Among the clinical parameters studied, only tumor size was correlated with metastatic involvement in axillary lymph nodes. The size of the metastases and the number of positive SLN also directly increased the possibility of systemic recurrence. The different rates of recurrence indicate that the biological significance of these types of metastases is different and that patients with SLN metastases may also have different risks of metastatic involvement of other axillary lymph nodes.

The data related to breast cancer's epidemiology in Brazil are heterogenous, reflecting the country's socioeconomic inequalities. Significant number of cases of this disease are attended through the health insurance system, but data on these cases is poorly disseminated. Objective: To evaluate epidemiological data on breast cancer from patients attended through the health insurance system in the municipality of Jundiaí, São Paulo. Methods: This was a retrospective study conducted through reviewing the medical files of 105 patients diagnosed with breast cancer, who were attended between January 2014 and December 2015. The information gathered included: age, clinical staging, histological type, immunohistochemical profile, surgical treatment and adjuvant treatment. Results: The study included 105 patients with breast cancer who were treated exclusively within the health insurance system of Jundiaí. The patients' mean age was 50.8 years. We observed that 13 patients (12.3%) were diagnosed with ductal carcinoma in situ (stage 0), 43 (40.9%) with stage I, 34 (32.3%) with stage II, 11 (10.4%) with stage III and 2 (1.9%) with stage IV. Conservative surgery was performed on 76 patients (72.3%), while 29 (27.7%) underwent mastectomy. Among the latter, immediate reconstruction was performed in 82.7% (24) of the cases. Conclusion: The high rates of early diagnosis and conservative surgery show that screening for breast cancer within the health insurance system of the municipality of Jundiaí, has been effective. Accessible mammography and the socioeconomic level of the population seem to be the main factors responsible for the obtained findings.

Introduction: Recent studies have questioned the efficacy of mammo graphy in reducing breast cancer-related mortality. Additionally, the efficacies of commercially available gloves marketed as aiding the detection of breast lumps have not been independently verified. Aim:To evaluate the efficacy of clinical breast examination gloves in the detection of breast lumps.

Introduction: Lymphangioma or cystic hygroma is a rare and benign lesion usually found in children or newborns, hardly described after two years of age. It is characterized by congenital obstruction of the lymphatic vessels, which causes dilation and accumulation of lymph inside it. In adults, it can be secondary to trauma and can occur in the neck, head and, more rarely, in the breast and armpit3 . In this study we present an atypical case of recurrent axillary lymphangioma in an elderly patient. Case report: Female patient, 71 years old, with no history of neoplasms, was referred to the breast surgery center in December 2019 due to bulging in the right axillary region over the past three months, with progressive increase in size. She was submitted to a puncture with complete emptying of the lesion, however, she developed a recurrence of the condition. On initial physical examination, she had bulging in the right axillary region, painless on palpation, softened, measuring about 10.0 cm. Investigation continued with mammography and ultrasound, which did not show any breast changes, but showed a cystic lesion in the right axillary extension of 9.0 cm. The patient returned in March 2020 with recurrence of the condition after another relief puncture, presenting a lesion of about 18 cm, in the same topography and with the same aspect of the previous lesion on physical examination. Initially, it was opted for resection of axillary cyst, however, due to the COVID-19 pandemic, the patient’s age and probable benign etiology of the lesion, clinical control was chosen. In August 2020, she presented worsening of the axillary bulging condition, with a lesion measuring about 20.0 cm. We proceeded with the definitive surgical approach with the excision of an axillary cyst with resection of a skin spindle in August 2020. The procedure occurred without complications. The final anatomopathological result showed in cytology the presence of proteinaceous material and mature lymphocytes, corroborating the definitive diagnosis of lymphangioma. During the postoperative period, the patient presented recurrence of the axillary bulging condition, with the need for relief drainage, due to local discomfort. We opted for a new surgical approach to drainage. During the operation, it was possible to observe remnants of the lymphangioma capsule completely adhered to the pectoralis major muscle. We proceeded with vacuum drain and excision of samples from the lesion attached to the muscle was continued. The findings confirmed the diagnosis of lymphangioma. The patient recovered well, with a drain removed on the 10th post operation day. In view of the current situation of the COVID-19 pandemic, it was decided to maintain the clinical follow-up of the patient and she has not had recurrence of the condition so far (five months of follow-up).

RESUMORelato do caso de uma mulher com 83 anos apresentando nódulo e retração de pele na mama direita com oito meses de evolução. Ao exame físico verificou-se nódulo sólido de 5 cm, localizado no quadrante súpero-lateral de mama direita, associado a presença de retração de pele correspondente e linfonodos axilares não coalescentes ipsilaterais. O resultado da mamografia evidenciou nódulo de 4 cm de diâmetro irregular no quadrante súpero-lateral da mama direita (Bi-rads V). Estádio clínico: T2N1M0 (IIB). O tratamento cirúrgico incluiu mastectomia radical modificada (à Maden) com dissecção axilar níveis I, II e III. Avaliação histopatológica demonstrou a presença de carcinoma lobular infiltrativo que mediu 2,5 cm (T2), presença de linfadenite granulomatosa causada por tuberculose em linfonodos dos níveis I, II e III, associados a metástase de carcinoma lobular em um único nível linfático, nível I. Estádio patológico: pT2pN1aM0. A paciente recebeu tratamento para tuberculose ganglionar com rifampicina, isoniazida e pirazinamida por um ano. Foram solicitados receptores hormonais, os quais mostraram-se positivos, sendo feito terapia adjuvante com tamoxifeno. Durante o primeiro ano de seguimento a paciente evoluiu bem, sem sinais de recidiva local ou metástases a distância. ABSTRACTReport of a case of an 83-year-old woman presenting a nodule and skin retraction in the right breast for eight months. On physical examination, a solid nodule of 5 cm was observed, located in the upper-lateral quadrant of the right breast, associated with skin retraction and ipsilateral lymph nodes. Mammographic findings showed irregularly limited nodules of 4 cm in the upper-lateral quadrant of the right breast (Bi-rads V). Clinical staging: T2N1M0 (IIB). Surgical treatment included a modified radical mastectomy with axillary dissection levels I, II, and III. Histopathologic evaluation demonstrated the presence of an infiltrating lobular carcinoma measuring 2.5 cm (T2), presence of granulomatous lymphadenitis caused by tuberculosis in level I, II, and III lymph nodes, associated with lobular carcinoma metastasis in a single level I lymph node. Pathologic staging: pT2pN1aM0. The treatment for the axillary tuberculous lymphadenitis was done with rifampin, isoniazid and pyrazinamide for one year. Hormone receptors were positive, and adjuvant therapy was initiated with tamoxifen. During the first year of follow-up the patient had no signal of local recurrence or distant metastases.