Breast Sarcomas: Experience of a Reference Center in Colombia.

Introduction  Breast sarcomas are tumors of a mesenchymal origin, with an incidence of less than 1% of the total breast tumors. The diagnosis of this disease is a challenge for pathologists, radiologists, and breast surgeons.  Aim To describe the diagnostic, therapeutic, and outcomes approach of patients with breast sarcoma treated at the National Cancer Institute (NCI) in Bogota, Colombia.  Materials and methods It is a descriptive and retrospective case series study of patients diagnosed with breast sarcoma treated at the NCI during the period between August 1, 2016 and March 30, 2019.  Results  We identified 14 patients diagnosed with breast sarcoma, 10 (71.4%) patients with primary breast sarcomas, and four (28.6%) with sarcomas associated with radiotherapy. The most frequent histological subtype in both, primary and secondary sarcomas, was angiosarcoma (n = 5, 35.7%). 100% (n = 14) of patients received surgical management as primary treatment. Eight (57.1%) patients presented recurrence (disease-free survival (DFS) follow-up of 5.95 months). A total of five deaths were recorded, representing 35.7% of patients (overall survival (OS) follow-up of 23.5 months). Conclusion Breast sarcomas are characterized by aggressive clinical behavior, which is why it is important to make a precise histological diagnosis and thus provide patients with radical surgical procedures that ensure local control of the disease and improve DFS.

Clinical Behavior of Triple Negative Breast Cancer in a Cohort of Latin American Women.

INTRODUCTION: Breast cancer is a worldwide public health problem. In Colombia, there are 13,000 new cases, having the highest incidence and mortality among cancers. This article describes the clinical behavior of patients with triple negative breast cancer (TNBC) treated at the National Cancer Institute (NCI) in Bogota, Colombia. METHODS: A historical cohort and analytical study that included elderly patients diagnosed with TNBC treated at the National Cancer Institute Functional Breast Cancer Unit (NCI-FBCU) was conducted. RESULTS: Of the 1,066 patients registered in the unit from September 1st 2013 to December 31st 2016: 146 (13.7 %) had triple negative tumors. The average age was 57.3 years; 61% of patients had locally advanced tumors. The majority of patients received neoadjuvant chemotherapy as their first treatment (69.1%), and in 41.2% of the cases platinum was added to the chemotherapy regimen. The most common surgery conducted was modified radical mastectomy in 57.8% of cases. The pathological complete response (pCR) (Chevallier 1 and 2) was reached in 22.6% and, in this group of patients, a greater overall survival (OS) was found [hazard ratio (HR) 0.08, 95% CI 0.01-0.63; p = 0.016]. Progression of the disease occurred in 36.5% of cases, being lungs the most frequent location (44.4%). The death incidence rate was 1.21 deaths per 100 patients/month. The median event-free survival (EFS) was 18.2 months. CONCLUSION: TNBC occurs in Latin American women at advanced clinical stages with aggressive clinical behavior, with lower OS rates, and higher risk of metastasis compared to other molecular subtypes.

Hyperprogression in Pediatric Melanoma Metastatic to the Breast Treated with a Checkpoint Inhibitor.

Metastatic melanomas in the pediatric population are rare, but they have been appearing more frequently. Unfortunately, little is known about the differences in the biology and therapeutic implications of pediatric metastatic melanomas when compared to those found in adults. Herein, we have presented the case of a 13-year-old girl with a stage IIID malignant melanoma arising from a congenital nevus. This patient underwent surgical management, and she received adjuvant interferon therapy; however, this treatment was incomplete due to a grade 3 transaminase elevation and the early recurrence of the disease. An isolated metastasis to the breast was documented, and a mastectomy was performed. Soon afterward, low-volume lung metastases developed, and she was treated with nivolumab. After two treatment cycles, the disease continued to develop in a hyperprogressive manner. Advances in the characterization and understanding of pediatric melanomas are needed, as well as experience in the management of new therapies in these cases, which would help clarify the extent to which we can extrapolate the data obtained from the adult population. Therapeutic interventions in melanoma cases are evolving rapidly, and the role of metastasectomies in the era of immunotherapy and BRAF and MEK-targeted therapies is largely unknown. Moreover, the identification of risk factors for the development of hyperprogression and its underlying mechanisms are also warranted.

Educación en Colombia para la detección temprana del cáncer de mama / Education for the early detection of breast cancer in Colombia

Introducción. El cáncer de mama representa un problema de salud pública cada vez mayor en Colombia. La mayoría de los estudiantes de medicina y de los profesionales de la salud no reciben capacitación para la detección temprana del cáncer de mama. Objetivo. Describir el proceso llevado a cabo por el Instituto Nacional de Cancerología de Colombia, para capacitar a los profesionales de la salud (médicos generales, ginecólogos, médicos familiares y enfermeras) en la detección temprana del cáncer de mama, mediante cursos presenciales y virtuales. Resultados. Con las dos modalidades de cursos, 1.875 profesionales de la salud han sido capacitados, la mayoría de ellos mediante el curso virtual (n=1.294; 73,0 %). Asimismo, los médicos generales han sido los profesionales que más se han certificado mediante alguna de las dos modalidades del curso (n=919; 49,0 %). Los dos cursos generan gran satisfacción en los participantes, con una tasa de certificación del 100 % en la modalidad presencial y del 73,0 % en la virtual. Conclusiones. Es difícil medir el impacto de la capacitación profesional en el diagnóstico precoz del cáncer de mama, porque la mayoría de las regiones de Colombia no tienen registros de cáncer. Es probable que, con un tiempo mayor de seguimiento, se logre medir el impacto real de los cursos en la detección temprana del cáncer de mama y, por ende, en la mortalidad debida a la enfermedad (AU)

Introduction: Breast cancer represents an increasing public health issue in Colombia. Most undergraduate medical students and health professionals do not receive training in early detection of breast cancer. Material and methods: This article describes the process and achievements developed by the National Cancer Institute of Colombia (NCIC) to train health professionals (general practitioners [GP], gynecologists, family doctors and chief nurses) in early detection of breast cancer through two modalities courses: physical presence and virtual. Results: With these two course modalities 1,875 health professionals have been trained, most of them were certified through the virtual course (n=1.294; 73,.0 %). Most of the trained health professionals were GP (n=919; 49,0 %). Both modalities had a high level of satisfaction of the participants, a certification rate of 100 % in the face-to-face modality and 73.0 % in the virtual one. Conclusions: It is difficult to measure the impact of professional training in the clinical staging of breast cancer mainly because most regions in Colombia do not have cancer records. We should have a longer follow-up time to be able to measure the real impact in achieving lower clinical staging and, therefore, to reduce mortality due to the disease (AU)

[Coinfection of dengue and chikungunya viruses. Narrative review]. / Co-infección por los virus del dengue y chikungunya. Revisión narrativa.

BACKGROUND: Dengue and chikungunya viruses are transmitted by the female Aedes aegypti and Aedes albopictus, which are widely distributed in tropical and subtropical areas, facilitating coinfection. AIM: To determine the magnitude, geographical distribution and clinical picture of dengue and chikungunya coinfection. MATERIAL AND METHODS: Narrative review. A search in the PubMed and Lilacs databases was made, using the MeSH terms "Chikungunya", "CHIKV", "DENV", "Dengue" and "coinfection. The articles of the last 20 years were included. RESULTS: A total of 45 articles were included. The largest coinfection report was in Asia followed by Africa. In the Americas, the information is limited because of the recent circulation of chikungunya. The magnitude of coinfection varies between 0% and 31.9%. No differences were found in the distribution of coinfection by sex and age. The clinical picture of monoinfection and coinfection was similar. Some case reports show severe cases with central nervous system involvement, hemorrhagic manifestations and Still's disease. CONCLUSION: The clinical manifestations of coinfection by dengue and chikungunya viruses are similar to those due to monoinfection, which difficult the diagnosis and measurement of its magnitude.

Co-infección por los virus del dengue y chikungunya: revisión narrativa / Coinfection of dengue and chikungunya viruses: narrative review

Resumen Introducción: Los virus del dengue y chikungunya son transmitidos por la hembra de los mosquitos Aedes aegypti y Aedes albopictus, ampliamente distribuidos en zonas tropicales y subtropicales, lo que facilita la co-infección. Objetivo: Determinar la magnitud, la distribución geográfica y el cuadro clínico de la co-infección por dengue y chikungunya. Material y Métodos: Revisión narrativa. Búsqueda en las bases de datos PubMed y Lilacs, utilizando los términos MeSH "Chikungunya", "CHIKV", "DENV", "Dengue" y "coinfection. Se incluyeron los artículos de los últimos 20 años. Resultados: Se incluyeron 45 artículos. El mayor reporte de co-infección fue en Asia seguido de África. En las Américas la información es limitada por la reciente circulación del chikungunya. La magnitud de la co-infección varió entre 0 y 31,9%. No se encontraron diferencias en la distribución de la co-infección por sexo y edad. El cuadro clínico de la mono-infección y la co-infección fue similar. Algunos reportes de caso exponen cuadros graves con afección del sistema nervioso central, manifestaciones hemorrágicas y enfermedad de Still. Conclusión: Las manifestaciones clínicas de la co-infección por dengue y chikungunya son similares a la mono-infección, situación que dificulta el diagnóstico y la medición de su magnitud.

Background: Dengue and chikungunya viruses are transmitted by the female Aedes aegypti and Aedes albopictus, which are widely distributed in tropical and subtropical areas, facilitating coinfection. Aim: To determine the magnitude, geographical distribution and clinical picture of dengue and chikungunya coinfection. Material and Methods: Narrative review. A search in the PubMed and Lilacs databases was made, using the MeSH terms "Chikungunya", "CHIKV", "DENV", "Dengue" and "coinfection. The articles of the last 20 years were included. Results: A total of 45 articles were included. The largest coinfection report was in Asia followed by Africa. In the Americas, the information is limited because of the recent circulation of chikungunya. The magnitude of coinfection varies between 0% and 31.9%. No differences were found in the distribution of coinfection by sex and age. The clinical picture of monoinfection and coinfection was similar. Some case reports show severe cases with central nervous system involvement, hemorrhagic manifestations and Still's disease. Conclusion: The clinical manifestations of coinfection by dengue and chikungunya viruses are similar to those due to monoinfection, which difficult the diagnosis and measurement of its magnitude.

Prevalencia de malignidad en las secreciones patológicas por pezón evaluadas en consulta de mastología / Prevalence of malignancy in patients with abnormal nipple discharge assessed at the breast specialist clinic

Objetivo: Describir la prevalencia de malignidad en las pacientes que presentan secreciones patológicas por pezón y que fueron evaluadas en la consulta de mastología en los hospitales de San José e Infantil Universitario de San José entre enero de 2009 a enero de 2015. Materiales y métodos: Estudio de corte transversal en pacientes que consultaron por secreción patológica por pezón o en quienes se encontró este hallazgo al examen físico. Se excluyeron hombres, embarazadas y mujeres en período de lactancia. Resultados: Se presentaron 70 pacientes con telorrea, de las cuales en el 38,5% se comprometió la mama derecha (27 mamas), en el 32,8% la mama izquierda (23 mamas) y hubo compromiso bilateral en el 28,5% de las pacientes (40 mamas), obteniendo un total de 90 mamas afectadas. El 98,6% presentó este síntoma como motivo de consulta. Se presentó mayor número de casos en la población de mujeres premenopáusicas (47,1%, 33/70). El papiloma intraductal se reconoció como agente causal en el 16,6%, la tasa de malignidad en estas secreciones fue de 2,8% (2/70 pacientes). Conclusiones: En las pacientes con secreción por el pezón se debe descartar la presencia de enfermedad maligna mediante la toma de imágenes complementarias, para así poder definir la mejor conducta médica.

Objective: To describe the prevalence of malignancy in patients presenting with pathologic nipple discharge (ND) attending the breast specialist clinic of San José and Infantil Universitario de San José hospitals between January 2009 and January 2015 Materials and methods: A cross-sectional cohort study conducted in patients who consulted for abnormal ND or with ND found in the clinical examination. Men and lactating and pregnant women were excluded. Results: Seventy (70) patients consulted for abnormal ND, 38.5% had discharge from the right nipple (27 breasts), 32.8% from the left nipple (23 breasts) and 28.5% had bilateral ND (40 breasts), obtaining a total of 90 affected breasts. This complaint was the reason for consultation in 98.6%. Most of the cases were found in the premenopausal women population (47.1%, 33/70). An intraductal papilloma was the cause of ND in 16.6% and the malignancy rate found in these patients was 2.8% (2/70 patients) Conclusions: A malignant lesion must be ruled out in patients presenting with nipple discharge by performing further imaging investigations to best define medical management.