Vilmar Marques de Oliveira

Late Seroma after Breast Augmentation with Silicone Prostheses: A Case Report

Since its introduction in 1962, the use of cosmetic silicone breast implants has increased rapidly (1). It is estimated that between one and two million women currently have silicone breast implants (2). During the past decade, a number of studies have evaluated the potential health risks associated with breast augmentation with silicone gel-filled implants (3). The implantation of silicone prostheses may lead to early and late complications. The most common early complications are infection and hematoma formation. Among late complications, the most common is capsular contracture. A retrospective epidemiological study to evaluate the occurrence and severity of local complications after cosmetic breast implantation observed, among 754 women (1,572 implants), the following results: placement was submuscular for 91.3% of the implants, subglandular for 2.6% and 6.1% had no available information. Overall, 77.8% of the implantations were not followed by complications, 17.8% were followed by one complication, 3.6% were followed by two complications and 0.8% was followed by three or more complications. In 94.6% of the implantations, no additional hospitalizations were recorded as a result of complications. Forty-seven of 57 explantations ⁄ reimplantations were secondary to postoperative complications. General complications, such as hematoma and infection were rare, occurring in 2.3% and 2.0% of the implantations, respectively. Capsular contracture remains the most common complication, occurring in 11.4% of the implantations. One case of late seroma was reported in this study (4). The incidence of seroma in the immediate postoperative period ranges around 0.1% for aesthetic breast augmentation (4). Late seroma formation is an extremely rare complication. There is no data regarding its incidence in the literature, only a few isolated reports can be found. This report presents a case of late seroma (after five years of breast augmentation) with no recognized cause.

Valores preditivos das categorias 3, 4 e 5 do sistema BI-RADS em lesões mamárias nodulares não-palpáveis avaliadas por mamografia, ultra-sonografia e ressonância magnética

OBJECTIVE: To evaluate the predictive value of BI-RADS™ categories 3, 4 and 5 in non-palpable breast masses assessed by mammography, ultrasound and magnetic resonance imaging MATERIALS AND METHODS: Twenty-nine patients with BI-RADS categories 3, 4 and 5 nonpalpable breast masses identified by mammograms were submitted to complementary ultrasound and magnetic resonance imaging studies, besides excisional biopsy. In total, 30 biopsies were performed. The lesions as well as their respective BI-RADS classification into 3, 4 and 5 were correlated with the histopathological results. The predictive values calculation was made by means of specific mathematical equations. RESULTS: Negative predictive values for category 3 were: mammography, 69.23%; ultrasound, 70.58%; and magnetic resonance imaging, 100%. Positive predictive values for category 4 were: mammography, 63.63%; ultrasound, 50%; and magnetic resonance imaging, 30.76%. For category 5, positive predictive values were: mammography and ultrasound, 100%; and magnetic resonance imaging, 92.85%. CONCLUSION: For category 3, the negative predictive value of magnetic resonance imaging was high, and for categories 4 and 5, the positive predictive values of the three modalities were moderate.OBJECTIVE: To evaluate the predictive value of BI-RADS™ categories 3, 4 and 5 in non-palpable breast masses assessed by mammography, ultrasound and magnetic resonance imaging MATERIALS AND METHODS: Twenty-nine patients with BI-RADS categories 3, 4 and 5 nonpalpable breast masses identified by mammograms were submitted to complementary ultrasound and magnetic resonance imaging studies, besides excisional biopsy. In total, 30 biopsies were performed. The lesions as well as their respective BI-RADS classification into 3, 4 and 5 were correlated with the histopathological results. The predictive values calculation was made by means of specific mathematical equations. RESULTS: Negative predictive values for category 3 were: mammography, 69.23%; ultrasound, 70.58%; and magnetic resonance imaging, 100%. Positive predictive values for category 4 were: mammography, 63.63%; ultrasound, 50%; and magnetic resonance imaging, 30.76%. For category 5, positive predictive values were: mammography and ultrasound, 100%; and magnetic resonance imaging, 92.85%. CONCLUSION: For category 3, the negative predictive value of magnetic resonance imaging was high, and for categories 4 and 5, the positive predictive values of the three modalities were moderate.

Quimioprevenção do câncer de mama

Chemoprevention is defined as the use of natural or synthetic chemical agents to reverse, suppress or prevent carcinogenic progression of invasive cancer. Drugs that act as chemoprevention agents for breast cancer are divided into two major groups: drugs that prevent Estrogen Receptor (ER) - positive breast cancers [selective estrogen receptor modulators (SERM), aromatase inhibitors GnKH agonists and phytoestrogens] and drugs that prevent ER - negative breast cancers [cyclooxygenase-2 (COX-2) inhibitors, retinoids, statins, receptor tyrosine, kinase inhibitors, monoclonal antibody against HER-2 and telomerase inhibitors]. Results from the NSABP Study of Tamoxifen and Raloxifene (STAR), which compared the risk-reducing efficacy as well as toxicity of these two SERMs in a similar high-risk for breast cancer population, showed that Raloxifene is as effective as Tamoxifen in reducing the risk of non-invasive breast cancer (p=.83). It has a statistically significant lower risk of thromboembolic events and cataracts, however a non- statistically significant higher risk of noninvasive breast cancer. Based on promising data involving reduction of contralateral breast cancer risk in adjuvant studies, several aromatase inhibitors, including letrozole, anastrozole and exemestane, are being included in trials to evaluate their efficacy in breast cancer prevention in both case-control and cohort studies As such randomized studies to confirm this efficacy are needed. Positive results of several recent clinical trials for preventing breast cancer in high-risk populations suggest that chemoprevention is a rational and attractive strategy.

The interaction between aromatase, metalloproteinase 2,9 and cd44 in breast cancer

OBJECTIVE This study intends to verify the expression levels and correlation of aromatase, matrix metalloproteinase 2 (MMP-2), matrix metalloproteinase 9 (MMP-9) and CD44 in ductal carcinoma in situ (DCIS) and infiltrating ductal carcinoma (IDC) when both are found in the same breast. METHODS One hundred and ten cases were evaluated by tissue microarray (TMA) and immunohistochemically screened with anti-aromatase polyclonal antibodies, anti-MMP-2 monoclonal antibodies, anti-MMP-9 polyclonal antibodies and anti-CD44 monoclonal antibodies. RESULTS Aromatase was expressed in IDC and DCIS in 63 (57.3%) and 60 (67%) of the cases respectively; MMP-2 was similarly expressed in IDC and DCIS in 15 (13.60%) cases; MMP-9 was positively expressed in IDC and DCIS in 83 (75.50%) and 82 (74.50%) cases, respectively; CD44 was positively expressed in IDC and DCIS in 49 (44.50%) and 48 (42.60%) of the cases, respectively; all of them were highly correlated (p<0,001). The correlation analysis found positive, statistically significant correlation, in IDC between aromatase and MMP-2 (p<0.001) and between aromatase and MMP-9 (p=0.034). Positive correlation between aromatase and MMP-2 (p<0.001) and between MMP-9 and CD44 (p=0.030) were found in DCIS. CONCLUSION These results allow us to conclude that aromatase through local estrogen synthesis in breast tissue plays an important role in breast carcinogenesis, mainly influencing MMP-2 and MMP-9 which are important participants in tumor cell invasion and dependence of their connection to CD44 for action.

Nódulos benignos da mama: uma revisão dos diagnósticos diferenciais e conduta

The benign mammary tumors are responsible for up to 80% of the clinical masses. Its differential diagnosis is wide, involving mammary cysts, fibroadenomas, phyllodes tumors, papillomas, hamartomas, and adenomas, among others. The fibroadenoma is the most common mammary neoplasia in patients under 35 years old, while the cysts are more frequent in the perimenopause. The differential diagnosis among solid or cystic nodules can be made through the fine-needle aspiration or by ultrasound, being therapeutic for the last ones. In this article, the differential diagnostic aspects will be revised between these tumors, as well as the new therapeutic approaches.

Oncoplastic Mammaplasty With Geometric Compensation-a Technique for Breast Conservation

To describe a technique of oncoplastic mammaplasty, referred to as geometric compensation, which is suitable for tumors close to the skin in areas not included in the classic preoperative drawings for mammaplasty.

Cyclooxygenase-2 and human epidermal growth factor receptor type 2 (HER-2) expression simultaneously in invasive and in situ breast ductal carcinoma

CONTEXT AND OBJECTIVE Cyclooxygenase-2 (COX-2) and human epidermal growth factor receptor type 2 (HER-2) are associated with tumorigenesis. Studies have shown that HER-2 can regulate COX-2 expression. The aim of this study was to evaluate the correlation between COX-2 and HER-2 expression in normal breast epithelium and in ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC) present in the same breast. DESIGN AND SETTING Cross-sectional study at the Mastology Unit of the Department of Gynecology and Obstetrics, Santa Casa de Misericórdia de São Paulo Hospital. METHODS COX-2 and HER-2 were detected using immunohistochemistry on 100 tissue fragments. HER-2 > +2 was subjected to fluorescence in situ hybridization (FISH). RESULTS COX-2 expression was detected in 87%, 85% and 75% of IDC, DCIS and normal epithelium, respectively. HER-2 expression was detected in 34% of IDC and 34% of DCIS. COX-2 in DCIS correlated with HER-2 in IDC (P = 0.049) and DCIS (P = 0.049). COX-2 in normal epithelium correlated with HER-2 in IDC (P = 0.046) and DCIS (P = 0.046). COX-2 in IDC was not associated with HER-2 (P = 0.235). Comparison between COX-2 and HER-2 in DCIS showed that there was a statistically significant difference with regard to nuclear grades II and III and presence of comedonecrosis (P < 0.001). In IDC, there was significant expression with nuclear grades II and III and histological grade II (P < 0.001). CONCLUSIONS Our findings provide evidence that HER-2 and COX-2 regulate each other.

Proposta de sistematização do estudo elastográfico de lesões mamárias pela ultrassonografia

OBJECTIVE: Proposal of systematization for the elastographic study in the ultrasound routine. METHODS: Evaluation was made of 308 patients forwarded to the breast intervention service in the CTC-Genesis from May 1, 2007 to March 1, 2008 to perform percutaneous breast biopsy. Prior to the percutaneous biopsy, an ultrasound study and an elastography were performed. Lesions were primarily analyzed and classified according to the Bi-Rads® lexicon criteria by the conventional ultrasound scan (B mode). The elastography was then performed and analyzed in accordance with the systematization proposed by the authors, using images obtained during compression and after decompression of the area of interest. Lesions were classified following the system developed by the authors using a four-point scale, where scores (1) and (2) were considered benign, score (3) probably benign and score (4) suspicion of malignancy. Results obtained by the two methods were compared with the histological results using the areas within the ROC (receiver operator curves) curves. RESULTS: The area within the curve for elastography was of 0.952 with a confidence interval between 0.910 and 0.966, error of 0.023, and of 0.867 with a confidence interval between 0.823 and 0.903, error of 0.0333 for the ultrasound. When the areas were compared, a difference between the curves of 0.026 was observed, which was statistically significant. CONCLUSION: This work shows the systematization of the elastographic study using information obtained during compression and after decompression of the ultrasound scan sample, thus showing that elastography might enhance the assessment of risk of malignancy for lesions characterized by the ultrasound.

Application of Breast Ultrasound Elastography to Differentiate Intracapsular Collection from Silicone-Induced Granuloma of Breast Implant Capsule Complementarily to Contrast-Enhanced Breast Magnetic Resonance Imaging

Background: To determine whether there is correlation between magnetic resonance imaging (MRI) findings and breast elastography to differentiate seroma/hematoma from silicone-induced granuloma of breast implant capsule (SIGBIC). Methods: Prospective study of 99 patients with breast implants submitted to breast MRI during the period from February 1 to May 1, 2017. Patients who present MRI findings of seroma/hematoma or SIGBIC were submitted to a complementary ultrasound elastography study to evaluate the correlation of the results. The criteria adopted for the diagnosis of granuloma by MRI were heterogeneous hypersignal in the T2-weighted sequences, late contrast enhancement, and black drop sign. Lesions that did not enhance after the use of contrast were considered as seroma/hematoma. By elastography, the results were considered positive for granuloma when presented as hard lesions, whereas seroma/hematoma presented as soft lesions. Results: Of the 99 patients evaluated, 15 were included in the study. Of the 15 patients, 9 had solid intracapsular MRI masses, whereas 6 presented collections without contrast enhancement. The complementary elastography study showed correlation with MRI results in all cases of SIGBIC and seroma/hematoma, being elastography able to differentiate lesions from solid to cystic. Conclusions: Elastography of intracapsular masses in breast implants presented results compatible with those found by MRI to differentiate solid lesions from collections.

Cirurgia oncoplástica e reconstrutiva da mama: Reunião de Consenso da Sociedade Brasileira de Mastologia

Objetivo: Apesar do grande numero de publicacoes em cirurgia oncoplastica e reconstrutiva da mama, diversas questoes permanecem controversas. Assim, o objetivo desta Reuniao de Consenso, foi desenvolver um guia pratico de recomendacoes baseadas nas melhores evidencias disponiveis na literatura. Metodo: Os painelistas foram os membros da Comissao de Cirurgia Oncoplastica e Reconstrutiva da Sociedade Brasileira de Mastologia. A reuniao foi realizada em agosto de 2015 em Bento Goncalves (RS). Cada painelista recebeu e respondeu previamente um questionario com 46 itens, com base na melhor evidencia cientifica e em sua experiencia. Foi considerado consenso a concordância de 75% entre painelistas. Resultados: Houve consenso em 25 itens, dos quais para oito houve concordância de 100%. O mais importantes foram: compro- metimento das margens em cirurgia oncoplastica pode ser resolvido com ampliacao de margens na maioria dos casos; tumores multifocais nao sao contraindicacao para cirurgia oncoplastica; idade >70 anos nao representa contraindicacao para uso de tecnicas oncoplasticas; reconstrucao imediata pode ser indicada com seguranca para a maioria das candidatas a mastectomia; pa- cientes com indicacao de radioterapia pos-mastectomia podem ser submetidas a reconstrucao imediata, devendo ter ciencia dos riscos maiores para mau resultado estetico; mastectomia com preservacao do complexo areolopapilar e segura nos casos de câncer; radioterapia apos a mastec- tomia com preservacao do complexo areolopapilar nao esta indicada fora dos criterios classicos de irradiacao do plastrao; tela abdominal reduz chances de hernia no caso de reconstrucao com TRAM. Conclusao: atraves desta reuniao foi possivel estabelecer importantes pontos consensu- ais de acordo com a opiniao dos especialistas, que poderao auxiliar os mastologistas na tomada de decisoes em cirurgias oncoplasticas e reconstrutivas da mama.