Benedito Borges da Silva

Preoperative pelvic lymphoscintigraphy is of limited usefulness for sentinel lymph node detection in cervical cancer.

OBJECTIVES To analyze concordance between preoperative lymphoscintigraphy and intraoperative lymphatic mapping (ILM) for sentinel lymph node identification using technetium 99m-labeled-dextran 500 (99m-Tc) and patent blue dye in patients with early cervical cancer undergoing radical hysterectomy and pelvic lymphadenectomy, as well as to evaluate sentinel lymph node (SLN) detection. STUDY DESIGN Forty-seven patients underwent surgical treatment for cervical cancer. For SLN identification, 99m-Tc and blue patent were injected into the cervix on the eve and day of surgery, respectively. Preoperative pelvic lymphoscintigraphy was performed in all patients after 99m-Tc injection. Concordance between preoperative lymphoscintigraphy and ILM was evaluated. RESULTS Of the 56 patients who underwent preoperative lymphoscintigraphy, 43 (81.13%) had at least one lymph node identified. Bilateral lymph nodes were identified in 21 (37.5%) patients. Sentinel lymph nodes detected on ILM had been previously found on preoperative lymphoscintigraphy in 66.7%, 67.2% and 0% in the right, left and central locations, respectively. In 14 patients (25%), only one lymph node was identified on preoperative lymphoscintigraphy, but more than one sentinel lymph node was detected on intraoperative mapping. In nine (16.1%) patients, lymphoscintigraphy showed only unilateral lymph nodes, but ILM identified bilateral sentinel lymph nodes. CONCLUSION The combination of patent blue and radionuclide techniques produced excellent results for SLN detection in cervical cancer. Preoperative lymphoscintigraphy does not offer any advantage over ILM for SLN identification.

Estudo do linfonodo sentinela no câncer do colo uterino com azul patente

OBJECTIVE The purpose of this study was to determine the feasibility of sentinel node identification in patients with invasive cervix cancer undergoing radical hysterectomy and pelvic lymphadenectomy using intraoperative lymphatic mapping with patent blue dye. METHODS Fifty one patients wtih Figo I and II cervical cancer were submitted to radical hysterectomy and pelvic lymphadenectomy. The patent blue V was injected around the tumor before beginning surgery. At the time of pelvic lymphadenectomy, lymph nodes with obvious uptake of the dye were separated from the remainder of the lymphadenectomy specimen. RESULTS Sentinel nodes were detected in 32 of the 51 patients. Four cases of false negative were observed. The specificity, sensitivity, positive predictive value and negative predictive value were 38.6%, 42.8%, 10% and 80.9%, respectively. CONCLUSIONS Identification of sentinel node with patent blue dye is feasible in cervical cancer. A larger series will be required to establish sentinel detection in cervical cancer for further therapy concepts and planning.

Melanoma Metastasis to the Breast Masquerading as Fibroadenoma

Background: Although primary malignant breast lesions are common, tumor metastasis to the breast is rare. Melanoma metastasis to the breast occurs even more rarely. Case: In the present case report, we describe an adolescent girl with malignant melanoma metastasis to the breast masquerading as fibroadenoma, in which it was impossible to perform differential diagnosis based only on the physical examination and ultrasonographic evaluation. The definitive diagnosis both of the primary and of the metastatic lesion was reached by immunohistochemistry, which revealed positivity to Mart-1 antibody. Conclusion: Melanoma metastasizing to the breast is occasionally indistinguishable from a benign lesion at ultrasonographic evaluation. Emphasis should be made on the importance of a correct diagnosis prior to therapeutic management.

Zinc and metalloproteinases 2 and 9: What is their relation with breast cancer?

Zinc is the catalytic component of proteins that regulate responses to DNA damage, intracellular signaling enzymes, and matrix metalloproteinases, which are important proteins in carcinogenesis. The objective of this review is to bring current information on the participation of zinc and matrix metalloproteinases types 2 and 9 in mechanisms involved in the pathogenesis of breast cancer. We conducted a literature review, in consultation with the PubMed, Lilacs, and Scielo databases. The zinc and cysteine residues are structural elements shared by all members of the family of matrix metalloproteinases, and these proteins appear to be involved in the propagation of various types of neoplasms, including breast cancer. Moreover, transported zinc is likely to be used for the metalation of the catalytic domain of the newly synthesized metalloproteinases before the latter are secreted. Accordingly, increase in zinc concentrations in cellular compartments and the reduction of this trace element in the blood of patients with breast cancer appear to alter the activity of metalloproteinases 2 and 9, contributing to the occurrence of malignancy. Thus, it is necessary to carry out further studies with a view to clarify the role of zinc and metalloproteinases 2 and 9 in the pathogenesis of breast cancer.

Current aspects of polycystic ovary syndrome: A literature review.

Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine disorder with variable prevalence, affecting about one in every 15 women worldwide. The diagnosis of polycystic ovary syndrome requires at least two of the following criteria: oligoovulation and/or anovulation, clinical and/or biochemical evidence of hyperandrogenism and morphology of polycystic ovaries. Women with PCOS appear to have a higher risk of developing metabolic disorders, hypertension and cardiovascular disorders. The aim of this article was to present a review of the literature by searching the databases Pubmed and Scielo, focusing on publications related to polycystic ovaries, including its pathogenesis, clinical manifestations, diagnosis and therapeutic aspects, as well as its association with cardiovascular and arterial hypertensive disorders.

Marked regression of tumor occupying almost the entire breast following chemotherapys

Image from a 26-year old, breast-feeding woman, G6, P6, delivered seven months previously and hospitalized with an advanced breast tumor affecting the entire right breast. The tumor was ulcerated, infected, infiltrating the chest wall and ipsilateral axillary lymph nodes fixed to one another (Figure 1). Chest x-ray, chest and abdomen CT, and bone scintigraphy detected no signs of metastases. Histology revealed a poorly differentiated invasive ductal carcinoma. Therefore, T4cN2aMO, stage IIIc. The patient ceased breast-feeding and received primary chemotherapy with doxorubicin and cyclophosphamide (four cycles) followed by four cycles of paclitaxel, culminating in marked regression of the tumor and mammary gland (Figure 2). The patient received additional radiotherapy; however, there was a recurrence of the lesion locally and in the lungs nine months later. Breast cancer that occurs during pregnancy or within one year after an obstetric delivery is considered pregnancy-associated breast cancer. The women with this association are at a statistically significant higher risk of presenting with a more advanced disease, worse prognosis and higher risk of death 1 . Anthracyclines and taxanes are the most active widely used chemotherapeutic agents in the treatment of advanced breast cancer 2 , as in the present case. To our knowledge, this is the first report of marked regression of tumor and mammary gland following chemotherapy for advanced breast cancer in a young breastfeeding woman.