[Carcinosarcoma of the breast a rare entity with fatal prognosis. One case report]. / Carcinosarcoma mamario una rara entidad con pronóstico fatal. A propósito de un caso.

BACKGROUND: breast metaplastic carcinomas are a heterogeneous group of neoplasms that exhibit a poor prognosis compared with invasive ductal carcinoma. Correspond less than 1% of all malignant neoplasms of the mammary gland. They usually present as high-grade tumors with a lower rate of lymph node metastases and decreased expression of estrogen and progesterone receptors and Her2 and increased expression of Her1 and Ki-67. CLINICAL CASE: we report a 52 year old woman with a breast carcinosarcoma presented with a left breast tumor fungated, ulcerated, polypoid and 18 cm in major diameter with lymph node metastases at diagnosis. She received multimodal management with neoadjuvant chemotherapy, followed by mastectomy and adjuvant chemotherapy; she presented progression of the disease with lung metastases and local massive recurrence, eventually died from complications associated to the disease. CONCLUSIONS: metaplastic carcinomas of the breast are extremely rare entities. Due the nature of disease and presentation, the prognosis is poor in these patients. There are several histologic subtypes based on studies of hematoxylin and eosin and immunohistochemical stains. It requires multimodal therapy (surgery, radiotherapy and chemotherapy) for best results.

Antecedentes: los carcinomas metaplásticos de la glándula mamaria son un grupo heterogéneo de neoplasias con pobre pronóstico en comparación con el carcinoma ductal invasor. Corresponden a menos de 1% del total de las neoplasias malignas de la glándula mamaria. Casi siempre se manifiestan como tumores de alto grado con menor índice de metástasis ganglionares y menor expresión de receptores de estrógeno y progesterona, Her2 y mayor expresión de Her1 y Ki-67. Caso clínico: se reporta el caso de una mujer de 52 años de edad con carcinosarcoma mamario que se manifiesta con un tumor mamario izquierdo, fungado, ulcerado, polipoide, de 18 cm de diámetro, con metástasis ganglionares al momento del diagnóstico. Recibió tratamiento multimodal con quimioterapia neoadyuvante seguida de mastectomía y quimioterapia complementaria; evolucionó con metástasis pulmonares y recurrencia local masiva. Falleció por complicaciones derivadas de la enfermedad.Conclusiones: los carcinomas metaplásticos de la glándula mamaria son padecimientos sumamente raros. Debido a la naturaleza de la enfermedad y su forma de presentación el pronóstico es pobre. Existen varios subtipos histológicos basados en estudios de hematoxilina y eosina o tinciones de inmunohistoquímica. El tratamiento debe ser multimodal (cirugía, radioterapia y quimioterapia) para obtener mejores resultados.

[Cardiac tamponade due to pericardial metastases of an unknown primary tumor]. / Taponamiento cardiaco por metástasis pericárdicas originadas de tumor primario desconocido.

BACKGROUND: the pericardiocenthesis is indicated as treatment of cardiac tamponade. The prevention of recurrences can be achieve by pericardial instillation of sclerosing agents, radionuclide agents as well as external beam radiotherapy that had given good results in radiosensitivity tumors. Pericardial window, pleuropericardiotomy, pericardiectomie and percutaneous pericardiotomie, are used when the pericardiocenthesis cannot be carried out. CLINICAL CASE: a female patient, 34 years with cardiac tamponade was attended in the emergency room due to hemopericardium and pericardial metastases of unknown primary tumor. She was managed with pericardial window and systemic chemotherapy. After two year, she is alive without evidence of pericardial effusion recurrence and without evidence of tumor activity. CONCLUSIONS: pericardiocentesis is an indication in cardiac tamponade. The multimodal treatment provides better results in patients with metastases to the pericardium and cardiac tamponade. It includes local and systemic chemotherapy and radiation therapy.