Introduction: Breast sarcoma is a rare form of malignancy that arises from connective tissue, comprising less than 5% of all sarcomas. Undifferentiated pleomorphic sarcoma (UPS) of the breast is a rare and aggressive subtype of radiation-induced sarcoma that can occur in treated breast cancer patients. The diagnosis is challenging and often missed due to the low incidence, long latency period, unspecific imaging finding, and difficulties in clinical and histological detection. Case report: A 56-year-old woman was diagnosed with early-stage triple-negative breast cancer in 2013 and underwent breast-conserving therapy (BCT). After five years follow-up, she developed mastalgia and breast induration, and after mammography and ultrasound without suspicious lesions, a magnetic resonance imaging (MRI) was performed and showed a highly suggestive malignancy mass measuring 8.0 cm and invading the chest wall. The core biopsy revealed a spindle cells malignant tumor, negative for pan cytokeratin and most of immuno-histochemical markers, suggesting sarcoma, but requiring investigation of surgical specimen to exclude metaplastic carcinoma. She underwent Halsted radical mastectomy, full-thickness left anterior chest wall resection contemplating segments of the 4th and 5th ribs and reconstruction with synthetic mesh. The surgical specimen evidenced a UPS with clear margins. The patient had good postoperative recovery and remains in follow-up with the mastology team. Conclusion: This report shows that radiation-induced sarcomas of the breast can be difficult to diagnose, and how later treatment can demand a major surgery with higher morbidity. Prognosis may improve if detected early.

Objectives: Describe the frequency and factors associated with the indication of Sentinel lymph node biopsy (SLNB) after neoadjuvant chemotherapy (NACT) and the impact of SLNB on prognosis. Methods: Retrospective cohort study of women with breast cancer submitted to NACT from january 2013 to july 2015 at Hospital do Cancer III of the National Cancer Institute (HCIII/INCA). The data were collected in electronic and physical records. This study was approved by INCA's ethics and research committee. Results: A total of 783 women with mean age of 52 years (±11) were included. The majority were diagnosed with clinical stage IIIA (23%) and IIIB (33%), and with a Luminal A subtype (ER+ and / or PR+, HER2-) (52%). After NACT, complete response was observed in 15% and partial in 58%. Mastectomy was performed in 85% of the women, and 25% were submitted to SLNB (alone 14% and SLNB + Lymphadenectomy 11%). The factors associated with SLNB were: Initial clinical stage (OR = 6.22 95%CI 4.28-9.06) and complete response to NACT (OR=1.96 95%CI 1.29-2.97). In the follow-up, were observed 23% of recurrence /metastasis and 13% of death. After adjustment (cT, cN and NACT response), there was no association between the performance of SLNB with recurrence/metastasis (HR=1.51 95%CI 0.93-2.46) and death (HR=1.48 95%CI 0.76-2.90). Conclusion: The indication of SLNB after NACT was associated with initial clinical stage and complete response to NACT. After adjustment, SLNB was not associated with prognosis.

Existem algumas possibilidades para se fazer o diagnóstico das lesões subclínicas: a biópsia cirúrgica; a biópsia por agulha grossa; e a punção aspirativa por agulha fina (PAAF).

Purpose: compare demographic, clinical and treatment characteristics of women undergoing neoadjuvant chemotherapy (NAC) for breast cancer (BC) treatment according to the axillary approach and analyze factors associated with the indication of sentinel lymph node biopsy (SLNB) in a real-life scenario. Methods: retrospective cohort study in women diagnosed with BC with indication for NAC. Demographic, clinical, tumor, surgical and adjuvant treatment variables were obtained.. A univariate logistic regression was performed to evaluate the independent factors associated with SLNB indication and a multiple model was applied for adjustments. Results: A total of 918 patients were included in this study, 161 (17.5%) of whom underwent SLNB, 105 (11.4%) who underwent SLNB followed by AL and 652 (71.0%) who underwent AL only. Concerning the adjusted model, women in stage III were 95% less likely to be submitted to an SLNB (OR = 0.05 95% CI 0.01-0.17; p<0.001) compared to those in stage I. Women who underwent mastectomies exhibited a 90% lower chance of undergoing SLNB than those who underwent conservative surgery (95% CI 0.06-0.17; p <0.001). Considering NAC responses, cases with no response or presenting disease progression exhibited a 55% lower chance of undergoing SLNB compared to those displaying a total response (OR = 0.45 95% CI 0.24-0.82; p = 0.009). Conclusion: SLNB was performed in 29% of the patients following NAC. Patients presenting a more advanced clinical stage of the disease with a worse NAC response and those who underwent mastectomies were less likely to undergo SLNB.

Objective: To evaluate the survival of patients with metastatic breast tumors, with human epidermal growth factor (HER2) receptors, present and treated in Unit 3 of the National Cancer Institute. Methodology: Retrospective cohort study with women diagnosed and treated in Unit 3 of the National Cancer Institute, in the years 2008 and 2009 (n=2035). For this analysis, patients with HER2 positive at diagnosis, clinical staging I to III (n=412) and who progressed with metastasis in the follow-up period (n=92) were selected. In this group of patients, 15.2% did herceptin palliative and 84.8% did not. Results: Among the 92 positive Herb 2 patients who progressed with distant metastasis, 32.6% had bone or soft tissue, 62% visceral and 5.4% locoregional metastasis, respectively. The mean survival of the patients was 38.4 months. Among those taking Herceptin, the mean survival was 49.7 months, while those who did not were 35.9 months. Among 31 patients with bone metastasis, enrolled between 2007 and 2009, 5 (16%) did Herceptin and 31 (84%) did not. The mean survival was 51.3 months and 31.7 months, respectively. In general, those patients who did not take Herceptin had a 2.35-fold higher risk of death compared to those who did (HR=2.35 95%CI 1.12-4.95, p=0.024). Conclusion: The use of trastuzumab in the palliative treatment of Herb2 positive patients had an impact on survival in the present study, including isolated bone metastases.