A South African Breast Implant-Associated Anaplastic Large Cell Lymphoma: Clinical Presentation and Six-Year Follow-Up.

Breast augmentation is the most common surgical procedure for women globally, with 1,795,551 cases performed in 2019. Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is highly uncommon, with 733 reported cases as of January 2020. In South Africa, there are less than 4000 breast augmentation surgeries annually. This case presents the first case report documentation of a South African woman diagnosed with BIA-ALCL. The patient was a 61-year-old woman who consulted the Breast Care Centre of Excellence in Johannesburg in 2015. She had a prior history of bilateral augmentation mammoplasty with subsequent implant exchange. The patient presented with periprosthetic fluid with a mass-like enhancement on the left breast. Aspiration of the mass-like fluid was positive for CD45, CD30, and CD68 and negative for CD20 and ALK-1, indicative of BIA-ALCL. Surgical treatment included bilateral explantation, complete capsulectomies, and bilateral mastopexy. Macroscopic examination of the left breast capsulectomy demonstrated fibrous connective tissue. The histological examination of the tumor showed extensive areas of broad coagulative necrosis with foamy histiocytes. Immunohistochemistry examination of this tumor showed CD3-, CD20-, and ALK-1-negative and CD30- and CD68-positive stains. PCR analysis for T-cell clonality showed monoclonal T-cell expansion. These findings confirm the presence of BIA-ALCL. The patient recovered well after surgery and did not require adjuvant therapy. A patient with a confirmed diagnosis of BIA-ALCL was successfully treated with explantation and complete capsulectomy. She was followed up regularly for six years, and the patient remains well and in remission.

First Intraoperative Radiation Therapy Center in Africa: First 2 Years in Operation, Including COVID-19 Experiences.

PURPOSE: There is a shortage of radiation therapy service centers in low- to middle-income countries. TARGIT-intraoperative radiation therapy (IORT) may offer a viable alternative to improve radiation treatment efficiency and alleviate hospital patient loads. The Breast Care Unit in Johannesburg became the first facility in Africa to offer TARGIT-IORT, and the purpose of this study was to present a retrospective review of patients receiving IORT at this center between November 2017 and May 2020. PATIENTS AND METHODS: Patient selection criteria were based mainly on the latest American Society of Radiation Oncology guidelines. Selection criteria included early-stage breast carcinoma (luminal A) and luminal B with negative upfront sentinel lymph node biopsy that negated external-beam radiation therapy (EBRT). Patient characteristics, reasons for choosing IORT, histology, and use of oncoplastic surgery that resulted in complications were recorded. RESULTS: One hundred seven patients successfully received IORT/TARGIT-IORT. Mean age was 60.8 years (standard deviation, 9.3 years). A total of 73.8% of patients presented with luminal A, 15.0% with luminal B, and 5.6% with triple-negative cancer. One patient who presented with locally advanced breast cancer (T4N2) opted for IORT as a boost in addition to planned EBRT. Eighty-seven patients underwent wide local excision (WLE) with mastopexy, and 12 underwent WLE with parenchymal. Primary reasons for selecting IORT/TARGIT-IORT were distance from the hospital (43.9%), choice (40.2%), and age (10.3%). CONCLUSION: This retrospective study of IORT/TARGIT-IORT performed in Africa confirms its viability, with low complication rates and no detrimental effects with breast conservation, resulting in positive acceptance and the potential to reduce Oncology Center patient loads. Limitations of the study include the fact that only short-term data on local recurrence were available. Health and socioeconomic value models must still be addressed in the African setting.

Colour Coding Navigation: "Triage" Techniques to Improve Compliance in Breast Cancer Patients Requiring Primary Chemotherapy.

OBJECTIVE: This is a pilot study to assess whether a file-colour-coded triage navigation system for patients on primary chemotherapy improves compliance and adherence and if it decreases defaulting. MATERIALS AND METHODS: All breast cancer patients are discussed in a multidisciplinary meeting. All patients are triaged before starting on primary chemotherapy based on their specific challenges and beliefs and are consulted by the navigation team and contacted before the beginning of treatment and after each chemotherapy session by a navigator in the unit. File stratification for ease of navigation was instituted by a colour code dot into three groups. The three groups are:Code Green: Compliant on treatmentCode Yellow: Side effects on treatment/ considering defaultingCode Red: Non-compliantThe code red patients were further assessed in terms of reasons for non-adherence or non-compliance:Fear of chemotherapy side effectsThe belief that chemotherapy kills the patientInterest in "alternative treatment regimens"Other barriers to treatment as identified by the navigators. RESULTS: The system allows the navigation team to focus on which patients require specific navigation and inform the treating oncologists. Code green patients were courtesy called after each chemotherapy session. The code yellow patients had early involvement with the survivorship team to ensure appropriate management of any side effects. Access to the complimentary oncology navigator and complementary health website was instituted. The oncology navigator visited each patient at the oncology unit on the day the patient was due to have chemotherapy. For Code red 1 and 2, a "buddies" network of patients who have been through similar treatment regimens was assigned by the navigation team. This was coordinated by patient navigators (trained counsellors who have had breast cancer treatment). Code red three was managed by a complementary health specialist who understood the value of chemotherapy. For Code red 4, the oncology navigator manages the concerns from finances services to family issues. For the 122 patients in total for primary chemotherapy, stratification was as follows:Code Green=64.8%Code Yellow=27.0%Code Red=8.2%. CONCLUSION: This system provides the Multidisciplinary team with the opportunity to improve patient adherence/compliance with primary chemotherapy. 80% of the code red patients eventually agreed to receive the recommended treatment. Navigation enhanced patient supervision, and the coding system improved patient primary chemotherapy adherence. Such a system would benefit larger oncological practices to improve primary chemotherapy adherence by empowering the navigation team to identify patients requiring more intensive navigation supervision.

Targeted Intraoperative Radiotherapy Is a Safe Approach for Patients with Pacemakers: A Case Study and Literature Review.

Case reports detailing the effects of targeted intraoperative radiation therapy (IORT) on patients with cardiac pacemakers (PMs) are rare. This growing population sub-group requiring IORT and lack of standardized guidelines necessitate more practical published research. An 81-year-old patient with clinical stage II, T1 N0 grade III, triple-negative invasive ductal carcinoma and an implanted single-lead chamber PM (VVIR mode, model: Biotronik, type Effecta SR) received targeted intraoperative radiotherapy at the time of wide local excision and sentinel lymph node biopsy. It presents the shortest distance between the outer diameter of the PM and IORT applicator in literature. Target IORT was performed utilizing an Intrabeam device (50 kV, Carl Zeiss Surgical, Oberkochen, Germany). This case elucidates the successful use of targeted IORT for breast-conserving surgery in a patient with a single ipsilateral chamber VVIR mode PM. No device failure or malfunction was reported for the PM before, during, or after the procedure. These findings support the use of targeted IORT for patients diagnosed with early-stage breast carcinomas who have a PM implanted. However, further research is needed to understand the safety of other methods and devices for IORT patients with cardiac implantable electronic devices.

High Mobility Group Box 1 in Human Cancer.

High mobility group box 1 (HMGB1) is an extremely versatile protein that is located predominantly in the nucleus of quiescent eukaryotic cells, where it is critically involved in maintaining genomic structure and function. During cellular stress, however, this multifaceted, cytokine-like protein undergoes posttranslational modifications that promote its translocation to the cytosol, from where it is released extracellularly, either actively or passively, according to cell type and stressor. In the extracellular milieu, HMGB1 triggers innate inflammatory responses that may be beneficial or harmful, depending on the magnitude and duration of release of this pro-inflammatory protein at sites of tissue injury. Heightened awareness of the potentially harmful activities of HMGB1, together with a considerable body of innovative, recent research, have revealed that excessive production of HMGB1, resulting from misdirected, chronic inflammatory responses, appears to contribute to all the stages of tumorigenesis. In the setting of established cancers, the production of HMGB1 by tumor cells per se may also exacerbate inflammation-related immunosuppression. These pro-inflammatory mechanisms of HMGB1-orchestrated tumorigenesis, as well as the prognostic potential of detection of elevated expression of this protein in the tumor microenvironment, represent the major thrusts of this review.