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Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):113-115
DOI 10.1590/S0100-72031999000200010
The authors report a rare case of dermatomyositis diagnosed at the Mastology Sector of the Division of Gynecology of the Federal University of São Paulo - Escola Paulista de Medicina, which caused breast deformity due to formation of bilateral dystrophic calcifications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(2):113-115
DOI 10.1590/S0100-72031999000200010
The authors report a rare case of dermatomyositis diagnosed at the Mastology Sector of the Division of Gynecology of the Federal University of São Paulo - Escola Paulista de Medicina, which caused breast deformity due to formation of bilateral dystrophic calcifications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):321-327
DOI 10.1590/S0100-72032001000500008
Purpose: to determine the relationship between fine needle aspiration cytology guided by ultrasound of nonpalpable breast lesions (cystic or solid masses) with the ultrasound and histopathological features of the biopsy lesions. Methods: a total of 617 nonpalpable lesions were analyzed by ultrasound. Fine needle aspiration cytology was guided by ultrasonography and the cysts were distinguished from the solid masses by comparing the biopsies. The cytologic results were compared with the histological results in the case surgical biopsy was carried out. Results: of the 617 nonpalpable lesions 471 were cysts (451 simple cysts with 100% negative cytology and 20 cases were considered complex cysts; 3 (15%) of these had a positive or suspected cytology and in 2 cases malignancy was confirmed. There were 105 solid masses, 63 of them with negative cytology. Fifty-nine cases had a negative biopsy, and 4 cases (0.3%) were false-negative but all of them presented disagreement between the cytological and image features; in 14 cases (13%) there was a suspected cytology and in 5 of them carcinoma was confirmed; in 14 cases (13%), the samples were insufficient, 1 case was carcinoma and in 51 cases, a triple diagnosis was concordant and the lesions were followed-up. Conclusion: cytological analysis of simple cysts is not required, but when they are complex, cytological analysis is mandatery. In the case of nonpalpable solid masses, cytology must be correlated with ultrasound and mammography features. If the results are discordant, the lesion should be followed-up.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2001;23(5):321-327
DOI 10.1590/S0100-72032001000500008
Purpose: to determine the relationship between fine needle aspiration cytology guided by ultrasound of nonpalpable breast lesions (cystic or solid masses) with the ultrasound and histopathological features of the biopsy lesions. Methods: a total of 617 nonpalpable lesions were analyzed by ultrasound. Fine needle aspiration cytology was guided by ultrasonography and the cysts were distinguished from the solid masses by comparing the biopsies. The cytologic results were compared with the histological results in the case surgical biopsy was carried out. Results: of the 617 nonpalpable lesions 471 were cysts (451 simple cysts with 100% negative cytology and 20 cases were considered complex cysts; 3 (15%) of these had a positive or suspected cytology and in 2 cases malignancy was confirmed. There were 105 solid masses, 63 of them with negative cytology. Fifty-nine cases had a negative biopsy, and 4 cases (0.3%) were false-negative but all of them presented disagreement between the cytological and image features; in 14 cases (13%) there was a suspected cytology and in 5 of them carcinoma was confirmed; in 14 cases (13%), the samples were insufficient, 1 case was carcinoma and in 51 cases, a triple diagnosis was concordant and the lesions were followed-up. Conclusion: cytological analysis of simple cysts is not required, but when they are complex, cytological analysis is mandatery. In the case of nonpalpable solid masses, cytology must be correlated with ultrasound and mammography features. If the results are discordant, the lesion should be followed-up.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369
DOI 10.1590/S0100-72032007000700007
Fibroadenoma is the most frequent benign neoplasia in the female breast and it is considered a mixed tumor, constituted by variable amounts of connective and epithelial tissue. Cyclosporine A seems to be related with the development of mamary fibroadenomas in patients who underwent kidney transplantation in reproductive age. We reported the case in which the patient, in therapeutic use of cyclosporine A, after kidney transplantation, presented several bilateral lumps. The imaging and palpable findings suggested fibroadenoma, confirmed after biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2007;29(7):366-369
DOI 10.1590/S0100-72032007000700007
Fibroadenoma is the most frequent benign neoplasia in the female breast and it is considered a mixed tumor, constituted by variable amounts of connective and epithelial tissue. Cyclosporine A seems to be related with the development of mamary fibroadenomas in patients who underwent kidney transplantation in reproductive age. We reported the case in which the patient, in therapeutic use of cyclosporine A, after kidney transplantation, presented several bilateral lumps. The imaging and palpable findings suggested fibroadenoma, confirmed after biopsy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):37-42
DOI 10.1590/S0100-72032004000100006
PURPOSE: to evaluate the accuracy of directional vacuum-assisted biopsy (mammotomy), guided by ultrasonography, in the diagnosis of nonpalpable breast lesion, as compared with excision biopsy, and to evaluate the therapeutic value of mammotomy in nonpalpable benign lesions. METHODS: 114 patients, who presented nonpalpable breast lesion, visible on ultrasonography, were included. The patients were referred to complementary ultrasonographic evaluation due to mastalgia or earlier found mammographic alteration. All were submitted to mammotomy guided by ultrasonography using Mammotome® (Biopsys, Irvine, Califórnia), with a 11 gauge needle. The excision biopsy was performed with previous puncture of those patients who presented residual lesion after the mammotomy, that is, 88 patients. To evaluate comparatively the mammotomy results with those of excision biopsy, the sensitivity and specificity rates, positive and negative predictive values, and the agreement proportion were calculated. Not only the sensibilities, but also the specificities and the agreement proportions of both examinations were compared through Wald statistics, using a model for classified data. RESULTS: of 114 patients, 88 were submitted to excision biopsy. The remaining 26 did not show post-mammotomy lesions visible on ultrasonography, and for one year they were without alterations on the bi-annual mammographic and ultrasonographic examinations. The diameter of those lesions was less than 1.5 cm. Among the 88 patients that underwent excision biopsy, 69 (78,4%) showed benign and 19 (21,6%), malignant lesions. Mammotomy diagnosed 16 of the malignant lesions, with three false-negative and no false-positive results. The false results occurred in the first cases, showing the existence of a learning curve of the method, or due to technical difficulty such as the blurring of ultrasonographic image by bleeding. The sensitivity and specificity were 84,2% and 100%, respectively, with 100% positive predictive and 95,8% predictive negative values. The mammotomy accuracy was 96,6%. Complications were rare: two cases of hematomas, none of them needing surgical drainage; a case of vasovagal reflex not allowing the conclusion of the examination. The cosmetic results were very favorable due to small incisions (3 mm) and to the smaller amount of excised tissue. CONCLUSION: mammotomy guided by ultrasonography showed to be a diagnostic method with high accuracy, and it may be used as therapy for benign, smaller than 1.5 cm lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2004;26(1):37-42
DOI 10.1590/S0100-72032004000100006
PURPOSE: to evaluate the accuracy of directional vacuum-assisted biopsy (mammotomy), guided by ultrasonography, in the diagnosis of nonpalpable breast lesion, as compared with excision biopsy, and to evaluate the therapeutic value of mammotomy in nonpalpable benign lesions. METHODS: 114 patients, who presented nonpalpable breast lesion, visible on ultrasonography, were included. The patients were referred to complementary ultrasonographic evaluation due to mastalgia or earlier found mammographic alteration. All were submitted to mammotomy guided by ultrasonography using Mammotome® (Biopsys, Irvine, Califórnia), with a 11 gauge needle. The excision biopsy was performed with previous puncture of those patients who presented residual lesion after the mammotomy, that is, 88 patients. To evaluate comparatively the mammotomy results with those of excision biopsy, the sensitivity and specificity rates, positive and negative predictive values, and the agreement proportion were calculated. Not only the sensibilities, but also the specificities and the agreement proportions of both examinations were compared through Wald statistics, using a model for classified data. RESULTS: of 114 patients, 88 were submitted to excision biopsy. The remaining 26 did not show post-mammotomy lesions visible on ultrasonography, and for one year they were without alterations on the bi-annual mammographic and ultrasonographic examinations. The diameter of those lesions was less than 1.5 cm. Among the 88 patients that underwent excision biopsy, 69 (78,4%) showed benign and 19 (21,6%), malignant lesions. Mammotomy diagnosed 16 of the malignant lesions, with three false-negative and no false-positive results. The false results occurred in the first cases, showing the existence of a learning curve of the method, or due to technical difficulty such as the blurring of ultrasonographic image by bleeding. The sensitivity and specificity were 84,2% and 100%, respectively, with 100% positive predictive and 95,8% predictive negative values. The mammotomy accuracy was 96,6%. Complications were rare: two cases of hematomas, none of them needing surgical drainage; a case of vasovagal reflex not allowing the conclusion of the examination. The cosmetic results were very favorable due to small incisions (3 mm) and to the smaller amount of excised tissue. CONCLUSION: mammotomy guided by ultrasonography showed to be a diagnostic method with high accuracy, and it may be used as therapy for benign, smaller than 1.5 cm lesions.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(7):415-420
DOI 10.1590/S0100-72032005000700008
PURPOSE: to evaluate the cost of preventive mammographic screening in climacteric women, as compared to the cost of breast cancer treatment in more advanced stages. METHODS: one thousand and fourteen patients attended at the Climacteric outpatient service of the Gynecology Department, Federal University of São Paulo Paulista School of Medicine, were included in the study and submitted to mammographic test. All mammographic test's were analyzed by the same two physicians and classified according to the BI-RADS (Breast Imaging Reporting and Data System American College of Radiology) categories. The detected lesions were submitted to cytological and histological examination. RESULTS: the final diagnostic impression of the 1014 examinations, according to the classification of BI-RADS categories was: 1=261, 2=671, 3=59, 4=22 and 5=1. The invasive procedures were performed through a needle guided by ultrasound or stereotactic examinations: 33 fine-needle aspiration biopsies, 6 core biopsies guided by ultrasound and 20 core biopsies guided by stereotactic examination. Five cancer diagnoses were established. The total cost of this screening based on Brazilian procedure values was R$ 76,593.79 (25,534 dollars). Therefore, the cost of the diagnosis of the five cases of cancer in this screening was R$ 15,318.75 (5,106 dollars) each. However, the average cost per patient screened was R$ 75.53 (25 dollars). CONCLUSIONS: considering that the total treatment cost of only one case of breast cancer in advanced stage including hospital costs, surgery, chemotherapy, radiotherapy and hormonal treatment is similar to the cost of 1,000 mammographic screenings in climacteric women, it may be concluded that the cost of the early cancer diagnosis program is worth it and should be included in the public health program, as a way of lowering the public health expense.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(7):415-420
DOI 10.1590/S0100-72032005000700008
PURPOSE: to evaluate the cost of preventive mammographic screening in climacteric women, as compared to the cost of breast cancer treatment in more advanced stages. METHODS: one thousand and fourteen patients attended at the Climacteric outpatient service of the Gynecology Department, Federal University of São Paulo Paulista School of Medicine, were included in the study and submitted to mammographic test. All mammographic test's were analyzed by the same two physicians and classified according to the BI-RADS (Breast Imaging Reporting and Data System American College of Radiology) categories. The detected lesions were submitted to cytological and histological examination. RESULTS: the final diagnostic impression of the 1014 examinations, according to the classification of BI-RADS categories was: 1=261, 2=671, 3=59, 4=22 and 5=1. The invasive procedures were performed through a needle guided by ultrasound or stereotactic examinations: 33 fine-needle aspiration biopsies, 6 core biopsies guided by ultrasound and 20 core biopsies guided by stereotactic examination. Five cancer diagnoses were established. The total cost of this screening based on Brazilian procedure values was R$ 76,593.79 (25,534 dollars). Therefore, the cost of the diagnosis of the five cases of cancer in this screening was R$ 15,318.75 (5,106 dollars) each. However, the average cost per patient screened was R$ 75.53 (25 dollars). CONCLUSIONS: considering that the total treatment cost of only one case of breast cancer in advanced stage including hospital costs, surgery, chemotherapy, radiotherapy and hormonal treatment is similar to the cost of 1,000 mammographic screenings in climacteric women, it may be concluded that the cost of the early cancer diagnosis program is worth it and should be included in the public health program, as a way of lowering the public health expense.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):455-458
DOI 10.1590/S0100-72032000000700009
Primary angiosarcoma of the breast is a rare tumor, which appears between 14 and 82 years, with an average of 35 years of age. Its predominant clinical aspect is a painful mass with diffuse increase in the breast and violet or blackened color. Equally to other cases of sarcoma, the medium size of the lesion is approximately 5 cm at the diagnosis. Histologically, it is characterized by the proliferation of endothelial cells that form vascular channels linked to each other infiltrating glandular structures and fatty tissue. Its histological diagnosis is difficult and not always the right diagnosis is immediately established, mainly in the cases of a low malignancy degree, due to limited biopsy material. Because of the difficult diagnosis and aggressivity, it is a neoplasia with ominous prognosis, due to frequent metastasis. In our service, a 18-year-old patient presented with a painful lump which grew quickly. It was biopsied and a hemangioma was diagnosed, a wide excision being indicated. Three months later, she suffered a tumoral relapse, that was biopsied again and mastectomy was indicated, because it was an angiosarcoma with low degree of malignancy. After other relapses, chemotherapy was indicated and later, radiotherapy. During radiotherapy she developed new metastases, and died of pulmonary metastasis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2000;22(7):455-458
DOI 10.1590/S0100-72032000000700009
Primary angiosarcoma of the breast is a rare tumor, which appears between 14 and 82 years, with an average of 35 years of age. Its predominant clinical aspect is a painful mass with diffuse increase in the breast and violet or blackened color. Equally to other cases of sarcoma, the medium size of the lesion is approximately 5 cm at the diagnosis. Histologically, it is characterized by the proliferation of endothelial cells that form vascular channels linked to each other infiltrating glandular structures and fatty tissue. Its histological diagnosis is difficult and not always the right diagnosis is immediately established, mainly in the cases of a low malignancy degree, due to limited biopsy material. Because of the difficult diagnosis and aggressivity, it is a neoplasia with ominous prognosis, due to frequent metastasis. In our service, a 18-year-old patient presented with a painful lump which grew quickly. It was biopsied and a hemangioma was diagnosed, a wide excision being indicated. Three months later, she suffered a tumoral relapse, that was biopsied again and mastectomy was indicated, because it was an angiosarcoma with low degree of malignancy. After other relapses, chemotherapy was indicated and later, radiotherapy. During radiotherapy she developed new metastases, and died of pulmonary metastasis.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):533-536
DOI 10.1590/S0100-72031998000900007
Purpose: to evaluate the effects of tamoxifen (TAM) on plasma levels of estradiol, progesterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormone-binding globulin (SHBG) when given to premenopausal women in the doses of 10 and 20 mg/day for 22 days. Patients and Methods: a randomized double-blind study was performed with 43 premenopausal eumenorrheic women. The patients were divided into three groups: A (N = 15, placebo); B (N = 15, TAM 10 mg/day) and C (N = 13, 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Two hormone determinations were performed, both on the 22nd day of the menstrual cycle: the first in the cycle that preceded the use of the drug and the second, in the following cycle, after 22 days of using the medication. We used the Levine and Student tests in order to evaluate the homogeneity of the sample and the variation of the hormone determinations respectively. Results:serum levels of estradiol, progesterone and SHBG increased significantly in groups B and C. In group C, we also observed increase in serum level of FSH (p < 0.0045) and a fall in prolactin level (p < 0.0055). Conclusions: TAM promoted a significant increase in serum concentrations of estradiol, progesterone and SHBG either in the doses of 10 or 20 mg/day. However, significant increase in FSH and decrease in prolactin were obtained only with the dose of 20 mg/day.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1998;20(9):533-536
DOI 10.1590/S0100-72031998000900007
Purpose: to evaluate the effects of tamoxifen (TAM) on plasma levels of estradiol, progesterone, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and steroid hormone-binding globulin (SHBG) when given to premenopausal women in the doses of 10 and 20 mg/day for 22 days. Patients and Methods: a randomized double-blind study was performed with 43 premenopausal eumenorrheic women. The patients were divided into three groups: A (N = 15, placebo); B (N = 15, TAM 10 mg/day) and C (N = 13, 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Two hormone determinations were performed, both on the 22nd day of the menstrual cycle: the first in the cycle that preceded the use of the drug and the second, in the following cycle, after 22 days of using the medication. We used the Levine and Student tests in order to evaluate the homogeneity of the sample and the variation of the hormone determinations respectively. Results:serum levels of estradiol, progesterone and SHBG increased significantly in groups B and C. In group C, we also observed increase in serum level of FSH (p < 0.0045) and a fall in prolactin level (p < 0.0055). Conclusions: TAM promoted a significant increase in serum concentrations of estradiol, progesterone and SHBG either in the doses of 10 or 20 mg/day. However, significant increase in FSH and decrease in prolactin were obtained only with the dose of 20 mg/day.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):545-552
DOI 10.1590/S0100-72032003000800002
ABSTRACT PURPOSE: to evaluate the changes in the cell phenotype determined by primary chemotherapy. METHODS: we evaluated the expression of proliferating cells of nuclear antigen (PCNA) and the estrogen (RE) and progesterone (RP) receptors in 17 stage II breast cancer patients before and after chemotherapy by immunohistochemistry. The values were compared with menopausal status, tumoral clinical response and with axillary lymph node status. RESULTS: there was a significant decrease in the average index of anti-PCNA-stained cells before (time A) and after (time B) chemotherapy (p=0.041). Responder patients displayed a significant decrease in PCNA levels [time A=53.1 and time B= 30.7 (p=0.011)]. A similar trend was observed in patients with histologic grade GII/GIII [time A=63.1 and time B=38.7 (p=0.049)]. There was no significant difference in PCNA expression regarding menopause status and axillary lymph node involvement. There was a significant decrease in RE after chemotherapy in the premenopausal patients [time A=60.3 and time B=24.1 (p=0.027)] and in those who showed a therapeutic response [time A=59.1 and time B=37.9 (p=0.030)]. We observed a significant increase in RP after chemotherapy in the postmenopausal patients [time A=35.3 and time B=58.3 (p=0.023)]. There was no relationship between hormone receptors and axillary lymph nodes. CONCLUSIONS: the decrease in PCNA levels in patients with high histologic grade, in RE in premenopausal patients, and both, PCNA and RE, in the tumors with clinical response after chemotherapy shows that the drugs acted on proliferating cells, and therefore PCNA can be used as a parameter of treatment response.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2003;25(8):545-552
DOI 10.1590/S0100-72032003000800002
ABSTRACT PURPOSE: to evaluate the changes in the cell phenotype determined by primary chemotherapy. METHODS: we evaluated the expression of proliferating cells of nuclear antigen (PCNA) and the estrogen (RE) and progesterone (RP) receptors in 17 stage II breast cancer patients before and after chemotherapy by immunohistochemistry. The values were compared with menopausal status, tumoral clinical response and with axillary lymph node status. RESULTS: there was a significant decrease in the average index of anti-PCNA-stained cells before (time A) and after (time B) chemotherapy (p=0.041). Responder patients displayed a significant decrease in PCNA levels [time A=53.1 and time B= 30.7 (p=0.011)]. A similar trend was observed in patients with histologic grade GII/GIII [time A=63.1 and time B=38.7 (p=0.049)]. There was no significant difference in PCNA expression regarding menopause status and axillary lymph node involvement. There was a significant decrease in RE after chemotherapy in the premenopausal patients [time A=60.3 and time B=24.1 (p=0.027)] and in those who showed a therapeutic response [time A=59.1 and time B=37.9 (p=0.030)]. We observed a significant increase in RP after chemotherapy in the postmenopausal patients [time A=35.3 and time B=58.3 (p=0.023)]. There was no relationship between hormone receptors and axillary lymph nodes. CONCLUSIONS: the decrease in PCNA levels in patients with high histologic grade, in RE in premenopausal patients, and both, PCNA and RE, in the tumors with clinical response after chemotherapy shows that the drugs acted on proliferating cells, and therefore PCNA can be used as a parameter of treatment response.