Primary systemic therapy in HER2-positive operable breast cancer using trastuzumab and chemotherapy: efficacy data, cardiotoxicity and long-term follow-up in 142 patients diagnosed from 2005 to 2016 at a single institution

Objective: The aim of this study was to evaluate the efficacy, cardiotoxicity profile and long-term benefits of neoadjuvant therapy in human epidermal growth factor receptor 2-positive operable breast cancer patients. Patients and methods: A total of 142 patients diagnosed from 2005 to 2016 were included in the study. The treatment consisted of a sequential regimen of taxanes and anthracyclines plus trastuzumab. The clinical and pathological responses were evaluated and correlated with clinical and biological factors. The cardiotoxicity profile and long-term benefits were analyzed. Results: The median age was 49 years, and 4%, 69% and 27% of patients had stage I, II and III breast cancer, respectively, while 10% had inflammatory breast cancer at diagnosis. Hormone receptor (HR) status was negative in 43%, and 62% had grade III breast cancer. The clinical complete response rate was 49% and 63% as assessed using ultrasound and magnetic resonance imaging, respectively, and this allowed a high rate of conservative surgery (66%). The pathological complete response (pCR) rate was 52%, and it was higher in HR-negative (64%) patients than in HR-positive (41%) patients and in grade III breast cancer (53%) patients than in grade I-II breast cancer (45%) patients. Patients who achieved pCR had longer disease-free survival and a trend toward improved overall survival. A total of 2% of patients showed a 10% decrease in left ventricular ejection fraction to <50% during treatment. All patients except one recovered after discontinuation of trastuzumab. Conclusion: A sequential regimen of taxanes and anthracyclines plus trastuzumab was effective, with high pCR rates and long-term benefit, and had a very good cardiotoxicity profile

Infrecuente tumor benigno: lipoma de laringe e hipofaringe

Introduction.- Lipomas are the most common mesenchimal benign tumours of the body, only 15% are localizated on head and neck. They represent 0,5% of larynx beningn tumours, less than 100 cases are described in literature. Clinic include disphonia, disphagia and airway obstruction. The diagnosis is based on the clinical symptoms, physichal exploration and image techniques. Direct laryngoscopy localizate and detect lesion CT shows a tipically fat density pattern. Treatment is based on extirpation and must includes all the mass. Clinic case.- We bring a new case of laryngeal lipomata, in a 46 years old male. Since 10 years ago, he had lateral laryngeal moving with swallowing. In last months, solid disphagia, airway obstruction and pharyngolalia. In nasofibroscopy there was a globulous depressible mass on larynx posterior wall, unde left areytenoeppiglottic fold, which occupies laryngeal space, and get move with swallowing. CT and MR were compatible with benign fat mass. Left lateral pharynguectomy, and extirpation of a 6x4 cm encapsulated lipomatous mass was performed. The anatomopathologycal result was mature adipocyte tissue, compatible with lipoma Conclussion.- Lipoma is a rare tumour at larynx. Due to its slow and silent clinical evolution, many years should go by since first symptoms untill definitive diagnostic, it should compromise the upper airway. Pharyngeal and laryngeal endoscopy, give us the initial diagnostic approach, complemented with image techniques as CT and MR, which are very usefull in masses with fat components.Introducción.- Los lipomas son los tumores beningnos de origen mesenquimal más frecuente del organismo, sólo el 15% se localiza en cabeza y cuello. Representan aproximadamente el 0,5% de los tumores beningnos de laringe, existiendo menos de 100 casos descritos. La clínica incluye disfonía, disfagia y disnea. El diagnóstico se basa en la clínica, exploración y técncias de imagen. La laringoscopia directa localiza y detecta la lesión. La CT demuestra un patrón típico de densidad grasa. El tratamiento es quirúrgico debiendo incluir toda la lesión. Caso clínico.- Aportamos un nuevo caso de lipoma laríngeo, en un paciente varón de 46 años. Desde hacía 10 años sensación de desplazamiento lateral laríngeo con la deglición. En los últimos meses, disfagia a sólidos, disnea y faringolalia. Por fibrolaringoscopia se aprecia una tumoración globolosa depresible en pared posterior de la laringe, debajo del repliege aritenoepiglótico izquierdo, que obstruye la luz laríngea, móvil con la deglución CT y RNM compatibles con formación benigna grasa. Faringuectomía lateral izquierda, y exéresis de lesión encapsulada de aspecto lipomatoso de 6x4 cm. El resultado anatomopatológico fue de tejido adiposo maduro compatible con LIPOMA. Conclusión.- El lipoma es un tumor de escasa frecuencia a nivel laríngeo. Dada su lenta y silenta evolución clínica, pueden pasar años desde los primeros síntomas hasta el diagnóstico definitivo omprometiendo incluso la permeabilidad de la vía aérea. La enodoscopia faringolaríngea es fundamental en su diagnóstico, complementada con técnicas de imagen como la CT y la RM, de gran utilidad en las tumoraciones con componente gras