Resultados de la cirugía conservadora y radical de la mama en pacientes operadas en el Centro de Investigaciones Médico Quirúrgicas, Cuba / Results of Conservative or Radical Breast Surgeries in Patients Operated on at Centro de Investigaciones Médico Quirúrgicas, Cuba

Introducción: El cáncer ha causado más muertes que todas las guerras y catástrofes conocidas. En particular, el cáncer de mama se ha convertido en una pandemia que amenaza con seguir propagándose. Objetivo: Describir las diferencias en cuanto a los resultados obtenidos de la cirugía conservadora y radical como tratamiento del cáncer de mama. Métodos: Se realizó un estudio analítico, observacional, descriptivo y retrospectivo en un universo de 177 pacientes con diagnóstico de cáncer de mama en el servicio de Cirugía General del Centro de Investigaciones Médico Quirúrgicas de La Habana, Cuba. Todas recibieron tratamiento quirúrgico en el período comprendido de enero de 2011 a diciembre de 2016. Resultados: De las pacientes estudiadas, el 92,09 por ciento no presentaron antecedentes de patología mamaria, mientras que el 36,72 por ciento tuvieron como antecedente patológico familiar cáncer de mama. Predominaron las pacientes mayores de 70 años en ambas técnicas quirúrgicas. En el grupo de 30-40 años solamente se practicaron técnicas conservadoras. Con respecto al estadiamiento, predominó la etapa II de la enfermedad. La sobrevida global a los 5 años fue superior al 90 por ciento, mientras que el intervalo libre de enfermedad se mantuvo en valores similares para ambas técnicas. Conclusiones: Se realizaron mayor número de cirugías conservadoras de mama en pacientes que se encontraban en etapas clínicas más tempranas de la enfermedad y la sobrevida global de los procedimientos conservadores fue ligeramente mayor(AU)

Introduction: Cancer has caused more deaths than all known wars and catastrophes. Particularly speaking, breast cancer has become a pandemic that threatens to continue to spread. Objective: To describe the differences based on the results obtained from conservative and radical surgery as a treatment for breast cancer. Methods: An analytical, observational, descriptive and retrospective study was carried out with a universe of 177 female patients diagnosed with breast cancer in the general surgery service of Centro de Investigaciones Médico Quirúrgicas, of La Habana, Cuba. All of them received surgical treatment in the period from January 2011 to December 2016. Results: 92.09 percent of the patients studied had no history of breast pathology, while 36.72 percent had breast cancer as a family pathological history. Patients over 70 years of age predominated in both surgical techniques. In the group of 30-40 years of age only conservative techniques were performed. With respect to staging, there was a predominance of the disease in stage II. Overall survival at 5 years was higher than 90 percent, while the disease-free interval remained at similar values for both techniques. Conclusions: A greater amount of breast-conserving surgeries were performed in patients at earlier clinical stages of the disease, while overall survival of conservative procedures was slightly higher(AU)

Câncer de Mama e Eritrodermia: Relato de Caso / Breast Cancer and Erythroderma: Case Report / Cáncer de Mama y Eritrodermia: Relato de Caso

Introdução: A eritrodermia esfoliativa é um evento raro que está associado a diversas doenças como psoríase, eczemas, neoplasias malignas, uso de medicamentos, entre outras. Relato do caso: Paciente de 63 anos apresentou quadro de exantema difuso iniciado em janeiro de 2018, evoluindo com descamação generalizada da pele e formação de úlceras, sentindo calafrios. Não referiu histórico de câncer na família. Na anamnese, não houve relato de nenhum tipo de eczema, doença de pele preexistente ou uso de plantas medicinais. Foi identificada neoplasia maligna de mama do subtipo molecular luminal A, posteriormente. Após mastectomia com linfadenectomia, houve apenas melhora parcial do quadro da eritrodermia. Atualmente, em uso de doxorrubicina. Conclusão: A paciente apresentou quadro clínico inicial condizente com o que se espera de eritrodermia, que pode estar associada ao surgimento de neoplasia maligna de mama. O presente relato é importante, pois pode auxiliar em diagnósticos diferenciais para a eritrodermia, mesmo na vigência de um quadro clínico atípico.

Introduction: Exfoliative erythroderma is a rare event associated with several diseases such as psoriasis, eczema, malignant neoplasms, medication use, among others. Case report: A 63-year-old patient presented diffuse rash that started in January 2018, evolving with generalized skin desquamation and ulcer formation, with chills. Did not report family history of cancer. In the anamnesis, there was no report of any type of eczema, preexisting skin disease or use of medicinal plants. Malignant breast cancer of luminal A molecular subtype was identified later. After mastectomy with lymphadenectomy, there was only partial improvement in erythroderma. Currently using doxorubicin. Conclusion: The patient presented an initial clinical condition consistent with what is expected from erythroderma, which may be associated with the emergence of malignant breast neoplasm. The present report is important because it can help in differential diagnoses for erythroderma, even in the presence of an atypical clinical case.

Introducción: La eritrodermia exfoliativa es un evento raro asociado con varias enfermedades como psoriasis, eccema, neoplasmas malignos, uso de medicamentos, entre otros. Relato del caso: Paciente de 63 años presentó una erupción cutánea difusa que comenzó en enero de 2018, que evolucionó con descamación generalizada de la piel y formación de úlceras, con escalofríos. No informó antecedentes familiares de cáncer. En la anamnesis, no hubo informes de ningún tipos de eccema, enfermedad cutánea preexistente o uso de plantas medicinales. La neoplasia de mama maligna del subtipo molecular luminal A se identificó más tarde. Después de la mastectomía con linfadenectomía, solo hubo una mejoría parcial en la eritrodermia. Actualmente usa doxorrubicina. Conclusión: La paciente presentó un cuadro clínico inicial consistente con lo que se espera de la eritrodermia, que puede estar asociada con la aparición de neoplasma maligno de mama. El presente informe es importante porque puede ayudar en los diagnósticos diferenciales de eritrodermia, incluso en presencia de un cuadro clínico atípico.

Erector spinae plane block combined with a novel technique for selective brachial plexus block in breast cancer surgery: a case report / 대한마취과학회지

BACKGROUND: The breast is innervated by the intercostal nerves and the brachial plexus. We propose a technique to perform breast surgery without general anesthesia using the erector spinae plane (ESP) block and selective block of four nerves that arise from the brachial plexus innervate the breast and the axilla (SBP block). CASE: A 77-year-old man with breast cancer was scheduled for radical mastectomy and axillary clearance. He had a previous history of myocardial infarction with dilated cardiomyopathy and severely impaired ejection fraction. The surgery was performed under regional anesthesia with combined ESP and SBP block. The patient did not require opioids or other supplemental analgesics intra- or postoperatively and was discharged uneventfully. CONCLUSIONS: SBP is a novel block that selectively blocks branches of the brachial plexus that innervate the breast.

Reconstrução mamária em mulheres jovens e suas peculiaridades / Breast reconstruction in young women and their peculiarities

Introdução: O objetivo do trabalho foi avaliar as principais características e métodos utilizados na reconstrução mamária de mulheres jovens, considerando suas peculiaridades. Métodos: Foi realizada uma revisão retrospectiva dos prontuários das pacientes submetidas à mastectomia seguida de reconstrução mamária no período de janeiro de 2008 a dezembro de 2015, sendo selecionados aqueles cuja reconstrução foi realizada em mulheres de até 40 anos de idade. Resultados: 43 pacientes foram selecionadas. A média de idade foi de 33,86 anos. Grande parte possuía alguma comorbidade, sendo as mais comuns o sobrepeso e o transtorno ansioso/depressivo. Quatorze pacientes tinham história familiar da doença. A maioria obteve o diagnóstico de carcinoma ductal invasor. Tratamentos oncológicos complementares foram realizados em grande parte dos casos. Todas as pacientes foram submetidas à mastectomia total na mama portadora da neoplasia, sendo que em 16 houve a opção pela mastectomia redutora de risco contralateral. Do total de 43 reconstruções, 36 foram imediatas e 7 tardias; sendo 17 reconstruídos com implantes mamários, 13 com expansores teciduais, 4 com TRAM e 9 com GD. Houve 15 complicações, sendo as mais graves um caso de infecção com perda da reconstrução e um caso de necrose de aréola. Conclusões: Mulheres jovens submetidas à reconstrução mamária representam um subgrupo populacional com características próprias. Os padrões tumorais, pessoais e sociais diferem e, com base nesta imensa lista de variáveis, as possibilidades de tratamento são diversas. Em nossa casuística, o emprego de implantes mamários e expansores teciduais foi realizado com maior frequência neste subgrupo de pacientes.

Introduction: To evaluate the main features and methods used in breast reconstruction in young women considering their unique characteristics. Methods: A retrospective records review of patients who underwent mastectomy followed by breast reconstruction between January 2008 and December 2015 was conducted, selecting those reconstructions that were performed in women younger than 40 years. Results: Forty-three patients were selected. The average age was 33.86 years. Many had some comorbidities, the most common being overweight and anxiety/ depressive disorder. Fourteen patients had a family history of the disease. Most were diagnosed with invasive ductal carcinoma. Additional cancer treatments were administered in most cases. All patients underwent a full mastectomy in the breast with cancer, and in 16, there was the option of contralateral risk-reducing mastectomy. Of the 43 reconstructions, 36 were immediate and 7 were delayed, and 17 involved use of implants, 13 involved use of tissue expanders, 4 involved the TRAM, and 9 involved the GD. We observed 15 complications; the most severe were infection with reconstruction loss in one patient and areola necrosis in another. Conclusions: Young women undergoing breast reconstruction represent a population subgroup with its own characteristics. The tumors and personal and social patterns differ, and based on this long list of variables, treatment options are diverse. In our series, breast implants and tissue expanders were often most used.

Clinicopathologic and Prognostic Significance of the Zinc Finger of the Cerebellum Family in Invasive Breast Cancer / 한국유방암학회지

PURPOSE: Five members of the zinc finger of the cerebellum (ZIC) family—ZIC1, ZIC2, ZIC3, ZIC4, and ZIC5—have been shown to be involved in various carcinomas. Here, we aimed to explore the clinicopathologic and prognostic roles of ZIC family members in invasive breast cancer patients using immunohistochemical analysis, western blotting analysis, and real-time quantitative polymerase chain reaction (RT-qPCR). METHODS: A total of 241 female invasive breast cancer patients who underwent radical mastectomy between 2009 and 2011 were enrolled. ZIC proteins in 241 pairs of breast tumors and corresponding normal tissues were investigated using immunohistochemistry and the clinicopathologic roles of proteins were analyzed using Pearson's chi-square test. Kaplan-Meier curves and Cox regression analysis were also used to analyze the prognostic value of the ZIC proteins. In addition, 12 pairs of fresh-frozen breast tumors and matched normal tissues were used in the western blotting analysis and RT-qPCR. RESULTS: Only ZIC1 expression in normal tissues was obviously higher than that in tumors (p < 0.001). On multivariate analysis, ZIC1 expression (in overall survival analysis: hazard ratio [HR], 0.405, 95% confidence interval [CI], 0.233–0.702, p=0.001; in disease-free survival analysis: HR, 0.395, 95% CI, 0.234–0.669, p=0.001) was identified as a prognostic indicator of invasive breast cancer. CONCLUSION: ZIC1, but not the other proteins, was obviously decreased in breast tumors and associated with clinicopathologic factors. Thus, ZIC1 might be a novel indicator to predict the overall and disease-free survival of invasive breast cancer patients.

Abordagem Fisioterapêutica de uma Paciente com Linfedema de Membro Superior Prévio à Cirurgia para Câncer de Mama: Relato de Caso / Physiotherapeutic Approach of a Patient with Upper Limb Lymphedema Prior to Surgery for Breast Cancer: Case Report / Enfoque Fisioterapéutico de um Paciente con Linfedema de Miembro Superior Previo a la Cirugía para Cáncer de Mama: Relato de Caso

Introdução: O linfedema é a complicação mais comum após o tratamento do câncer de mama. Quando se manifesta antes do tratamento cirúrgico, como condição clínica por si só, é visto como um critério de inoperabilidade, representando um fator de mau prognóstico. Relato do caso: Este artigo visa a descrever a evolução clínica de uma paciente com linfedema de membro superior prévio à cirurgia para o câncer de mama, à condução do tratamento fisioterapêutico e à viabilidade do procedimento cirúrgico. Conclusão: Por meio deste relato de caso, foi possível descrever o tratamento fisioterapêutico de uma paciente com linfedema prévio à cirurgia para o câncer de mama. A equipe de fisioterapia pôde atuar em parceria com a equipe médica, controlando a descompensação linfática e auxiliando no caminho até a realização do procedimento cirúrgico. O cuidado fisioterapêutico se mostra fundamental desde o início do tratamento oncológico, de forma a detectar precocemente sintomas e distúrbios, intervindo de maneira eficaz e resolutiva e buscando proporcionar qualidade de vida e os melhores resultados possíveis para as pacientes.

Introduction: Lymphedema is the most common complication after breast cancer treatment. When it manifests itself before surgical treatment, as a clinical condition alone, it is seen as a criterion of inoperability, representing a factor of poor prognosis. Case report: This article aims to describe the clinical evolution of a patient with upper limb lymphedema prior to surgery for breast cancer, the conduct of the physiotherapeutic treatment and the feasibility of the surgical procedure. Conclusion: Through this case report it was possible to describe the physiotherapeutic treatment of a patient with lymphedema prior to surgery for breast cancer. The physiotherapy team can work in partnership with the medical team, controlling the lymphatic decompensation and assisting in the way until the surgical procedure is performed. Physiotherapeutic care has been fundamental since the beginning of cancer treatment, in order to detect early symptoms and disorders, intervening effectively and resolutely and seeking to provide quality of life and the best possible outcomes for patients.

Introducción: El linfedema es la complicación más común después del tratamiento del cáncer de mama. Cuando se manifiesta antes del tratamiento quirúrgico, como condición clínica por sí solo, es visto como un criterio de inoperabilidad, representando un factor de mal pronóstico. Relato del caso: En este artículo se pretende describir la evolución clínica de una paciente con linfedema de miembro superior previo a la cirugía para el cáncer de mama, la conducción del tratamiento fisioterapéutico y la viabilidad del procedimiento quirúrgico. Conclusión: A través de este relato de caso fue posible describir el tratamiento fisioterapéutico de una paciente con linfedema previo a la cirugía para el cáncer de mama. El equipo de fisioterapia puede actuar en asociación con el equipo médico, controlando la descompensación linfática y auxiliando en el camino hasta la realización del procedimiento quirúrgico. El cuidado fisioterapéutico se muestra fundamental desde el inicio del tratamiento oncológico, para detectar precozmente síntomas y disturbios, interviniendo de manera eficaz y resolutiva y buscando proporcionar calidad de vida y los mejores resultados posibles para las pacientes.

Recursos fisioterapêuticos utilizados no pós-operatório de mulheres mastectomizadas / Physical therapy techniques used in women after mastectomy

O câncer de mama é a neoplasia de maior incidência entre as brasileiras. O tratamento padrão para o câncer de mama é composto por cirurgia conservadora. Disfunções provenientes do pós-operatório (PO) podem gerar prejuízos, nas relações familiares e sociais, o que pode interferir na qualidade de vida da mulher. A fisioterapia traz como objetivo minimizar o impacto negativo causado pelo câncer. Portanto, este estudo vem apresentar uma revisão sistemática sobre a atuação da fisioterapia no pós-operatório de câncer de mama, e discorrer sobre recursos fisioterapêutico utilizados no pós-operatório. Trata-se de um estudo realizado através de uma revisão bibliográf ca, na qual foram utilizados artigos de caráter científicos publicados nos últimos 10 anos nos banco de dados: Scielo, Lilacs, Medline, Bireme, Instituto Nacional do Câncer (INCA), Ministério da Saúde. Os resultados obtidos demonstraram que a fisioterapia contribui para a recuperação da mulher após submeterem-se à cirurgia, prevenindo e diminuindo o risco de complicações no PO de câncer de mama. A revisão bibliográfica evidenciou a importância da atuação fisioterapêutica, visando o tratamento integral e cuidados da paciente no PO de câncer de mama.(AU)

The breast cancer is the most common neoplasia between the Brazilian women, and the conservative surgery is considered the standard treatment. Post-operative dysfunctions can cause harm to familiar and social relationship, which can interfere in the women quality of life. The physical therapy aims to reduce the negative impact caused by the disease. Therefore, the present study is a systematic review about physical therapy performance on post operative breast cancer and verifies which physical therapy tools are used. This is a literature review which used scientific articles published in Portuguese in the last 10 years on the main electronic databases: Scielo, Lilacs, Medline, Bireme, National Institute of Cancer and Health Ministry. The results demonstrated that the physical therapy contributes to the women recovery after surgery, preventing and reducing the risk of complications in the post operative of breast cancer. The review evidenced the importance of the techniques used by Physical Therapists, aiming the integral treatment and cares to patients in post-operative of breast cancer.(AU)

Correlation between the Expression of Topo I la and Ki67 in Breast Cancer and its clinical Pathological characteristics

Objective: To investigate the expression of Topo Ha and Ki67 and its clinical significance

Methods: The clinical pathological data of one hundred and sixteen invasive breast cancer patients who were admitted into our hospital from July 2013 to December 2015 and underwent radical mastectomy were retrospectively analyzed. The expression of topoispmerase [Topo] lla and Ki67 was detected using immunohistochemical method, and the correlation between the two kinds of proteins and the general clinical pathological characteristics of the patients was analyzed

Results: The positive expression rates of Topo Ha and Ki67 in breast cancer were 58.6% and 75% respectively

The expression of Topo lla was in no apparent correlation with the age, tumor size, estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor 2 [HER-2] [P>0.05], but in a correlation with the number of metastatic lymph glands [P<0.05]. The expression of Ki67 was in no apparent correlation with the age, tumor size, EP and HER-2, but in a correlation with the number of metastatic lymph glands and PR [P<0.05]. The multi-factor logistic regression analysis results suggested that the number of metastatic lymph glands was the independent predictive factor of Topo lla positive expression and the number of metastatic lymph glands and PR protein expression state are the independent predictive factors of Ki67 positive expression

Conclusion: Topo lla and Ki67 can be regarded as the indicators for reflecting the proliferation activity of tumor cells, and the detection of Topo lla and Ki67 expression is of great significance to the prognosis evaluation of breast cancer patients and clinical treatment

Carcinoma metaplásico escamoso primario de mama: un subtipo infrecuente. A propósito de tres casos en el Hospital Universitario del Caribe / Primary breast squamous metaplastic squamous cell carcinoma of the breast: a rare subtype. Presentation of three cases in the Hospital Universitario del Caribe

De todas las neoplasias malignas de mama los carcinomas ductales son los más frecuentes. Menos del 5% son denaturaleza metaplásica y 0,04%-0,1% presentan diferenciación de células escamosas, subtipo que se considera más agresivo. Debido a los pocos casos en la literatura,no hay consenso sobre su diagnósticoy tratamiento. Presentamos tres casos con ese diagnóstico vistos entre 2014 y 2015 en nuestra institución y que corresponden a mujeres de 57, 49 y 65 años sin factores de riesgo y que presentaron cuadros clínicos similares consistentes con aparición de masa de crecimiento rápido. Dos de las pacientes se habían diagnosticado previamente con carcinoma ductal infiltrante de tipo no especial en biopsias por tru-cut con diagnóstico definitivo en la mastectomía radical que reportó en todos los casos carcinoma metaplásico escamoso confirmado por inmunohistoquímica.

Ductal carcinomas are the most common of all breast malignancies, less than 5% are of metaplastic nature, and 0.04% to 0.1% have squamous cell differentiation. These special subtypes are considered more aggressive. Due to the few cases in the literature, there is no consensus about its diagnosis and treatment. Three cases are presented with this diagnosis, seen in our institution between 2014 and 2015. They were women of 57, 49, and 65 years old with no risk factors, and who presented with similar clinical features, consisting of the appearance of a rapid growing mass. Two of the patients had been previously diagnosed with infiltrating ductal carcinoma of no special type by core needle biopsy, with a definitive diagnosis in radical mastectomy, which reported squamous metaplastic carcinoma confirmed by immunohistochemistry.

Sarcoma pleomórfico gigante de la mama / Giant pleomorphic breast sarcoma

Abstract It is reported the case of a female patient 50 years old who, after failed attempts at diagnosis, arrives at breast surgery service of the E.S.E. Hospital Universitario del Caribe with history of five months consistent inthe excessive growth of a mass in right breast; patient received radical mastectomy plus reconstruction withlatissimus dorsi muscle flap. Following excision of tumor mass of 6,500 g is performed immunohistochemicaldiagnosis of a giant pleomorphic sarcoma.

Resumen introducción: Los tumores derivados del tejido conectivo interlobulillar de la mama son en mayor proporción malignos y, en virtud a su ubicación, en la actualidad reciben el nombre de "sarcomas" de la mama. Caso clínico: Se reporta el caso de una paciente femenina de 50 años de edad quien, posterior a fallidosintentos de diagnóstico, acude al servicio de cirugía de mama de la E.S.E. Hospital Universitario del Caribecon un cuadro de cinco meses de evolución consistente en el crecimiento desmedido de una masa en mamaderecha; la paciente recibió mastectomía radical más reconstrucción con colgajo de músculo dorsal ancho.Posterior a exéresis de masa tumoral de 6.500 g de peso se lleva a cabo diagnóstico inmunohistoquímico deun sarcoma pleomórfico gigante de la mama.

Cuidado de enfermería en paciente postoperada de mastectomía: estudio de caso / Nursing care in postoperative mastectomy patient: a case study

Introducción: El cáncer de mama es una de las neoplasias más frecuentes en mujeres a nivel mundial y causan más muertes cada año. El diagnóstico oportuno es muy importante ya que es de relevancia en la elección y eficacia del tratamiento, teniendo mayor éxito cuando se detecta temprano. La mejor estrategia para la detección temprana es a través de la prevención primaria mediante información, orientación y educación a la población femenina acerca de los factores de riesgo y la promoción de conductas favorables a la salud. El objetivo del estudio fue identificar dominios y clases afectadas en paciente postoperada de mastectomía. Materiales y Métodos: Estudio de caso en paciente femenina de 47 años de edad diagnosticada con cáncer de mama izquierda, realizándole mastectomía radical izquierda en una institución de salud del sector privado de Tampico, Tamaulipas, México. Se aplicó el proceso enfermero, realizando la valoración de enfermería con la Taxonomía II de Diagnósticos de enfermería, se describen los dominios y clases afectadas en el periodo posoperatorio, implementándose el plan de cuidados de enfermería con las interrelaciones diagnósticos, intervenciones y resultados. Resultados: La paciente evolucionó favorablemente, egresando al tercer día de la intervención quirúrgica, se proporcionó educación para sus cuidados en el domicilio. Discusión y Conclusiones: Al finalizar la investigación del caso, se observó la importancia de llevar a cabo el plan de cuidados de enfermería con las respectivas interrelaciones para brindar atención de calidad.

Introduction: Breast cancer is one of the most common cancers in women worldwide and causes more deaths each year. Early diagnosis is very important because it is relevant in the choice and treatment efficacy, with greater success when caught early. The best strategy for early detection is through primary prevention through information, guidance and education to the female population about risk factors and promoting positive health behaviors. The aim of the study was to identify domains and affected classes in a postoperative mastectomy patient. Materials and Methods: A case study in female patients of 47 years of age diagnosed with left breast cancer, performing left radical mastectomy in a private health institution in Tampico, Tamaulipas, Mexico. The nursing process was applied, making the nursing assessment with Taxonomy II Nursing Diagnoses, domains and affected classes in the postoperative period are described, implementing the nursing care plan with interrelationships, diagnoses, interventions and outcomes. Results: The patient improved, egressing the third day after surgery, education was provided for care at home. Discussion and Conclusions: After investigating the case, the importance of carrying out the plan of nursing care with the respective relationships to provide quality care was observed.

Repair of cervical postradiation ulcer following radical mastectomy with lower trapezius myocutaneous flap / 中华烧伤杂志

<p><b>OBJECTIVE</b>To explore the clinical effects of ipsilateral lower trapezius myocutaneous flap for repairing cervical ulcer as a result of radiotherapy after radical mastectomy.</p><p><b>METHODS</b>Six patients with cervical ulcers as a result of radiotherapy after radical mastectomy were hospitalized from March 2010 to February 2015, suffering from persistent pain in different degrees. The wound area ranged from 6 cm × 4 cm to 10 cm × 6 cm before debridement, 8 cm × 5 cm to 16 cm × 10 cm after debridement. Ipsilateral lower trapezius myocutaneous flap was used to repair the wound after thorough debridement, with the area ranging from 10 cm × 7 cm to 20 cm × 13 cm. The donor sites were sutured directly or covered with medium-thickness skin graft obtained from the back.</p><p><b>RESULTS</b>Pain was obviously relieved in all the patients 2 days after surgery. The wounds in five patients were healed, while necrosis of superficial skin approximately 1 cm in diameter appeared at the distal end of one myocutaneous flap, and it healed after dressing change. During the follow-up period of 3 to 18 months, no recurrence of ulcer was found, the texture of the myocutaneous flaps was soft with good appearance, and the donor sites healed well.</p><p><b>CONCLUSIONS</b>On the basis of thorough debridement, it is feasible to repair the cervical ulcer as a result of radiotherapy after radical mastectomy with the ipsilateral lower trapezius myocutaneous flap.</p>

Lymph node metastasis and prognostic analysis of 354 cases of T1 breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To analyze the characteristics of lymph node metastasis and prognosis in patients with T1 breast cancer.</p><p><b>METHODS</b>The clinicopathological data of 354 patients with T1 breast cancer after standard treatment from March 2007 to September 2011 were collected to analyze the relationship between the clinical characteristics of T1 breast cancer, lymph node metastasis and prognostic features.</p><p><b>RESULTS</b>In the 354 patients with T1 breast cancer, 105 patients (29.7%) had lymph node metastasis, among them 73 cases (69.5%) had 1-3 lymph node metastasis, and 32 cases (30.5%) had more than 4 lymph node metastasis. The lymph node metastasis rate was 8.3% in T1a patients, 39.7% in T1b patients, and 30.4% in T1c cases (P = 0.005). Pairwise comparison showed that the difference of lymph node metastasis rate between T1a, T1b and T1c patients was statistically significant (P = 0.001 and P = 0.006, respectively). The difference of lymph node metastasis rates in T1b and T1c patients was statistically insignificant (P = 0.171). In the 354 patients of T1 breast cancer, 92 patients had vascular tumor thrombi and their lymph node metastasis rate was 71.7%, while the lymph node metastasis rate in 262 patients without vascular tumor thrombus was 14.9% (P < 0.001). The median follow-up was 49 months (range 27-81 months). 12 patients developed recurrence, and 3 patients died, one of them died of cerebrovascular accident. The 4-year disease-free survival for all patients was 96.6%, and the 4-year overall survival rate was 99.2%.</p><p><b>CONCLUSIONS</b>There is a correlation between vascular tumor thrombus, tumor size and lymph node metastasis rate. The lymph node metastasis rate is lower in T1a patients and relatively higher in T1b/c patients. Compared with patients without vascular tumor thrombus, the T1 breast cancer patients with vascular tumor thrombi have a higher lymph node metastasis rate. Generally speaking, there is a still good prognosis in patients with T1 breast cancer.</p>

Preventive effect of low-dose carvedilol combined with candesartan on the cardiotoxicity of anthracycline drugs in the adjuvant chemotherapy of breast cancer / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the effect of low-dose carvedilol combined with candesartan in the prevention of acute and chronic cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.</p><p><b>METHODS</b>Forty patients were randomly divided into two groups: the experimental group with chemotherapy plus low-dose carvedilol combined with candesartan (20 cases) and control group with chemotherapy alone (20 cases). The same chemotherapy was given to the two groups. All the 40 patients had no contraindication for carvedilol and candesartan. Patients of the experimental group received low-dose carvedilol from 2.5 mg orally twice a day at first cycle to 5 mg twice a day gradually if no side reactions, and candesartan 2.5 mg orally once a day. Electrocardiogram, ultrasonic cardiogram, arrhythmia, troponin and non-hematologic toxicity were recorded and compared after the second, forth and sixth cycle of chemotherapy. Each cycle included 21 days.</p><p><b>RESULTS</b>LVEF was decreased along with the prolongation of chemotherapy in the experimental group and control group. LVEDD and LVESD showed no significant changes in the experimental group, but gradually increased in the control group. After four and six cycles of chemotherapy, LVEF were (57.00 ± 5.13)% and (45.95 ± 3.68)%, respectively, in the control group, significantly lower than that of (67.00 ± 5.13)% and (57.50 ± 2.57)%, respectively, in the experimental group (P < 0.05). After six cycles of chemotherapy, LVEDD and LVESD were (50.00 ± 10.48) mm and (35.01 ± 2.99) mm, respectively, in the control group, significantly higher than those before chemotherapy (P < 0.05) and experimental group (P < 0.001). The rate of ST segment and T wave abnormalities was 80.0% in the control group after six cycles of chemotherapy, significantly higher than that of 25.0% after four cycles of chemotherapy (P = 0.001) and 10.0% after two cycles of chemotherapy (P < 0.001). The reduction of QRS voltage, arrhythmia and abnormal troponin were 55.0%, 45.0% and 45.0%, respectively, in the control group, significantly higher than those in the experimental group (20.0%, P < 0.05), (10.0%, P = 0.010) and (10.0%, P < 0.05), respectively. The rate of abnormal expression of troponin was 45.0% in the control group, significantly higher than the 10.0% in the experimental group (P < 0.05).</p><p><b>CONCLUSIONS</b>The use of low-dose carvedilol combined with candesartan can reduce the acute and chronic cardiotoxicity of anthracycline drugs, and with tolerable toxicities. This may provide a new approach to prevent cardiotoxicity of anthracycline drugs in adjuvant chemotherapy of breast cancer.</p>

Clinical characteristics and survival analysis of 22 cases of pure epithelial breast metaplastic carcinoma / 中华肿瘤杂志

<p><b>OBJECTIVE</b>Pure epithelial breast metaplastic carcinoma is a rare and highly malignant tumor. In this study, our purpose was to analyze the clinical features, treatment method and prognostic factors, so to explore the approach for early diagnosis and appropriate treatment of this cancer.</p><p><b>METHODS</b>Clinical data of 22 patients with histopathologically confirmed pure epithelial breast metaplastic carcinoma and treated at Tianjin Cancer Hospital from 1974 to 2008, were reviewed retrospectively. Survival rate was calculated by life tables. Kaplan-Meier unvariate analysis and Log-rank test were used to compare the survival rates. Multivariate factors for survival were analyzed by Cox proportional hazards regression model.</p><p><b>RESULTS</b>The median age of the 22 cases of pure epithelial breast metaplastic carcinoma was 52.5 years. Among them 20 cases went to see a doctor for painless mass, and two cases shown as skin inflammation. Clarifying a diagnosis was difficult before operation so that its diagnosis mainly depended on postoperative histopathologic examination. Twelve cases had axillary lymph node metastasis, 7 cases distant metastasis, and the lung was the most common metastatic organ. The 5-year survival rate was 55.6%, with a median follow-up of 46 months. It was found by Kaplan-Meier unvariate analysis that the age (P = 0.044), number of positive axillary lymph nodes (P = 0.011) and therapeutic schedule (P = 0,003) significantly influenced the outcome of the patients, but tumor size (P = 0.194) was not. Cox multivariate analysis results showed that number of positive axillary lymph nodes was independent prognostic factor for pure epithelial breast metaplastic carcinoma (P = 0.038).</p><p><b>CONCLUSIONS</b>Pure epithelial breast metaplastic carcinoma is seldom seen. It is easy to cause distant metastasis and has a poor prognosis. ER, PR and HER-2 expressions in most samples are negative. The more axillary lymph nodes have metastasis, the poorer is the prognosis. A reasonable and comprehensive treatment can improve the prognosis obviously.</p>

The Metastatic Rate of Internal Mammary Lymph Nodes When Metastasis of Internal Mammary Lymph Node Is Suspected on PET/CT / 한국유방암학회지

PURPOSE: Metastatic status of internal mammary lymph node (IMLN) has a clinical importance in assessing the stage and prognosis of breast cancer. But, when metastasis of IMLN is suspected; the management is controversial. We retrospectively reviewed 36 breast cancer patients who underwent IMLN biopsy, and investigated the pathologic status of IMLN which suspected metastasis with positron emission tomography and computed tomography (PET/CT). METHODS: From January 2007 to December 2012, 36 patients underwent IMLN biopsy for suspected IMLN metastasis on PET/CT, when diagnosed with primary or recurrent breast cancer. Clinicopathologic features of these patients and metastatic status of IMLNs were investigated. RESULTS: A total of 36 patients were included in this study. Twenty-four patients diagnosed with primary breast cancer and 12 patients diagnosed with recurrent breast cancer underwent IMLN biopsy. The mean number of IMLNs was 2.72+/-2.05, and the total metastatic rate of IMLNs was 72.2% (26 out of 36). IMLN metastasis was confirmed on pathologic examination in 19 patients (79.2%, 19 out of 24) with primary breast cancer and in 7 patients (58.3%, 7 out of 12) with recurrent breast cancer. The mean standardized uptake values of metastatic and nonmetastatic IMLNs in primary breast cancer were 3.50+/-2.51 and 3.72+/-3.55, respectively and those of metastatic and nonmetastatic IMLN in recurrent breast cancer were 3.92+/-2.67 and 4.12+/-3.57, respectively. In both groups, there was no statistically significant difference between the SUVs of metastatic and nonmetastatic IMLNs (p=0.291 and p=0.951, respectively). CONCLUSION: Due to the recent advances in diagnostic and surgical skills, IMLN biopsy can be performed safely without any complications without performing radical mastectomy. If IMLN metastasis is suspected on PET/CT, IMLN biopsy is useful to assess the exact stage and to determine the treatment for breast cancer. Further follow-up studies are needed to assess the locoregional recurrence and to compare the improvement in overall survival and disease-free survival.

Histopathological Study of Neoplastic Lesions of Breast.

Aims and Objectives: 1) To study the incidence of various neoplastic lesions of breast. 2) To study the histopathological features of neoplasms and classify them according to WHO classification (2003). 3) To compare the results of study with those of other studies. Materials and Methods: The present study was prospective as well as retrospective which include 252 cases from October 2005 to October 2010. The specimens were received in different forms such as excisional biopsies, modified radical mastectomies, simple mastectomies, tru-cut biopsies, wide local excision and quadrantectomy specimens. Detail gross examination was done for each specimen and histopathological features were studied to classify neoplasms according to WHO classification 2003. Results: Out of total 9086 biopsies, breast biopsies were 366 (4%) during this 5 year study. Total 252 breast neoplasms were studied, where, the incidence of benign neoplasms was 50.4% (127 cases) & for malignant neoplasms was 49.6% (125 cases). Among all types of specimen received, excision biopsy was most common (48%). Upper outer quadrant was most commonly involved region for breast neoplasms. Fibroadenoma, benign phyllodes neoplasm, tubular adenoma, central papilloma, peripheral papilloma, lipoma and neurofibroma were seen among benign neoplasms. While invasive ductal carcinoma not otherwise specified, mixed carcinoma, metaplastic carcinoma, mucinous carcinoma, malignant phyllodes neoplasm, invasive lobular carcinoma, invasive papillary carcinoma, medullary carcinoma, intracystic papillary carcinoma, malignant peripheral nerve sheath neoplasm and collision neoplasm were studied among malignant neoplasms. The most common benign neoplasm was fibroadenoma (87%) and invasive ductal carcinoma not otherwise specified (88%) was malignant neoplasm. Conclusions: Fibroadenoma was the most common (87%) benign breast neoplasm. Among all malignant breast neoplasms, invasive ductal carcinoma, not otherwise specified was most common (88%). In cases of benign neoplasms, the highest incidence was found in the age group of 10-20 years (37%) while in the malignant neoplasms, it was 40 - 60 years (51.2%). The incidence of malignant breast neoplasm in male was 2.4%.

10-year changes and development of surgical treatment for breast cancer in China / 中华肿瘤杂志

<p><b>OBJECTIVE</b>To investigate the changes and development of surgical treatment for breast cancer from 1999 to 2008 in China, and compare the differences between the surgical methods used in high-resource and low-resource areas.</p><p><b>METHODS</b>Clinicopathological data of surgical treatment for female primary breast cancer was collected via medical chart review at hospitals in seven geographic areas in China. Chi-square test and chisqure test for linear trends were used to analyze the changes and development of the surgical methods used for breast cancer in the 10 years.</p><p><b>RESULTS</b>A total of 4211 primary breast cancer patients were selected from the 10-year database, including 4078 women (97.5%) treated by surgical operation. Among 3271 women (80.21%) treated with modified radical mastectomy, the surgical rate was rising from 68.89% in 1999 to 80.17% in 2008, ascending by 11.28% (χ(2) = 31.143, P < 0.001). In high-resource areas, the surgical rate of modified radical mastectomy was rising from 45.64% in 1999 to 76.13% in 2008, ascending by 30.49% (χ(2) = 89.393, P < 0.001), while in low-resource areas it kept a steady rate at 80% in the ten years (χ(2) = 2.113,P = 0.146). Among 231 women (5.66%) treated with breast-conserving surgery, the surgical rate was rising from 1.29% in 1999 to 11.57% in 2008, ascending by 10.28% (χ(2) = 102.835, P < 0.001). In high-resource areas, the surgical rate of breast-conserving surgery was rising from 2.68% in 1999 to 16.87% in 2008, ascending by 14.19% (χ(2) = 69.544, P < 0.001), while in low-resource areas it was rising from 0.42% in 1999 to 6.22% in 2008, ascending by 5.80% (χ(2) = 30.003, P < 0.001). Among 469 women (11.50%) treated with Halsted radical mastectomy, the surgical rate was declining from 28.28% in 1999 to 4.96% in 2008, descending by 23.32% (χ(2) = 206.202, P < 0.001). In high-resource areas, the surgical rate of Halsted radical mastectomy was declining from 50.34% in 1999 to 3.29% in 2008, descending by 47.05% (χ(2) = 274.830, P < 0.001), while in low-resource areas it was declining from 14.58% in 1999 to 6.64% in 2008, descending by 7.94% (χ(2) = 8.166, P = 0.004). Among 3786 women treated with breast mastectomy (including modified radical mastectomy and Halsted radical mastectomy), the surgical rate was declining from 98.46% in 1999 to 86.36% in 2008, descending by 12.10% (χ(2) = 95.744, P < 0.001). In high-resource areas, the surgical rate of breast mastectomy was declining from 96.64% in 1999 to 80.66% in 2008, descending by 15.98% (χ(2) = 53.446, P < 0.001), while in low-resource areas it was declining from 99.58% in 1999 to 92.12% in 2008, descending by 7.46% (χ(2) = 36.758,P < 0.001).</p><p><b>CONCLUSIONS</b>The main primary surgical treatment for breast cancer is modified radical mastectomy during the period 1999 - 2008. Halsted radical mastectomy is gradually replaced by modified radical mastectomy and breast-conserving surgery. The rate of changes for breast-conserving surgery and mastectomy is higher in high-resource areas than that in low-resource areas. Breast-conserving surgery will become the main treatment for early-stage breast cancer.</p>

A prática da reconstrução mamária no universo psicoafetivo da mulher mastectomizada / The practice of breast reconstruction in the psychic and emotional universe of woman submited to mastectomies

Objetivo: conhecer e analisar o significado da reconstrução mamária em mulheres portadoras de câncer submetidas à mastectomia radical ou sua perspectiva, por meio de informações por elas aportadas, sentimentos, adesão e sentidos relacionados a sua prática, com vistas a subsidiar a abordagem desse tratamento no campo da saúde pública brasileira. Métodos: para isso, foi realizado um estudo exploratório de natureza qualitativa, utilizando-se entrevistas com um grupo de 20 mulheres a respeito da reconstrução mamária. Resultados e discussão: verificou-se a influência positiva do procedimento sobre a qualidade de vida e bem-estar, quando incluído na terapêutica médica. Como fator negativo, registrou-se a falta de informação por parte das mulheres a respeito da possibilidade cirúrgica da reconstrução mamária como parte importante do tratamento.