Download Fernando Martínez Ortiz. Hospital Torrecárdenas. Almería

Jerez 2015. SEC.
Dr. Fernando Martínez Ortiz
Servicio de Anatomía Patológica.
Hospital Torrecárdenas (Almería)
Caso clínico:
• Mujer de 47 años.
• Cáncer ductal invasivo de mama derecha,
G1 de la clasificación de Nottingham.
• 3 ganglios linfáticos axilares…
Caso clínico:
• Mujer de 47 años.
• Cáncer ductal invasivo de mama derecha,
G1 de la clasificación de Nottingham….
• …..primer día de intraoperatorias de este
patólogo.
¿¡ Hematoxilina-eosina !?
DIAGNÓSTICO: METÁSTASIS DE CARCINOMA
2 Días después
P 63
Mammaglobina
DIAGNÓSTICO: METÁSTASIS DE CARCINOMA
DIAGNÓSTICO: INCLUSIÓN GLANDULAR
BENIGNA EN GANGLIO CENTINELA
Incidencia: 0,2-1,5 %
Falsos positivos (Hospital Torrecárdenas 2014)
- Número de pacientes: 127
- Número de ganglios centinelas obtenidos: 247
- Número de falsos positivos: 2 (0,8 %)
Rosai and Ackerman's Surgical Pathology, 10th Edition
By Juan Rosai, MD
Breast tissue. One of the most unusual forms of ectopia is represented by
normal mammary lobules within axillary lymph nodes.[1351,1360,1365] A
slightly more common occurrence is the presence in axillary nodes of tubules
lined by a single layer of cuboidal cells (sometimes with a hobnail
appearance), located in the nodal capsule or immediately beneath. These
formations are similar to the müllerian-type epithelial inclusions in pelvic lymph
nodes previously described. Since some of these cases occur in patients
with breast carcinoma, the distinct possibility exists of mistaking them
for metastatic tumor.[1354,1355] We have recently reviewed 17 cases of
epithelial inclusions in axillary lymph nodes of females, and classified them
into three major groups: those composed exclusively of glandular structures,
those made up only of squamous cysts, and those containing both glandular
and squamous epithelium.[1353] The issue is further discussed in Chapter 20.
ORIGEN:
- Embólico.
- Restos embrionarios.
MORFOLOGÍA:
-Similar al epitelio glandular mamario normal.
- Aspecto “epidérmico” con queratinización.
DATOS DE AYUDA:
-Metástasis: subcapsular o interior del parénquima
-Inclusiones no tienen atipia.
-Comparación con características del tumor primario (¿Digitalización?)
ORIGEN:
- Embólico.
- Restos embrionarios.
MORFOLOGÍA:
-Similar al epitelio glandular mamario normal.
- Aspecto “epidérmico” con queratinización.
DATOS DE AYUDA:
-Metástasis: subcapsular o interior del parénquima
-Inclusiones no tienen atipia.
-Comparación con características del tumor primario (¿Digitalización?)
IMPORTANTE: PUEDEN COEXISTIR
…The yields of the two methods are very comparable, with accuracy and false-negativity rates ranging
from 79 to 98% and from 9 to 52%, respectively, for frozen sections and from 77-99% and from 5 to 70%,
respectively, for intra-operative cytology…
…Our data support the evidence that FSA should be used with caution for non palpable tumours and
microcalcifications. Althoug our cohort had a clinical false negative rate of 9% and a similar distribution of in situ
lesions between one-stage and two-stage operated patients the use of preoperative stereotactic biopsy
indicanting non-palpability, a mass below 1 cm or microcalcifications increased the chance for a clinical false
negative FSA, and thus, a second operation…
Dr. Tote Viguer
Muchas
gracias
(Nos vemos en Almería)