Primary Leiomyosarcoma of the Breast: A Successful Surgical Treatment in a 45-Year-Old Woman.

BACKGROUND Spindle cell carcinomas and sarcomas are 2 uncommon primary spindle cell malignant tumors of the breast. Histopathology and immunohistochemistry for cell phenotypic markers can identify the type of tumor. This report is of a 45-year-old woman with a primary leiomyosarcoma of the breast, successfully treated by surgical excision. CASE REPORT A 45-year-old woman presented to our clinic in February 2018 with a 10.5-cm tumor in the right breast with lateral invasion of the pectoralis minor and pectoralis major. When the tumor first appeared in 2016, it was 5 cm in size and was diagnosed pathologically as a sarcoma. On immunohistochemical examination, the tumor cells were positive for smooth muscle actin, and vimentin with Ki 67 index of 15-20%. Previous treatment with 10 cycles of Gemcitabine was unsuccessful and showed rapid tumor growth up to 18 cm in May 2018. The patient underwent total right mastectomy with excision of the pectoralis minor muscle and partial excision of pectoral major muscle with axillary lymph node dissection. Pathological assessment revealed a necrotic mass 21.0×16.0×12.0 cm in size with invasion into the overlying breast skin and pectoralis major muscle with 2 out of 20 axillary lymph nodes with tumor growth. CONCLUSIONS This study has demonstrated the value of immunohistochemistry and histology in the diagnosis of primary spindle cell malignant breast cancers. To decrease the chance of recurrence and improve patient outcomes, primary leiomyosarcoma of the breast should be removed with a sufficient excision margin.

Prevalence, incidence, and mortality rates of breast cancer in Kazakhstan: data from the Unified National Electronic Health System, 2014-2019.

Background: Although there are numerous sources of epidemiologic information on breast cancer in Kazakhstan, none of them have specifically examined the burden of this disease. Therefore, this article aims to provide an overview of the breast cancer prevalence, incidence, mortality, and distribution and changes over time in Kazakhstan based on nationwide large-scale healthcare data from the National Registry in order to encourage more research on the impact of various diseases at the regional and national levels. Methods: The study cohort included all adult women older than 25 years who were diagnosed with breast cancer in any clinical setting of the Republic of Kazakhstan during the period of 2014-2019. The data were extracted from the Unified Nationwide Electronic Health System (UNEHS) to get an overview of descriptive statistics, incidence, prevalence, and mortality rate calculations and the Cox proportional hazards regression model. All survival functions and factors associated with mortality were tested for significance. Results: The cohort population (n = 55,465) comprised subjects with the age at the diagnosis of breast cancer from 25 to 97 years, with a mean of 55.7 ± 12.0 years. The majority of the study population belonged to the age group 45-59 years, which is 44.8% of the cohort. The all-cause mortality rate of the cohort is 16%. The prevalence rate increased from 30.4 per 10,000 population in 2014 to 50.6 in 2019. The incidence rate varied from 4.5 per 10,000 population in 2015 to 7.3 in 2016. Mortality rates were stable and high in the senile age patients (75-89 years old). Breast cancer mortality was positively associated with women who had been diagnosed with diabetes, HR 1.2 (95% CI, 1.1-2.3), whereas it was negatively associated with arterial hypertension, HR 0.4 (95% CI, 0.4-0.5). Conclusion: Overall, Kazakhstan is experiencing an increase in the incidence of breast cancer cases, but the mortality rate has started to decline. The switch to population mammography screening could reduce the breast cancer mortality rate. These findings should be utilized to help Kazakhstan determine what cancer control priorities should be utilized, including the need to implement efficient and affordable screening and prevention programs.

Novel Association of IGF2BP2 Gene Variants With Altered Risk of Breast Cancer and as Potential Molecular Biomarker of Triple Negative Breast Cancer.

BACKGROUND: Several studies documented that insulin-like growth factor-2 mRNA-binding protein 2 (IGF2BP2) contributes to carcinogenesis, and 1 report documented the association of IGF2BP2 rs4402960 with increased risk of breast cancer (BC). This study investigated the association of rs4402960 and rs1470579 IGF2BP2 variants with BC and triple negative BC (TNBC). MATERIALS AND METHODS: This case-control study included 488 BC patients comprising 130 TNBC and 358 non-TNBC patients, and 476 cancer-free controls. Genomic DNA was obtained from peripheral venous blood, and genotyping was done by allelic exclusion method on real-time PCR. RESULTS: The rs440960, but not rs1470579, minor allele was significantly associated with BC, and significantly higher rs4402960 T/T genotype frequency was noted in BC patients than controls; the distribution of rs1470579 genotypes were comparable between BC patients and controls. In contrast, significantly lower rs1470579 minor allele frequency, and reduced rs1470579 A/C and C/C, and rs4402960 T/T genotype frequencies were seen in TNBC cases. Among TNBC cases, rs4402960 and rs1470579 correlated with menses pattern, histological type, breastfeeding, oral contraceptive use and hormonotherapy. Among non-TNBC patients, and rs1470579 correlated significantly with breast feeding, oral contraceptive use, hormonotherapy, and nodal status; rs4402960 also correlated with menses pattern. Two-locus (rs440960-rs1470579) haplotype analysis confirmed the positive association of TC, and negative association of GC and TA haplotypes with BC, while TC and GC haplotypes were negatively associated with TNBC. CONCLUSION: Whereas rs440960 was positively associated with BC, both rs4402960 and rs1470579 were negatively associated with TNBC, suggesting potential diagnostic/prognostic role in BC and its complications.

Transaxillary gasless endoscopic thyroidectomy versus conventional open thyroidectomy: systematic review and meta-analysis.

AIM: This systematic review and meta-analysis evaluates surgical outcome and safety results of conventional (OT) versus endoscopic transaxillary gasless thyroidectomies (ET). MATERIAL AND METHODS: A systematic literature search was performed. The weighted mean differences or the odd ratios with corresponding 95% CIs were examined for surgical outcomes and complications. The results were analysed using fixed- or random-effects models. The heterogeneity was checked by the Cochran Q test and the extent of inconsistency was evaluated by the I2 statistic. RESULTS: Ten studies and 1597 patients were included. All studies found that ET required longer operative time. Postoperative pain was significantly lower after ET on day 1 and day 7. No statistical difference was found in complication rates. CONCLUSIONS: ET has disadvantages such as longer surgery time, but it is a feasible and safe procedure with lower postoperative pain and comparable complication rates to OT. However, good quality prospective randomised studies are necessary to draw firmer conclusions.

Massive Retroperitoneal and Subcutaneous Emphysema after Transanal Excision of Rectal Cancer.

Transanal excision (TAE) is considered a safe, alternative approach for patients with early stage of rectal cancer. Complications associated with TAE are rare, such as bleeding, perforation, incontinence, and rectal stricture. Subcutaneous emphysema is early complication of laparoscopic surgery, common during upper gastrointestinal and gynecological surgery. We report a case of retroperitoneal and subcutaneous emphysema emerging after TAE of rectal tumor. The patient presented with changed bowel habits. Colonoscopy with pathology reports, ultrasound, and magnetic resonance imaging showed an adenocarcinoma in the rectum at a 5 cm from the anus and did not reveal signs of invasive growth, pathologic lymph nodes, or systemic metastases. After surgery patient complained about abdominal pain and severe subcutaneous emphysema. Computed tomography showed retroperitoneal emphysema with no signs of rectal wall defect. He received antibiotics and was kept hospitalized with a solid diet and the retroperitoneal air disappeared on the thoracic X-ray. Patients who remain clinically stable or steadily improving without signs if peritonitis can be managed conservatively. Only in case of ineffectiveness of conservative therapy, undergo surgery.