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A multipara pregnant woman, 38 years old, presented with an initial suspicion of antibiotic-refractory mastitis. A breast biopsy revealed luminal type B invasive carcinoma and the image showed bone and liver metastases. She developed oligosymptomatic hypercalcemia requiring hydration and underwent cesarean at 35 weeks and 6 days; 2 days later, she received an osteolysis inhibitor, and a week later started chemotherapy. A baby boy was born with Apgar 9/10; hypercalcemia was observed after 12 h; then, he developed lethargy, hypotonia, and bradypnea after 21 h, requiring continuous positive airway pressure and monitoring. He received volume expansion with an improvement in his condition. Signs of breast cancer are confused with physiological breast changes in pregnancy such as engorgement, hypertrophy, and nipple discharge, implying a delay in diagnosis. Hypercalcemia during pregnancy occurs in about 0.03% of women; maternal complications include acute kidney injury, severe hypertension, and pre-eclampsia. Fetal adverse outcomes include intrauterine growth restriction, fetal demise in utero, neonatal hypocalcemia, tetany, and permanent hypoparathyroidism. Primary hyperparathyroidism is the main cause; hypercalcemia from metastatic breast cancer can be due to osteolytic metastases and humoral hypercalcemia of malignancy caused by peptide release related to parathyroid hormone, which promotes bone resorption and renal calcium reabsorption. In cases of malignant hypercalcemia, pamidronate is effective in inhibiting osteolysis, but it reduces uterine contractions and presents a teratogenic risk. Calcitonin is well tolerated during pregnancy but has a limited effect; the use of glucocorticoids can also be considered. In case of maternal hypercalcemia, the newborn’s calcium levels must be monitored. Hypercalcemia in pregnancy is a rare condition when cancer-related hypercalcemia may cause great maternal morbidity and fetal and neonatal morbidity and mortality. The manifestations presented by the neonate were compatible with the suspicion of neonatal hypercalcemia. Diagnostic confirmation was made based on the metabolic condition; the basis of emergency treatment is intravenous hydration.

Objetivos: avaliar adesão ao tratamento, controle da pressão arterial (PA) e variáveis psicossociais em indivíduos hipertensos, antes e durante a pandemia de COVID-19. Métodos: estudo de coorte prospectiva com 96 adultos hipertensos para analisar as variáveis (instrumentos): sociodemográficas (entrevista); impacto psicológico da pandemia (questionário IES-R); sintomas de estresse, ansiedade e depressão (questionário EADS-21); adesão ao tratamento farmacológico (questionário BMQ); e controle da pressão arterial (medidas de PA). Para comparar escore BMQ e controle da PA foi utilizado o teste de McNemar's, já para avaliar associação entre as variáveis: teste qui-quadrado, exato de Fisher, teste T e Mann-whitney. Resultados: houve significativa redução do controle pressórico com início da pandemia (McNemar's qui-quadrado=12,565, p=0.00567) e os fatores de risco associados foram: raça branca (OR=7,765; IC 95%=1,903, p=0,016), escolaridade menor que quatro anos (OR=7,531, IC 95%=1,258, p=0,031) e menos horas diárias dedicadas a assuntos relacionados à pandemia (OR=3,852, IC 95%=1,526, p=0,016). Nível reduzido de sintomas depressivos foi identificado como fator protetor contra descontrole da PA (OR=0,130, IC 95%=0,24 -0,681, p = 0,018). Não houve variação significativa na adesão ao tratamento medicamentoso p=0.557). Conclusão: a pandemia de COVID-19 aumentou a taxa de PA descontrolada, mas não comprometeu adesão ao tratamento.

Adenoid cystic carcinoma (AdCC) of the breast is an uncommon invasive lobular neoplasm whose morphology is similar to the homonymous tumor of salivary glands and with a peculiar behavior toward the “triple-negative” (TN) profile. Tumors belonging to this family do not immunohistochemically express three of the main prognostic biomarkers and tend to show a more aggressive behavior. However, this rare histological pattern of breast cancer is generally associated with good prognosis. In this study, the authors describe the case of a 49-year-old woman diagnosed with this rare malignant tumor and who underwent breast-conserving surgery. Recent studies have aimed to understand the genes, genetic alterations, and etiological aspects related to the still obscure etiopathogenesis of AdCC. Thus, morphological and molecular aspects relevant to AdCC and reported in the literature will be discussed.