Doenças hematopoiéticas podem ser encontradas na mama e simular uma neoplasia mamária, como leucemia e/ou linfoma. Apesar de os linfomas serem considerados tumores linfonodais, 25-40% acometem sítios extranodais, sendo um deles a mama. Os linfomas primários da mama representam 0,1-0,5% de todas as neoplasias da mama. Podem ter origem primária ou secundária. Os primários normalmente iniciam-se na mama sem acometimento de outros sítios linfonodais. O diagnóstico é feito através do exame físico e anatomopatológico. Relatamos um caso de uma paciente, idosa, de 77 anos, que compareceu em nosso serviço com uma massa progressiva envolvendo toda a mama direita, ulcerada e associada a sinais e sintomas inflamatórios com linfonodos axilares palpáveis. Os exames de imagem foram inespecíficos e não ajudaram no diagnóstico, não tendo sido recomendados para o rastreio dessa neoplasia. O exame anatomopatológico revelou um linfoma de células B difuso infiltrando a mama (linfoma não Hodgkin). Devido à raridade do caso, a etiopatogenia é desconhecida, e o tratamento foi realizado com os esquemas quimioterápicos para linfoma segundo o consenso para linfomas de células B, sendo a base o tratamento com antraciclinas. A paciente realizou seis ciclos de CHOP (ciclofosfamida, doxorrubicina, vincristina e prednisona), com a regressão total da lesão. O uso do rituximabe, bem como a radioterapia, permanecem controversos na literatura, mas a radioterapia é indicada por alguns autores na dose de 30 a 45 GY. Nossa paciente realizou radioterapia da mama e da axila com ausência de remissão da doença, não tendo sido necessário tratamento complementar ou cirurgia da mama. PALAVRAS-CHAVE:Linfoma; Neoplasias da mama; Linfoma não Hodgkin. RESUMO ABSTRACTHematopoietic diseases can be found in the breast and mimic a mammary neoplasm, such as leukemia and/or lymphoma. Although lymphomas are considered lymph node tumors, 25-40% have extranodal sites. Primary lymphomas of the breast represent 0.1-0.5% of all breast neoplasms and may have primary or secondary origin. Primary lymphomas normally start in the breast without involvement of other sites. The diagnosis is made through physical and pathological examination. We report a 77-year-old female who had a locally advanced mass in the right breast associated with inflammatory signs and symptoms and with palpable axillary lymph nodes. The imaging tests were non-specific and didn't help the diagnosis. The pathology report revealed a diffuse, B-cell lymphoma infiltrating the breast (lymphoma non-Hodgkin's). Due to the rarity of the case, and the unknown pathogenesis systemic chemotherapy with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) regime were performed. The use of rituximab, as well as radiotherapy, remain controversial in the literature, but for some authors the radiotherapy is indicated with a total dose of 30 to 45 GY. Our patient performed radiotherapy of the breast and axilla. Because of total remission of the disease, it was not necessary complementary treatment or breast sur...

Accelerated partial breast irradiation (APBI), a radiation technique in which only the tumor bed is treated, has now become an acceptable radiation modality for selected early‐stage breast cancer patients. Compared to conventional whole breast irradiation (WBI), APBI has some benefits with regard to the reduced total irradiated breast volume and the shorter treatment time. The role of APBI, which can be delivered using diverse techniques, has been evaluated in several prospective randomized phase III trials. These clinical trials demonstrate diverging outcomes relating to local recurrence, while establishing comparable effect in terms of survival between APBI with WBI. The aim of this study was to review the current status of APBI with a focus on clinical practice.

Background: Nipple-sparing mastectomy (NSM) is increasingly performed for breast cancer (BC) treatment. To ensure local control with this procedure, it is important to obtain clear surgical margins. Here, we aimed to estimate the confidence in intraoperative evaluation of the retroareolar margin (IERM) and the necessity of removing the intra-nipple ducts.Methods: In this retrospective cohort study, we evaluated 224 BC (infiltrating carcinoma 178, ductal carcinoma in situ 46) patients, who underwent NSM. IERM was determined via cytology and frozen sections. Following gland removal, the intra-nipple ducts were excised and embedded in paraffin for analysis.The retroareolar tissue was also paraffin-embedded and reanalyzed for definitive evaluation of retroareolar margins (DERM). The IERM predictive capacity in relation to DERM and the frequency of intra-nipple duct involvement were estimated.Results: IERM classified the sub-nipple areolar complex area as cancer-free in 219 cases (97.8%). The condition of clear retroareolar margin was confirmed by DERM in 216 cases (98.6%). The IERM accuracy was estimated as 98.6%. Ductal carcinoma in situ was detected in intra-nipple ducts using paraffin sections in 1.8% of the cases, despite clear IERM (4/219). Conclusions:In conclusion, IERM affords high accuracy and its results are suitable to manage the nippleareolar complex. Nevertheless, some patients may retain residual disease in the intra-nipple ducts; thus, these ducts should ideally be removed during NSM.

Introduction: Hemangiomas are benign vascular tumors rarely located in the breast (incidence of 0.4% to 0.8%). They mainly affect post-menopause women on hormone replacement therapy (HRT). These tumors are classified as capillary or cavernous according to the size of vessels involved and can show heterogeneity in imaging tests. Case report: The patient is a woman aged 56 years, G3P3, living in the city of Florianópolis. She has been on HRT, without a family history of gynecological cancer. She reported breast implant and bariatric surgery in 2007. The patient sought medical care due to a tumor in the left breast that she noticed six months before, with slight growth. Physical examination identified a superficial purplish nodule in the left axillary tail, measuring 1.5 cm. Magnetic resonance imaging (MRI) revealed an intramammary lymph node (BI-RADS 2); mammography (MMG) indicated a 2.4 cm nodule in the left axillary tail (BI-RADS 4), suggesting biopsy; ultrasound (US) identified an irregular peripheral nodule at 2 h on the left, with the same classification. Core biopsy revealed cavernous hemangioma. Mammaplasty was performed with excision of the lesion. Commentaries: In hemangiomas, imaging findings can vary. MMG usually shows an oval or lobular mass, isodense or high-density, and circumscribed margins. The heterogeneity in the US may be related to vascular channels histologically seen in cavernous hemangiomas. MRI characteristics vary according to the possibility of internal thrombosis, but they often include an ovoid mass and circumscribed margins. The MRI report showed no hemangioma; however, MMG and US indicated similar characteristics. Although rare and with a heterogeneous presentation, hemangioma should be remembered as a differential diagnosis since, in addition to its similarities to benign lesions, such as bruises and sebaceous cysts, it can also be mistaken for inflammatory carcinoma and ductal carcinoma in situ, mimics that have been described in the literature.

Introduction: The nipple-areola complex (NAC) has glandular tissue in intrapapillary ducts (IPDs). When the NAC is preserved during mammary adenectomies (MA) for the treatment of breast cancer (BC), this glandular tissue, which is a potential focus of tumor residues, remains. Objective: To estimate the frequency of neoplastic development in IPDs among BC patients treated with MA. Method: After the MA and with evidence of free retroareolar margin through intraoperative examination, the nipple was inverted, and its central portion, where mammary ducts are located, removed. A pointed-tip scalpel was used, preserving a tissue rim of 1.0 to 2.0 mm. The analysis involved 219 cases submitted to this type of surgery in the Clínica Professor Alfredo Barros. In all patients, the distance tumor-NAC was ≥2.0 cm, according to magnetic resonance imaging (MRI). The intrapapillary tissue removed was sent for microscopic examination of sections embedded in paraffin. Results: We found 4 cases of ductal carcinoma in situ (none infiltrating) in IPDs (1.19%). Considering only the 217 cases with free retroareolar margin in the definitive examination, the number of patients with ductal carcinoma in situ in IPDs decreased to 2 (0.9%). Conclusion: IPDs are rarely involved in selected cases of MA (distance tumor-NAC≥2.0 cm on MRI and free retroareolar margin). Ideally, they should be removed, especially when the intent is avoiding radiotherapy.