação do comportamento epidemiológico e biológico. O objetivo do presente trabalho é realizar um estudo retrospectivo entre homens com câncer de mama no serviço de mastologia do Hospital da Mulher Professor Dr. José Aristodemo Pintotti, da Universidade Estadual de Campinas (UNICAMP), no período de janeiro de 2005 a dezembro de 2009. Doze pacientes do sexo masculino foram diagnosticados com neoplasia mamária. Dados clínicos foram obtidos por meio da revisão dos prontuários. Com uma incidência de 0,57% (12/2.100) de câncer de mama masculino, a idade média foi 65 anos. Apesar do tamanho dos tumores variar entre 1,3 e 8,0 cm, 83% dos pacientes tinham tumores localmente avançados, sendo 75% com comprometimento axilar no momento do diagnóstico, e apenas 1 paciente com metástase à distância. Os tumores eram do tipo carcinoma ductal invasivo, com receptor de estrógeno positivo em 75,0% dos participantes da pesquisa, e receptor de progesterona positivo em 58,4%. Oitenta e três por cento foram submetidos ao tratamento cirúrgico radical. Quimioterapia adjuvante foi administrada em 58,40%, radioterapia em 41,67% e tamoxifeno em 41,67%. Recidivas ocorreram em 6 pacientes (50%), principalmente em osso, pulmão e cérebro. Conclui-se que como existe pouca informação a respeito do câncer de mama masculino, os pacientes demoram a procurar avaliação médica, causando atraso no diagnóstico e apresentação em estágios clínicos mais avançados, impactando negativamente na sobrevida.

Male breast cancer is a rare presentation, and it is responsible for less than 1% of the cases in Europe and the United States. In Brazil, this data is not available, which makes it harder to identify the tumor behavior. We have performed a retrospective study in men with breast cancer, at the Hospital da Mulher Professor Dr. José Aristodemo Pintotti, of Universidade Estadual de Campinas (UNICAMP), between January 2005 and December 2009. Twelve male patients were diagnosed with breast cancer. Data was obtained from clinical reports. The male breast cancer incidence was 0.57% (12/2.100), with medium age of 65. Although the tumor sizes vary between 1.3 and 8.0 cm, 83% of the patients presented a locally advanced disease, 75% with positive limphnodes in the axilla and only one patient had distant methastasis at the diagnosis. The tumors were invasive ductal carcinoma, with positive estrogen receptor in 75.0% of the research participants, and positive progesterone receptor in 58.4%. Eighty three percent underwent radical surgical treatment. Adjuvant chemotherapy

Fusion of magnetic resonance and scintimammography images for breast cancer evaluation: a pilot study.

BACKGROUND: To achieve a more specific method to estimate the real size of breast cancer, we have developed a method to fuse magnetic resonance imaging (MRI) and scintimammography (SM) images. The aim of this study was to assess the feasibility of this method and to evaluate its accuracy to measure the size of breast cancer compared with MRI alone, mammography, and clinical examination, employing pathologic size as the gold standard. METHODS: Twenty consecutive breast cancer women at stages IIA-IIIA, scheduled for mastectomies, underwent SM with (99m)Tc-sestamibi and MRI with gadolinium 2-10 days before surgery. All patients had had recent mammographies and were examined clinically. Software was developed in visual language to perform the fusion between MRI and SM images and tumor measurements (MRI/SM). The tumor size, in 3 diameters (anteroposterior, longitudinal, and transverse), for each examination was correlated with pathological measurements using linear regression. RESULTS: The MRI/SM technique was successfully performed in all patients, and the principal tumor was measured by this method. The MRI/SM cancer measurements correlated better with pathology than MRI, mammography, and clinical exam in all diameters analyzed (r = 0.88, 0.81, 0.81; SE = 0.11, 0.14, 0.11 in anteroposterior, longitudinal, and transverse diameters, respectively). CONCLUSIONS: The MRI/SM is a feasible technique and appears to be more accurate than other examinations (MRI alone, mammography, and clinical exam) to measure breast cancer size.

Nonproliferative epithelial alteration and expression of estrogen receptor and Ki67 in the contralateral breast of women treated with tamoxifen for breast cancer.

The aim of study was to evaluate the frequency of nonproliferative epithelial alteration and expression of Ki67 and estrogen receptors (ER) in patients using tamoxifen. Forty-four women were selected who had been taking 20mg of tamoxifen daily for at least 12 months for adjuvant treatment of breast cancer. The women underwent core biopsy in the contralateral breast into an area of highest fibroglandular mammographic density. Fragments were analyzed by immunohistochemistry for monoclonal antibody Ki67 and ER, and histopathologic analysis. It was verified that 82% of the patients presented nonproliferative epithelial alteration, 70% were ER-negative, and all had low Ki67 expression. There was no association between duration of tamoxifen therapy, patient age, mammographic density, and presence of nonproliferative alteration (P>0.05). In conclusion, tamoxifen for more than a year showed a high frequency of nonproliferative epithelial alteration and low expression of Ki67 and ER in the normal breast tissue, consistent with low cell proliferation.

Pseudomamma on the foot: an unusual presentation of supernumerary breast tissue.

A 22-year-old woman sought medical care for a lesion in the plantar region of her left foot, a well-formed nipple surrounded by areola and hair. Microscopic examination of the dermis showed hair follicles, eccrine glands, and sebaceous glands. Fat tissue was noted at the base of the lesion. Clinical and histopathologic findings were consistent with the diagnosis of supernumerary breast tissue, also known as pseudomamma. To our knowledge, this is the first report of supernumerary breast tissue on the foot.

Radioguided surgery using intravenous 99mTc sestamibi associated with breast magnetic resonance imaging for guidance of breast cancer resection.

The purpose of this study was to evaluate the feasibility of surgery radioguided with intravenous (99m)Tc sestamibi associated with magnetic resonance imaging (MRI) of the breast to detect tumor extent and guide complete tumor resection. A descriptive experimental study was developed with 10 breast cancer patients (stage IIA-IIB) who underwent mastectomy. From 2 to 10 days before surgery, the patients underwent breast MRI with 0.1 mmol/kg of gadolinium and scintimammography with a 740 MBq of (99m)Tc sestamibi. A region of interest was drawn around the tumor image and an uptake curve as a function of time was plotted to calculate the optimal time to perform radioguided surgery. In the perioperative period, the same dose of (99m)Tc sestamibi was intravenously injected into the patients. Tumor resection was performed under the guidance of a gamma probe. MRI was used to evaluate the skin and deep fascia involvement and to detect occult tumor foci which were also excised. Subsequently a modified radical mastectomy was performed. Tumor and residual breast were histopathologically examined. In a series of 10 women, all demonstrated (99m)Tc sestamibi uptake in tumor cells. Eight patients showed no disease in the residual breast, one presented with one foci of invasive ductal carcinoma measuring 0.5 cm in diameter located 5 cm from the tumor bed, and one presented with one foci of ductal carcinoma in situ measuring 0.8 cm at the resection margin. The mean tumor size in the histopathologic assessment was 3.3 cm and in MRI was 5.0 cm. Radioguided surgery using (99m)Tc sestamibi associated with MRI is a feasible technique that can be employed in tumor resection.

Fibroadenoma in axillary supernumerary breast: case report.

CONTEXT: Supernumerary breast tissue may be affected by the same diseases and alterations that compromise topical breast tissue. Nevertheless, reports of fibroadenoma in supernumerary breast tissue in the axillae are rare. OBJECTIVE: To describe a case of fibroadenoma in an axillary supernumerary breast. DESIGN: Case report. CASE REPORT: A 39-year-old woman was referred to the gynecology and obstetrics outpatient clinic at Hospital Estadual Sumaré, complaining of bilateral axillary masses. The patient reported cosmetic problems and local pain and discomfort. On physical examination, alterations compatible with bilateral axillary accessory breasts, without palpable nodules, were observed. Supplementary examinations (mammography and ultrasonography) revealed a 1.1 cm mass in the right axillary breast. The patient underwent resection of the supernumerary breasts and histopathological examination revealed fibroadenoma of the right axillary breast tissue.

Avaliação do tecido glandular e neoplasia residual no retalho cutâneo após mastectomia com preservação de pele por câncer de mama / Evaluation of glandular tissue and residual tumor in the skin flap after slin-parking mastectomies due breast cancer

O objetivo do trabalho foi avaliar a prevalência de tecido glandular e neoplasia residual no retalho cutâneo de pacientes submetidas à mastectomia com preservação de pele (MPP). Quarenta e duas mulheres portadoras de carcinoma de mama, estadio 0 a III, foram submetidas à MPP entre junho de 2003 e janeiro de 2004. Antes da cirurgia, foram desenhadas duas linhas na pele da mama, representando as incisões da MPP e da mastectomia convencional. Após a cirurgia, o retalho cutâneo que permaneceria após a MPP foi retirado. Neste, foram avaliadas a presença de tecido glandular mamário, através da identificação de unidades ducto tubulares alveolares (UDTL), assim como, a presença de neoplasia residual, por microscopia óptica. Estes dados foram correlacionados com outros parâmetros clínicos e patológicos, através de teste exato de Fisher e curva ROC. Em 25/42 (59,5%) dos casos havia UDTL remanescente, associada significativamente com espessura do retalho cutâneo > 5 mm. Em 4/42 das pacientes havia neoplasia residual na pele, associada à espessura > 5mm e presença de UDTL. A curva ROC mostrou que conforme a espessura do retalho cutâneo diminui, também diminui a prevalência de UDTL. Foi concluído que alta prevalência de UDTL e de neoplasia residual estiveram associadas a espessuras de retalhos cutâneos > que 5 mm.

The objective of the study was to evaluate the prevalence of glandular tissue and residual tumor in the skin flap after skin-sparing mastectomies (SSM). Forty-two breast cancer female patients, stage 0 - III, without clinical skin involvement, underwent SSM from June 2003 to January 2004. Before surgery, two lines were drawn on the breast skin, representing SSM and conventional mastectomy incisions. After surgery, the skin flap that would remain after SSM was removed and immediate breast reconstruction was begun. The presence and amount of remaining glandular breast tissues were histologically evaluated in the skin flap, identifying terminal duct-lobular units (TDLU) under an optical microscope, as well as the presence of residual disease. These data were correlated with other clinical and pathological parameters, using the Fisher exact test and ROC curve. The prevalence of residual breast tissue in the sample was 59,5% (25/42) and the presence of TDLU was significantly associated with skin flaps thicker than 5mm. Residual disease was found in 9,5% (4/42) of the women and associated with skin flaps > 5mm thick and presence of TDLU. The ROC curve showed that, as skin flaps reduces in thickness, the presence of TDLU also decreases. It was concluded that a high prevalence of glandular breast tissue and residual disease in the skin flap were associated with skin flaps thickness > 5mm.

Fibroadenoma in axillary supernumerary breast: case report

CONTEXTO: O tecido mamário supranumerário pode ser acometido pelas mesmas doenças e alterações que comprometem o tecido mamário tópico. Porém, o relato de fibroadenoma em mama acessória axilar é raro. OBJETIVO: Descrever um caso de fibroadenoma de mama supranumerária axilar. TIPO DE ESTUDO: Relato de caso. RELATO DE CASO: Mulher de 39 anos, encaminhada ao Ambulatório de Ginecologia e Obstetrícia do Hospital Estadual Sumaré, com queixa de massa axilar bilateral. Paciente referia problemas cosméticos, dor e desconforto local. No exame físico, observaram-se alterações compatíveis com mamas acessórias axilares bilaterais, sem nódulos palpáveis. Os exames complementares (mamografia e ultra-sonografia) demonstraram nódulo de 1.1 cm em mama axilar direita. Paciente foi submetida à ressecção de mamas supranumerárias, com exame histopatológico revelando fibroadenoma de tecido mamário axilar direito.

Evaluation of residual glandular tissue after skin-sparing mastectomies.

BACKGROUND: The oncological safety of skin-sparing mastectomy (SSM) has been the object of several studies. METHODS: From June 2003 to January 2004, 42 breast cancer patients, stage 0 to IIIA, underwent SSM. Before surgery, two lines were drawn on the breast skin, representing SSM and conventional mastectomy incisions. After surgery, the skin flap that would remain after SSM was removed, and immediate breast reconstruction was begun. The presence and amount of remaining glandular breast tissues were histologically evaluated in the skin flap. Terminal ductal lobular units (TDLUs) and residual disease were identified. These data were correlated with other clinical and pathologic parameters by using Fisher's exact test (P value) and receiver operating characteristic curves. RESULTS: The prevalence of residual breast tissue in the sample was 59.5%, and the presence of TDLUs was significantly associated with skin flaps thicker than 5 mm. Residual disease was found in 9.5% of the women and was associated with skin flaps >5 mm thick and the presence of TDLUs. There was no significant association between the presence of TDLUs and residual disease with age, body mass index, menopausal status, clinical and pathologic staging, breast volume, mammographic density, neoadjuvant chemotherapy, type of surgery, and presence of an extensive in situ component. The receiver operating characteristic curve showed that as skin flaps decrease in thickness, TDLUs also decrease. CONCLUSIONS: A high prevalence of glandular breast tissue and residual disease in the skin flap was associated with a skin flap thickness >5 mm.

Impact of the preservation of the intercostobrachial nerve in axillary lymphadenectomy due to breast cancer.

This study evaluated the relationship between preservation of the intercostobrachial (ICB) nerve and pain sensitivity of the arm, the total time of the surgery, and the number of dissected nodes in patients submitted to axillary lymphadenectomy due to breast cancer. An intervention, prospective, randomized, and double blind study was performed on 85 patients at the State University of Campinas, Brazil, from January 1999 to July 2000. The patients were divided into two groups, according to whether the ICB nerve was preserved or not. The surgeries were performed by the same surgeons, utilizing the same technique. The postoperative evaluations were performed at 2 days, 40 days, and 3 months. The pain sensitivity of the arm was evaluated through a specific questionnaire (subjective evaluation) and through a neurologic examination (objective evaluation). The surgical technique presented a feasibility of 100% and preservation of the ICB nerve was related to a significant decrease in the pain sensitivity of the arm, both in the subjective and objective evaluations. After 3 months, in the subjective evaluation, 61% of the patients were asymptomatic in the ICB nerve preservation group, with 28.6% in the nerve section group (p<0.01). In the objective evaluation, 53.7% of the patients presented normal neurologic examination in the ICB nerve preservation group, with 16.7% in the nerve section group (p<0.01). No significant difference was observed in the total time of the surgery (p=0.76) and the number of dissected nodes between the two groups (p=0.59). Local relapse was not observed in any group after 36 months of follow-up. These data support that preservation of the ICB nerve is feasible and leads to a significant decrease in the alteration of pain sensitivity of the arm, without interfering with the total time of the surgery, the number of dissected nodes, and local relapse rate.

Preservação do nervo intercostobraquial na linfadenectomia axilar por carcinoma de mama / Preservation of intercostobrachial nerve during axillary clearance for breast cancer

Objetivos: avaliar a associação entre a preservaçao do nervo intercostobraquial e a sensibilidade dolorosa do braço, tempo de cirurgia e número de linfonodos dissecados em pacientes submetidas à linfadenectomia axilar por carcinoma de mama. Métodos: foi realizado um estudo de intervenção, tipo ensaio clínico, randomizado e duplo-cego com 85 pacientes atendidas no Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas, no período de janeiro de 1999 a julho de 2000. As pacientes foram divididas aleatoriamente em dois grupos, conforme a intenção da preservação ou näo do nervo intercostobraquial. As cirurgias foram realizadas sempre por dois dos pesquisadores, utilizando a mesma técnica. As avaliações pós-operatórias foram feitas com 2 dias, 40 dias e após 3 meses, por um dos pesquisadores que não havia participado das cirurgias. A sensibilidade dolorosa no braço foi avaliada mediante emprego de questionário específico e pelo exame físico neurológico, sempre correlacionado com o membro contralateral. Para a análise estatística foram utilizados os testes t de Student e exato de Fisher. Resultados: a técnica cirúrgica de preservação do nervo intercostobraquial foi factível em 100 por cento dos casos, associando-se a diminuição significativa nas alterações de sensibilidade dolorosa do braço, em comparação com as pacientes que tiveram o nervo intercostobraquial seccionado. Após 3 meses, na avaliação subjetiva 61 por cento das pacientes encontravam-se assintomáticas no grupo da preservação e 28,6 por cento no grupo da secção (p<0,01). Na avaliação objetiva, a porcentagem de pacientes com exame físico neurológico normal no metâmero do nervo intercostobraquial foi de 53,7 por cento e 16,7 por cento (p<0,01) entre os grupos da preservação e secção, respectivamente. Não houve diferença significativa no tempo de cirurgia e número de linfonodos dissecados entre os grupos. A média de tempo foi de 81,2 e 79,1 minutos nos grupos da preservação e secção do nervo e a média do número de linfonodos dissecados foi de 19,5 e 20,4 linfonodos entre os grupos da preservaçao e secçao do nervo intercostobraquial, respectivamente. Conclusão: a preservação do nervo intercostobraquial é factível e leva à diminuição significativa das alterações de sensibilidade dolorosa no braço, sem interferir no tempo cirúrgico e no número de linfonodos dissecados