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Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.

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OBJECTIVE: To assess the neoplastic invasion of superficial and deep inguinal lymph nodes of women with invasive vulvar squamous carcinoma smaller than 5 centimeters with a clinically normal inguinal region. METHODS: the medical records of 59 women cared at the State University of Campinas with invasive vulvar squamous carcinoma T1 and T2 and who presented clinically normal inguinal regions (N0) were reviewed. Clinical characteristics of both tumor and patients were evaluated as well as the follow-up data. Odds ratios and Fisher's Exact Test were used to assess the correlations between the invasion of inguinal lymph nodes and tumor size, grade, relapses and clinical complications. Confidence limits of 95% were used. RESULTS: Age of the patients ranged from 34 to 91 years (mean 67 years), and follow-up time ranged from 3 days (peri-operatory death) to 252 months (mean 27 months). Clinically, 22 (37%) women had lesions T1 lesions and 37 (63%) T2. Histological analysis showed unilateral lymphatic invasion in six (10%) women and bilateral in three (5%). There was no significant association between tumor size and lymph node invasion. Also, pathologic tumor size and grade were not associated with lymph node neoplastic involvement. Relapses and late complications were not correlated with lymph node neoplastic invasion. CONCLUSIONS: Superficial and deep inguinal dissection disclosed clinically undetectable lymph node neoplastic invasion, although tumor size and histological grade, relapses and late complications were not associated with node involvement.

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OBJETIVO: Avaliar em mulheres com carcinoma escamoso da vulva menor que 5 cm e clinicamente sem comprometimento inguinal a invasão por neoplasia nos linfonodos inguinais superficiais e profundos. MÉTODOS: Foram avaliados os dados de 59 mulheres atendidas entre outubro de 1982 e janeiro de 2004 na Universidade Estadual de Campinas, em decorrência de carcinoma escamoso invasivo da vulva T1 ou T2 e com linfonodos inguinais clinicamente livres de invasão neoplásica (N0). Foram levantadas características clínicas do tumor e das pacientes e os dados do seguimento. Foram calculados os odds ratio e teste exato de Fisher para as associacões entre a invasão dos linfonodos inguinais com o tamanho do tumor, grau histológico, recidivas e complicacões. A confianca estatística foi de 95 por cento. RESULTADOS: A idade das mulheres variou de 34 a 91 anos (média de 67 anos), com tempo de seguimento entre três dias (óbito perioperatório) e 252 meses (média de 27 meses). Clinicamente, 22 (37 por cento) mulheres apresentavam tumores T1 e 37 (63 por cento) T2. Após análise histológica, seis (10 por cento) mulheres apresentavam invasão unilateral e três (5 por cento) bilateral, não havendo associacão entre o tamanho do tumor e a invasão dos linfáticos inguinais. Também o tamanho do tumor à avaliacão patológica e seu grau histológico não se mostraram associados à invasão nos linfonodos inguinais. Recidivas e complicacões tardias não se correlacionaram com a invasão neoplásica inguinal. CONCLUSÕES: A disseccão inguinal superficial e profunda revelou invasão neoplásica clinicamente não detectável em 15 por cento das mulheres estudadas, apesar de que tamanho e grau histológico do tumor, recidivas e complicacões tardias não estiveram associadas com a invasão nos linfonodos.

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The role of the central nervous system (CNS) in the control of hydrosaline homeostasis has been strikingly demonstrated by several studies. Recent and growing evidence suggests that insulin or a nonapeptide-derived from the C-terminus of the insulin beta-chain may influence many brain functions. However, there is little information on the insulin-activated neural pathways regulating urinary sodium excretion. Also, we examined the influence of nitric oxide synthase activity by chronic oral administration of N(omega)-nitro-l-arginine methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthesis, after previous i.c.v. administration of insulin to unanesthetized, unrestrained rats that were randomly assigned to one of seven separated groups: (a) i.c.v. 0.15 M NaCl-injected (n = 11) and i.c.v. 126 ng (n = 11) insulin-injected rats; (b) i.c.v. insulin-injected in systemic L-NAME-treated (n = 10) and vehicle-treated insulin-injected rats (n = 10); and (c) subcutaneously (SC) insulin-injected rats (n = 5). We showed that centrally administered insulin produced increase in the urinary output of sodium (from 0.15 M NaCl: 855.6 +/- 85.1 Delta%.min(-1) to 126 ng insulin: 2055 +/- 310.6 Delta%.min(-1)) and potassium (126 ng: from 0.15 M NaCl: 460.4 +/- 100 Delta%.min(-1) to 126 ng insulin: 669 +/- 60.8 Delta%.min(-1)). The urinary sodium excretion response to i.c.v. 126 ng insulin microinjection was significantly abolished by previous systemic treatment of animals with 15 mg/kg/day L-NAME (from vehicle + 126 ng insulin: 1935 +/- 258.3 Delta%. min(-1) to L-NAME + 126 ng insulin: 582.3 +/- 69.6 Delta%. min(-1)). In addition, we showed that insulin-induced natriuresis occurred by increasing post-proximal tubule sodium rejection (FEPP(Na)), despite an unchanged glomerular filtration rate (C(Cr)). The current data suggests the novel concept that CNS NO-dependent neural pathways may play an instrumental role on efferent insulin-sensitive nerve activity from periventricular region. Speculatively, it seems interesting to suggest that perhaps one of the efferent signals triggered by insulin in the CNS may be nitrergic in nature, and that defects in this efferent signal could result in insulin central resistance, inability of renal tubules to handle the hydro electrolyte balance and hypertension.

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