Breast sarcomas are a heterogenous group of malignancies that originate from the breast support stroma. They represent less than 0.1% of all breast neoplasms and less than 5% of all sarcomas. They are more frequent in women and between the fourth and sixth decades. Previous breast cancer treatment and radiotherapy are the main risk factors. The usual clinical presentation is a breast mass, which grows progressively and can reach a large size. They rarely attach themselves to the thorax or infiltrate the skin. Skin changes, when occur, are usually secondary to a large distitute. The tumor is usually well or partially defined, with a firm consistency. Lymph nodes are palpable in up to 25% of cases but tend to be reactional. Imaging findings are nonspecific. For histopathological diagnosis, it is necessary to exclude metaplastic carcinoma, and immunohistochemistry is useful to detect evidence of epithelial origin. Treatment requires resection with wide margins, and mastectomy may be necessary. Hematogenous dissemination occurs, and lymph node interventions should only be performed in the presence of a proven histopathological impairment. There is a trend of improvement in survival with radiotherapy after conservative surgery. After mastectomy, radiotherapy may be beneficial in cases of increased risk of local recurrence (lesions larger than 50 mm, unsuitable margins, and higher grade variants). The role of chemotherapy remains controversial. Liposarcoma, a histological subtype of sarcoma, despite being the second most frequent subtype in soft tissues, rarely occurs in the breast. Liposarcoma encompasses a spectrum, from lesions with essentially benign behavior to frankly malign lesions. Liposarcomas classified as myxoid, pleomorphic, and dedifferentiated have a higher risk of recurrence and metastases. The main differential diagnoses of breast liposarcoma include other breast tumors with lipomatous or liposarcomatous components, fat necrosis, and metaplastic carcinoma. CSSP, 48 years old, female, attended the Mastology Service of the Central Hospital of the Army, referring a breast nodule for 2 months with growth in the period. On clinical examination, a well-defined, mobile oval nodule with firm consistency was observed, measuring 40 mm, with no associated findings. At mammography and ultrasonography, the nodule was oval and circumscribed. Magnetic resonance imaging showed heterogeneous enhancement and a type II curve. A simple mastectomy was performed due to the poor tumor-breast relationship, with a histopathological result of dedifferentiated liposarcoma with areas of myxoid pattern, measuring 40 mm, and free histopathological margins. Adjuvant radiotherapy was indicated due to the diagnosis of dedifferentiated liposarcoma with areas of myxoid pattern.

Introduction: The role of primary chemotherapy in breast cancer is well established and has positively impacted the number of conservative surgeries. However, for effective locoregional control, it is necessary for complete resection of the residual tumor, with histopathological free margins. Preoperative evaluation of the residual tumor is essential. A clinical examination is impaired due to tissue alterations induced by chemotherapy, and the use of imaging methods had conflicting results. Objective: The aim of this study was to evaluate the agreement between the ultrasound measurement and the histopathological measurement of the residual tumor in breast cancer patients undergoing neoadjuvant chemotherapy. Methods: A cross-sectional study was conducted comparing the average and other measures of dispersion of the echographic and histopathological measurements of the residual tumor. Additionally, we compared the average and other measures of dispersion of the individual differences between the echographic and histopathological measurements of the residual tumor. The scenario was a quaternary hospital in Rio de Janeiro where breast cancer patients were treated. Results: The average ultrasound measurement was 18 mm (95%CI 13.75–22.25), with a median of 16. The average histopathological measurement was 16 mm (95%CI 11.62–20.38), with a median of 12. The average of the individual differences between the echographic and histopathological measurements of the residual tumor was 2 mm (95%CI 0.38–4.38), with a median of 2 mm. Conclusion: Ultrasonography is an effective tool in the preoperative evaluation of breast cancer patients undergoing primary chemotherapy.

Introdução: Tatuagens são cada vez mais comuns; contudo, informações sobre complicações são pouco disponibilizadas. Os pigmentos utilizados derivam de compostos de carbono e de sais metálicos inorgânicos. A presença dos sais, que são radiopacos, em linfonodos regionais após a realização de tatuagens já foi documentada em exames de imagem. Objetivo: Relatar um caso de depósito de sais metálicos radiopacos em linfonodo axilar, mimetizando calcificações suspeitas. Métodos: Revisão nas bases de dados em comparação ao relato de caso. Resultados: Este relato descreve o achado de depósito de sais radiopacos em linfonodo axilar, mimetizando calcificações suspeitas, observadas em mamografia de rastreio de paciente do sexo feminino, com 56 anos, cinco meses após ter realizado tatuagem com finalidade artística no membro superior homolateral. Conclusão: A presença de tatuagens, principalmente quando localizadas no trajeto das cadeias de drenagem para a região axilar (que inclui dorso, membro superior, ombro e tórax), deve fazer parte de anamnese e estar presente nos registros médicos por ocasião da realização do rastreio do câncer de mama.