Kátia Maciel Pincerato

Analysis by MRI of residual tumor after radiofrequency ablation for early stage breast cancer.

OBJECTIVE The objective of our study was to evaluate the effectiveness of MRI in the detection of possible residual lesions after radiofrequency ablation (RFA) in the treatment of breast cancer. SUBJECTS AND METHODS We prospectively evaluated 14 patients who had undergone ultrasound-guided core biopsies diagnostic of invasive ductal carcinoma (IDC; range of diameters, 1.0-3.0 cm) and then ultrasound-guided percutaneous RFA with sentinel node biopsy as the primary treatment. Breast MRI was performed 1 week before RFA to evaluate tumor extension and again 3 weeks after RFA to verify the presence of possible residual lesions. Conventional surgical resection of the tumors was performed 1 week after RFA. The MRI findings were compared with histopathologic analyses to confirm the presence or absence of residual tumor. RESULTS There was no residual enhancement in seven lesions on the postablation breast MRI scans. These findings were confirmed by negative histopathologic findings in the surgical specimens. The MRI scans of five patients showed small areas of irregular enhancement that corresponded to residual lesions. In the two remaining patients, we observed enhancement of almost the entire lesion, indicating that RFA had failed. CONCLUSION Breast MRI is effective in detecting residual lesions after RFA in patients with IDC.

Coordinated expression of oestrogen and androgen receptors in HER2-positive breast carcinomas: impact on proliferative activity.

Aims Human epidermal growth factor receptor 2 (HER2)-positive breast cancers are aggressive neoplasms associated with a variable response to systemic therapies. Therefore, the identification of biomarkers to better characterise this heterogeneity would improve treatment efficacy. The aim of this study was to evaluate the influence of androgen receptor (AR) and oestrogen receptor (ER) on clinicopathological features in a series of HER2-positive breast carcinomas. Methods A total of 104 carcinomas were selected and reviewed. Immunohistochemical studies for ER, progesterone receptor and Ki-67 were analysed on tumour whole histological sections. AR expression was analysed on samples represented on tissue microarrays. According to steroid receptor expression, cases were classified into three groups: AR positive/ER positive (48 cases), AR positive/ER negative (41 cases) and AR negative/ER negative (13 cases). Results AR-positive tumours corresponded to 89 (85.6%) of 104 carcinomas. AR-positive carcinomas were associated with a higher frequency of ER and progesterone receptor co-expression and lower proliferative activity determined by the expression of Ki-67. AR-negative carcinomas were more often high grade. The group of AR-positive/ER-negative carcinomas was associated with the highest frequency of apocrine morphological features. The group of AR-negative/ER-negative carcinomas was associated with the highest proliferative activity and the highest frequency of high histological and nuclear grade. The lowest frequency of high-grade tumours and the lowest proliferative activity were seen among tumours with expression of both receptors. Conclusions These results suggest that co-expression of AR and ER can provide a protective effect based on phenotypical presentation of HER2-positive carcinomas. Furthermore, lack of both steroid hormone receptors characterises the most aggressive phenotype.

Geographic differences in the distribution of molecular subtypes of breast cancer in Brazil.

BackgroundTo compare the distribution of the intrinsic molecular subtypes of breast cancer based on immunohistochemical profile in the five major geographic regions of Brazil, a country of continental dimension, with a wide racial variation of people.MethodsThe study was retrospective observational. We classified 5,687 invasive breast cancers by molecular subtype based on immunohistochemical expression of estrogen-receptor (ER), progesterone-receptor (PR), human epidermal growth factor receptor 2 (HER2), and Ki-67 proliferation index. Cases were classified as luminal A (ER and/or PR positive and HER2 negative, Ki-67 < 14%), luminal B (ER and/or PR positive, HER2 negative, and Ki-67 > 14%), triple-positive (ER and/or PR positive and HER2 positive), HER2-enriched (ER and PR negative, and HER2- positive), and triple-negative (TN) (ER negative, PR negative, and HER2- negative). Comparisons of the ages of patients and molecular subtypes between different geographic regions were performed.ResultsSouth and Southeast regions with a higher percentage of European ancestry and higher socioeconomic status presented with the highest proportion of luminal tumors. The North region presented with more aggressive subtypes (HER2-enriched and triple-negative), while the Central-West region predominated triple-positive carcinomas. The Northeast—a region with a high African influence—presented intermediate frequency of the different molecular subtypes. The differences persisted in subgroups of patients under and over 50 years.ConclusionsThe geographic regions differ according to the distribution of molecular subtypes of breast cancer. However, other differences, beside those related to African ancestry, such as socioeconomic, climatic, nutritional, and geographic, have to be considered to explain our results. The knowledge of the differences in breast cancer characteristics among the geographic regions may help to organize healthcare programs in large countries like Brazil with diverse economic and race composition among different geographic regions.

Conization, frozen section examination, and planned hysterectomy in the treatment of high-grade cervical intraepithelial neoplasia

PURPOSE We tested the role of frozen section examination of the cone specimen in the evaluation of the resection margin status and to rule out invasion in patients with high-grade cervical intraepithelial neoplasia. METHODS Twenty-five patients with cervical intraepithelial neoplasia underwent conization followed by frozen section examination and planned hysterectomy. The results of the definitive paraffin exam were compared with frozen section examination. RESULTS In the evaluation of the margins by frozen section examination, 16 patients (64%) had positive cone margins and 9 (36%) had negative margins. The definitive paraffin examination of margin status was concordant in all the cases. Intraoperative diagnosis of invasion was made in 5 cases, and 1 of these was microinvasive. Among the remaining 20 cases, we detected 2 additional microinvasive carcinomas after paraffin study, so the diagnosis of the frozen section examination was concordant with the paraffin sections in 23/25 cases (92%). Two cases of microinvasive carcinoma were diagnosed as cervical intraepithelial neoplasia by frozen section examination and had less than 2 mm stromal invasion. CONCLUSIONS In high-grade cervical intraepithelial neoplasia, frozen section examination can provide immediate and precise evaluation of the cone margin status in high-grade cervical intraepithelial neoplasia. It can identify frank invasion and permit adequate treatment in a one-stage procedure. In early microinvasive disease, frozen section examination fails to detect the area of invasion but reliably detects clear resection margins.

Acurácia do Linfonodo Sentinela em Pacientes com Câncer Inicial da Mama Tratadas com Quimioterapia Neoadjuvante

Objetivo: avaliar a capacidade preditiva do estudo do linfonodo sentinela (LS) em relacao ao estado linfonodal axilar em pacientes com carcinoma invasor inicial de mama submetidas ou nao a quimioterapia neoadjuvante. Metodos: foi realizado estudo prospectivo de 112 pacientes, que foram divididas em dois grupos. O primeiro grupo foi constituido por 70 pacientes que nao receberam quimioterapia previa (Grupo I) e o segundo foi formado por 42 pacientes que foram submetidas a quimioterapia neoadjuvante, com tres ciclos do esquema AC (adriamicina + ciclofosfamida) (Grupo II). A resposta a quimioterapia foi parcial >50% em 21 pacientes, sendo que em tres foi completa, e parcial <50% em 19 pacientes; em duas pacientes houve progressao da doenca. Procedeu-se a injecao peritumoral de dextran marcado com 99mTc. A mesma foi realizada com auxilio de estereotaxia em 29 pacientes com tumores nao palpaveis, sendo 16 do grupo I e 13 do grupo II. Os acumulos radioativos demonstrados por cintilografia orientaram a biopsia do LS axilar, com auxilio de probe portatil. O estudo anatomopatologico dos LS compreendeu inicialmente um unico corte histologico. Os LS livres foram submetidos a cortes seriados a cada 50 mm e corados por HE. Resultados: o LS foi identificado em 108 pacientes. Em tres pacientes do grupo I e em uma do grupo II, nas quais nao se obteve identificacao do LS, as lesoes nao eram palpaveis. A acuracia do metodo na predicao do estado linfonodal axilar foi de 100% no grupo de pacientes que nao receberam quimioterapia neoadjuvante e de 93% naquele em que esta forma de tratamento previo foi utilizada. Essa diferenca se mostrou estatisticamente significante. Conclusoes: o presente trabalho possibilitou-nos concluir que em todas as pacientes que nao receberam tratamento quimioterapico previo o estudo do LS foi eficaz para predizer o estado dos linfonodos da axila. A taxa de resultados falso-negativos no grupo de pacientes submetidas a quimioterapia neoadjuvante parece invalidar o emprego do estudo do LS nas mesmas.

Metástase oculta em linfonodo sentinela no câncer de mama em estádios iniciais

PURPOSE: sentinel lymph node biopsy in early-stage breast cancer patients has been substituting the total axillary lymph node is presented dissection. The technique of processing the sentinel lymph node and the aim of this study was to investigate the efficacy of occult metastasis identification based on the standard histological and immunohistochemical examination. METHODS: between 2002 and 2005, 266 sentinel lymph nodes were harvested from axillary biopsy of 170 patients with early stage breast cancer. All lymph nodes were considered to be negative according to standard intra-operative cytological assessment. Lymph nodes were transversally sectioned in four or five slices and embedded in paraffin blocks. Two paraffin-embedded tissue sections with 4 µm in thickness were mounted on glass slides and stained with hematoxylin-eosin and immunoperoxidase (cytokeratin AE1/AE3) techniques. RESULTS: standard histological examination identified metastasis in 22 patients (12.9%) and micrometastatic disease was observed in six of these patients (3.5%). The immunohistochemical examination identified metastatic disease in 16 patients (9.4%). Among them, isolated tumor cells were observed in 11 (6.5%) and micrometastases were identified in five (2.9%). CONCLUSIONS: the association of the standard histological examination and immunohistochemical technique increases the chances of sentinel lymph node metastasis identification.

Cat scratch disease presenting as axillary lymphadenopathy and a palpable benign mammary nodule mimicking a carcinoma

We present a case involving a 74-year-old woman with cat scratch disease characterized by an enlarged and hard axillary lymph node as well as a palpable breast nodule mimicking a carcinoma. The lymph node and the breast nodule were excised. The pathologic examinations revealed granulomatous lymphadenitis with gram-negative bacilli and an intraductal papilloma. Antibiotic therapy (azithromycin) was prescribed and the patients clinical evolution was excellent.

Idiopathic granulomatous mastitis: diagnosis and follow-up with magnetic resonance imaging

Study carried out at Instituto de Responsabilidade Social do Hospital Sírio Libanês – São Paulo (SP), Brazil. 1Hospital Sírio-Libanês – São Paulo (SP), Brazil. *Corresponding author: felipe.andrade@hsl.org.br Conflict of interests: nothing to declare. Recebido em: 12/19/2016. Aceito em: 05/30/2017 A mastite granulomatosa é uma condição rara e benigna da mama que, em alguns casos, possui etiologia desconhecida de doença inflamatória benigna, a mastite idiopática. Seu diagnóstico normalmente é feito por exclusão. Os exames de imagens têm demonstrado achados inespecíficos que podem sugerir uma doença inflamatória, um carcinoma ou não apresentar alterações. Deve ser realizado um diagnóstico diferencial com outras causas de mastites, sempre alertando para o risco de carcinoma inflamatório. Os exames de imagem servem mais para descartar uma malignidade do que para confirmar a mastite granulomatosa idiopática. Em função de tanto os exames de imagem como o exame físico poderem simular uma lesão maligna da mama, o laudo histopatológico é fundamental para estabelecer o diagnóstico. A sua etiologia permanece desconhecida, portanto, o tratamento é controverso na literatura, com alguns autores recomendando cirurgia, outros a imunossupressão e, por fim, alguns antibióticos. É apresentado o caso de uma paciente de 21 anos com uma lesão suspeita na mama associada à descarga papilar. Durante a investigação, houve um realce de 12 x 6 x 8,5 cm na ressonância magnética associado a sinais inflamatórios na pele e nos linfonodos. O exame anatomopatológico evidenciou um quadro de mastite granulomatosa idiopática. O realce desapareceu completamente após o tratamento conservador com corticoterapia. A mamografia e o ultrassom também podem demonstrar alterações inespecíficas, tais como assimetria focal, massa indefinida ou distorção. Apesar das limitações dos exames de imagem, demonstrou-se, neste relato, que a ressonância magnética pode ser utilizada para monitorar a resposta clínica ao tratamento conservador e o acompanhamento pelo risco de recorrência.