Carcinoma medular da mama: correlação anátomo-radiológica

OBJETIVO: Avaliar as características radiológicas do câncer de mama medular em pacientes submetidas a tratamento cirúrgico no Instituto Nacional de Câncer (INCA) - Ministério da Saúde, Rio de Janeiro, RJ, correlacionando os achados com estudo histopatológico. MATERIAIS E MÉTODOS: Foi realizado estudo descritivo retrospectivo de mulheres submetidas a tratamento cirúrgico no INCA, no período de janeiro de 1997 a dezembro de 2006, para identificação das pacientes com carcinoma medular e análise dos achados radiológicos. RESULTADOS: Foram identificadas 21.287 pacientes com diagnóstico de carcinoma neste período, sendo 76 pacientes com diagnóstico de carcinoma medular típico (0,357%). Nessas pacientes selecionadas, a idade média foi de 51,9 anos (32 a 81 anos). Dezenove pacientes apresentavam lesão na mamografia, sendo 17 (89,5%) nódulos e 2 assimetrias focais (10,5%). Entre as pacientes com nódulo, 15 (88,1%) apresentavam alta densidade e 2 eram isodensos (11,9%). Doze pacientes apresentavam achados ultra-sonográficos e, destas, 11 (91,6%) apresentavam nódulos hipoecóicos. Foi observada uma paciente com nódulo anecóico com áreas de degeneração cística. CONCLUSÃO: O nódulo foi o achado radiológico dominante (89,5%), dos quais 88,1% apresentaram nódulos com alta densidade e margens circunscritas. Apesar das características radiológicas de benignidade, um nódulo com alta densidade, sólido, margens circunscritas e crescimento rápido deve ser investigado para confirmar o diagnóstico.

Radioterapia externa conformada 3D para o carcinoma de próstata: experiência do Instituto do Radium de Campinas com 285 pacientes

OBJETIVO: Reportar resultados de tratamentos do câncer de próstata com radioterapia conformada 3D realizados em uma única instituição. MATERIAIS E MÉTODOS: De julho de 1997 a janeiro de 2002, 285 pacientes consecutivos com câncer de próstata foram submetidos a radioterapia conformada 3D com dose mediana de 7.920 cGy na próstata e analisados retrospectivamente. A distribuição segundo o grupo de risco foi a seguinte: baixo risco - 95 (33,7%); risco intermediário - 66 (23,4%); alto risco - 121 (42,9%) pacientes. RESULTADOS: Em seguimento mediano de 53,6 meses (3,6-95,3 meses), sobrevidas atuariais global, causa específica, livre de metástases a distância e livre de recidiva bioquímica em cinco anos foram de 85,1%, 97,0%, 94,2% e 75,8%, respectivamente. Sobrevidas atuariais livre de toxicidade retal e urinária tardias em cinco anos foram de 96,4% e 91,1%, respectivamente. Ressecção transuretral pré-radioterapia conformada 3D e doses > 70 Gy em 30% do volume da bexiga implicaram maior toxicidade urinária tardia grau 2-3 em cinco anos (p = 0,0002 e p = 0,0264, respectivamente). CONCLUSÃO: A primeira experiência relatada de radioterapia conformada 3D no Brasil permitiu altas doses de radiação, com toxicidades retal e urinária aceitáveis. A existência de ressecção transuretral de próstata pré-radioterapia conformada 3D pode sinalizar maior risco de toxicidade urinária tardia grau 2-3 após irradiação. Restrição da dose < 70 Gy em 30% do volume da bexiga à tomografia de planejamento pode reduzir complicações urinárias tardias.

Sinais de hipervascularização em imagens de ressonância magnética em metástases ósseas de carcinoma de células renais

OBJETIVO: Avaliar a frequência de hipervascularização pela visualização de vasos no interior ou ao redor de metástases ósseas de carcinoma de células renais. MATERIAIS E MÉTODOS: Foram avaliados, retrospectivamente, exames de ressonância magnética de 13 pacientes com diagnóstico de carcinoma de células renais, com 15 lesões ósseas metastáticas, que não haviam sido submetidos a nenhum tratamento. RESULTADOS: Foram encontrados sinais de hipervascularização em 12 das 15 lesões (80%), sendo 6 na coluna lombar, 3 na bacia, 1 na coluna torácica, 1 na ulna e 1 na tíbia. CONCLUSÃO: A alta frequência de hipervascularização em metástases ósseas de carcinoma de células renais encontrada neste trabalho pode sugerir a etiologia renal, tornando-se muito útil na apresentação clínica usual de lesão óssea única com neoplasia primária desconhecida.

Carcinoma verrucoso da mão: uma rara apresentação avaliada por ressonância magnética

O carcinoma verrucoso é uma variante do carcinoma de células escamosas, vista em mucosas e pele, raramente encontrada na mão. Nós relatamos um caso de duas lesões no dorso da mão, sem contato entre si, que foram ressecadas em bloco e confirmadas como carcinoma verrucoso.

Metástase na mama originada de carcinoma ovariano: relato de caso e revisão da literatura

Carcinoma primário de ovário raramente origina metástase para mama, com poucos casos descritos na literatura. Os autores relatam um caso de uma paciente com carcinoma ovariano que evoluiu com metástase para mama após cerca de oito anos do diagnóstico inicial da neoplasia e realizam revisão bibliográfica do assunto, dando ênfase aos aspectos de imagem.

Mucinous carcinoma of the breast: iconographic essay with histopathological correlation

The present essay is aimed at describing the most characteristic imaging findings of mucinous carcinoma of the breast, with emphasis on the patterns related to better prognosis. The authors selected cases of mucinous carcinoma of the breast whose images were available, highlighting the imaging findings suggestive of this subtype of breast cancer, either at mammography, ultrasonography or magnetic resonance imaging.

Preparation and management of complications in prostate biopsies

Transrectal ultrasonography-guided biopsy plays a key role in prostate sampling for cancer detection. Among interventional procedures, it is one of the most frequent procedures performed by radiologists. Despite the safety and low morbidity of such procedure, possible complications should be promptly assessed and treated. The standardization of protocols and of preprocedural preparation is aimed at minimizing complications as well as expediting their management. The authors have made a literature review describing the possible complications related to transrectal ultrasonography-guided prostate biopsy, and discuss their management and guidance to reduce the incidence of such complications.

Relationship between two year PSA nadir and biochemical recurrence in prostate cancer patients treated with iodine-125 brachytherapy

Objective To evaluate the relationship between two year PSA nadir (PSAn) after brachytherapy and biochemical recurrence rates in prostate cancer patients. Materials and Methods In the period from January 1998 to August 2007, 120 patients were treated with iodine-125 brachytherapy alone. The results analysis was based on the definition of biochemical recurrence according to the Phoenix Consensus. Results Biochemical control was observed in 86 patients (71.7%), and biochemical recurrence, in 34 (28.3%). Mean PSAn was 0.53 ng/ml. The mean follow-up was 98 months. The patients were divided into two groups: group 1, with two year PSAn < 0.5 ng/ml after brachytherapy (74 patients; 61.7%), and group 2, with two year PSAn ≥ 0.5 ng/ml after brachytherapy (46 patients; 38.3%). Group 1 presented biochemical recurrence in 15 patients (20.3%), and group 2, in 19 patients (43.2%) (p < 0.02). The analysis of biochemical disease-free survival at seven years, stratified by the two groups, showed values of 80% and 64% (p < 0.02), respectively. Conclusion Levels of two year PSAn ≥ 0.5 ng/ml after brachytherapy are strongly correlated with a poor prognosis. This fact may help to identify patients at risk for disease recurrence.

Primary neuroendocrine breast carcinoma: a case report and literature review

The authors present a case of a neuroendocrine carcinoma in an asymptomatic 75-year-old woman, detected in routine breast screening. The lesion was visible at mammography as a well circumscribed, medium density nodule, with no associated microcalcifications, and at ultrasonography as a hypoechoic nodule, with irregular shape and ill-defined margins. Magnetic resonance imaging revealed findings consistent with malignancy.

Multiparametric magnetic resonance imaging of the prostate: current concepts

Multiparametric MR (mpMR) imaging is rapidly evolving into the mainstay in prostate cancer (PCa) imaging. Generally, the examination consists of T2-weighted sequences, diffusion-weighted imaging (DWI), dynamic contrast-enhanced (DCE) evaluation, and less often proton MR spectroscopy imaging (MRSI). Those functional techniques are related to biological properties of the tumor, so that DWI correlates to cellularity and Gleason scores, DCE correlates to angiogenesis, and MRSI correlates to cell membrane turnover. The combined use of those techniques enhances the diagnostic confidence and allows for better characterization of PCa. The present article reviews and illustrates the technical aspects and clinical applications of each component of mpMR imaging, in a practical approach from the urological standpoint.

The role of transrectal ultrasound in the diagnosis of prostate cancer: new contributions

Objective: The present study was aimed at evaluating the contribution of transrectal prostate ultrasound in the screening for prostate neoplasias and in the guidance of prostate biopsies. Materials and Methods: Prospective study developed over a one-year period. All the patients with indication for prostate biopsy were evaluated. Regardless of PSA values, the patients underwent ultrasound in order to identify suspicious nodules (confirmed by two observers). Sextant biopsy was subsequently performed. In cases of finding suspicious nodules, an additional puncture directed to such nodules was done. Results: In a total of 155 cases the prevalence of malignancy was of 53%. Suspicious nodules were detected in 34 patients, and 25 where malignant (positive predictive value of 74%). The specificity and sensitivity for suspicious nodules were 88% and 31% respectively. Comparatively with the randomly obtained sextant specimens, the rate of findings of neoplasia was higher in the specimens obtained with puncture directed to the nodule (p = 0.032). No statistically significant difference was observed in the Gleason score for both types of specimens (p = 0.172). Conclusion: The high positive predictive value and the high rate of findings of neoplasia in specimens of suspicious nodules should be taken into consideration in the future. The authors suggest a biopsy technique similar to the one described in the present study (sextant biopsy plus puncture directed to the suspicious nodule).

Renal cell carcinoma: histological classification and correlation with imaging findings

AbstractRenal cell carcinoma (RCC) is the seventh most common histological type of cancer in the Western world and has shown a sustained increase in its prevalence. The histological classification of RCCs is of utmost importance, considering the significant prognostic and therapeutic implications of its histological subtypes. Imaging methods play an outstanding role in the diagnosis, staging and follow-up of RCC. Clear cell, papillary and chromophobe are the most common histological subtypes of RCC, and their preoperative radiological characterization, either followed or not by confirmatory percutaneous biopsy, may be particularly useful in cases of poor surgical condition, metastatic disease, central mass in a solitary kidney, and in patients eligible for molecular targeted therapy. New strategies recently developed for treating renal cancer, such as cryo and radiofrequency ablation, molecularly targeted therapy and active surveillance also require appropriate preoperative characterization of renal masses. Less common histological types, although sharing nonspecific imaging features, may be suspected on the basis of clinical and epidemiological data. The present study is aimed at reviewing the main clinical and imaging findings of histological RCC subtypes.

Diagnostic underestimation of atypical ductal hyperplasia and ductal carcinoma in situ at percutaneous core needle and vacuum-assisted biopsies of the breast in a Brazilian reference institution

Abstract Objective: To determine the rates of diagnostic underestimation at stereotactic percutaneous core needle biopsies (CNB) and vacuum-assisted biopsies (VABB) of nonpalpable breast lesions, with histopathological results of atypical ductal hyperplasia (ADH) or ductal carcinoma in situ (DCIS) subsequently submitted to surgical excision. As a secondary objective, the frequency of ADH and DCIS was determined for the cases submitted to biopsy. Materials and Methods: Retrospective review of 40 cases with diagnosis of ADH or DCIS on the basis of biopsies performed between February 2011 and July 2013, subsequently submitted to surgery, whose histopathological reports were available in the internal information system. Biopsy results were compared with those observed at surgery and the underestimation rate was calculated by means of specific mathematical equations. Results: The underestimation rate at CNB was 50% for ADH and 28.57% for DCIS, and at VABB it was 25% for ADH and 14.28% for DCIS. ADH represented 10.25% of all cases undergoing biopsy, whereas DCIS accounted for 23.91%. Conclusion: The diagnostic underestimation rate at CNB is two times the rate at VABB. Certainty that the target has been achieved is not the sole determining factor for a reliable diagnosis. Removal of more than 50% of the target lesion should further reduce the risk of underestimation.