Hospital México

Background Dual HER2 blockade with pertuzumab, trastuzumab, and a taxane is the current standard first-line treatment for HER2-positive metastatic breast cancer (mBC), based on pivotal trials such as the CLEOPATRA. Since 2014, this regimen has been implemented in the Costa Rican public healthcare system. However, real-world data from Central America are lacking. Methods We conducted a retrospective, multicenter observational study of 148 patients with histologically confirmed HER2-positive mBC who were treated between August 2015 and August 2021 at five Costa Rican public hospitals. Primary endpoints were progression-free survival (PFS), overall survival (OS), and safety profile. Survival analysis was performed using Kaplan-Meier estimates. Results Median age was 58 years; 95% had ECOG 0-1; 54% were hormone receptor-positive. Visceral metastases were present in 37.8%, and 4.7% had brain metastases at diagnosis. Paclitaxel was the most used taxane (85%). Median duration of anti-HER2 therapy was 22.7 months. Median PFS was 19 months (95% CI: 15-25), and median OS was 73 months (95% CI: 38-74), with a median follow-up of 27.5 months. Most adverse events were grade 1-2, with peripheral sensory neuropathy (34%) and diarrhea (21%) being the most common. Grade 3 cardiotoxicity occurred in two patients. Subgroup analysis by hormone receptor status showed no statistically significant differences in PFS (HR-positive: 18.2 months (95% CI 14.1-22.3) vs. HR-negative: 20.1 months (95% CI 15.8-24.4); p = 0.42) or OS (HR-positive: 71 months (95% CI 36-106) vs. HR-negative: 74 months (95% CI 40-108); p = 0.38). Conclusion This first Central American real-world study demonstrates that first-line pertuzumab, trastuzumab, and taxane yields PFS, OS, and safety outcomes comparable to pivotal trials in HER2-positive mBC, despite including patients with prior trastuzumab exposure and brain metastases. These findings contribute to regional real-world evidence and underscore the need for neurological monitoring, given the high rate of central nervous system (CNS) progression. Cross-study comparisons remain descriptive due to population and design differences.

Accurate staging of breast cancer (BC) is essential for guiding treatment decisions and estimating prognosis. Current guidelines discourage routine diagnostic imaging in asymptomatic patients. However, adherence is often inconsistent in clinical practice. In Latin America (LATAM), this is further challenged by higher rates of advanced-stage presentations and aggressive tumor subtypes, which may lead to more frequent imaging. Yet, there is a lack of data on real-world imaging patterns in the region. Understanding current staging practices is critical to identifying care gaps, informing context-appropriate guidelines, and promoting efficient diagnostic strategies. We conducted a cross-sectional, anonymous online survey among oncologists and breast surgeons from LATAM countries. The survey included 63 items covering sociodemographic characteristics, imaging use by clinical stage, decision-making criteria, access to diagnostic technologies, turnaround times, and familiarity with guidelines. Descriptive statistics were used for analysis. A total of 269 physicians participated. Respondents included physicians from 18 LATAM countries and Spain; 55.4% were oncologists and 44.6% breast surgeons; 57.3% worked primarily in public settings, and 55.4% had over 10 years of experience. While 43.5% managed more than 50 BC patients per month, only 18.2% were exclusively dedicated to BC care. Guideline awareness was high (NCCN: 89%, ESMO: 71.4%, national: 70.6%), and 89.1% stated that guideline recommendations were important for decision making in clinical practice. Despite this, routine use of diagnostic imaging was reported in 34.2% of asymptomatic patients with stage I disease, 48% in stage II without nodal involvement, 77.7% in stage II with nodal involvement, and 91.1% in stage III. Chest CT (65.9%), abdominal CT (63.2%), and bone scintigraphy (62.7%) were reported as the most frequently used studies, though abdominal ultrasound (US) (42.2%), chest X-ray (40.9%), and PET-CT (23.3%) were also reported. Imaging decisions were primarily influenced by tumor size (78.3%) and biological subtype (65.9%). Chest X-ray and abdominal US reported use decreased from 62.8% in stage I to 24.7% in stage III patients, while thoraco-abdominal CT use increased from 36.2% in stage I to 85.7% in stage III patients. The reported use of imaging did not change based on medical specialty or years of clinical practice. Access to advanced imaging modalities such as PET-CT was more restricted; only 43.9% had consistent availability, and 44.6% reported turnaround times >4 weeks, compared to <3% for chest X-ray or abdominal US, 15.9% for thoraco-abdominal CT, and 27.1% for bone scintigraphy. Most respondents (62.5%) indicated that imaging decisions and turnaround times (82.2%) would differ based on patients' insurance status (public vs private). Overall, the findings highlight a disconnect between guideline-based recommendations and real-world practice, shaped by system-level disparities and resource constraints. Our findings underscore a significant gap between guideline recommendations and real-world diagnostic imaging practices for BC staging across LATAM. Despite high awareness of guidelines, the frequent use of imaging reflects inconsistent adherence to guideline recommendations. Early-stage patients often undergo extensive imaging, with limited access and long delays—particularly for advanced modalities like PET-CT— that may contribute to treatment delays. These findings support the need for regionally adapted staging guidelines and targeted educational strategies to improve guideline-concordant care across LATAM. This work was conducted with the collaboration of LABCA, ACHO, ACM and SVM. W. A. Mantilla, M. A. Bravo, V. Acosta-Marín, A. M. Osorio, C. Villarreal-Garza, A. W. Mushtaq, F. E. Petracci, S. Cervera, G. Santander, A. Reyes-Morales, D. U. Landaverde, J. C. Samamé-Pérez-Vargas, J. Moreno-Rios, L. Gutiérrez, B. Moreno-Jaime, J. J. Caicedo, S. Quintero, A. M. Mejía, H. Carranza, S. X. Franco. Real-world patterns and preferences in the use of diagnostic imaging for breast cancer staging in Hispano-America: A multinational physician survey [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-10-21.

Fungi are a group of microorganisms encompassing thousands of species, with only a minority causing disease in humans. Fungal pathogens and infections are increasing global public health problems. They are an important cause of opportunistic infections in immunocompromised patients; however, they can also affect immunocompetent individuals. This paper reviews the incidence, clinical features, radiographic manifestations, and pathological findings of major fungal infections in non-immunocompromised patients. Only a restricted subset of fungi, specifically the endemic dimorphic fungi, selected Aspergillus manifestations, and Cryptococcus gattii are consistently associated with pulmonary infection in immunocompetent individuals. Endemic mycoses are determined by their geographic distribution, which makes it necessary to consider the diagnosis when pulmonary infection occurs in endemic areas. However, their clinical and radiological manifestations are frequently nonspecific. On the other hand, other fungi, mainly Aspergillusspp. are involved in a variety of diseases, including allergic bronchopulmonary aspergillosis, which is frequently diagnosed based on imaging criteria, and a series of conditions in the spectrum of chronic aspergillosis, including simple aspergilloma, chronic cavitary pulmonary aspergillosis, chronic fibrosing pulmonary aspergillosis, subacute invasive pulmonary aspergillosis, and aspergillus nodules.

Capnocytophaga canimorsus is a zoonotic Gram-negative bacterium commonly present in the oral flora of dogs and cats. Although human infection is uncommon, it can lead to rapidly progressive and life-threatening disease, particularly in immunocompromised individuals such as those with asplenia. Severe acute respiratory distress syndrome (ARDS) requiring extracorporeal membrane oxygenation (ECMO) has been rarely reported. We describe a 60-year-old woman with hypothyroidism and a remote history of splenectomy who presented with fever, malaise, and gastrointestinal symptoms one week after a dog bite. Blood cultures obtained early during hospitalization grew C. canimorsus. Her clinical course was complicated by rapidly progressive ARDS and multiorgan failure, requiring invasive mechanical ventilation. Despite optimized lung-protective ventilation, neuromuscular blockade, prone positioning, and broad-spectrum antimicrobial therapy, refractory hypoxemia persisted. Veno-venous (VV) ECMO was initiated as rescue therapy, resulting in progressive improvement in gas exchange and pulmonary mechanics. ECMO support was successfully discontinued after 11 days, followed by liberation from mechanical ventilation and full clinical recovery. Severe C. canimorsus infection can result in fulminant ARDS and multiorgan dysfunction. Early recognition and timely escalation to advanced supportive therapies, including VV-ECMO, may be lifesaving in selected patients.

Objetivo. Describir la presentación clínica, los hallazgos ecográficos e imagenológicos y la confirmación histopatológica de un caso de enfermedad de Rosai–Dorfman (ERD) con compromiso orbitopalpebral extranodal, destacando el abordaje multidisciplinario entre los servicios de órbita, ecografía ocular y patología oftálmica.Caso clínico. Paciente masculino de 18 años con aumento progresivo de volumen palpebral superior derecho y proptosis bilateral de ocho meses de evolución. El examen evidenció exoftalmos derecho que aumentaba con la maniobra de Valsalva y limitación de las ducciones. La tomografía computarizada mostró una lesión orbitaria derecha bien delimitada, sin erosión ósea. La ecografía demostró una masa homogénea hipoecoica con extensión extra e intraconal y flujo intralesional hipovascular al Doppler color. Se realizó biopsia incisional mediante abordaje orbitario anterior, cuyo estudio histopatológico reveló histiocitos con emperipolesis e inmunopositividad para CD68 y S100, confirmando ERD extranodal orbitaria.Conclusión. La ERD debe considerarse en el diagnóstico diferencial de masas orbitarias en pacientes jóvenes, incluso en ausencia de linfadenopatía. Como en el caso presentado, la integración de la evaluación clínica, los estudios de imagen —incluyendo ecografía Doppler— y la confirmación histopatológica con inmunohistoquímica resulta esencial para establecer el diagnóstico definitivo y orientar el manejo individualizado.