Metastatic Occult Primary Lobular Breast Cancer: A Case Report.

Breast cancer is the most common malignancy diagnosed in women. Invasive lobular breast cancer (ILC) is the second most common histologic subtype after invasive ductal carcinoma. Metastatic occult primary breast cancer, although rare, is a well-known clinical entity that usually presents with axillary lymphadenopathy without a detectable breast tumour. A perimenopausal woman in her 50s presented with abdominal pain, fatigue, and weight loss. Imaging showed peritoneal carcinomatosis with ascites, ovarian masses, and a lesion in the ascending colon. Gastric and colon biopsies showed infiltration from lobular breast cancer. Diagnostic workup, including mammography, breast ultrasound, and breast MRI, showed no evidence of breast pathology or axillary lymphadenopathy. First-line treatment with goserelin, letrozole, and palbociclib commenced with clinical improvement and radiological response. This case illustrates the challenges faced by clinicians in the diagnosis and treatment of lobular breast cancer without an identifiable primary lesion or axillary lymphadenopathy.

Clinical Evaluation of Serum Levels of SARS-CoV-2 Anti-Spike Protein IgG Antibodies in Infected Patients and Vaccinated Subjects.

BACKGROUND: The aim was clinical evaluation of immune response against SARS-CoV-2, analyzing serum levels of IgG antibodies against the SARS-CoV-2 protein S in infected and vaccinated patients, as well as in subjects with and without frequent comorbidities (arterial hypertension, diabetes mellitus, heart disease, and chronic respiratory disease). METHODS: Patients infected by SARS-CoV-2 confirmed by RT-PCR and subjects vaccinated with vaccines based on the mRNA encoding the SARS-CoV-2 protein S were studied. SARS-CoV-2 anti-S IgG serum levels were quantified by chemiluminescent microparticle immunoassay. RESULTS: There were 79 infected patients with a median age of 53.0 years; 35 women and 44 men; 42 patients with any comorbidities and 37 without comorbidities. The median of SARS-CoV-2 anti-S IgG serum level was 203.4 BAU/mL (11.6 - 5,620.6). The median antibody level in the infected patients with any comorbidities was higher than those without comorbidities. The group of vaccinated subjects included 96 subjects with a median age of 49.5 years; 77 women and 19 men; 31 subjects with any comorbidities and 65 without comorbidities. The median of SARS-CoV-2 anti-S IgG serum levels was 1,145.6 BAU/mL (138.3 - 4,828.1). No significant differences were found in terms of specific or global comorbidities in the vaccinated subjects. CONCLUSIONS: SARS-CoV-2 anti-S IgG serum levels were 5.6 times higher in vaccinated subjects than infected patients. The vaccination produces higher serum antibody levels than SARS-CoV-2 infection. This reinforces the indication for the vaccine in infected patients. These antibodies did not decrease significantly in patients with frequent comorbidities such as hypertension, diabetes, heart disease or chronic respiratory disease.

[Evaluation of susceptibility of multidrug-resistant Pseudomonas aeruginosa strains against ceftolozane/tazobactam]. / Evaluación de la sensibilidad de cepas de Pseudomonas aeruginosa multi-resistentes frente a ceftolozano/tazobactam.

BACKGROUND: Pseudomonas aeruginosa is an opportunistic pathogen associated with high morbidity and mortality. For multidrug-resistant strains (MDR), ceftolozane/tazobactam (CTZ) has been authorized by the European Medicines Agency (EMA) for complicated urinary tract infections, acute pyelonephritis, and complicated intraabdominal infections. AIM: To determine the susceptibility to CTZ of P. aeruginosa MDR in isolated clinical samples at the University Hospital Puerto Real. METHODS: The susceptibility according to the EUCAST to CTZ criteria of strains of P. aeruginosa MDR, between January 2015 and August 2017 has been studied. The multiresistance criteria were those defined by the Centers for Disease Control and Prevention. The antibiotic susceptibility was obtained by automated MicroScan® system (Beckman Coulter). Susceptibility to CTZ was determined using gradient strips (Liofilchem®, Werfen). RESULTS: Of 1253 strains isolated, 7% presented MDR. We studied the susceptibility of a total of 78 strains of MDR P. aeruginosa, of which 5 (6.4%) were resistant to CTZ according to the EUCAST criteria. CONCLUSIONS: In our environment, the in vitro resistance to CTZ in MDR P. aeruginosa strains is approximately 6%. CTZ is an option for the treatment of infections by MDR P. aeruginosa when there is no other alternative and its in-vitro susceptibility has been proven.

Evaluación de la sensibilidad de cepas de Pseudomonas aeruginosa multi-resistentes frente a ceftolozano/tazobactam / Evaluation of susceptibility of multidrug-resistant Pseudomonas aeruginosa strains against ceftolozane/tazobactam

Resumen Introducción: Pseudomonas aeruginosa es un patógeno oportunista asociado a alta morbi-mortalidad. Para cepas multi-resistentes (MDR), ceftolozano/tazobactam (CTZ) se ha autorizado por la Agencia Europea del Medicamento (EMA) para infecciones del tracto urinario complicadas, pielonefritis aguda e infecciones intra-abdominales complicadas. Objetivo: Determinar la sensibilidad a CTZ de P. aeruginosa MDR en muestras clínicas aisladas en el Hospital Universitario Puerto Real. Material y Métodos: Se estudió la sensibilidad según criterios EUCAST a CTZ de cepas de P. aeruginosa MDR, entre enero de 2015 y agosto de 2017. Los criterios de multi-resistencia fueron definidos por el Centers for Disease Control and Prevention. La sensibilidad antimicrobiana se obtuvo mediante sistema MicroScan® (Beckman Coulter). La sensibilidad a CTZ se determinó mediante tiras de gradiente (Liofilchem®, Werfen). Resultados: De 1253 cepas, 7% fueron MDR. Se estudió la sensibilidad de 78 cepas de P. aeruginosa MDR, de las cuales cinco (6,4%) resultaron resistentes a CTZ según criterios EUCAST. Conclusiones: En nuestro medio la resistencia in vitro a CTZ en cepas de P. aeruginosa MDR es aproximadamente 6%; CTZ es una opción de tratamiento de infecciones por cepas de P. aeruginosa MDR cuando no exista otra alternativa y se haya comprobado su sensibilidad in vitro.

Background: Pseudomonas aeruginosa is an opportunistic pathogen associated with high morbidity and mortality. For multidrug-resistant strains (MDR), ceftolozane/tazobactam (CTZ) has been authorized by the European Medicines Agency (EMA) for complicated urinary tract infections, acute pyelonephritis, and complicated intraabdominal infections. Aim: To determine the susceptibility to CTZ of P. aeruginosa MDR in isolated clinical samples at the University Hospital Puerto Real. Methods: The susceptibility according to the EUCAST to CTZ criteria of strains of P. aeruginosa MDR, between January 2015 and August 2017 has been studied. The multiresistance criteria were those defined by the Centers for Disease Control and Prevention. The antibiotic susceptibility was obtained by automated MicroScan® system (Beckman Coulter). Susceptibility to CTZ was determined using gradient strips (Liofilchem®, Werfen). Results: Of 1253 strains isolated, 7% presented MDR. We studied the susceptibility of a total of 78 strains of MDR P. aeruginosa, of which 5 (6.4%) were resistant to CTZ according to the EUCAST criteria. Conclusions: In our environment, the in vitro resistance to CTZ in MDR P. aeruginosa strains is approximately 6%. CTZ is an option for the treatment of infections by MDR P. aeruginosa when there is no other alternative and its in-vitro susceptibility has been proven.

Quantitative evaluation of breast cancer response to neoadjuvant chemotherapy by diffusion tensor imaging: Initial results.

BACKGROUND: Diffusion tensor imaging (DTI) yields several parameters that have not been tested in response evaluation to neoadjuvant chemotherapy (NAC). PURPOSE: To evaluate and compare in reference to histopathology findings the ability of DTI and dynamic contrast-enhanced (DCE) MRI to monitor response to NAC. STUDY TYPE: Retrospective. POPULATION: Twenty patients treated with neoadjuvant chemotherapy. FIELD STRENGTH/SEQUENCE: 1.5T MRI axial, bilateral T2 -weighted, DTI, and DCE-MRI. ASSESSMENT: A standardized blinded image analysis at pixel resolution generated color-coded maps of DTI and DCE parameters STATISTICAL TESTS: Pearson's correlation analysis and Bland-Altman plots of the DTI and DCE size changes and of the pathological final residual tumor diameter and DCE or DTI final diameter, from pre- to post-NAC. Spearman coefficient of rank correlation between the DTI and DCE size changes from pre- to post-NAC and Miller and Payne (M&P) pathological response grading. Receiver operating characteristic curve analyses to differentiate between responders to nonresponders on the basis of the DTI and DCE percent size changes and the changes in DTI parameters. RESULTS: DTI and DCE changes in the cancers' diameter and volume from pre- to post-NAC exhibited high and significant Pearson correlation (r = 0.82 P = 1.2 × 10-5 ). The DTI volume changes exhibited a significant Spearman coefficient rank correlation (0.68, P = 0.001) with the pathological M&P grading and differentiated between responders and nonresponders with area-under-the-curve (AUC) of 0.83 ± 0.10. A similar AUC for differentiating responders from nonresponders was exhibited by the changes in the highest diffusion coefficient (0.84 ± 0.11) and the mean diffusivity (0.83 ± 0.11). The DTI residual-tumor-diameter showed a high and significant Pearson correlation (r = 0.87 P = 1.2 × 10-6 ) to pathology tumor diameter. DATA CONCLUSION: DTI monitors changes in cancer size and diffusion tensor parameters in response to NAC with an accuracy equivalent to that of DCE, enabling differentiation of responders from nonresponders and assessment of residual tumor size in high congruence with pathology. LEVEL OF EVIDENCE: 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:1080-1090.

Cirugía guiada con radiotrazadores de lesiones de mama no palpables y del ganglio centinela / Radioguided localization with radiotracer of non palpable breast lesions and sentinel node

Objetivo. Evaluar nuestra experiencia en el procedimiento de localización prequirúrgica de lesiones de mama no palpables (LMNP) y del ganglio centinela (GC) con radiotrazadores. Material y métodos. Se incluyeron las LMNP localizadas prequirúrgicamente durante el período comprendido desde enero de 2001 a diciembre de 2011. La inyección del radiotrazador se realizó guiada con ecografía o mamografía. Se obtuvo comprobación con gammagrafía prequirúrgica en todos los casos. El cirujano localizaba en quirófano las LMNP y el GC axilar con una sonda detectora portátil. El estudio histológico del GC se realizó intraoperatorio para evitar reintervenciones si estaba indicada la linfadenectomía axilar. Resultados. Se incluyeron 881 pacientes, de las cuales 226 presentaban lesiones benignas en las que estaba indicada la tumorectomía, y 655 presentaban lesiones malignas en las que estaba indicado el tratamiento quirúrgico conservador. La tasa de detección de las LMNP fue del 99,4%, consiguiendo reducir las reintervenciones por bordes afectos hasta un 7,4%. Conclusión. En nuestra experiencia la cirugía radioguiada de LMNP con radiotrazadores es una técnica sencilla y rápida que permite la extirpación con márgenes quirúrgicos suficientes y resultado estético óptimo, así como la biopsia del GC en la misma intervención ((AU)

Objective. To evaluate our experience with preoperative localization of non-palpable breast lesions (NPBL) with the injection of a radiotracer, or radioguided occult lesion localization technique, and with localization of NPBL and sentinel node (SN) with a single injection of radiotracer, or SN and occult lesion localization technique. Material and methods. We included NPBL in which excision was indicated during the period from January 2001 to December 2011. The radiotracer was injected under stereotactic or ultrasound guidance. Scintigraphy was carried out in all patients before surgery. The surgeon in the operating room had a hand-held gamma probe to locate the lesions in the breast and in the axilla. Intraoperative pathological examination of the SN was done to avoid reinterventions if there were indications for axillary lymphadenectomy. Results. We included 881 patients: 226 benign lesions were localized in patients with indications for lumpectomy and 655 malignant lesions in patients scheduled for breast conserving treatment. The detection rate of NPBL was 99.4%. Reoperations were reduced to 7.4%. Conclusion. In our experience, radioguided surgery of NPBL with radioguided occult lesion localization-SN and occult lesion localization is a quick and simple technique that allows tumor excision with adequate surgical margins and optimal cosmetic results, as well as SN biopsy during the same operation ((AU)