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CANCER DE MAMA OCULTO
M. Díaz-Miguel
Fundación Tejerina
Madrid
Madrid, Junio de 2021
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CANCER DE MAMA OCULTO / CANCER DE ORIGEN OCULTO
DIAGNOSTICADO POR LA PRESENCIA DE AL MENOS UNA METASTASIS
(antiguo concepto que lo definía como sólo a aquella lesión no palpable)
Descrito por Halsted en 1907
representa el 0,1-0,8%
su incidencia no disminuye
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CANCER DE MAMA OCULTO / CANCER DE ORIGEN DESCONOCIDO
Supervivencia COD
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CANCER DE MAMA OCULTO
Abbruzzese JL. J.Clin. Oncol. 1995
/ CANCER DE ORIGEN OCULTO
Supervivencia
COD, localizado 1º
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CANCER DE MAMA OCULTO
Abbruzzese JL. J.Clin. Oncol. 1995
/ CANCER DE ORIGEN OCULTO
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CANCER DE MAMA OCULTO / CANCER DE ORIGEN OCULTO
Supradiafrg.
Pulmón
Mama
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CANCER DE MAMA OCULTO / CANCER DE ORIGEN OCULTO
Axilares
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CANCER DE MAMA OCULTO
/ CANCER DE ORIGEN OCULTO
Mujeres con adenopatias: Igual que Ca de mamaen estadio II
¿DIAGNOSTICO DE EXCLUSION ?
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CANCER DE MAMA OCULTO
Situación clínica en la que una paciente
presenta una adenopatía axilar diagnosticada
de metástasis de un Ca. de mama siendo
negativa la exploración clínica y radiológica.
RNM
PET
….
Tomosintesis
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CANCER DE MAMA OCULTO
Situación clínica en la que una paciente
presenta una adenopatía axilar diagnosticada
de metástasis de un Ca. de mama siendo
negativa la exploración clínica y radiológica.
Bresser, Sittard ( Neteherlands) -2010
Masinghe, Edimburgh ( UK)-----------2011
Barthon, S. London (UK)---------------2011
He, M. y Thang,LC. Shanghai (RP China) 2012
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CANCER DE MAMA OCULTO
Ca de mama METASTASICOYASINTOMÁTICO.
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CANCER DE MAMA OCULTO
560 mamoplastias de reducción
Cambios patológicos en 338 (60,4%)
-Carcinomas → 4 casos (0,7%), 3 CDI pequeños y 1CDIS
-Hiperplasia atípica → 8 casos (1,4%)
Ishag MT.- Ann J. Clin Pathol 2003 Sept; 120 (3):377-80
ASINTOMATICO
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1907: Halsted 3 casos 1909: Cameron 3 “1948: Jackson 4 “1951: Weinberger 5 “
1954: Owen 5451/25 0,5%
1955: Rx
Mamografía L.N.P.
Escasos verdaderos ocultos
CANCER DE MAMA OCULTO
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Owen HW, Dockerty MB, Gray HK. Occult carcinoma of the breast.Surg Gynecol Obstet 1954;98:302–8.
Patel J, Nemoto T, Rosner D, Dao TL, Pickren JW. Axillary lymphnode metastasis from an occult breast cancer. Cancer 1981;47:2923–7.
Rosen PP. Axillary lymph node metastases in patients with occult noninvasivebreast carcinoma. Cancer 1980;46:1298–
CANCER DE MAMA OCULTO
0.3-1%
INCIDENCIA
SERIES DE POBRE SIGNIFICACION
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CANCER DE MAMA OCULTO
?
Primario muy pequeño.
Resolución espontánea del primario
Distinta naturaleza.
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CANCER DE MAMA OCULTO
DIAGNOSTICO
RNM.- Bresser (2010): Revisión de 8 estudios retrospectivos
2 de cada 3 casos es informado pero con baja especificidad
1 de ellos es visto en la eco de S.L.
Imprescindible la biopsia guiada
PET.- Anqin Han. (2012) lo revisa en Ca de origen desconocido
162 pctes. 3 son de mama los 3 son VP
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CANCER DE MAMA OCULTO
DIAGNOSTICO
¿Dco. De exclusion?................
TAC, Endoscpias traquea y GI,
MARCADORES….
NO
PET
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CANCER DE MAMA OCULTO
DIAGNOSTICO
Inmunohistoquimica:
Kaufman (1996) y Yamaguchi (2006)
RR.HH. + CK15 (GCDFP)
CEA, CK7, ER/PR, y mammaglobin + Y MT JUNTO A Negatividad en CK20 and TTF-1
Sensibilidad 63% y especificidad de 95%
(Gros Cistic Disease Fluid Protein - 15)
HER2 ?
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¿DIAGNOSTICO DE EXCLUSION?
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CANCER DE MAMA OCULTO / CANCER DE ORIGEN OCULTO
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CANCER DE MAMA OCULTO
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CANCER DE MAMA OCULTO / CANCER DE ORIGEN OCULTO
LUGAR DE AFECTACION METASTASICA
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TRATAMIENTO
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CANCER DE MAMA OCULTO He,M. EJSO 38(2012) 1022
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CANCER DE MAMA OCULTO
Evaluación pronostica por examen de los ganglios.
Control regional de la enfermedad, con o sin Rt
TRATAMIENTO DE LA AXILA
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CANCER DE MAMA OCULTO
TRATAMIENTO DE LA MAMA
Mastectomía radical, clásica o modificada
Mastectomía subcutánea
Cuadrantectomía con Rt ( Feigemberg, 1976)
Radioterapia sin cirugía ( I. Curie)
Vigilancia y esperar (Milan, Anderson)
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CANCER DE MAMA OCULTO
Van Ooijen B, Bontenbal M, Henzen-Logmans SC, Koper PC.
Axillary nodal metastases from an occult primary consistent with breast
carcinoma. Br J Surg 1993; 80:1299–300.
Merson M, Andreola S, Galimberfi V, Bufalino R, Marchini S, and
Veronesi U. Breast Carcinoma Presenting as Axillary Metastases
Without Evidence of a Primary Tumor. Cancer 1992; 70: 504-508.
Observacion tras el tratamiento de la axila
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CANCER DE MAMA OCULTO
El tratamiento local es mejor que la observación**
Wang X, Zhao Y, Cao X. Clinical Benefits of Mastectomy on Treatment
of Occult Breast Carcinoma Presenting Axillary Metastases. The Breast
Journal 2010; 16 (1): 32–37.
Masinghe SP, Faluyi OO, Kerr GR, Kunkler IH. Breast Radiotherapy for
Occult Breast Cancer with Axillary Nodal Metastases: Does it Reduce the
Local Recurrence Rate and Increase Overall Survival? Clinical Oncology
2011; 23: 95e-100.
Barton SR, Smith IE, Kirby AM, Ashley S, Walsh G, Parton M. The role of
ipsilateral breast radiotherapy in management of occult primary breast
cancer presenting as axillary lymphadenopathy. Eur J Cancer 2011; 47:
2099 –2106.
Blanchard DK, Farley DR. Retrospective study of women presenting with
axillary metastases from occult breast carcinoma. World J Surg 2004;
28:535–9.
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Loco regional He,M. EJSO 38(2012) 1022
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He,M. EJSO 38(2012) 1022metastasis
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He,M. EJSO 38(2012) 1022Supervivencia
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CANCER DE MAMA OCULTO
Foroudi.IJR Oncology 47 (2000) Num 1
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CANCER DE MAMA OCULTO
IJR Oncology 47 (2000) Num 1
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CANCER DE MAMA OCULTO
Radioterapia sin cirugía
NO EXISTE NINGÚN ESTUDIO PROSPECTIVO
RAMDOMIZADO QUE COMPARE MASTECTOMIA Y
RADIOTERAPIA SOLA
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CANCER DE MAMA OCULTO
Análisis de Surveillance, Epidemiology and End Results. 2006
(SEER)
750 casos:
470 mastectomía
126 linfadenectomía
94 observación
SM: Sig. Mayor a los 10 años en grupo de mastectomía
Walker GV, Smith GL, Perkins GH, et al. Population-based analysis
of occult primary breast cancer with axillary lymph node metastasis.
Cancer 2010; 116:4000.
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1) no ALND, mastectomy, or RT (observation)
2) ALND only;
3) mastectomy plus ALND with or without postmastectomy radiation
4) breast-conserving therapy (BCT) with ALND and radiation (BCT).
Definitive locoregional treatment with either Mast or BCT improved the outcome of patients with T0N+breast cancer, and no difference in survival was observed between the treatments.
CANCER DE MAMA OCULTO
Análisis de Surveillance, Epidemiology and End Results. 2006
(SEER)
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CANCER DE MAMA OCULTO
Radioterapia sin cirugía
NO EXISTE NINGÚN ESTUDIO PROSPECTIVO
RAMDOMIZADO QUE COMPARE MASTECTOMIA Y
RADIOTERAPIA SOLA
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Radioterapia sin cirugía
Campana F, Fourquet A, Ashby MA et al. Presentation of axillary
lymphadenopathy without detectable breast primary (ToN1b breast
cancer): experience at Institute Curie. Radiother Oncol 1989; 15:321-7.
Ellerbroeck N, Holmes F, Singletary E. Treatment of isolated axillary
metastases in patients with an occult primary consistent with breast. Int.
J. Radiation Oncology Biol Phys 1989; 17(Suppl 1):178.
San Roman JM, Diaz-Faes J, Ruibal A, Sogo E, Suarez JM, Tejerina A
and Vazquez C. Treatment of T0 N1 tumors. What type of surgery?
Senology. Portugal: Ed Monduzzi 1998; p: 185-9.
CANCER DE MAMA OCULTO
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Mahmood U, Cosí M, Hanlon A, Buras R, Tkaczuk K, Feigenberg S.
Local therapy in the management of occult primary breast cancer. Int. J.
Radiation Oncology Biol Phys 2010; 78: s159.
Walker GV, Smith GL, Perkins GH et al. Population-Based Analysis of
Occult Primary Breast Cancer With Axillary Lymph Node Metastasis.
Cancer 2010; 1: 4000-4006.
CANCER DE MAMA OCULTO
Radioterapia sin cirugía
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GRACIAS
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