RESUMO
Breast cancer is the most incidental and deadly neoplasm worldwide; in Mexico, very few epidemiologic reports have analyzed the pathological features and its impact on their clinical outcome. Here, we studied the relation between pathological features and the clinical presentation at diagnosis and their impact on the overall and progression-free survival of patients with breast cancer. For this purpose, we collected 199 clinical records of female patients, aged at least 18 years old (y/o), with breast cancer diagnosis confirmed by biopsy. We excluded patients with incomplete or conflicting clinical records. Afterward, we performed an analysis of overall and progression-free survival and associated risks. Our results showed an average age at diagnosis of 52 y/o (24-85), the most common features were: upper outer quadrant tumor (32%), invasive ductal carcinoma (76.8%), moderately differentiated (44.3%), early clinical stages (40.8%), asymptomatic patients (47.8%), luminal A subtype (47.8%). Median overall survival was not reached, but median progression-free survival was 32.2 months (29.75-34.64, CI 95%) associated risk were: clinical stage (p < 0.0001) symptomatic presentation (p = 0.009) and histologic grade (p = 0.02). Therefore, we concluded that symptom presence at diagnosis impacts progression-free survival, and palpable symptoms are related to an increased risk for mortality.
Assuntos
Neoplasias da Mama , Carcinoma Ductal de Mama , Adulto , Feminino , Humanos , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/patologia , México/epidemiologia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos , Adulto Jovem , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou maisRESUMO
OBJECTIVE: We report on a patient with gallstone ileus and cholecystoduodenal fistula at the Hospital de Especialidades, Centro Medico Nacional Siglo XXI (IMSS) Mexico City, Mexico. CLINICAL CASE: A 54-year-old male patient was admitted to the hospital with a diagnosis of acute cholecystitis. He had undergone an appendectomy at 34 years of age. There was no history of biliary disease. He was afebrile, with moderate abdominal distention and right upper quadrant pain, Murphy (+). His white blood cell count was 8,900/mm(3) with 40% bands. His liver function tests, amylase and lipase, were all within normal limits. Ultrasound revealed edema and thickening of the gallbladder wall with calculi. He underwent exploratory surgery, which provided the following findings: sclerotrophic gallbladder with intense surrounding inflammation. We therefore decided to perform a cholecystostomy. Two days postoperatively the patient presented abdominal distention and vomiting as well as the presence of intestinal material through the cholecystostomy catheter. Plain abdominal film showed the bowel to be dilated and an aberrantly located gallstone. Cholecystography was performed and showed a cholecystoduodenal fistula. Computed tomography was carried out and disclosed the bowel to be slightly dilated and with an intraluminal gallstone. A laparotomy with enterolithotomy was performed. Sized of the gallstone found was approximately 3 cm. Presently the patient is asymptomatic.