RESUMEN
BACKGROUND: Carcinoid tumors of the breast have been described in the literature. The diagnosis is made by identification of typical histologic features and confirmed by a positive argyrophilic reaction or the presence of neurosecretory granules. There are several theories of the pathogenesis of carcinoid tumors in the breast and controversy as to whether these tumors actually originate in the breast ducts or are tumors that arise from neuroectodermal cells that have migrated to the breast ducts. Historically, treatment of carcinoid of the breast has been by mastectomy. METHODS: We report three cases of primary carcinoid tumor of the breast treated with lumpectomy and axillary node dissection. No adjuvant radiation or systemic treatment was administered. RESULTS: In all three cases, no metastases were identified in lymph nodes sampled and all patients have remained clinically free of recurrent disease. CONCLUSIONS: Decisions about the need for radiation or systemic treatment of breast carcinoid tumors depend on one's interpretation of the pathogenesis of this disease. Breast conservation is a surgical option that has not been previously reported. Larger series of carcinoid tumors of the breast, their treatment, and their follow-up are needed.
Asunto(s)
Neoplasias de la Mama/patología , Neoplasias de la Mama/cirugía , Tumor Carcinoide/patología , Tumor Carcinoide/cirugía , Mastectomía Segmentaria , Anciano , Biopsia con Aguja , Neoplasias de la Mama/etiología , Tumor Carcinoide/etiología , Femenino , Humanos , Escisión del Ganglio Linfático , Persona de Mediana Edad , Sistemas Neurosecretores/patología , Selección de Paciente , Tinción con Nitrato de PlataRESUMEN
Closed suction drainage has been used to prevent seroma formation after lumpectomy and axillary node dissection for breast cancer. To study the efficacy of closed suction drains, the authors conducted a prospective randomized study from 1987 to 1990 of 227 axillary dissections. One hundred eight were randomized to a drain group (DG) and 119 to a no drain group (NDG). Drains were removed on the first postoperative day just before patient discharge. Postoperatively, all palpable axillary collections were aspirated on each follow-up visit. The volume aspirated, the number of aspirations, the time to seroma resolution, and all complications were recorded. The mean number of aspirations in the DG was significantly lower than the NDG (2.2 +/- 2.2 versus 3.3 +/- 2.1; p less than or equal to 0.002). Mean volume aspirated in the DG (146.3 +/- 181.1 mL) was less than the NDG (266.1 +/- 247.6 mL; p less than or equal to 0.003), and the time to seroma resolution was decreased in the DG as compared with the NDG (11.5 +/- 10 days versus 18 +/- 10.1 days; p less than or equal to 0.0002). Closed suction drainage after lumpectomy and axillary node dissection is advantageous in decreasing the incidence and degree of seroma formation and need not delay early hospital discharge.
Asunto(s)
Neoplasias de la Mama/cirugía , Escisión del Ganglio Linfático , Mastectomía Segmentaria , Cuidados Posoperatorios/métodos , Anciano , Axila , Femenino , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/terapia , SucciónRESUMEN
A biological study was conducted on tears from 20 subjects with a clinical sicca syndrome. Electrophoresis of lacrymal proteins, determination of lacrymal and salivary immunoglobulins G, and a human basophil degranulation test (HBDT) with a lacrymal gland extract as antigen were performed in each patient. Three different groups could be distinguished: a group with normal electrophoresis and normal HBDT corresponding to hyposecretion; a second group with abnormal electrophoresis and negative HBDT corresponding to an inflammatory state of the lacrymal gland; and a third group with abnormal electrophoresis and positive HBDT corresponding to a deficit in synthesis function of the lacrymal gland. These findings demonstrate that HBDT with lacrymal gland extract as antigen is a reliable means of diagnosis of the sicca syndrome.