RESUMO
Background: The incidence of breast cancer is increasing globally; however, survival outcomes vary and are lower in developing countries. Methods: We analyzed the 5- and 10-year survival rates for breast cancer according to the type of healthcare insurance (public vs. private) in a referral center for cancer care in the Brazilian southeast region. This hospital-based cohort study included 517 women diagnosed with invasive breast cancer between 2003 and 2005. The Kaplan-Meier method was used to estimate the probability of survival, and the Cox proportional hazards regression model was used to assess prognostic factors. Results: The 5- and 10-year breast cancer survival rates were as follows: private healthcare service survival rate of 80.6% (95% CI 75.0-85.0) and 71.5% (95% CI 65.4-77.1), respectively, and public healthcare service survival rate of 68.5% (95% CI 62.5-73.8) and 58.5% (95% CI 52.1-64.4), respectively. The main factors associated with the worst prognosis were lymph node involvement in both healthcare services and tumor size >2 cm only in public health services. The use of hormone therapy (private) and radiotherapy (public) was associated with the best survival rates. Conclusions: The survival discrepancies found between health services can be explained mainly by the difference in the stage of the disease at the time of diagnosis, indicating inequalities in access to the early detection of breast cancer.
RESUMO
Disgerminoma cerebral é um raro tumor de células germinativas que se origina em um sítio extragonadal. Representa aproximadamente 3% dos tumores intracranianos em crianças abaixo de 15 anos (STROTHER et al., 2002). Por razões ainda desconhecidas, esses tumores são mais frequentes em países asiáticos, onde perfazem 12% dos tumores intracranianos (KNIERIM et al., 2003). O pico de incidência do tumor está entre 10 e 14 anos, e a localização pineal é mais frequente nos homens, enquanto a supra-selar acomete mais as mulheres. Relato de caso de um paciente de 19 anos que há 2 anos apresentava diplopia e parestesia fugaz de mão esquerda. Realizou Ressonância Magnética do Crânio que identificou lesões nodulares no mesencéfalo à direita e em região talâmica bilateral. O diagnóstico histológico foi retardado em função do uso de corticóide, que promoveu uma redução da lesão impedindo acesso a biópsia. Após suspensão da corticoterapia e recrescimento das lesões, foi realizada biópsia com a confirmação, por imunohistoquímica, de um disgerminoma cerebral. O paciente foi submetido à radioterapia cranioespinhal, e uma nova ressonância magnética demonstrou resposta completa ao tratamento efetuado.
Intracranial Dysgerminoma is a rare extragonadal germ cell tumor which originates itself at a extragonadal site. It represents approximately 3 percent of intracranial tumors in children under the age of 15. For unknown reasons, these tumors are more frequent in Asian countries, where they account for 12 percent of intracranial neoplasms. They show a peak in incidence between 10 and 14 years of age with a male predominance. We have reported a case of a 19 year-old patient who had been showing signs of diplopia and transitory parestesia of the left hand. He underwent brain magnetic resonance which identified nodule lesions in the right mesencephalus and in the bilateral thalamic region as well. The histologic diagnosis was delayed due to the use of corticoid which contributed to the lesion reduction preventing access to the biopsy. After the interruption of the corticotherapy and injury regrowth, a biopsy was performed with the confirmation, by means of immunohistochemistry, of a brain disgerminoma. The patient was submitted to a craniospinal radiotherapy, and a new magnetic resonance indicated a complete answerto the treatment.
Assuntos
Neoplasias Embrionárias de Células Germinativas , Disgerminoma , RadioterapiaRESUMO
Rabdomiossarcoma é o sarcoma de partes moles, mais comum na infância, portanto de rara ocorrência em adultos e localiza-se no trato genital feminino. Entre seus subtipos, destaca-se como mais freqüente o embrionário. Representa um tumor agressivo, de difícil diagnóstico e tratamento envolvendo excisão cirúrgica, radioterapia e quimioterapia. Os autores apresentam um caso de rabdomiossarcoma embrionário localizado em vagina, enfatizando os aspectos relevantes sobre o tema.
Rhabdomyosarcoma is the most common soft tissue sarcoma of childhood, although it is rare in adults and in the female genital tract. Among its subtypes, embryonal distinguish as the most frequent one. It represents an aggressive tumor, with difficult diagnostic and its treatment includes surgical excision, radiotherapy and chemotherapy. The authors present a case of embryonal rhabdomyosarcoma localized in vagina, emphasizing relevant aspects about the topic.