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class="elsevierStyleTextfn">Scientific letter</span>" "titulo" => "Somatostatin Receptors Expression in Breast Cancer" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "545" "paginaFinal" => "547" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Francisco-Javier Gómez-de la Fuente, Julio Jiménez-Bonilla, José Estévez, Isabel Martínez-Rodríguez, Ignacio Banzo" "autores" => array:5 [ 0 => array:3 [ "nombre" => "Francisco-Javier" "apellidos" => "Gómez-de la Fuente" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 1 => array:3 [ "nombre" => "Julio" "apellidos" => "Jiménez-Bonilla" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 2 => array:3 [ "nombre" => "José" "apellidos" => "Estévez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] 3 => array:3 [ "nombre" => "Isabel" "apellidos" => "Martínez-Rodríguez" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] ] ] 4 => array:4 [ "nombre" => "Ignacio" "apellidos" => "Banzo" "email" => array:1 [ 0 => "ignacio.banzo54@gmail.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" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Medicina Nuclear, Grupo de Investigación Imagen Molecular IDIVAL, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Obstetricia y Ginecología, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, Santander, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "<span class="elsevierStyleItalic">Corresponding author</span>." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Expresión de receptores de somatostatina en cáncer de mama" ] ] "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" => 1393 "Ancho" => 990 "Tamanyo" => 81297 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole-body (A), SPECT (axial view [B], sagittal view [C]) and left lateral planar in prone position (D) images identified a focal increased uptake in the left breast.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Breast cancer is the leading cause of cancer-related death in women. The American Cancer Society estimates that 40<span class="elsevierStyleHsp" style=""></span>890 women will die of the disease within 2016 in the United States.<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a> Data of mortality from breast cancer has been improving over the past 25 years, mainly in relation to developments in early detection and better treatment.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> The estimated number of breast cancers diagnosed in Spain during 2014 was 26<span class="elsevierStyleHsp" style=""></span>354; this number represented an adjusted rate to the European standard population of 85 per 100<span class="elsevierStyleHsp" style=""></span>000 women.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Breast cancer is heterogeneous disease, including different histological, immunological and molecular subtypes. Several studies have reported somatostatin receptors in primary breast cancers.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4–7</span></a> We present the case of an unsuspected breast carcinoma with expression of somatostatin receptors diagnosed by imaging during the assessment of a hypertension study. Written informed consent for scientific use of the images was obtained from the patient.</p><p id="par0010" class="elsevierStylePara elsevierViewall">A 46-year-old woman was referred to Nuclear Medicine Department with the suspicion of pheocromocytoma or paraganglioma. She had a 2-year history of resistant hypertension. Laboratory findings revealed increased urinary levels of norepinephrine 231<span class="elsevierStyleHsp" style=""></span>μg/24<span class="elsevierStyleHsp" style=""></span>h (normal range 15–80<span class="elsevierStyleHsp" style=""></span>μg/24<span class="elsevierStyleHsp" style=""></span>h) and vanillylmandelic acid 8.5<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h (normal range 2–8<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h), with normal serum levels of renin 10<span class="elsevierStyleHsp" style=""></span>pg/ml (normal range 2–21<span class="elsevierStyleHsp" style=""></span>pg/ml) and aldosterone 18<span class="elsevierStyleHsp" style=""></span>ng/dl (normal range 2–23<span class="elsevierStyleHsp" style=""></span>ng/ml). <span class="elsevierStyleSup">123</span>I-Metaiodobenzylguanidine whole-body scintigraphy showed a suboptimal image quality due to antihypertensive therapy. In this context, <span class="elsevierStyleSup">111</span>In-Pentetreotide scan was requested (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). Whole-body and single photon emission computed tomography (SPECT) scans identified a focal pathological uptake in the left chest wall, although its exact location (breast or axilla) was not achieved. Left lateral thoracic planar image performed with the patient lying prone revealed the localization of the focal uptake in the breast tissue.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination was normal. Complementary imaging tests (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>) included mammography, ultrasound scan and magnetic resonance imaging (MRI). Mammography showed fibroglandular tissue, but focal mass was not detected. Ultrasound scan identified a hypo echoic and homogeneous nodule of 10<span class="elsevierStyleHsp" style=""></span>mm in the left breast. MRI located the lesion at the upper-outer quadrant of the left breast, with kinetic malignant features. No other lesion was found. A large needle biopsy was performed. Histological result revealed ductal carcinoma, ER+++, PR+++, Cadherine-E+++, Ki-67 10% and Her-2+.</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The patient underwent left lumpectomy and sentinel lymph node biopsy. After a concentric incision around areola in upper-outer quadrant, an excision of tissue with wire-guided localization was performed. Specimen size was 6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>6<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>3<span class="elsevierStyleHsp" style=""></span>cm in its length<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>width<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>height. Distance from closet margin was 5<span class="elsevierStyleHsp" style=""></span>mm. Two sentinel lymph nodes were removed at axilla level II. Final pathological analysis reported an invasive ductal carcinoma of 0.8<span class="elsevierStyleHsp" style=""></span>mm, Grade 1 (tubule formation, score 2; nuclear pleomorphism, score 2; mitotic count, score 1). No vascular, lymphatic or perineural invasion was observed. Immunohistochemical staining of the tumor cells were positive for neuroendocrine proteins chromogranin and synaptophysin. The two-sentinel lymph node were negative for metastases. Adjuvant hormonotherapy with Tamoxifen and radiotherapy (48<span class="elsevierStyleHsp" style=""></span>Gy, with boost to the tumor bed) was also administered with good tolerance. After 9 months, she continues on treatment with Tamoxifen (20<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h). There is no clinical evidence of recurrence. Hypertension has been controlled with Spironolactone 25<span class="elsevierStyleHsp" style=""></span>mg/48<span class="elsevierStyleHsp" style=""></span>h; Amlodipine<span class="elsevierStyleHsp" style=""></span>+<span class="elsevierStyleHsp" style=""></span>Valsartan 10/160<span class="elsevierStyleHsp" style=""></span>mg/24<span class="elsevierStyleHsp" style=""></span>h; Bisoprolol 2.5<span class="elsevierStyleHsp" style=""></span>mg/12<span class="elsevierStyleHsp" style=""></span>h.</p><p id="par0025" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleSup">111</span>In-Pentetreotide scintigraphy allows study in vivo of the presence of somatostatin receptors, mainly subtype 2, but also subtype 5. Somatostatin receptors are frequently expressed in breast cancer compared to normal breast tissue.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">4,5,8</span></a> Reubi et al. demonstrated somatostatin receptors in 46% of breast cancer tissues analyzed by in vitro autoradiography.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> This incidence was even higher (74%) in a series of 52 primary breast carcinomas reported by van Eijck et al, who used somatostatin receptor imaging.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a> In other report, Bajc et al. found a higher incidence of somatostatin receptors in patients with breast cancer than in controls, and detected all ductal breast carcinomas greater than 20<span class="elsevierStyleHsp" style=""></span>mm in size studied with <span class="elsevierStyleSup">111</span>In-Pentetreotide scan.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Among the 5 subtypes of somatostatin receptors, the subtype 2 is predominant in breast cancer. A correlation between the tumor grade and the expression of somatostatin receptor 2 has been indicated by Orlando at al.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a> These authors found that breast cancers expressing an up regulation of somatostatin receptor 2 mRNA may have a better prognosis. The presence of somatostatin receptor 2 has been also correlated with estrogen and progesterone levels.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Frati et al.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> reported also a correlation between expression of somatostatin receptors subtype 2 and subtype 4 with luminal breast cancer, but not with triple negative or HER2 tumor marker.</p><p id="par0035" class="elsevierStylePara elsevierViewall">We considered that the present clinical case is relevant in different aspects. First, the management of the breast lesion initially detected on somatostatin receptor imaging led up to early diagnosis of breast cancer in an asymptomatic patient from the breast point of view. Lesion size and somatostatin receptors density would be determining factors for the breast cancer imaging with somatostatin scintigraphy.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a> Second, as the tumor was positive on <span class="elsevierStyleSup">111</span>In-Pentetreotide imaging, an indicator of somatostatin receptors expression, the surgical specimen was immunohistochemically tested to search neuroendocrine markers. This procedure is not routinely performed in invasive breast carcinomas. Third, the patient might benefit from treatment with somatostatin analogs, although the clinical studies still have to demonstrate the effectiveness of the use of such therapy in breast cancer patients.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Gómez-de la Fuente F-J, Jiménez-Bonilla J, Estévez J, Martínez-Rodríguez I, Banzo I. Expresión de receptores de somatostatina en cáncer de mama. Cir Esp. 2017;95:545–547.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1393 "Ancho" => 990 "Tamanyo" => 81297 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Whole-body (A), SPECT (axial view [B], sagittal view [C]) and left lateral planar in prone position (D) images identified a focal increased uptake in the left breast.</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" => 938 "Ancho" => 1600 "Tamanyo" => 188622 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Mammogram (A) showed fibroglandular tissue. Ultrasonogram (B) identified a 10<span class="elsevierStyleHsp" style=""></span>mm nodule within the left breast. MRI (C) located the lesion at the upper outer quadrant of the left breast with kinetic malignant features.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cancer Statistics, 2016" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "R.L. Siegel" 1 => "K.D. Miller" 2 => "A. 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Somatostatin Receptors Expression in Breast Cancer
Expresión de receptores de somatostatina en cáncer de mama
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