RESUMO
BACKGROUND: Sentinel lymph node biopsy in patients with ductal carcinoma in situ still controversial, with positive lymph node in range of 1.4-12.5% due occult invasive breast carcinoma in surgical specimen. OBJECTIVE: To know the frequency of sentimel node metastases in patients with ductal carcinoma in situ, identify differences between positive and negative cases. METHODS: Retrospective study of patients with ductal carcinoma in situ treated with sentinel lymph node biopsy because mastectomy indication, palpable tumor, radiological lesion = 5 cm, non-favorable breast-tumor relation and/or patients whom surgery could affect lymphatic flow drainage. RESULTS: Of 168 in situ carcinomas, 50 cases with ductal carcinoma in situ and sentinel lymph node biopsy were included, with a mean age of 51.6 years, 30 (60%) asymptomatic. The most common symptoms were palpable nodule (18%), nipple discharge (12%), or both (8%). Microcalcifications were common (72%), comedonecrosis pattern (62%), grade-2 histology (44%), and 28% negative hormonal receptors. Four (8%) cases had intra-operatory positive sentinel lymph node and one patient at final histo-pathological study (60% micrometastases, 40% macrometastases), all with invasive carcinoma in surgical specimen. Patients with intra-operatory positive sentinel lymph node where younger (44.5 vs 51 years), with more palpable tumors (50% vs 23.1%), and bigger (3.5 vs 2 cm), more comedonecrosis pattern (75% vs 60.8%), more indifferent tumors (75% vs 39.1%), and less cases with hormonal receptors (50% vs 73.9%), compared with negative sentinel lymph node cases, all these differences without statistic significance. CONCLUSIONS: One of each 12 patients with ductal carcinoma in situ had affection in sentinel lymph node, so we recommend continue doing this procedure to avoid second surgeries due the presence of occult invasive carcinoma.
Antecedentes: en pacientes con carcinoma ductal in situ la biopsia de ganglio centinela es motivo de controversia porque se reportan ganglios positivos en 1.4-12.5% debido al carcinoma invasor oculto en la pieza quirúrgica. Objetivo: conocer la frecuencia de metástasis en ganglio centinela en pacientes con carcinoma ductal in situ e identificar las diferencias entre los casos positivos y negativos. Material y métodos: estudio retrospectivo, transversal, analítico de pacientes con carcinoma ductal in situ a quienes se realizó una biopsia de ganglio centinela por requerir mastectomía, tener un tumor palpable, lesión radiológica = 5 cm, inadecuada relación mama-tumor o porque la escisión pudiera afectar el flujo linfático. Resultados: de 168 carcinomas in situ, se incluyeron 50 casos con carcinoma ductal in situ y biopsia de ganglio centinela, de pacientes con edad promedio de 51.6 años, 30 (60%) de ellas asintomáticas. Los signos reportados fueron: nódulo palpable (18%), secreción por el pezón (12%) o ambos (8%). Predominaron las microcalcificaciones (72%), comedonecrosis (62%) y grado histológico -2 (44%) con 28% de receptores hormonales negativos. En el estudio transoperatorio 4 (8%) pacientes tuvieron ganglio centinela positivo y un caso en estudio histopatológico definitivo (60% micrometástasis, 40% macrometástasis), todos con carcinoma invasor en la pieza quirúrgica. Las pacientes con ganglio centinela transoperatorio positivo eran más jóvenes (44.5 vs 51 años), con más tumores palpables (50 vs 23.1%), más grandes (3.5 vs 2 cm), más comedonecrosis (75 vs 60.8%), más indiferenciados (75% vs 39.1%) y menos receptores hormonales (50 vs 73.9%), que las que tenían ganglio centinela negativo, sin que estas diferencias tuvieran significación estadística. Conclusiones: puesto que 1 de cada 12 pacientes con carcinoma ductal in situ tiene afectación ganglionar en el ganglio centinela, se recomienda seguir tomando la biopsia para evitar segundas cirugías por un carcinoma invasor oculto.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/secundário , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela , Adulto , Axila , Calcinose/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Lobular/diagnóstico , Carcinoma Lobular/secundário , Estrogênios , Feminino , Humanos , Excisão de Linfonodo , Mamografia , Pessoa de Meia-Idade , Invasividade Neoplásica , Estadiamento de Neoplasias , Neoplasias Hormônio-Dependentes/diagnóstico , Neoplasias Hormônio-Dependentes/secundário , Fluido do Aspirado de Mamilo , Progesterona , História ReprodutivaRESUMO
BACKGROUND: The main focus of several studies concerned with cancer progression and metastasis is to analyze the mechanisms that allow cancer cells to interact and quickly adapt with their environment. Integrins, a family of transmembrane glycoproteins, play a major role in invasive and metastatic processes. Integrins are involved in cell adhesion in both cell-extracellular matrix and cell-cell interactions, and particularly, ß1 integrin is involved in proliferation and differentiation of cells in the development of epithelial tissues. This work aimed to investigate the putative role of ß1 integrin expression on survival and metastasis in patients with breast invasive ductal carcinoma (IDC). In addition, we compared the expression of ß1 integrin in patients with ductal carcinoma in situ (DCIS). METHODS: Through tissue microarray (TMA) slides containing 225 samples of IDC and 67 samples of DCIS, ß1 integrin expression was related with several immunohistochemical markers and clinicopathologic features of prognostic significance. RESULTS: ß1 integrin was overexpressed in 32.8% of IDC. In IDC, ß1 integrin was related with HER-2 (p = 0.019) and VEGF (p = 0.011) expression and it had a significant relationship with metastasis and death (p = 0.001 and p = 0.05, respectively). Kaplan-Meier survival analysis showed that the overexpression of this protein is very significant (p = 0.002) in specific survival (number of months between diagnosis and death caused by the disease). There were no correlation between IDC and DCIS (p = 0.559) regarding ß1 integrin expression. CONCLUSIONS: Considering that the expression of ß1 integrin in breast cancer remains controversial, specially its relation with survival of patients, our findings provide further evidence that ß1 integrin can be a marker of poor prognosis in breast cancer. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/6652215267393871.
Assuntos
Biomarcadores Tumorais/análise , Neoplasias da Mama/química , Carcinoma Ductal de Mama/química , Carcinoma Intraductal não Infiltrante/química , Integrina beta1/análise , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Carcinoma Ductal de Mama/mortalidade , Carcinoma Ductal de Mama/secundário , Carcinoma Ductal de Mama/terapia , Carcinoma Intraductal não Infiltrante/mortalidade , Carcinoma Intraductal não Infiltrante/secundário , Carcinoma Intraductal não Infiltrante/terapia , Distribuição de Qui-Quadrado , Intervalo Livre de Doença , Feminino , Humanos , Imuno-Histoquímica , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Receptor ErbB-2/análise , Fatores de Tempo , Análise Serial de Tecidos , Regulação para Cima , Fator A de Crescimento do Endotélio Vascular/análiseRESUMO
PURPOSE: A case of erythema multiforme associated with prophylactic use of phenytoin during cranial radiation therapy is reported. SUMMARY: A 60-year-old woman with intraductal adenocarcinoma of the breast and cerebral metastasis who had an implanted central venous catheter arrived at the hospital for the treatment of cerebral metastasis. She underwent whole brain irradiation and was given a total dose of 3750 cGy over 15 fractional doses spaced over three weeks. At the beginning of cranial radiation therapy, prophylactic oral ranitidine, oral dexamethasone, and oral phenytoin were initiated to prevent seizures. After 30 days of continuous prophylactic phenytoin and cranial radiation therapy, the patient developed an episode of coughing with yellow sputum, mucositis, and a minor skin reaction that was diagnosed in the emergency department as radiotherapy-associated lesions. After 2 days, the patient returned to the hospital with severe mucositis and an erythematous macular eruption on the scalp and auricular region within the radiation field. These were believed to be due to the radiation therapy, and the patient was subsequently hospitalized. The eruption dramatically extended over the next day, with itching micropapular urticarial lesions over large areas of the face, trunk, and genital region. The condition had worsened by the next day, with erythematous eruptions on the whole body (including the extremities), skin detachment, and vesicular lesions on the eyelids. The patient was then diagnosed toxic epidermal necrolysis. CONCLUSION: A patient with intraductal adenocarcinoma of the breast and cerebral metastasis developed erythema multiforme after receiving concurrent phenytoin and radiation therapy.
Assuntos
Anticonvulsivantes/efeitos adversos , Neoplasias Encefálicas/radioterapia , Carcinoma Intraductal não Infiltrante/radioterapia , Eritema Multiforme/etiologia , Fenitoína/efeitos adversos , Anticonvulsivantes/uso terapêutico , Neoplasias Encefálicas/complicações , Neoplasias Encefálicas/secundário , Neoplasias da Mama/patologia , Neoplasias da Mama/radioterapia , Carcinoma Intraductal não Infiltrante/complicações , Carcinoma Intraductal não Infiltrante/secundário , Irradiação Craniana/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Fenitoína/uso terapêutico , Convulsões/etiologia , Convulsões/prevenção & controle , Síndrome de Stevens-Johnson/diagnóstico , Síndrome de Stevens-Johnson/etiologiaRESUMO
Ductal carcinoma in situ (DCIS) represents a small number of cases in countries with inadequate breast cancer screening programs, and in the majority of cases is diagnosed as a palpable lump. It has been proposed that DCIS with palpable lump > or = 2.5 cm can be associated with microinvasion or invasive carcinoma and risk of axillary metastasis. The purpose of the present study is to evaluate incidence of microinvasion, invasion, and the role of lymphatic mapping and sentinel lymph node biopsy in DCIS > or = 2.5 cm. We conducted a retrospective analysis of patients with histologically proven incisional, excisional, or core biopsy of DCIS lump > or = 2.5 cm at a tertiary-care hospital. All patients underwent lymphatic mapping with sentinel lymph node biopsy.A total of 24 patients were included with average tumor size of 4 cm (range, 2.5-6 cm); 29% had microinvasive and 12.5% had invasive disease, three patients (12.5%) had positive sentinel lymph node, all had micrometastasis, and no metastasis were found in non-sentinel lymph nodes. Incidence of microinvasion and invasion were directly related with tumor size (10% for DCIS tumor size of 2.5-3.5 cm, 57% for 3.6-4.5 cm, and 71% for tumors between 4.5 and 6 cm). In addition, axillary metastasis incidence had a direct relationship with tumor size. (0% in 2.5-3.5-cm tumor size, 14% for 3.6-4.5 cm, and 28% in DCIS between 4.6 and 6.0 cm). The present study shows high incidence of microinvasion and invasion in DCIS diagnosed in tumors > or = 2.5 cm and supports the importance of axillary evaluation in patients with tumors >3.5 cm by means of lymphatic mapping and sentinel lymph node biopsy.
Assuntos
Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/secundário , Linfonodos/patologia , Adulto , Idoso , Axila , Feminino , Humanos , Incidência , Metástase Linfática , Pessoa de Meia-Idade , Invasividade Neoplásica , Valor Preditivo dos Testes , Estudos Retrospectivos , Biópsia de Linfonodo SentinelaAssuntos
Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/secundário , Carcinoma Intraductal não Infiltrante/secundário , Metástase Linfática/diagnóstico , Biópsia de Linfonodo Sentinela , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico por imagem , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante/diagnóstico por imagem , Corantes , Reações Falso-Negativas , Feminino , Humanos , Metástase Linfática/diagnóstico por imagem , Metástase Linfática/patologia , Estadiamento de Neoplasias , Cintilografia , Compostos Radiofarmacêuticos , Biópsia de Linfonodo Sentinela/métodosAssuntos
Humanos , Feminino , Carcinoma Ductal de Mama/secundário , Carcinoma Intraductal não Infiltrante/secundário , Metástase Linfática/diagnóstico , Neoplasias da Mama/patologia , Biópsia de Linfonodo Sentinela , Biópsia de Linfonodo Sentinela/métodos , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama , Carcinoma Intraductal não Infiltrante/diagnóstico , Carcinoma Intraductal não Infiltrante , Compostos Radiofarmacêuticos , Reações Falso-Negativas , Metástase Linfática/patologia , Metástase Linfática , Estadiamento de Neoplasias , CorantesRESUMO
A panel of nine monoclonal and polyclonal antibodies were tested regarding specificity for metastatic breast cancer. A hundred metastatic tumors were stained, 50 of breast origin and 50 of other origins. Antibodies used were anti-alpha-lactalbumin, anti-lactoferrin, anti-casein, E29 (Dako-EMA), anti-secretory component, anti-gross cystic disease fluid protein (GCDFP15), BRST1, BRST2, and MC5. Analyses of the results were performed using chi-square and logistic regression. Positivity for MC5, BRST1, BRST2, lactoferrin, EMA, and GCDFP15 was significantly higher in tumors of breast origin than in others (p less than 0.05). Analyses of the whole panel indicated that GCDEP15 and MC5 were the best markers for identification of breast cancer metastases. When both were positive (58% of breast origin cases), the predicted probability of breast origin was 98%, compared to only 5% when both were negative. Comparison of anti-GCDFP15 with BRST2, a monoclonal antibody against the same protein, showed a slightly better sensitivity of the former, and a similar degree of specificity for breast tissue. In conclusion, a panel of antibodies can be used to securely differentiate metastatic breast cancer from other cancers in a large number of metastatic tumors of unknown origin.
Assuntos
Anticorpos Monoclonais/imunologia , Anticorpos Antineoplásicos/imunologia , Antígenos de Neoplasias/análise , Biomarcadores Tumorais/análise , Neoplasias da Mama/patologia , Carcinoma Intraductal não Infiltrante/secundário , Metástase Linfática/diagnóstico , Proteínas de Neoplasias/análise , Neoplasias Primárias Desconhecidas/diagnóstico , Carcinoma Intraductal não Infiltrante/química , Carcinoma Intraductal não Infiltrante/diagnóstico , Feminino , Humanos , Neoplasias/patologia , Neoplasias Primárias Desconhecidas/patologia , Neoplasias Ovarianas/química , Neoplasias Ovarianas/diagnóstico , Neoplasias Ovarianas/secundário , Valor Preditivo dos TestesRESUMO
From June 1952 through December 1976, 695 radical operations were performed on 653 women suffering from invasive cancer of the breast. All operations were performed by a single surgeon (E.C.); the same principles in the selection of the patient techniques of surgery and overall treatment were practiced. Postoperative radiation therapy was used only in the beginning of the study, and 56 (15.9%) of the group with axillary metastases received such therapy. No patient with negative axillary lymph node received radiation therapy. No postoperative adjuvant chemotherapy or immunotherapy was administered. Complete follow-up data were obtained in 94.7% of all patients. In accord with the UICC clinical classification, 96 were classified as stage I (14.7%), 445 as stage II (68.1%), and 111 as stage III (17.%); 1 (0.1%) was not classified. From the 653 patients, 651 (two postoperative deaths) were observed for an average of 141.9 months. The longest period of follow-up evaluation for any patient was more than 35 years and the minimum, 10 years. Survival was calculated for the entire study group and for patients classified by nodal status and stage of disease. The 10-year overall survival rate for 651 patients is 60.4%; for those with positive nodes 46.4%, and for those with negative nodes, 76.7%. The overall survival, according to clinical stage, was as follows: the 5-year survival for patients in stage I was 89.5%, and the 10-year survival was 83.1%. In the stage II group, the 5-year survival was 76.1% and the 10-year survival, 58.5%. The patients in stage III had only a 62.1% 5-year survival and a 47.7% 10-year survival.