Chyle Leak After Axillary Node Clearance in Breast Cancer Surgery-A Rare Complication and a Proposed Management Strategy from the British and Italian Experience.

BACKGROUND: Chyle leak after axillary surgery is a rare complication that lacks consensus and management guidelines. This study aimed to present the experiences of two centers in chyle leak management after axillary node clearance for breast cancer. Furthermore the authors provide a review of its pathophysiology and clinical diagnostic methods. They compare approaches for management of the axilla with those for other locations. METHODS: A multicentre case series descriptive analysis of chyle leak after breast cancer axillary node clearance between 1 January 2013 and 31 May 2020 was performed. RESULTS: The center in the United Kingdom and the center in Italy performed 655 and 4969 axillary node clearances, respectively. Four patients experienced chyle leaks. All the leaks had left-sided surgery (3 patients had level 3 clearances with mastectomy and implant-based breast reconstructions; 1 patient had level 2 clearance with therapeutic mammoplasty). All the leaks appeared within 3 days after surgery. Leak duration was between 11 and 29 days. The maximum daily output was 600 mL. All the leaks were treated conservatively with nutritional team support together with close drainage monitoring. The management strategy included a low-fat diet, a high-protein diet, total parenteral nutrition, and medium chain triglyceride supplements, as well as other elements. No negative effects on oncoplastic and reconstructive breast surgery wound-healing and no delays in adjuvant treatment were observed. CONCLUSION: The incidence of chyle leak after breast cancer axillary node clearance was 0.07%. Early diagnosis and close monitoring together with conservative management involving nutritional team support can result in successful treatment of chyle leak without negative sequalae of breast cancer oncologic treatment.

Malignant phyllodes tumor of the breast: a systematic review.

Phyllodes tumors (PT) are fibroepithelial neoplasms of the breast showing a peculiar leaf-like appearance. They account for 0.3 to 1% of all primary breast tumors and 2.5% of all fibroepithelial breast tumors. PT are classified into benign, borderline and malignant based upon their stromal morphology with a distribution of 60%, 20%, and 20%, respectively. Malignant PT of the breast constitute an uncommon challenging group of fibroepithelial neoplasms. They have a relatively high tendency to recur, although distant metastasis is uncommon, and nearly exclusive to malignant PT. Adequate surgical resection remains the standard approach to achieve maximal local control. Giant malignant PT are rare and a pose a diagnostic dilemma for pathologists, especially when comprised of sarcomatous elements. This review highlights the morphological features of PT detected in cytology and histology specimens and discusses diagnostic pitfalls and differential diagnosis.

Breast Shwannoma - Time to explore alternative management strategy?

Schwannoma (SCH) is a benign peripheral nerve sheath neoplasm of Schwann cell origin. It can be observed anywhere whilst the breast is uncommon site. Preliminary investigations are not entirely diagnostic and surgical excision is often required to reach a conclusion. We conducted a retrospective review in two European Breast units to know more about this rare condition. Herein, we provide a comprehensive review and we question whether the surgical approach to management can be changed.

Unusual presentation of a large GIST in an extraintestinal site: a challenging diagnosis dilemma.

Gastrointestinal stromal tumour (GIST) is a recent recognised tumour entity. In the past, those tumours were classified as leiomyomas, leiomyosarcomas and leiomyoblastomas, but it is now evident that GIST is a separate tumour entity and is the most common sarcoma of the gastrointestinal tract especially with advances in immunohistochemical staining techniques and improvements in microscopic structural imaging. We present a case of GIST of unusual location and presentation pattern, with an overview over current GISTs' diagnosis and management strategies. The precise incidence and tumour behaviour of rare extragastrointestinal stromal tumour (EGIST) remain to be clarified. Further research is needed in large series with long duration of follow-up and modified risk stratification assessment tailored for EGISTs.

Fibromatosis, a benign breast disease mimicking carcinoma. A case report.

INTRODUCTION: Fibromatosis is an uncommon breast lesion that can mimic breast carcinoma in its clinical presentation. CASE SUMMARY: We present a clinical case in which a diagnosis and treatment dilemma existed, in terms of ultrasound findings that were not clear and suspicious, as well as results of Fine needle aspiration cytology. Our findings are compared with previous published cases. Also, literature review regarding fibromatosis presentation and diagnosis has been discussed, as well as treatment options. CONCLUSION: Management of breast fibromatosis remains controversial because of the low incidence and further efforts needed to establish evidence-based treatment guidelines.

Unilateral breastfeeding: an unusual practice that might be the reason for future development of contralateral breast disease.

BACKGROUND: A significant number of mothers have breastfed their babies from one breast only or from one breast more than the other. They presented to the breast clinic with complaints that mainly involve the breast that was not used or less used for breastfeeding. METHODS: The database of the Breast Unit at King Fahd Hospital, Jeddah, Saudi Arabia, was reviewed from April 1998 to March 2010. The lactation history of any patient coming to the breast clinic was documented, including number of children, duration of lactation, and the way they performed breastfeeding. RESULTS: During the study period, 54 patients have breastfed their babies exclusively from one breast (Group 1), and 21 have breastfed from one breast more than the other (Group 2). Patients gave different reasons for this practice, with nipple retraction being the commonest. In Group 1, 46 of 54 (85%) presented with complaints in the breast that was not used for breastfeeding (unsuckled), and only eight of 54 (15%) presented with complaints in the used (suckled) breast (p = 0.000). In Group 2, 13 of 21 (62%) presented with complaints in the breast that was less used for breastfeeding (less suckled), five of 21 (24%) presented with complaints in the breast more used for breastfeeding (more suckled), and three of 21 (14%) presented with complaints in both breasts equally (p = 0.418). CONCLUSION: Mothers who practice unilateral breastfeeding are candidates for future development of different breast problems in the unsuckled/less suckled breast.