The Influence of Breast Cancer on the Distribution of Cherry Angiomas on the Anterior Thoracic Wall: A Case Series Study.

BACKGROUND/AIMS: Cherry angiomas (CAs) are one of the most common vascular manifestations of the skin. By and large, these benign lesions often only represent an aesthetic problem. In the literature, few authors have focused on the pathogenesis of these lesions, and some risk factors have been identified, such as the presence of cutaneous and non-skin neoplasias. In this study, the correlation between the distribution of CAs and breast cancer was investigated. METHODS: We carried out a study whereby 50 women with unilateral breast cancer and the presence of CAs on the anterior thoracic wall were evaluated, with a particular focus on the difference in the number of CAs between the two haemithoraces. The data was elaborated using the Wilcoxon signed-rank test in order to evaluate whether there was a statistical significance in the distribution of CAs. RESULTS: In 31 patients we found that the number of CAs was greater on the cancerous breast than on the contralateral one (p value <0.0001). This was confirmed both in the group of patients suffering from ductal breast cancer and in the group with early invasive breast tumours. CONCLUSION: It is not clear whether CAs develop prior to or following breast cancer, indicating the possibility that this cutaneous manifestation could take on a predictive, prognostic development or represent only an epiphenomenon. Further in-depth studies into the pathogenesis of CAs and the relationship with breast cancer could lead to noteworthy diagnostic-therapeutic advances.

Borderline Case in Reconstructive Plastic Surgery of the Lower Limb Treated with Bone Drilling and Use of Dermal Regeneration Template.

The traumatic pathology of the lower limb represents a very complex branch of medicine, which, despite the wide presence of guidelines, aimed at regulating the various therapeutic procedures, and is still greatly influenced by random variables and by the multiple responses to treatments. In this report, we present our experience with a borderline case, where the timing of the trauma and the patient's characteristics made it difficult to use the most recommended procedures in trauma management.

Optimizing Fat Grafting Using a Hydraulic System Technique for Fat Processing: A Time and Cost Analysis.

Background Many authors have researched ways to optimize fat grafting by looking for a technique that offers safe and long-term fat survival rate. To date, there is no standardized protocol. We designed a "hydraulic system technique" optimizing the relationship among the quantity of injected fat, operative time, and material cost to establish fat volume cutoffs for a single procedure. Methods Thirty-six patients underwent fat grafting surgery and were organized into three groups according to material used: standard, "1-track," and "2-tracks" systems. The amount of harvested and grafted fat as well as material used for each procedure was collected. Operating times were recorded and statistical analysis was performed to establish the relationship with the amount of treated fat. Results In 15 cases the standard system was used (mean treated fat 72 [30-100] mL, mean cost 4.23 ± 0.27 euros), in 11 cases the "1-track" system (mean treated fat 183.3 [120-280] mL, mean cost 7.63 ± 0.6 euros), and in 10 cases the "2-tracks" one (mean treated fat 311[220-550] mL, mean cost 12.47 ± 1 euros). The mean time difference between the standard system and the "1-track" system is statistically significant starting from three fat syringes (90 mL) in 17.66 versus 6.87 minutes. The difference between the "1-track" system and "2-tracks" system becomes statistically significant from 240 mL of fat in 15 minutes ("1-track") versus 9.3 minutes for the "2-tracks" system. Conclusion Data analysis would indicate the use of the standard system, "1-track," and "2-tracks" to treat an amount of fat < 90 mL of fat, 90 ÷ 240 mL of fat, and ≥ 240 mL of fat, respectively.

Cling Wrap Technique: An Inexpensive and Simple Way to Seal Negative Pressure Wound Therapy on External Fixation Devices.

SUMMARY: Negative pressure therapy is often applied to treat limb traumas with or without bone exposure. However, sealing a negative pressure dressing in the presence of an external fixation device may be complicated and time consuming. In this technique, we attempted to maintain vacuum conditions by preventing air leakage around the screws using plastic drape and cling wrap as the final layer over the external fixation device. To prevent rupturing of the wrap, the prominences of the pins and rods were covered using cotton wool roll. This novel solution is also effective for complex and extended wounds, with no need for additional dressing changes and no occurrence of complications for approximately 4 days. Furthermore, it is an inexpensive, quick, and readily available technique requiring minimal training to perform. It is also adaptable to any anatomical region, allowing the inspection of the limb when required.

A new case of radiation-induced breast angiosarcoma.

INTRODUCTION: Radiation-induced breast angiosarcoma is a severe but rare late complication in the breast-preserving management of breast cancer through surgery and radiotherapy. Often the initial diagnosis is complex given its relatively anodyne nature and the fact that it usually presents in the form of typically multifocal reddish-purple papular skin lesions. PRESENTATION OF THE CASE: We describe the clinical and pathologic findings of a 79-year-old woman, who developed a radiation-induced breast angiosarcoma after around 8 years. She initially refused a mastectomy leading to an adaptation in the management of this cancer. DISCUSSION: The average latency of secondary angiosarcoma of the breast following radiation therapy is around six years. Breast angiosarcoma is typically considered to affect the dermis, and is therefore cutaneous in origin. An incisional biopsy of the discoloured skin and underlying mass is necessary. The treatment is surgical resection. The role of chemotherapy has not been clearly defined. Most data originate from retrospective case series studies suggesting that angiosarcomas are relatively sensitive to taxanes and anthracyclines. CONCLUSION: The preferred treatment is always aggressive surgical removal and, as our atypical clinical case suggests, neoadjuvant chemotherapy in very high doses is also needed. A biopsy of any suspicious breast skin lesion after radiotherapy is recommended. Despite the treatment challenges, our case provides enlightening details on the management of such a rare cancer even when faced with unplanned events which do not always allow for a textbook approach.

A rare case of squamous cell carcinoma of a proliferating trichilemmal tumour.

INTRODUCTION: Squamous Cell Carcinoma (SCC) includes several subtypes and these can be classified according to their clinical behaviours from the least invasive to the most aggressive. Moreover, it is appropriate to analyse their clinicalpathological patterns 1. In light of its wide histopathological variability, we encountered a rare malignant cutaneous lesion: a SCC of a proliferating trichilemmal tumour (PTT) nature. CASE REPORT: We describe the clinical and pathologic findings of an 82-year-old woman, who developed a SCC with areas of trichilemmal differentiation. It has a surprising thickness of 25 mm, which passes through the dermis, infiltrates the hypodermis and evolves quickly. CONCLUSION: Considering its exophytic growth and the negative results of the post operative tests (ultrasounds confirmed absence of metastasis), the tumour was eradicated thanks to the surgical approach (a 1 cm border wide excision, including the periosteum in the central part of the lesion, followed by its reconstruction using a full-thickness skin graft) and the prompt intervention, without need for further complimentary treatments. The overall aesthetic results were pleasing. KEY WORDS: Adnexal tumour, PPT, SCC, Surgery.