INTRODUCTIONDespite many advances in the characterization of the behavioral variant of frontotemporal dementia (bvFTD), the diagnosis of this syndrome poses a significant challenge, while delays or diagnostic mistakes may impact the proper clinical management of these patients.OBJECTIVETo describe the clinical profile at first evaluation of a sample of patients with bvFTD from a specialized outpatient neurological unit, with emphasis on the analysis of the delay between the onset of symptoms and diagnosis.METHODSWe selected 31 patients that fulfilled international consensus criteria for possible or probable bvFTD. Patients' medical admission sheets were thoroughly reviewed.RESULTSPatients' mean age was 67.9±8.2 years; 16 (51.6%) were men. Mean number of years of formal education was 7.7±4.0 years. Mean age at onset was 62.2±7.7 years, indicating a mean of 5.8 years of diagnostic delay. Thirteen patients (41.9%) presented with initial behavioral complaints only, eleven patients (35.5%) had mixed behavioral and memory complaints, five patients (16.1%) presented with memory complaints only, and two patient (6.4%) had behavioral and speech problems. Nine patients (29%) were admitted with alternative diagnoses. Mean and standard deviation scores for the mini-mental state examination, animal category fluency and memory test for drawings (five-minute delayed recall) were 19.3±6.3, 8.3±4.1and 3.7±2.7, respectively.CONCLUSIONMost patients from this sample were evaluated almost six years after the onset of symptoms and performed poorly on both cognitive screening tests and functional evaluation measures.

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Introduction: Breast cancer is the most common malignancy in women worldwide, with the exception of nonmelanoma skin tumors. The initial stage of breast cancer is one of the main predictors of survival. Mammographic screening is the most effective method for an early detection of breast cancer and premalignant lesions, with an impact on reducing mortality, considering that correct positioning during the examination is a critical factor for its quality. Methods: A casecontrol study of a mammography positioning training program (MMG) in a private center specialized in breast diagnosis. In total, 200 incidences were evaluated in 50 examinations performed by two experienced techniques, 25 examinations each. Performance criteria were evaluated in the mediolateral oblique (MLO) and craniocaudal (CC) views. In the CC, well-demonstrated lateral quadrants (QLAT), visualization of the pectoral muscle (MP), centralized nipples (MC), welldemonstrated medial quadrants (QMED), absence of pleats or folds, centralized nipples, and symmetrical breasts were considered as adequate positioning. Buck’s low positioning was considered an error criterion. In the MLO assessment, the criteria for adequate positioning were the inframammary angles (AI) visualized, nipples profiled and at the height of the MP, symmetrical breasts, absence of pleats and folds, and symmetrical MP. Pending breasts and pectoralis minor (PP) visualization were considered positioning failures. An 11-h theoretical-practical training was applied: 7 h of practice and 4 h of theory; new tests were performed and the quality criteria were reassessed. Results: Positioning errors were significantly decreased after the training. Errors in the CC incidence decreased from 39% to 11% and in the MLO from 36% to 13%. After the training, the following improved criteria were evaluated in CC: QLAT well shown rose from 50% to 94%, MP visualization rose from 21% to 62%, MC rose from 49% to 79%, QMED well shown rose from 45% to 100%, absence of pleats or folds rose from 74% to 88%, profiled nipples rose from 91% to 95%, and symmetrical breasts rose from 86% to 98%. Buck’s low positioning dropped from 19% to 0%. In the MLO incidence, the criteria that improved were: AI visualization rose from 45% to 82%, profiled nipples rose from 93% to 95%, nipples at MP height rose from 24% to 84%, absence of pleats or folds rose from 39% to 70%, symmetrical breasts rose from 90% to 100%, symmetrical MP rose from 56% to 82%, symmetrical nipples rose from 72% to 86%, and PP visualization dropped from 13% to 7%. Conclusion: The MMG positioning training program improved examination quality. It acts on a vulnerable part, which is human error. The result indicates that a simple, low-cost intervention with low technological complexity can significantly impact the quality of MMG and screening programs in our country.

Objective: Pathological complete response rate (pCR), ypT0/is ypN0, after neoadjuvant chemotherapy (NAC) varies in each molecular subtype of breast cancer, being lower in hormone receptor-positive (HR+) tumors. The objective of this study is to analyze the pathological response rate (PR) only in the breast, only in the axilla or the pCR, correlating with the molecular subtypes. Methods: This is a retrospective observational study of stage II and III patients undergoing NAC between 2013 and 2020 at the Oncology and Mastology Service of Santa Casa de Misericórdia de Belo Horizonte – MG (SCMBH). This study was approved by the Research Ethics Committee of SCMBH with the number 3,787,212 complying with Resolution 196/96 of the National Council for Ethics in Research. Results: In all, 209 patients were selected with a mean age of 50.6 years; 22.0% were T2, 35.9% were T3, and 42.1% were T4; 17.2% were pre-NAC cN0 and 82.7% were cN+. Patients were divided into group A, RH+, with 147 patients (70.3%), and group B, HER2+ and TN, with 62 patients (29.7%). When comparing PR only in the breast, RH+ patients had a better result (4.8% versus 1.6%); as well as PR only in the axilla, 37.4% against 29.0%. When subdividing group A into RH+/HER2− and RH+/HER2+, the former presented better results in the breast (4.3% X 0%) and in the axilla (60.9% X 55.6%). Conclusion: Achieving pCR is not the only goal of NAC. Other benefits include the possibility of breast and axilla-conserving surgery. The study demonstrated good PR results in both the breast and the axilla in group A and in the RH+/HER2− subgroup. These responses allow for a less morbid surgical treatment, both aesthetically and because of the risk of lymphedema. The data presented provide a compelling rationale for the use of NAC in a molecular subtype considered to be relatively resistant to chemotherapy.

Introduction: Occult breast carcinoma is a rare presentation of breast cancer, with histological evidence of axillary lymph node involvement and clinical and radiological absence of malignant breast lesions. Its survival is similar to that of the usual presentation. The treatment consists of modified radical mastectomy or axillary drainage with breast irradiation, resulting in similar survival, associated with systemic therapy according to the staging. Neoadjuvant therapy should be considered in N2-3 axillary cases. Differential diagnoses of axillary lymphadenopathies include: non-granulomatous causes (reactive, lymphoma, metastatic carcinoma) and granulomatous causes (infectious – toxoplasmosis, tuberculosis, sarcoidosis, atypical mycobacteria). Objectives: To report the case of a patient who needed a differential diagnosis among the various causes of axillary lymphadenopathy. Methods: This is a literature review conducted in the PubMed database, using the keywords "granulomatous lymphadenitis", "breast sarcoidosis", "occult breast cancer". Inclusion and exclusion criteria were applied. Case report: V.F.S., female, 51 years old, was referred to an evaluation of axillary lymphadenopathy in May 2019. She was followed by the department of pulmonology due to mediastinal sarcoidosis since 2017. Physical examination indicated breasts without changes. Axillary lymph nodes had increased volume and were mobile and fibroelastic. Mammography revealed only axillary lymph nodes with bilaterally increased density, and the ultrasound showed the presence of atypical bilateral lymph nodes. Neither presented breast lesions. Axillary lymph node core biopsy was compatible with granulomatous lymphadenitis. This result corroborates the diagnosis of sarcoidosis affecting peripheral lymph nodes. The patient was referred back to the department of pulmonology, with no specific treatment since she is oligosymptomatic. Discussion: Despite the context of benign granulomatous disease, malignancy overlying the condition of sarcoidosis must be ruled out. The biopsy provided a safe and definitive diagnosis, excluding the possibility of occult breast carcinoma. The patient will continue to undergo breast cancer screening as indicated for her age and usual risk. Conclusion: In the presentation of axillary lymphadenopathy, the mastologist must know the various diagnoses to be considered. The most feared include lymphoma and carcinoma metastasis with occult primary site. A proper workup can determine the diagnosis and guide the appropriate treatment.