Journal of General Practice

Aim: To assess the importance of the sentinel ganglion (GS) detection technique by lymphoscintigraphy in order to avoid lymphedema of the upper limbs in malignant neoplasms of the breast. The sentinel ganglion is the first ganglion of the lymphatic chain to drain the lymph from the primary tumor. The lymphoscintigraphy allows to identify this ganglion, to facilitate its removal by the surgeon and to be analyzed by the pathological anatomy through an extemporaneous analysis in order to avoid axillary emptying in case of negative analysis for metastases.
Material and Methods: All lymphoscintigraphy were performed with the BrigthView Philips model camera at the SESARAM, E.P.E.. All of these studies followed the same protocol according to the EANM guidelines. An anamnesis of the patient was carried out, the explanation of the procedure and the positioning of the patient according to the protocol in force. A dynamic study was performed immediately after administration of the radiopharmaceutical and then static, anterior, oblique and lateral images. After processing the acquired images and marking GS on the skin with the aid of the Europrobe 3 probe, clinical reports were performed. For the analysis of the data, we selected female patients with breast neoplasia, who underwent the examination between June 23, 2017 and March 22, 2018, aged between 33 and 88 years.
Results: Through the evaluation of the sample of 56 users we can verify that this technique allowed to avoid axillary emptying in 39 patients. Of the 56 patients, 2 had bilateral breast neoplasia, 33 right breast neoplasm and 21 left breast cancer. Of the 2 patients with bilateral malignant neoplasia, one presented both negative ganglia and the other presented negative right GS and positive left GS and consequent axillary emptying. Of the 33 patients with neoplasia of the right breast 8, they emptied, and of the 21 patients with left breast neoplasia, 9 performed emptying.
Conclusions: According to the data obtained in the SESARAM E.P.E. Nuclear Medicine study, it was verified that lymphoscintigraphy allowed to avoid axillary emptying in 39 patients, which corresponds to 70% of the sample. It is confirmed that this diagnostic technique is an asset in the preservation of the lymphatic chain. The availability of this technique in a hospital regimen for the detection of sentinel ganglion in the Regional Health Service is considered important to avoid the limitations associated with axillary emptying and consequent improvement in the quality of life of these patients".

Pulmonary artery hypertension (PAH) is common cardio-pulmonary phenomenon associated with higher risk of premature death and disability. Several previous studies have shown that decreased number of circulating endothelial progenitor cells (EPCs) correlated well with vascular remodeling and impaired pulmonary artery function. Moreover, a deep deficiency of EPC characterized a poor clinical outcomes in PAH individuals. There is large body of evidence regarding that the EPCs could be not just biomarker of endothelial dysfunction, but a target of PAH therapy. However, improvement of PAH severity associated with increasing number of circulating EPC with angiopoetic phenotype accompanying sildenafil care. The short communication is depicted the predictive role of EPCs in risk stratification in PAH patients and possibilities to use EPC-based care aimed improving clinical outcomes.

Papillary carcinoma of the breast is a rare type of breast malignancy, less than 2% of breast cancers, and only a part of them are encapsulated papillary carcinoma (EPC). Usually, EPC are low-grade luminal like tumours. The authors report a case of a 50-year-old female with the diagnosis of an unusual high-grade triple negative EPC with an area of invasive papillary carcinoma and negative axillary lymph nodes. Considering its rarity, the description of this case and clinical management are important to better understand this entity and choose the best clinical practice.

A 10 year-old boy presented to the pediatric clinic with gross hematuria, tea-colored urine dating from 4 days before consulting, mild pelvic abdominal pain, decreased appetite and history of 2 days of fever prior, no nausea, no vomiting. Upon reviewing the past medical history over the previous weeks: patient noted that 15 days prior to consulting, he complained of sore throat with enlarged tonsils, no antibiotic was taken. On physical exam, patient has a blood pressure of 115/79, bilateral flank abdominal tenderness, no edema.

Phyllodes tumors are rare fibroepithelial lesions that count for 0.3-1% of all primary breast tumors.
Telling the difference between phyllodes tumors and giant juvenile fibroadenomas, that rarely affect adolescent and young women, is difficult but of importance because resection with margins is the mainstay of treatment for phyllodes tumors.
We report a clinical case of an eighteen-year-old female patient, with past history of left breast lump excision four years before, classified as “juvenile fibroadenoma”.
In early 2015, she was referred to the consultation by the appearance of a bulky ipsilateral lump (10.8 x 6.9 cm), core-biopsy histology revealed “fibroadenoma with more lax stroma vs benign phyllodes tumor”. Surgical excision of the lesion was performed.
Histology of the specimen confirmed “benign phyllodes breast tumor (14 x 12 x 8 cm and 788 g)”. Given its benign nature and negative margins, the patient did not require further treatment and currently attends in follow-up consultation.
A brief discussion of this rare form of fibroepithelial tumor, minding its classification, diagnosis, treatment, followup and prognosis is done.