Inflammatory Breast Cancer: What surgeons need to know.

Strict criteria to identify Inflammatory Breast Cancer (IBC) have been made available - these are based on pathological as well as clinical observations. It is mandatory to confirm the criteria used in any further report. Scientific evidence accumulated so far is confusing, and unclear therefore no hard conclusion can be drawn from the available literature on the management of IBC. The advent of new medications results into an up-to-date management and different outcomes. It is mandatory to follow these criteria if reliable guidelines are to be made available in the next future.

[Results of immediate breast reconstructions at Landspítali-The National University Hospital of Iceland, in 2008-2010]. / Tídni og árangur tafarlausra brjóstauppbygginga á Landspítala 2008-2010.

INTRODUCTION: In late 2007, the availability of immediate breast reconstructions increased as a result of the establishment of an oncoplastic breast surgical service at Landspítali-The National University Hospital The aim of this study was to look at the rates and early complications of immediate breast reconstructions in our hospital in 2008-2010 and compare with the results from the UK National Mastectomy and Breast Reconstruction Audit (NMBRA). MATERIAL AND METHODS: This is a retrospective population-based study, including all women who had immediate breast reconstruction at Landspítali in 2008-2010. RESULTS: 319 mastectomies and 157 breast reconstructions were performed. Of these, 98 (62%) were immediate, (mean age 49, 29-69). The immediate breast reconstruction rate was therefore 31%, with a respective 55% for patients 50 years old or younger. In comparison, the rate was 5% in 2000-2005. Immediate reconstructions with an extended autologous latissimus dorsi flap were performed in 25 (26%) cases and implant based reconstructions in the remaining (n=73, 74%). Inpatient complications occurred in 12 (12%) patients and 5 needed reoperation (3 post-operative bleeding, 1 skin necrosis, 1 imminent LD-flap failure). Readmission due to complications after discharge occurred in 14 (14%), while 37 (38%) developed mild complications not requiring readmission. The results were comparable to NMBRA, although the rates of autologous flap reconstructions were significantly higher than in this study (63% vs. 26%). CONCLUSION: As a result of the establishment of an oncoplastic breast surgical service at Landspítali, the rates of immediate breast reconstruction have increased significantly (from 5% to 31%). The complication rates are low and similar to NMBRA.

Dynamics of microvascular remodelling during tumor growth in bone.

Microcirculatory properties of tumors have been shown to play a pivotal role in tumor progression and inefficacy of therapies. Although the influence of the microenvironment on angiogenesis has been intensively investigated in soft tissue tumors, little is known about the microvascular properties in bone metastasis. To determine the impact of the bone microenvironment on tumor growth and microcirculation we performed intravital microscopy using the "femur window" after implantation of red-fluorescent-protein-transduced breast cancer cells into the femura of severe-combined-immunodeficient mice. Tumor size, functional vascular density, vessel diameter, and vessel distribution were quantified over 14 days. Tumor growth and microcirculation could be quantified at a high spatial resolution. Tumor progression was associated with a rapid remodeling process of the microcirculation within the tumor and the surrounding tissue. Although the total functional vascular density remained unaltered, we found a significant loss in small vessels and a concomitant increase in vascular diameter. The presented study demonstrates for the first time dynamics of morphological microcirculatory alterations of tumor growth in bone. The observed changes in tumor vascularization exhibit strong similarities to soft tissue tumors; however, the dynamics of vascular alterations are more rapid in the bone microenvironment.