Carcinoma oculto de la mama metastásico en ganglio intramamario / No disponible

Se presenta un caso de una mujer de 63 años con un nóduloen los cuadrantes externos de la mama derecha con característicasmamográficas y ecográficas de benignidad, en la queel estudio citológico evidencia un carcinoma, el cual histológicamentecorresponde a un ganglio linfático intramamario metastásicocon un primario en la glándula mamaria no detectado

A case of a 63-year old woman with a nodular lesion in theexternal quadrants of the right breast. The lesion was mammographicallyand ultrasonographically benign, but fine needleaspiration showed a carcinoma. Pathologic examinationrevealed a metastatic intramammary lymph node, but the primarycarcinoma in the breast could not be detected

Carcinoma micropapilar infiltrante de la mama y biopsia del ganglio centinela / Infiltrating micropapillary carcinoma of the breast and sentinel lymph node biopsy

Objetivo: Las características histopatológicas del tumorpueden hacer que no sea posible la práctica de la biopsia delganglio centinela (BGC). El propósito de este estudio es evaluarla aplicación y los resultados de esta técnica en pacientescon carcinoma micropapilar infiltrante (CMI) de la mama.Pacientes y método: Durante los últimos siete años ennuestro centro se ha efectuado la BGC en 294 pacientes y sehan diagnosticado 37 CMI. Se trata de un estudio retrospectivode la técnica utilizada para la estadificación ganglionar enestas pacientes. Los resultados de la BGC en pacientes conCMI se comparan con los resultados de esta técnica en pacientescon otros tipos histológicos de cáncer de mama.Resultados: La BGC sólo pudo efectuarse en 8 (22%) delas pacientes con CMI. Cuatro presentaron metástasis, unamicrometástasis y dos células tumorales aisladas (CTA). Ensólo una de las pacientes se detectaron más ganglios afectadosen el resto de la linfadenectomía. En aquellas pacientes en lasque no se pudo realizar la BGC, las principales contraindicacionesfueron: el diagnóstico prequirúrgico de afectación ganglionarmediante punción aspiración con aguja fina guiadaecográficamente y la multifocalidad.Conclusiones: La BGC puede realizarse en pocas ocasionesen pacientes con CMI. Cuando esta puede efectuarse, elporcentaje de metástasis es alto aunque con frecuencia el centinelaes el único ganglio afectado

Objective: Hystopatologic tumor characteristics can carryfailure in the practice of sentinel lymph node (SLN) biopsy.The aim of this study is to evaluate the application and the resultsof this technique in patients with infiltrating micropapillarycarcinoma (IMPC) of the breast.Patients and method: During the last seven years in ourcenter SLN biopsy has been performed in 294 patients and37 IMPC have been diagnosed. This is a retrospective study ofthe technique used for nodal staging in these patients. The resultsof SLN biopsy in those patients with IMPC were comparedwith the results of this technique in patients with other histologicaltypes of breast cancer.Results: SLN biopsy could be done in only 8 (22%) patientswith IMPC. Four had metastases, one micrometastasisand two isolated tumor cells. Only one patient showed morelymph nodes involved in the axilla. In those patients in whomthe SLN biopsy could not be done, positive fine needle aspirationunder ulltrasonographic guidance and multifocal breast involvementwere the main contraindications.Conclusions: SLN biopsy is infrequently indicated in thosepatients with IMPC and, when performed, the percentageof lymph node metastasis is high but mostly limited to SLN

[Two cases of postpartum pubis diastasis mistaken for neurological complications of epidural analgesia]. / Dos casos de diástasis de pubis postparto interpretados como complicación neurológica de la analgesia epidural.

Two healthy 31- and 34-year-old parturients received uncomplicated epidural analgesia for labor and delivery using standard techniques. Twenty-four and 12 hours postpartum, respectively, they developed severe lower back pain and difficulty moving their lower extremities. At first the symptoms were attributed to neurological complications of epidural analgesia and for this reason the anesthetist was called. Although both women appeared healthy and the neurological examinations were normal, emergency computed tomography scans were performed to rule out spinal compression because of the severity of pain and difficulty of movement. The diagnosis was only established after suspecting pubis diastasis, confirmed by palpation of symphysis gaps of 3 and 2 cm, respectively. Pelvic dysfunction associated with pregnancy and labour is a complication whose incidence varies from 1 in 300 to 1 in 30,000. It presents with severe pain located in the areas supplied by pudendal and genitofemoral nerves. The pain may radiate to the sacroiliac joints and shoot down the buttocks and legs. In the most severe cases it may be accompanied by urinary dysfunction and inability to walk. If the clinical features are not recognized, it can be difficult to differentiate pubis diastasis from severe neurological complications in women who have received a central nervous system block. We report two cases of peripartum pubis symphysis diastasis that were both initially mistaken for neurological complications of epidural analgesia for labor.

Hiperplasia ductal esclerosante subareolar de la mama: presentación de ocho casos / Subareolar sclerosing ductal hyperplasia of the breast: report of eight cases

La hiperplasia ductal esclerosante subareolar es una entidad clinicopatológica con características similares a las del adenoma del pezón pero localizada en la región subareolar sin afectarlo. Se revisan las características clínicas, radiológicas, anatomopatológicas y citológicas de ocho casos de hiperplasia ductal esclerosante subareolar.La forma clínica de presentación más frecuente cursó con derrame hemático por el pezón o retracción de la piel. Dos casos presentaron sospecha radiológica, ecográfica o citológica de malignidad. En ningún caso se constató afectación del pezón. El patrón anatomopatológico habitual fue el de papilomatosis, siendo los patrónes esclerosante o adenósico los que se prestaron a una interpretación erronea de malignidad antes del tratamineto quirúrgico. La hiperplasia ductal esclerosante es una entidad clinicopatológica benigna diferenciable del adenoma del pezón que en ocasiones puede ser confundida clínica, radiológica o citológicamente con una lesión maligna de la mama (AU)

Fibroadenoma y cáncer de mama: aspectos clinicopatológicos en 8 casos / Fibroadenoma and breast cancer: clinicopathologic features in eight cases

Objetivo: Revisar los hallazgos clinicopatológicos de los fibroadenomas afectados por un carcinoma de la mama. Pacientes y método: Se han observado 8 casos en los que existía infiltración de un fibroadenoma por un carcinoma durante un período de 11 años. Se revisan los aspectos clinicopatológicos de estos tumores, así como el de las lesiones asociadas en el parénquima circundante. Resultados: Cuatro de los casos presentaron lesiones in situ (dos ductales y dos lobulillares), identificándose en tres de ellos la presencia de neoplasia en el parénquima mamario circundante. En los otros 4 casos la lesión era infiltrante (dos ductales y dos lobulillares) y en todos ellos se extendía más allá del fibroadenoma. Conclusión: La asociación de carcinoma y fibroadenoma es poco frecuente y, en estos casos, tanto el tratamiento como el pronóstico están en función de las características propias del tumor que infiltra al fibroadenoma. (AU)

Assessment of breast cancer size: sonographic and pathologic correlation.

PURPOSE: Accurate presurgical assessment of tumor size in breast cancer is important for choosing appropriate treatment. We retrospectively compared presurgical sonographic measurements of tumor size with postsurgical measurements of size and other variables. METHODS: In 174 cases, tumor size was measured by sonography before surgery, and those measurements were compared with values obtained by histopathologic examination of the specimens. The histologic type and grade, the number of lesions, and the presence of an extensive intraductal component also were considered in the intramodal correlations of tumor size. RESULTS: Sonographic measurements of tumor size correlated well with size measured after surgery (r = 0.72; 95% confidence interval, 0.64-0.78). The correlation was higher for lesions of 20 mm or less in their longest diameter than for larger lesions. The intramodal size correlation was lower for tumors with an extensive intraductal component than for tumors without an extensive intraductal component. The sonographic versus pathologic correlation of tumor size was less accurate when several lesions were present. CONCLUSIONS: Sonography is useful for presurgical assessment of tumor size in patients with breast cancer, especially for single lesions of 20 mm or less and without an extensive intraductal component.

Metastatic breast carcinoma in axillary lymph nodes: in vitro US detection.

PURPOSE: To establish the ultrasonographic (US) characteristics of benign versus metastatic lymph nodes. MATERIALS AND METHODS: One hundred fifty-eight axillary lymph nodes in 40 patients (age range, 31-73 years) surgically treated for breast cancer have been studied in vitro with a 7.5-MHz US probe in a water bath. The long-to-short axis ratio and the hilar and cortical characteristics were evaluated; the US findings were correlated with the histopathologic findings. To estimate the long-to-short axis ratio, all lymph nodes were measured. RESULTS: Of the 158 lymph nodes, 45 showed histopathologic evidence of metastasis; 38 of the 45 revealed US signs of malignancy. The signs that caused malignancy to be suspected were a long-to-short axis ratio of less than 1.5, absence of a hilus, and disruption of the cortical zone. The most specific sign for the diagnosis of metastasis was absence of the hilus. The increase in the long-to-short axis ratio was the finding that caused the most false-negative interpretations. Signs of malignancy were more accurate in lymph nodes 10 mm or larger than they were in lymph nodes smaller than 10 mm. CONCLUSION: Findings of in vitro US studies of axillary adenopathy provide the basis for the evaluation of lymph node metastasis in vivo before surgery, especially in those lymph nodes 10 mm or larger.