Images in Clinical Rheumatology
Lumbar Pain as the Single Manifestation of an Occult Breast Cancer. Usefulness of Positron Emission Tomography
Dolor lumbar como única manifestación de un cáncer oculto de mama, utilidad de la tomografía por emisión de positrones
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Usefulness of positron emission tomography" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Figura 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 1267 "Ancho" => 3900 "Tamanyo" => 1461768 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">A. Hematoxilina-eosina (4×); se observan células tumorales de núcleos hipercromáticos. B. En la tinción de inmunohistoquímica (4×) las células conservan la expresión de E-cadherina, rodeadas de un estroma desmoplásico. C. 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(B) Shoulder CT, through the acromioclavicular joint, in which communication between the joint and the tumor (arrow) is seen. (C) Coronal section through the acromioclavicular joint with capsular distension.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Carlos Antonio Guillén Astete, Cristina de la Casa Resino" "autores" => array:2 [ 0 => array:2 [ "nombre" => "Carlos Antonio" "apellidos" => "Guillén Astete" ] 1 => array:2 [ "nombre" => "Cristina" "apellidos" => "de la Casa Resino" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1699258X1400093X" "doi" => "10.1016/j.reuma.2014.04.002" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1699258X1400093X?idApp=UINPBA00004M" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173574314001506?idApp=UINPBA00004M" "url" => "/21735743/0000001100000002/v2_201502230158/S2173574314001506/v2_201502230158/en/main.assets" ] "itemAnterior" => array:18 [ "pii" => "S2173574314001427" "issn" => "21735743" "doi" => "10.1016/j.reumae.2014.02.013" "estado" => "S300" "fechaPublicacion" => "2015-03-01" "aid" => "658" "copyright" => "Elsevier España, S.L.U." "documento" => "article" "subdocumento" => "sco" "cita" => "Reumatol Clin. 2015;11:116-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2600 "formatos" => array:3 [ "EPUB" => 44 "HTML" => 2309 "PDF" => 247 ] ] "en" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Images in Clinical Rheumatology</span>" "titulo" => "Complicated Parameniscal Giant Cyst With Distal Dissection and Regional Infection" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "116" "paginaFinal" => "117" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Quiste parameniscal gigante complicado con disección distal e infección regional" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 798 "Ancho" => 975 "Tamanyo" => 120772 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) External aspect of the right knee. 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Usefulness of Positron Emission Tomography" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "118" "paginaFinal" => "120" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marco Aurelio Ramírez Huaranga, Verónica Salas Manzanedo, Marcos Paulino Huertas, Yolanda Torres Sousa, Claudia Carolina Ramos Rodríguez" "autores" => array:5 [ 0 => array:4 [ "nombre" => "Marco Aurelio" "apellidos" => "Ramírez Huaranga" "email" => array:1 [ 0 => "hurauma@hotmail.com" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Verónica" "apellidos" => "Salas Manzanedo" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "Marcos Paulino" "apellidos" => "Huertas" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 3 => array:3 [ "nombre" => "Yolanda" "apellidos" => "Torres Sousa" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 4 => array:3 [ "nombre" => "Claudia Carolina" "apellidos" => "Ramos Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] ] ] "afiliaciones" => array:3 [ 0 => array:3 [ "entidad" => "Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Radiología, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Anatomía Patológica, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain" "etiqueta" => "c" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Dolor lumbar como única manifestación de un cáncer oculto de mama, utilidad de la tomografía por emisión de positrones" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 655 "Ancho" => 2015 "Tamanyo" => 561288 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Hematoxylin–eosin (4×); tumor cells with hyperchromatic nuclei are observed. (B) Immunohistochemical staining (4×) cells with expression of E-cadherin, surrounded by a desmoplastic stroma. (C) At higher magnification (20×), other areas of the cylinder forming gland precursors infiltrating the interstitium, which is fibrous and shows an inflammatory reaction, may be seen.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">A 68-year-old female patient with spondylolysis, fibromyalgia, osteoporosis and recent BI-RADS I (negative mammogram malignancy without nodules or calcifications) mammography screening presented lumbar pain after physical overexertion, with a vertebral crush fracture on D7 and normal laboratory tests (tumor, bone metabolism markers and acute phase reactants). Subsequently, given the progressive worsening, an extension study with bone scintigraphy (BS), computed tomography (CT) and magnetic resonance imaging (MRI) was performed, showing lesions suggestive of an infiltrative process in the D6, D7, D10 and L5 vertebral bodies and nonspecific left axilla lymphadenopathy, without a clear primary origin (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) Finally, she was studied using positron emission tomography (PET) to identify a small nodule in the lateral and deep region of the left breast, with pathology findings suggesting a metabolic origin (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), which led to an ultrasound-guided biopsy and a histological diagnosis of moderately differentiated infiltrating ductal carcinoma (<a class="elsevierStyleCrossRef" href="#fig0015">Fig. 3</a>). Hormonal treatment and lumpectomy of the nodule as well as left axillary lymphadenectomy was performed with a good outcome.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0010" class="elsevierStylePara elsevierViewall">The spine is the most common site of bone metastases; it is estimated that about 10% of cancer patients develop spinal metastases (>50%<span class="elsevierStyleHsp" style=""></span>multilevel metastases), especially associated to carcinoma of the breast, prostate and lung. While up to 36% of spinal lesions may be asymptomatic, low back pain secondary to a pathologic fracture is the predominant symptom.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Occult breast cancer consists in the appearance of a metastatic axillary lymph node, without a clinically and radiologically primary breast tumor; this is rare, and described in 0.3%–0.8% of all breast tumors.<a class="elsevierStyleCrossRefs" href="#bib0015"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">The first images, during the initial approach, are based on plain x rays. However, in most cases these findings are often nonspecific, making the use of other complementary imaging tests such as GO, CT, MRI and PET for providing great help in determining the cause of vertebral involvement.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>Of these, PET will identify lesions with an abnormal metabolism without an objective anatomic abnormality (sensitivity 62%–100% and specificity 96%–100%).<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> As for hidden breast cancer, the detection of such small lesions allows for the diagnosis when other conventional imaging tests do not lead to identification.<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7,8</span></a></p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethical Responsibilities</span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Protection of people and animals</span><p id="par0025" class="elsevierStylePara elsevierViewall">The authors declare that this study did not perform experiments on humans or animals.</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Data confidentiality</span><p id="par0030" class="elsevierStylePara elsevierViewall">The authors declare that they have followed the protocols of their workplace on the publication of data from patients, and all patients included in the study have received sufficient information and gave written informed consent to participate in the study.</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Right to privacy and informed consent</span><p id="par0035" class="elsevierStylePara elsevierViewall">The authors state that patient data does not appear in this article.</p></span></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Disclosures</span><p id="par0040" class="elsevierStylePara elsevierViewall">The authors have no disclosures to make.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:3 [ 0 => array:3 [ "identificador" => "sec0005" "titulo" => "Ethical Responsibilities" "secciones" => array:3 [ 0 => array:2 [ "identificador" => "sec0010" "titulo" => "Protection of people and animals" ] 1 => array:2 [ "identificador" => "sec0015" "titulo" => "Data confidentiality" ] 2 => array:2 [ "identificador" => "sec0020" "titulo" => "Right to privacy and informed consent" ] ] ] 1 => array:2 [ "identificador" => "sec0025" "titulo" => "Disclosures" ] 2 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2013-12-14" "fechaAceptado" => "2014-02-20" "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ramírez Huaranga MA, Salas Manzanedo V, Huertas MP, Torres Sousa Y, Ramos Rodríguez CC. Dolor lumbar como única manifestación de un cáncer oculto de mama, utilidad de la tomografía por emisión de positrones. Reumatol Clin. 2015;11:118–120.</p>" ] ] "multimedia" => array:3 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 810 "Ancho" => 1297 "Tamanyo" => 147635 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(A) Mammography BIRADS I. (B) Adenopathy with cortical thickening suspicious of metastasis. (C–E) A D7 vertebral fracture with a sclerotic pattern is seen in the sagittal CT and a hypointense signal on MR imaging T1.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 955 "Ancho" => 1757 "Tamanyo" => 192674 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">(A) Pathological uptake in the GO level of vertebral bodies and at the level of left axillary lymphadenopathy. (B and C) A positive correlation between bone and lymph nodes with an increase of metabolic activity in the PET is observed.</p>" ] ] 2 => array:7 [ "identificador" => "fig0015" "etiqueta" => "Fig. 3" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr3.jpeg" "Alto" => 655 "Ancho" => 2015 "Tamanyo" => 561288 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">(A) Hematoxylin–eosin (4×); tumor cells with hyperchromatic nuclei are observed. (B) Immunohistochemical staining (4×) cells with expression of E-cadherin, surrounded by a desmoplastic stroma. (C) At higher magnification (20×), other areas of the cylinder forming gland precursors infiltrating the interstitium, which is fibrous and shows an inflammatory reaction, may be seen.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:8 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "The pathophysiology of spinal metastases" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "D. Togawa" 1 => "U. Lewandrowsky" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "LibroEditado" => array:4 [ "titulo" => "Cancer in the spine. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 6 | 5 | 11 |
| 2024 October | 41 | 26 | 67 |
| 2024 September | 51 | 22 | 73 |
| 2024 August | 61 | 41 | 102 |
| 2024 July | 74 | 34 | 108 |
| 2024 June | 58 | 26 | 84 |
| 2024 May | 46 | 34 | 80 |
| 2024 April | 74 | 14 | 88 |
| 2024 March | 55 | 40 | 95 |
| 2024 February | 41 | 31 | 72 |
| 2024 January | 50 | 25 | 75 |
| 2023 December | 42 | 26 | 68 |
| 2023 November | 43 | 39 | 82 |
| 2023 October | 56 | 31 | 87 |
| 2023 September | 74 | 34 | 108 |
| 2023 August | 63 | 19 | 82 |
| 2023 July | 31 | 29 | 60 |
| 2023 June | 44 | 28 | 72 |
| 2023 May | 50 | 22 | 72 |
| 2023 April | 31 | 8 | 39 |
| 2023 March | 61 | 28 | 89 |
| 2023 February | 39 | 30 | 69 |
| 2023 January | 56 | 17 | 73 |
| 2022 December | 79 | 31 | 110 |
| 2022 November | 56 | 27 | 83 |
| 2022 October | 61 | 37 | 98 |
| 2022 September | 51 | 31 | 82 |
| 2022 August | 48 | 39 | 87 |
| 2022 July | 42 | 43 | 85 |
| 2022 June | 39 | 31 | 70 |
| 2022 May | 49 | 34 | 83 |
| 2022 April | 57 | 58 | 115 |
| 2022 March | 58 | 51 | 109 |
| 2022 February | 40 | 22 | 62 |
| 2022 January | 44 | 32 | 76 |
| 2021 December | 31 | 28 | 59 |
| 2021 November | 43 | 39 | 82 |
| 2021 October | 48 | 49 | 97 |
| 2021 September | 49 | 37 | 86 |
| 2021 August | 46 | 32 | 78 |
| 2021 July | 33 | 24 | 57 |
| 2021 June | 38 | 34 | 72 |
| 2021 May | 54 | 27 | 81 |
| 2021 April | 61 | 82 | 143 |
| 2021 March | 54 | 19 | 73 |
| 2021 February | 48 | 18 | 66 |
| 2021 January | 30 | 21 | 51 |
| 2020 December | 60 | 19 | 79 |
| 2020 November | 26 | 24 | 50 |
| 2020 October | 18 | 9 | 27 |
| 2020 September | 32 | 28 | 60 |
| 2020 August | 22 | 13 | 35 |
| 2020 July | 26 | 9 | 35 |
| 2020 June | 41 | 26 | 67 |
| 2020 May | 35 | 18 | 53 |
| 2020 April | 42 | 19 | 61 |
| 2020 March | 17 | 15 | 32 |
| 2020 February | 1 | 0 | 1 |
| 2018 May | 2 | 0 | 2 |
| 2018 April | 30 | 6 | 36 |
| 2018 March | 41 | 5 | 46 |
| 2018 February | 27 | 0 | 27 |
| 2018 January | 26 | 5 | 31 |
| 2017 December | 30 | 3 | 33 |
| 2017 November | 24 | 3 | 27 |
| 2017 October | 18 | 3 | 21 |
| 2017 September | 36 | 6 | 42 |
| 2017 August | 54 | 10 | 64 |
| 2017 July | 41 | 5 | 46 |
| 2017 June | 62 | 8 | 70 |
| 2017 May | 74 | 7 | 81 |
| 2017 April | 45 | 4 | 49 |
| 2017 March | 50 | 33 | 83 |
| 2017 February | 29 | 2 | 31 |
| 2017 January | 24 | 6 | 30 |
| 2016 December | 57 | 14 | 71 |
| 2016 November | 46 | 3 | 49 |
| 2016 October | 80 | 5 | 85 |
| 2016 September | 87 | 5 | 92 |
| 2016 August | 48 | 4 | 52 |
| 2016 July | 26 | 2 | 28 |
| 2016 January | 1 | 0 | 1 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 19 | 20 |
| 2015 October | 1 | 19 | 20 |
| 2015 September | 1 | 0 | 1 |
| 2015 August | 2 | 0 | 2 |
| 2015 July | 28 | 8 | 36 |
| 2015 June | 49 | 8 | 57 |
| 2015 May | 76 | 16 | 92 |
| 2015 April | 82 | 26 | 108 |
| 2015 March | 61 | 13 | 74 |
| 2015 February | 9 | 4 | 13 |
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