RESUMO
Introducción El Carcinoma Lobulillar Invasor (cli) es el tipo histológico especial más común del cáncer de mama. Presenta características histopatológicas asociadas a buen pronóstico, pero algunos estudios sugieren que los resultados a largo plazo pueden ser peores que los del Carcinoma Ductal Invasor (cdi). Objetivo Los objetivos principales del estudio fueron evaluar las características clínico-patológicas del cli y establecer el valor pronóstico. Material y método Se seleccionaron 244 pacientes con cli y se utilizó como grupo control a 524 pacientes con cdi, comparándolas con relación 2 a 1. Resultados No se observaron diferencias en edad, estado menopáusico, motivo de consulta e invasión linfovascular. Fueron más frecuentemente multifocales, multicéntricos, de mayor tamaño, bajo grado histológico y her2 negativo. La cirugía conservadora se realizó con menos frecuencia. No hubo diferencias significativas en recaída a distancia, cáncer de mama contralateral, sobrevida libre de enfermedad y global. Conclusiones Las pacientes con cli no tuvieron mejores resultados a pesar de un fenotipo biológico más favorable. La histología ductal o lobulillar no debería ser un factor en el manejo de la patología, y no debería considerarse un factor pronóstico o predictivo determinante al momento del diagnóstico
Introduction Invasive Lobular Carcinoma (ilc) is the second most common histologic type of breast cancer. Typically, displays features associated with a good prognosis, but some studies suggest that outcomes of ilc may be worse than for Invasive Ductal Carcinoma (idc). Objective The main purpose of this study was to evaluate the clinical-pathological characteristics of Lobular Breast Carcinoma and establish his prognostic value. Materials and method We selected a group of 244 patients with ilc and compared with 524 patients whit idc in relation 2:1. Results There were no differences in age, menopausal status, symptoms at time of diagnosis, and lymph vascular invasion. ilc were larger, low histological grade and her2 negative, more often mulfifocal and multicentric. Breast-preservation therapy was less frequent for Invasive Lobular Carcinoma. Distant relapse, contralateral cancer, overall survival, disease-free survival, did not differ between idc and ilc. Conclusions Women with ilc do not have better clinical outcomes than patients with idc, despite the fact that the biologic phenotype of ilc is quite favorable. The ductal or lobular histology should not be a factor in the therapeutic decision-making process, and should not be considered an important prognostic or predictive factor at diagnosis
Assuntos
Neoplasias da Mama , Carcinoma Lobular , Carcinoma DuctalRESUMO
Introducción El cáncer de mama es el cáncer de mayor frecuencia en mujeres a nivel mundial y la principal causa de muerte por cáncer en mujeres en países en desarrollo. Objetivos Los objetivos principales de este estudio fueron: evaluar las características clínico-patológicas de las pacientes con cáncer de mama en el Hospital Público Regional de San Rafael, Mendoza; y, adicionalmente, determinar el conocimiento de una cohorte independiente de mujeres con respecto a los controles mamarios en los Centros de Salud periféricos de esta ciudad. Material y método Para el análisis epidemiológico del cáncer de mama en San Rafael, se consultó el Registro Provincial de Tumores de Mendoza. Para estudiar las variables clínico-patológicas, se realizó un estudio descriptivo, de tipo transversal, de 51 pacientes consecutivos con diagnóstico de cáncer de mama, durante el período enero de 2014 a julio de 2016, en el Servicio de Ginecología del Hospital "Teodoro Schestakow" de la Ciudad de San Rafael, Mendoza. Para determinar el nivel de conocimiento con respecto al control mamario, se realizaron encuestas en centros de salud periféricos de los barrios Pueblo Diamante, Constitución, El Molino, Villa Laredo y El Sosneado, de San Rafael, con previa autorización de la Dirección del Área Municipal de Salud. Resultados El cáncer de mama en la mujer correspondió al 33,9% de todos los cánceres en el período 2008-2012, acorde al Registro Provincial de Tumores. La edad promedio al momento del diagnóstico fue de 53 años (rango: 24-81 años). Se diagnosticaron estadios avanzados (III y IV) en el 41,2% de las pacientes. El 96,1% de las pacientes presentó sintomatología mamaria al momento del diagnóstico, siendo el tumor mamario (en autoexamen) el más frecuente. Solo el 22% de las mujeres encuestadas realiza el control mamario anual; y solo el 7% de las pacientes refiere que se les efectúa examen mamario en la consulta médica. Conclusiones El diagnóstico de cáncer de mama en San Rafael se realiza principalmente en pacientes sintomáticas, lo que refleja las carencias en el diagnóstico precoz, en los controles mamarios y en la información de la población femenina. Esto representa una oportunidad para realizar campañas de prevención dirigidas a la población, así como educación de los efectores de salud de los centros periféricos.
Introduction Breast cancer is the most frequent cancer in women globally, and the leading cause of cancer death in women in developing countries. Objectives The main purposes of this study were to evaluate the clinical-pathological characteristics of breast cancer patients at the Regional Public Hospital of San Rafael, Mendoza; and additionally determine the knowledge of an independent cohort of women with respect to the breast controls in peripheral primary care centers of this city. Materials and method For the epidemiological analysis of breast cancer in San Rafael, the Provincial Registry of Tumors (Mendoza) was consulted. To evaluate the clinical-pathological characteristics of patients at the Regional Public Hospital of San Rafael, Mendoza, a descriptive and crosssectional study of 51 patients diagnosed with breast cancer, from January 2014 to July 2016, was carried out. To determinate the knowledge level, attitudes and practice with respect to breast controls in primary care centers we carried out several surveys of an independent cohort of women in peripheral primary care centers of this city. Results Breast cancer in women accounted for 33.9% of all cancers in the 2008-2012 period, according to the Provincial Registry of Tumors. The mean age at diagnosis was 53 years (range: 24-81 years). Advanced breast cancer (stages III and IV) was diagnosed in 41.2% of the patients. Breast clinical manifestations were detected in 96.1% of the patients at the time of diagnosis, being the breast lump (in self-examination) the most frequent symptom. Only 22% of the women surveyed performed annual breast control, and only 7% of the patients reported having a breast exam at the medical visit. Conclusions The diagnosis of breast cancer in San Rafael is performed mainly in symptomatic patients, reflecting the deficiencies in the early diagnosis, in the breast controls and lastly in the female population knowledge. This represents an opportunity to carry out prevention campaigns toward the population as well as education of the health effectors at the peripheral health centers.
Assuntos
Humanos , Feminino , Neoplasias da Mama , Neoplasias da Mama/epidemiologia , Mamografia , Diagnóstico PrecoceRESUMO
AIM: Accumulated evidence suggests that aberrant methylation of the TP73 gene and increased levels of ΔNp73 in primary tumours correlate with poor prognosis. However, little is known regarding the transcriptional and functional regulation of the TP73 gene in breast cancer. The aim of the present study was to determine the expression of the ΔNp73 isoform, its relationship with DNA methylation of TP73 and their clinical prognostic significance in breast cancer patients. METHODS: TP73 gene methylation was studied in TCGA datasets and in 70 invasive ductal breast carcinomas (IDCs). The expression of p73 isoforms was evaluated by immunohistochemistry (IHC) and Western blot and correlated with clinicopathological variables and clinical outcome. RESULTS: We observed that the methylation of diverse CpG islands of TP73 differed significantly between molecular subtypes. An inverse correlation was found between p73 protein expression and the methylation status of the TP73 gene. The expression of exon 3' of p73 (only expressed in ΔNp73) was significantly higher in patients with wild-type p53. Immunohistochemical analysis revealed that all p73 isoforms were localised in both the nuclear and cytoplasmic compartments. We confirmed a positive association between the expression of ∆Np73 and high histological grade. CONCLUSIONS: Our findings suggest that high expression of ΔNp73 could be used to determine the aggressiveness of IDCs and could be incorporated in the pathologist's report.
Assuntos
Neoplasias da Mama/diagnóstico , Carcinoma Ductal de Mama/diagnóstico , Ilhas de CpG/genética , Proteína Tumoral p73/genética , Mama/metabolismo , Mama/patologia , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/metabolismo , Carcinoma Ductal de Mama/patologia , Metilação de DNA , Intervalo Livre de Doença , Feminino , Humanos , Imuno-Histoquímica , Prognóstico , Isoformas de Proteínas , Proteína Tumoral p73/metabolismoRESUMO
Breast carcinogenesis is a multistep process that involves both genetic and epigenetic alterations. Identification of aberrantly methylated genes in breast tumors and their relation to clinical parameters can contribute to improved diagnostic, prognostic, and therapeutic decision making. Our objective in the present study was to identify the methylation status of 34 cancer-involved genes in invasive ductal carcinomas (IDC). Each of the 70 IDC cases analyzed had a unique methylation profile. The highest methylation frequency was detected in the WT1 (95.7%) and RASSF1 (71.4%) genes. Hierarchical cluster analysis revealed three clusters with different distribution of the prognostic factors tumor grade, lymph node metastasis, and proliferation rate. Methylation of TP73 was associated with high histological grade and high proliferation rate; methylation of RARB was associated with lymph node metastasis. Concurrent methylation of TP73 and RARB was associated with high histological grade, high proliferation rate, increased tumor size, and lymph node metastasis. Patients with more than six methylated genes had higher rates of relapse events and cancer deaths. In multivariate analysis, TP73 methylation and the methylation index were associated with disease outcome. Our results indicate that methylation index and methylation of TP73 and/or RARB are related to unfavorable prognostic factors in patients with IDC. These epigenetic markers should be validated in further studies to improve breast cancer management.
Assuntos
Neoplasias da Mama/genética , Carcinoma Ductal de Mama/genética , Ilhas de CpG , Metilação de DNA , Regulação Neoplásica da Expressão Gênica , Adulto , Mama/metabolismo , Mama/patologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/patologia , Carcinoma Ductal de Mama/diagnóstico , Carcinoma Ductal de Mama/patologia , Análise por Conglomerados , Proteínas de Ligação a DNA/genética , Feminino , Humanos , Pessoa de Meia-Idade , Proteínas Nucleares/genética , Prognóstico , Receptores do Ácido Retinoico/genética , Proteína Tumoral p73 , Proteínas Supressoras de Tumor/genética , Proteínas WT1/genéticaRESUMO
INTRODUCTION: Giant fibroadenoma is an uncommon variant of benign breast lesions. Aberrant methylation of CpG islands in promoter regions is known to be involved in the silencing of genes (for example, tumor-suppressor genes) and appears to be an early event in the etiology of breast carcinogenesis. Only hypermethylation of p16INK4a has been reported in non-giant breast fibroadenoma. In this particular case, there are no previously published data on epigenetic alterations in giant fibroadenomas. Our previous results, based on the analysis of 49 cancer-related CpG islands have confirmed that the aberrant methylation is specific to malignant breast tumors and that it is completely absent in normal breast tissue and breast fibroadenomas. CASE PRESENTATION: A 13-year-old Hispanic girl was referred after she had noted a progressive development of a mass in her left breast. On physical examination, a 10 × 10 cm lump was detected and axillary lymph nodes were not enlarged. After surgical removal the lump was diagnosed as a giant fibroadenoma. Because of the high growth rate of this benign tumor, we decided to analyze the methylation status of 49 CpG islands related to cell growth control. We have identified the methylation of five cancer-related CpG islands in the giant fibroadenoma tissue: ESR1, MGMT, WT-1, BRCA2 and CD44. CONCLUSION: In this case report we show for the first time the methylation analysis of a giant fibroadenoma. The detection of methylation of these five cancer-related regions indicates substantial epigenomic differences with non-giant fibroadenomas. Epigenetic alterations could explain the higher growth rate of this tumor. Our data contribute to the growing knowledge of aberrant methylation in breast diseases. In this particular case, there exist no previous data regarding the role of methylation in giant fibroadenomas, considered by definition as a benign breast lesion.