Postoperative surgical margin results of the phyllodes tumors from a tertiary hospital

SUMMARY OBJECTIVE: Phyllodes tumors in the breast are exceptionally uncommon fibroepithelial tumors. In the literature, they are typically categorized as benign phyllodes tumor, borderline phyllodes tumor, and malignant phyllodes tumor. This study aims to assess and present the clinical and surgical outcomes of patients diagnosed with phyllodes tumor. METHODS: The outcomes of patients aged 18 years and above diagnosed with phyllodes tumor between 2006 and 2023 were retrospectively reviewed. Patients were grouped as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared by clinical and surgical results. RESULTS: Of all 57 patients with phyllodes tumor, 64.9% (n=37) were benign phyllodes tumor and 35.1% (n=20) were borderline/malignant phyllodes tumor [22.8% (n=13) borderline phyllodes tumor and 12.3% (n=7) malignant phyllodes tumor]. When the patients were divided into two groups as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared, our cumulative (total) recurrence rate was 14.0%, with final surgical margin width between groups [(0<final surgical margin<2 mm vs final surgical margin≥2 mm) (p=0.154)] and recurrence [(8.1% benign phyllodes tumor vs 25.0% borderline/malignant phyllodes tumor) (p=0.080)]; there was no significant difference between our rates. CONCLUSION: Phyllodes tumors of the breast can be followed up with a narrow negative surgical margin (0 mm<final surgical margin<2 mm). However, after the initial surgery, re-excision is recommended for positive margins, while a wider surgical margin (≥10 mm) is not necessary for excision.

Outcomes in breast reconstruction using the BREAST-Q questionnaire at a third level hospital center in Mexico City

Background: Breast reconstruction can have a significant impact on the physical, emotional and psychological well-being of patients undergoing mastectomy. The type and timing of breast reconstruction influence the satisfaction index of reconstructed patients. Methods: A retrospective examination was carried out on patient records from 2016 to 2024 at general hospital of Mexico. The analysis encompassed 210 patients who underwent breast reconstruction during this frame time. The BREAST-Q questionnaire was administered in March 2024 and at various intervals during each patient磗 post-operative care. Patients were stratified according to multiple variables such as: oncological therapy, timing of reconstruction, type of reconstruction and educational attainment. Results: The average age of the participants was 50.3 years. In terms of reconstruction timing, 25.24% underwent immediate reconstruction, while 74.76% opted for delayed reconstruction. When it came to BMI, the average was 26.99 kg/m�. Regarding the type of flap used for reconstruction, the majority (82.86%) had a latissimus dorsi flap. The overall demonstrated a mean psychosocial well-being scale score of 76�6. Conclusions: Breast reconstruction goes beyond physical restoration; it can profoundly impact a patient's emotional recovery, self-image, and quality of life. By addressing not only the physical changes but also the emotional and psychological aspects of breast cancer treatment, reconstruction plays a vital role in helping patients move forward with confidence, resilience, and a sense of empowerment. Regardless of when we first contact the patient, it is always worthwhile to provide her with information and the option of reconstruction.

Neumatosis intestinal y neumoperitoneo: no siempre una indicación quirúrgica / Intestinal pneumatosis and pneumoperitonum: not al ways a surgical indication

Resumen La neumatosis intestinal y el neumoperitoneo no son entidades patológicas en sí mismas, son signos radio lógicos que resultan de alguna condición subyacente. En general, estos se asocian con procesos graves intra-abdominales que resultan en cirugías de urgencias con resecciones de intestino. A continuación, presentamos el caso de una mujer de 80 años, con diagnóstico de cáncer de mama estadio IV en tratamiento con ful vestrant y ribociclib, que ingresó a nuestro centro por dolor abdominal y vómitos. Se diagnosticó neumatosis intestinal y neumoperitoneo por lo que se procedió a laparotomía exploradora por sospecha de isquemia intestinal. No hubo evidencia de necrosis o perforación intestinal por lo que no se realizó resección. Evolucionó durante la internación de forma satisfactoria y en el control tomográfico al mes del egreso hubo resolución completa del cuadro. Si bien está descrito esta afectación en relación a los episodios de aumento de presión intraabdominal, como en la emesis, también se describió en pacientes con neoplasias, principalmente del tubo digestivo, ya sea por daño local o por toxicidad asociada a la quimioterapia. No encontramos reportes en la literatura de neumatosis intestinal vinculada a esta medicación antineoplásica en humanos. Probablemente en nuestro caso la etiolo gía haya sido multifactorial. Es posible que el ribociclib haya jugado un rol, ya sea por un mecanismo indirecto asociado a los vómitos y la inmunosupresión o directo sobre el enterocito debido a su mecanismo de acción celular no específico.

Abstract Pneumatosis intestinalis and pneumoperitoneum are not pathological entities in themselves, they are radiological signs that result from some underlying condition. In general, these are associated with serious intra-abdominal processes that result in emergency surgeries with bowel resections. Below, we present the case of an 80-year-old woman, diagnosed with stage IV breast cancer under treatment with fulvestrant and ribociclib, who was admitted to our center due to abdominal pain and vomiting. She was diagnosed with intestinal pneumatosis and pneumoperitoneum, so she underwent exploratory laparotomy for sus pected intestinal ischemia. There was no evidence of intestinal necrosis or perforation, so resection was not performed. She progressed satisfactorily during hospitalization and in the tomographic control one month after discharge there was complete resolution of the condition. Although this condition has been described in relation to episodes of increased intra-abdominal pressure, such as emesis, it has also been described in patients with neoplasms, mainly of the digestive tract, either due to lo cal damage or toxicity associated with chemotherapy. We found no reports in the literature of pneumatosis intesti nalis linked to this antineoplastic medication in humans. Probably in our case the etiology was multifactorial. It is possible that ribociclib played a role, either through an indirect mechanism associated with vomiting and im munosuppression or directly on the enterocyte due to its non-specific cellular mechanism of action.

Metastasis of breast cancer to the thyroid gland / Metástasis de cáncer de mama en glándula tiroides

Abstract Metastases to the thyroid gland from nonthyroidal malignant tumors are rare but significant. They are often asymptomatic, indicating advanced-stage primary tumors and poor prognosis. Although infrequently, breast cancer (BC) can metastasize to the thyroid gland. We present the case of a 56-year-old woman with a history of BC who pre sented with a nodular goiter. Physical examination and im aging revealed a thyroid nodule and cervical lymph nodes with suspicious features. Fine-needle aspiration biopsy (FNAB) confirmed the presence of atypical epithelial cells in the thyroid nodule and lymph nodes. Further evaluation, including positron emission tomography, histological biop sy, and immunohistochemistry, supported the diagnosis of metastatic BC to the thyroid gland. Due to the local extent of the disease, total thyroidectomy was not feasible. The treatment with ribociclib and letrozole was initiated, but unfortunately, the patient had an unfavorable progression with the development of metastasis in the nervous system. Metastatic carcinoma to the thyroid gland is rare but has increased due to improved diagnostic techniques. BC can metastasize to the thyroid. Diagnosis involves imaging, FNAB, and immunohistochemistry. Treatment options include surgery, radiotherapy, and chemotherapy, but the prognosis is generally poor.

Resumen Las metástasis en la glándula tiroides a partir de tu mores malignos no tiroideos son raras pero significativas. A menudo son asintomáticas, lo que indica tumores primarios en etapas avanzadas y un mal pronóstico. Aunque infrecuentemente, el cáncer de mama puede metastatizar en la glándula tiroides. Presentamos el caso de una mujer de 56 años con antecedente de cáncer de mama que consultó por bocio nodular. El examen físico y las imágenes revelaron un nódulo tiroideo y ganglios linfáticos cervicales con características sospechosas. La punción aspiración con aguja fina confirmó la presencia de células epiteliales atípicas en el nódulo tiroideo y los ganglios linfáticos. Una evaluación adicional, que incluyó tomografía por emisión de positrones, biopsia histológica e inmunohistoquímica, respaldó el diagnóstico de cáncer de mama metastásico en la glándula tiroides. Debido a la extensión local de la enfermedad, no fue factible realizar una tiroidectomía total. Se inició el tratamiento con ri bociclib y letrozol, pero desafortunadamente la paciente tuvo una progresión desfavorable con el desarrollo de metástasis en el sistema nervioso. El carcinoma metas tásico en la glándula tiroides es raro, pero ha aumentado debido a las técnicas de diagnóstico mejoradas. El cáncer de mama puede metastatizar en la tiroides. El diagnóstico implica imágenes, punción aspiración con aguja fina e in munohistoquímica. Las opciones de tratamiento incluyen cirugía, radioterapia y quimioterapia, pero el pronóstico generalmente es desfavorable.

Knowledge, attitude and practice of women towards self breast examination in the rural field practice area of IGGMC, Nagpur, Maharashtra

Background: Breast cancer is the most common cancer among females. In India, breast cancer is the top most cancer with about 13.6% new cases diagnosed in 2020. Current knowledge of the aetiology of breast cancer offers little prospect of primary prevention. So secondary prevention like breast screening, which include self breast examination have to be done. The present study was designed to determine the knowledge, attitude and practice regarding BSE among women aged 18 years and above. Methods: A cross sectional study was conducted on 241 females above 18 years of age in rural health care training centre affiliated to IGGMC, Nagpur. All consecutive participants were interviewed in person using a predesigned and pre-tested proforma. SPSS Version 20 was used to analyse the data collected. Results: It was seen that the mean age of participants was 29.98±7.382 years The majority of participants were belonged to the Hindu religion (63.9%) and nuclear family (82.57%). Majority of participants (68.05%) were having poor knowledge about BSE, most of the participants were having good attitude (51.45%), majority of participants (53.11%) were having poor practice to BSE. Conclusions: BSE is one of the most effective preventive health behaviour for the early detection of breast cancer. In this study, it is evident that knowledge about BSE is low. This indicate that there is a need for Health education about breast cancer and BSE among the rural population of India to improve the KAP about BSE for early detection and better survival.

Disability evaluation after latissimus dorsi muscle transfer in breast reconstruction using DASH score

Background: Breast reconstruction with latissimus dorsi muscle transfer is one of the most frequent procedures at our hospital. The objective is to evaluate if there is any functional impairment after the surgery with a potential impact of patient磗 daily life. Methods: Functional morbidity was analyzed applying the disabilities of the arm, shoulder and hand (DASH) questionnaire and shoulder range of motion with goniometer in 42 patients whose breast reconstruction was between 2016 and 2022 at our hospital. We collected data using Microsoft excel V16.47.1 and analyzed data with statistical package for the social sciences (SPSS) software, v23.0. Results: There was statistically significant difference for disability/symptom DASH score in cases of bilateral reconstruction and for cases undergoing a procedure on the right side versus left side. Conclusions: In patients with bilateral breast reconstruction, we found a greater DASH score in dysfunction and symptoms which associates with poor quality of life, as well as when the flap is on the contralateral extremity of the hand dominance; in those cases, there are other reconstructive procedures that provide greater safety and less disability to the patient. For evaluating extension, we need more prospective and comparative studies with strict follow up of the patients and same series of rehabilitation.

Comparative study of fine needle aspiration cytology and tru-cut biopsy in the diagnosis of breast lesions

Background: Breast carcinoma is one of the most researched cancers across the world. FNAC is often used as a first priority investigation in patients with breast lump. Tru-cut biopsy is useful in preoperative knowledge of prognostic parameters with the help of IHC markers ER, PR, Her2 neu. The technique is reliable, simple and reproducible which can be used even in resource poor countries like India. To analyze the sensitivity, specificity, positive predictive values and negative predictive values and the diagnostic accuracy (efficacy) of fine needle aspiration cytology and trucut biopsy. Methods: The study included 82 patients presenting with palpable breast lesions. All patients underwent FNAC followed by Tru-cut biopsy under ultrasound guidance. ER, PR, HER2 Neu, cytokeratin immunostaining was done in malignant cases. The data collected analysed statistically. Results: The sensitivity, specificity, PPV, NPV of FNAC were 96.61 %, 95.65 %, 98.28%, 90.91% respectively and that of trucut biopsy were 100%, 100%, 100%, and 100 % respectively. Conclusions: Out of total 82 patients, maximum no of cases (57) were duct carcinoma accounting 69.50% on FNAC and Tru-cut biopsy. IHC was done in all carcinomas. Maximum (46 cases) were luminal type. The present study emphasizes that tru-cut biopsy can serve as confirmative diagnostic tool over FNAC and provides information regarding prognostic factors and treatment modalities based on IHC markers.

The wet nurses of the Hospital Real of Santiago de Compostela between 1803 and 1808 / Las nodrizas del Hospital Real de Santiago de Compostela entre 1803 y 1808 / As amas de leite do Hospital Real de Santiago de Compostela entre 1803 e 1808

Objective. To analyze the duties of wet nurses at the Hospital Real in Santiago de Compostela (Spain). The secondary objectives were to compare the mortality rate and distribution by parish of the foundlings under the care of the Royal House between 1803 and 1808; and to determine the origin of the Galician foundlings who participated in the Royal Philanthropic Expedition of the Smallpox Vaccine in 1803. Methods. Historiographic study that analyzed sorted and not sorted in series indirect positional and quantitative historical sources.Results. The duties of wet nurses during the studied period were to provide basic care and cultural instruction. The mortality rate of foundlings fluctuated during that period and their distribution by parish (functional unit of healthcare services at that time) was similar in those years, with a predominance in the provinces of A Coruña and Pontevedra. A total of 5 Galician foundlings from the House analyzed were part of the smallpox vaccine expedition, their names were Juan Antonio, Jacinto, Gerónimo María, Francisco Florencio and Juan Francisco. Conclusion. During the observed period the wet nurses of the Hospital Real of Santiago de Compostela were in charge of pediatric care. Wet nurses were vital in the role of keeping the foundlings alive and can be considered as one of the forerunners of the pediatric nurse profession at that time.

Objetivo. analizar las funciones que realizaban las amas de leche en el Hospital Real de Santiago de Compostela (España). Los objetivos secundarios han sido: comparar la mortalidad y distribución por parroquias de los niños expósitos a cargo de la Real Casa entre 1803 y 1808, determinar la procedencia de los niños expósitos gallegos que participaron en la Real Expedición Filantrópica de la Vacuna de la viruela en 1803. Métodos. Estudio historiográfico que analizó fuentes históricas posicionales indirectas y cuantitativas seriadas y no seriadas. Resultados. las funciones de las nodrizas durante el período de estudio eran proporcionar los cuidados básicos e instrucción cultural; la mortalidad de los expósitos sufrió oscilaciones a lo largo del período analizado. La distribución por parroquias (unidad funcional de las áreas de salud en la época) fue similar en estos años, con predominancia de las provincias de A Coruña y Pontevedra. Un total de 5 niños expósitos gallegos de la Casa analizada han participado en la expedición filantrópica de la viruela, sus nombres fueron: Juan Antonio, Jacinto, Gerónimo María, Francisco Florencio y Juan Francisco. Conclusión. Durante el período de observación, las amas de leche del Hospital Real de Santiago de Compostela realizaban cuidados pediátricos. Las nodrizas cumplieron un rol fundamental para el mantenimiento con vida de los niños expósitos y pueden ser consideradas como una de las figuras precursoras de la profesión enfermera pediátrica en la época.

Objetivo. Analisar as funções desempenhadas pelas nutrizes no Hospital Real de Santiago de Compostela (Espanha). Os objetivos secundários foram: comparar a mortalidade e distribuição por freguesia dos enjeitados responsáveis pela Casa Real entre 1803 e 1808, determinar a origem dos enjeitados galegos que participaram na Real Expedição Filantrópica da Vacina contra a Varíola em 1803. Métodos. Estudo historiográfico que analisou fontes históricas posicionais indiretas e quantitativas seriadas e não seriadas. Resultados. As funções das amas de leite durante o período do estudo eram fornecer cuidados básicos e instrução cultural; A mortalidade dos enjeitados oscilou ao longo do período analisado. A distribuição por freguesias (unidade funcional das áreas de saúde da época) foi semelhante nestes anos, com predominância das províncias da Corunha e Pontevedra. Na expedição filantrópica contra a varíola participaram um total de 5 crianças galegas da Casa analisada, os seus nomes eram: Juan Antônio, Jacinto, Gerônimo María, Francisco Florencio e Juan Francisco. Conclusão. Durante o período de observação, as nutrizes do Hospital Real de Santiago de Compostela prestaram cuidados pediátricos. As amas de leite desempenharam um papel fundamental na manutenção da vida dos enjeitados e podem ser consideradas uma das figuras precursoras da profissão de enfermagem pediátrica da época.

Repercussions of the COVID-19 pandemic on breast cancer actions in a Brazilian state / Repercusiones de la pandemia de COVID-19 en las acciones contra el cáncer de mama en un estado brasileira / Repercussões a pandemia da COVID-19 nas ações do câncer de mama em um Estado Brasileiro

Objective. To analyze whether the COVID-19 pandemic had an impact on the screening, diagnosis and treatment of breast cancer in women up to 50 years of age in the state of Pará. Methods. Retrospective, cross-sectional study with a quantitative approach, using data from the Information Technology Department of the Brazilian Unified Health System. (DATASUS). The number of exams carried out in the pre-pandemic (2018-2019) and pandemic (2020-2021) period was analyzed based on the percentage variation, application of the chi-square test and G test for the time of exams and start time of treatment. Results. During the pandemic period, there was a greater number of screening mammograms (+3.68%), cytological (+23.68%), histological (+10.7%) and a lower number of diagnostic mammograms (-38.7%). The time interval for carrying out the exams was up to 30 days for screening and diagnostic exams and more than 60 days to start treatment during the pandemic period. Conclusion. Although the results indicate an increase in the number of screening and diagnostic procedures for breast cancer during the pandemic period, with the exception of diagnostic mammography, when considering probability values, the study points out that statistically the COVID-19 pandemic did not interfere with actions of breast cancer, in women over 50 years of age, in the state of Pará. Considering the autonomy of nursing and its role in public health, it is up to the professionals who are in charge of primary care programs to implement contingency plans in periods of crisis so that the population is not left unassisted.

Objetivo. Analizar si la pandemia de COVID-19 tuvo impacto en el tamizaje, diagnóstico y tratamiento del cáncer de mama en mujeres de 50 años y más del Estado do Pará-Brasil. Métodos. Estudio retrospectivo, transversal, con abordaje cuantitativo, en el que se utilizaron los datos del Departamento de Informática del Sistema Único de Salud de Brasil (DATASUS). Se comparó el número de exámenes realizados y el tiempo para el inicio de tratamiento en los períodos prepandémico (2018-2019) y pandémico (2020-2021). Resultados. Se observó un mayor número de mamografías de cribado (+3.68%), citologías (+23.68%) e histologías (+10.7%) y un menor número de mamografías diagnósticas (-38.7%) en el período pandémico. El tiempo para la realización de las pruebas fue de hasta 30 días para el cribado y diagnóstico y de más de 60 días para el inicio del tratamiento durante el período pandémico. Conclusión. Aunque los resultados indican un aumento del número de procedimientos de cribado y diagnóstico del cáncer de mama en el periodo pandémico, con la excepción de la mamografía diagnóstica, cuando consideramos los valores de p) el estudio muestra que la pandemia COVID-19 estadísticamente no interfirió en las acciones preventivas contra el cáncer de mama en mujeres de 50 años y más en el estado de Pará. Teniendo en cuenta la autonomía de la enfermería y su papel en la salud pública, corresponde a los profesionales responsables de los programas de atención primaria implementar planes de contingencia en tiempos de crisis para no dejar desatendida a la población.

Objetivo. Analisar se a pandemia da COVID-19 repercutiu no rastreamento, diagnóstico e tratamento do câncer de mama em mulheres paraenses a partir de 50 anos. Métodos. Estudo retrospectivo, transversal, de abordagem quantitativa, com utilização de dados do Departamento de Informática do Sistema Único de Saúde brasileiro. (DATASUS). Analisou-se o número de exames realizados no período pré-pandemia (2018-2019) e pandêmico (2020-2021) com base na variação percentual, aplicação do teste qui quadrado e teste G para o tempo de realização de exames e tempo de início de tratamento. Resultados. Observou-se no período pandêmico maior quantitativo de mamografias de rastreamento (+3.68%), citológicos (+23.68%), histológicos (+10.7%) e menor registro de mamografias diagnósticas (-38.7%). O intervalo de tempo para realização dos exames foi de até 30 dias para os exames de rastreamento e diagnóstico e tempo maior que 60 dias para início de tratamento no período pandêmico. Conclusão. Embora os resultados indiquem aumento no quantitativo de procedimentos de rastreamento e diagnósticos para o câncer de mama no período pandêmico, com exceção da mamografia diagnóstica, ao considerarmos os valores de probabilidade, o estudo aponta que estatisticamente a pandemia da COVID-19 não interferiu nas ações do câncer de mama, em mulheres a partir de 50 anos, no Estado do Pará. Considerando a autonomia da enfermagem e sua atuação na saúde pública, cabe aos profissionais que estão à frente dos programas da atenção básica implementar planos de contingência em períodos de crise para que a população não fique desassistida.

Exploring human mammaglobin: as a possible diagnostic and prognostic indicator in breast cancer tissue

Breast cancer is a major global health issue, with high diagnosis rates worldwide, especially in less developed areas, leading to significant mortality rates. This review focuses on the molecular characteristics of breast cancer, emphasizing the role of human mammaglobin-A (hMAM-A) as a diagnostic and prognostic marker. hMAM-A, a dimeric protein from the secretoglobin family, is produced exclusively by breast tissue and shows elevated levels in breast cancer cases, making it a highly accurate marker for disease detection. The review also examines various factors influencing breast cancer, such as age, tobacco use, menopausal status, and hormone replacement therapy (HRT). Younger age at diagnosis is associated with poorer outcomes, highlighting the importance of early detection. Tobacco smoke increases mortality rates in breast cancer patients. Menopausal status affects molecular subtypes and risk factors, impacting treatment and prognosis. HRT has a complex relationship with breast cancer risk. The review concludes by discussing the need for novel biomarkers, including hMAM-A, to improve breast cancer diagnosis and management.

Tumor budding in invasive breast carcinoma: an emerging prognostic factor

Background: Tumor budding refers to single or small cluster of tumor cells detached from the main tumor mass in histological sections. In colon cancer high tumor budding is associated with worse prognosis and correlates with metastatic lymph nodes. We studied tumor budding in modified radical mastectomy specimens to evaluate its utility as a prognostic factor by correlating high tumor budding score with known prognostic markers of breast cancer like axillary lymph nodal metastasis, clinical staging, tumor size, lymphovascular invasion, hormonal status and pathological grading. Aim was to evaluate tumor budding in invasive breast carcinoma and to describe clinical features and histopathological spectrum of Invasive Breast Carcinoma with/without lymph node metastasis on H&E slides. Secondly, to find association between grades of tumor budding and various clinical, gross, microscopic and immunohistochemical variables. Methods: The present study is a cross sectional study of 70 modified radical mastectomy specimens from June 2018 to Dec 2022. Along with tumor budding various prognostic parameters like hormonal markers, pathological grading and clinical grading were evaluated. Immunohistochemical marker Pancytokeratin was utilized for counting the tumor buds, wherever necessary. Statistical Analysis: Chi Square test was utilized to study significant differences between variables, p<0.05 was considered statistically significant. Results: A high tumor budding score (?4/HPF) had significant association with axillary lymph node involvement and clinical staging. Conclusions: In our study we detected the association of high tumor budding, PTB in invasive breast carcinoma with axillary lymph node involvement and clinical staging. Hence our results highlight the importance of tumor budding as a prognostic factor and submit that this histological feature could be included in diagnostic protocols just as in carcinoma of the colon.

Breast self-examination: knowledge, awareness, and practices among females of reproductive age group

Background: Breast cancer occurs in an observable organ, thus awareness regarding its symptoms can help in its early detection and treatment. Although breast self-examination (BSE) is an old technique, evidence reveals many of females are not aware regarding this, and those with knowledge about breast cancer examination either fail to practice it or do so incorrectly. Methods: It was a cross-sectional exploratory survey. 505 females attending outpatient department (OPD) at selected tertiary care hospital were recruited in the study using simple random sampling. Each participant was given a set of validated questionnaires to answer. The questionnaire was designed to obtain information regarding socio demographic data, knowledge, awareness, and practice regarding BSE. All data were coded, validated, and analyzed utilizing both descriptive and inferential statistics techniques. Results: The study revealed that the largest proportion (42.06%) of subjects fell within the age range of 20-30 years. Total mean score of knowledge and awareness regarding breast self-examination was 9.68±3.5. Maximum 58.42% of the subjects had average knowledge and awareness followed by 23.96% having good knowledge and awareness and least (17.62%) had poor knowledge and awareness regarding BSE. Almost half i.e., 50.49% (255) of participants reported to perform BSE and 49.51% of participants had never practiced BSE. Conclusions: The study revealed that while participants had average knowledge levels, they showed low involvement in routine BSE. This underscores the need for educational interventions to promote BSE practices, identify risk factors and warning signs, and encourage early-stage management of breast cancer, ultimately contributing to primary prevention in healthcare.

Mammary type adenocarcinoma of the vulva: a rare case report

A primary vulvar mammary type of adenocarcinoma is an exceptionally rare malignancy that is thought to arise from mammary-like vulvar glands. Its low incidence is partly responsible for the lack of guidelines for patient management. We present a case of a 74-year-old woman who presented with a palpable mass in her vulvar region and was submitted to an excisional biopsy, which was diagnosed as mammary-type adenocarcinoma. The patient then underwent a partial vulvectomy with unilateral inguinal sentinel lymph node biopsy followed by adjuvant hormonal therapy. This case report highlights the challenges in diagnosing and managing this rare entity and emphasizes the importance of a multidisciplinary approach to providing optimal care for patients with a mammary type of adenocarcinoma of the vulva.

Postpartum breast complications and breast-feeding practices in a baby-friendly hospital in Bangladesh

Background: Breastfeeding is essential for health of both infants and mothers, but it often encounters challenges such as postpartum breast complications. These issues can adversely affect maternal health and significantly hinder success of breastfeeding practices. Aim of study was to assess postpartum breast complications and breast-feeding practices.Methods: This cross-sectional study was conducted in department of obstetrics and gynaecology, Dhaka medical college hospital, Dhaka, Bangladesh from February 2006 to July 2006. Two hundred patients in the postnatal ward who delivered their babies at DMCH were randomly selected.Result: Among 200 postnatal women, 33.5% experienced breast problems. Women with breast problems were designated as group A and women without breast problems were designated as group B. Most women in groups A and B were aged between 21-30 years with average 24.8 years for both groups. Antenatal check-ups were similar across groups, with breastfeeding advice given to 55.2% in group A and 64.7% in group B pre-lacteal feeds were given to 19.4% of group A and 21.8% of group B neonates, while colostrum was fed to the majority. Most neonates were breastfed within 2 hours. Good breastfeeding position and attachment were observed in most cases. Exclusive breastfeeding was more common in group B (73.7%) than in group A (58.2%). Breast problems in group A included engorgement, lactation insufficiency, and nipple issues.Conclusions: The study reveals that postpartum breast complications, notably breast engorgement and lactation insufficiency, significantly affects the breastfeeding effectiveness of new mothers.

Síndrome de Mondor associada à mamoplastia de aumento: relato de caso / Mondor syndrome associated with breast augmentation: case report

A forma mamária da síndrome de Mondor é uma afecção rara e autolimitada que se caracteriza pela tromboflebite de veias superficiais da mama. Entender tal síndrome é de suma importância para o diagnóstico correto e o tratamento preciso e não iatrogênico, tendo em vista apresentar considerável relação com o carcinoma mamário. Esse relato de caso retrata o surgimento da síndrome de Mondor em uma paciente jovem de 22 anos, após uma mamoplastia de aumento. O sinal característico da afecção, o cordão fibroso, manifestou-se na mama direita a partir do vigésimo terceiro dia de pós-operatório, desaparecendo por completo após 10 semanas. O diagnóstico foi dado pelo cirurgião plástico que acompanhou a paciente mediante anamnese e exame físico, sem a urgência de um exame complementar, como a mamografia. Vale ressaltar que tal afecção rara pode acometer o sexo masculino - em menor frequência - e afetar outras regiões, como o pênis e o escroto. Ademais, é salutar reconhecer e diagnosticar a síndrome de Mondor, visto que as cirurgias com o fitoestético estão em constante crescimento na atualidade, com o escopo de conduzir os pacientes da melhor forma para um tratamento eficaz e menos invasivo (exceto na presença concomitante de câncer de mama, por exemplo), além de tranquilizá-los a respeito da afecção.

The breast form of Mondor syndrome is a rare and self-limited condition characterized by thrombophlebitis of the superficial veins of the breast. Understanding this syndrome is extremely important for correct diagnosis and precise, non-iatrogenic treatment, given that it has a considerable relationship with breast carcinoma. This case report portrays the emergence of Mondor syndrome in a young 22-year-old patient, after breast augmentation. The characteristic sign of the condition, the fibrous cord, appeared in the right breast from the twenty-third day after surgery, disappearing completely after 10 weeks. The diagnosis was given by the plastic surgeon who followed the patient through anamnesis and physical examination, without the urgency of a complementary exam, such as a mammography. It is worth mentioning that this rare condition can affect males - less frequently - and affect other regions, such as the penis and scrotum. Furthermore, it is beneficial to recognize and diagnose Mondor syndrome, as surgeries using phytoaesthetics are constantly growing today, intending to guide patients in the best way possible for an effective and less invasive treatment (except in the concomitant presence of cancer). breast, for example), in addition to reassuring them about the condition.

Linfoma anaplásico de grandes células T associado ao uso de implantes (BIA-ALCL): relato de caso / Implant-associated anaplastic large T-cell lymphoma (BIA-ALCL): case report

Reconhecido pela Organização Mundial de Saúde em 2016, o linfoma anaplásico de grandes células associado ao implante mamário (BIA-ALCL) é um subtipo incomum de linfoma não Hodgkin de células T, que se desenvolve após a inserção de próteses mamárias. A doença é uma afecção rara que afeta cerca de uma a cada 30.000 pessoas com implante mamário texturizado. As principais manifestações clínicas são o seroma tardio, assimetria mamária, massa e contratura capsular, com frequência mais elevada do primeiro. O explante da prótese com capsulectomia total pode ser suficiente para tratar o ALCL, com ressecções estendidas a locais adjacentes, quando necessário. Entretanto, em alguns casos, é realizada a radioterapia e/ou quimioterapia adjuvante. Conclui-se que, para um diagnóstico precoce e um tratamento efetivo, mulheres com seroma de aparecimento súbito e tardio deverão realizar exames complementares para a exclusão dessa afecção, mesmo com tempo inferior à média de desenvolvimento, que é de cerca de 10,6 anos.

Recognized by the World Health Organization in 2016, breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) is an uncommon subtype of T-cell non-Hodgkin lymphoma that develops after the insertion of breast implants. The disease is a rare condition that affects approximately one in every 30,000 people with textured breast implants. The main clinical manifestations are late seroma, breast asymmetry, mass, and capsular contracture, with a higher frequency of the former. Explantation of the prosthesis with total capsulectomy may be sufficient to treat ALCL, with resections extended to adjacent sites when necessary. However, in some cases, adjuvant radiotherapy and/or chemotherapy is performed. It is concluded that, for an early diagnosis and effective treatment, women with sudden and late-onset seroma should undergo additional tests to exclude this condition, even with a shorter development time than the average, which is around 10.6 years.

Representações culturais do câncer de mama: uma revisão de escopo / Breast cancer cultural representations: a scoping review

Resumo O objetivo deste artigo é mapear a produção científica global sobre representações sociais ou culturais e câncer de mama no campo da saúde coletiva e discutir como esse fenômeno se apresenta na literatura. Foi realizada uma revisão de escopo, tendo como norte a seguinte pergunta: "Como representações culturais ou sociais no contexto do câncer de mama são descritas na produção científica global no âmbito da saúde coletiva?". As buscas foram realizadas em cinco fontes de literatura científica, sendo incluídos 45 estudos. O tratamento analítico seguiu a técnica de análise de conteúdo na modalidade temática. O acervo analisado pode ser tematizado nas seguintes categorias: (1) Comprometimento na imagem corporal e nas interações; (2) Espiritualidade; (3) Perda do controle da vida; (4) Seguir com a vida e (5) Associação a questões étnico-raciais. Apesar dos avanços da biomedicina, observa-se que nas representações do câncer de mama ainda permanecem metáforas associadas ao câncer no século passado. Conclui-se que, dentre outros aspectos, a atenção a mulheres com câncer de mama não pode ser pautada apenas pelas abordagens biomédica e epidemiológica, uma vez que essa doença é atravessada por saberes que competem com essas abordagens.

Abstract This article aims to map the global scientific production on social or cultural representations and breast cancer in Public Health and discuss how it is presented in the literature. We conducted a scoping review guided by the question: "How are cultural or social representations in the context of breast cancer described in the global scientific Public Health production?". We searched for works in five scientific literature sources and included 45 studies. The analytical process followed the content analysis technique in the thematic modality. The analyzed collection can be thematized into the following categories: (1) Compromised body image and interactions, (2) Spirituality, (3) Loss of control over life, (4) Going on with life, and (5) Association with ethnic-racial issues. Despite advances in biomedicine, we observed that representations of breast cancer still have metaphors associated with cancer in the last century. We conclude that, among other aspects, care for women with breast cancer cannot be guided only by biomedical and epidemiological approaches since this disease is traversed by knowledge that competes with these approaches.

Reconstrução mamária: Experiência de 10 anos / Breast reconstruction: 10 years experience

Introdução: A reconstrução mamária pós-tratamento cirúrgico do câncer de mama (um dos principais cânceres que acometem as mulheres) tem sido progressivamente mais indicada, haja vista o benefício da recuperação psicológica e da qualidade de vida, seja utilizando implantes e/ou tecidos autólogos. O presente trabalho visa demonstrar a experiência da equipe, discutir técnicas operatórias e complicações em relação aos dados da literatura mundial, além de verificar a aplicabilidade da técnica na prática clínica da equipe. Método: Estudo observacional retrospectivo desenvolvido em hospital universitário em Juiz de Fora a partir da revisão de prontuários de pacientes submetidas a mastectomia com reconstrução mamária entre 2010 e 2020. Resultados: Das 860 mamas abordadas, 84% foram imediatas à cirurgia oncológica e 16% foram tardias; o principal acesso ao tecido mamário foi a incisão de Stewart, seguido de incisões inframamárias estendidas, periareolares e T invertido; quanto às técnicas reconstrutoras, destaca-se 35% dos casos com retalho com músculo grande dorsal, 25% com prótese pré-peitoral, 20% com retalho miocutâneo transverso do músculo reto abdominal e 10% com retalho muscular local. As complicações mais incidentes foram deiscência de sítio cirúrgico, seguida de necrose cutânea, seroma, infecção de sítio cirúrgico e hematoma, além de outros menos comuns como dor crônica e ruptura de prótese após mamografia. Conclusão: A reconstrução mamária pós-mastectomia é indispensável para a recuperação física e emocional da mulher, sendo as técnicas utilizadas nos últimos dez anos consistentes, confiáveis, de baixa morbidade e com ótimos resultados estéticos quando bem indicadas.

Introduction: Breast reconstruction after surgical treatment for breast cancer (one of the main cancers that affect women) has been progressively more recommended, given the benefits of psychological recovery and quality of life, whether using implants and/or autologous tissues. The present work aims to demonstrate the team's experience, and discuss operative techniques and complications concerning data from the world literature, in addition to verifying the applicability of the technique in the team's clinical practice. Method: Retrospective observational study developed at a university hospital in Juiz de Fora based on a review of medical records of patients who underwent mastectomy with breast reconstruction between 2010 and 2020. Results: Of the 860 breasts treated, 84% underwent immediate oncological surgery and 16% were late; the main access to the breast tissue was the Stewart incision, followed by extended inframammary, periareolar, and inverted T incisions; regarding reconstructive techniques, 35% of cases used a latissimus dorsi muscle flap, 25% used a prepectoral prosthesis, 20% used a transverse rectus abdominis myocutaneous flap and 10% used a local muscle flap. The most common complications were surgical site dehiscence, followed by skin necrosis, seroma, surgical site infection, and hematoma, in addition to other less common complications such as chronic pain and prosthesis rupture after mammography. Conclusion: Postmastectomy breast reconstruction is essential for a woman's physical and emotional recovery, with the techniques used in the last ten years being consistent, reliable, with low morbidity, and with excellent aesthetic results when correctly indicated.

Achados incomuns em ressonância magnética de pacientes com implantes mamários / Unusual findings on MRI of patients with breast implants

Introdução: O implante de prótese mamárias é uma das cirurgias mais realizadas no mundo. Ao longo do tempo, diversos materiais foram utilizados com objetivo de reconstituir o volume mamário. Apesar das melhorias técnicas, cirúrgicas e da segurança dos implantes atuais, os pacientes são confrontados com potenciais complicações "não usuais": rupturas intracapsulares e extracapsulares, hematomas tardios e deformidade de contorno, silicone intralinfonodal ou herniação da cápsula fibrosa. A ressonância magnética (RMN) é a modalidade de imagem mais útil para investigação dessas complicações. Método: Trata-se de uma série de casos em que foram levantadas alterações ditas "não usuais", pela baixa frequência ou ausência na citação da literatura, após cirurgias de inclusão de prótese de silicone. Os dados foram coletados da experiência pessoal da clínica privada de um dos autores, na cidade de Brasília-DF, entre abril de 2015 e março de 2023. Resultados: Foram um total de 211 pacientes avaliados, e foram encontradas alterações menos frequentes nas RMN de 12 pacientes (5,68%), das quais: 5 com volumosa quantidade de líquido pericapsular, 3 com granuloma capsular, 1 seroma tardio com conteúdo hemorrágico,1 rotura intra e extracapsular, 1 nódulo junto à cápsula fibrosa do implante, 2 linfonodopatia axilar ipsilateral, 1 silicone intralinfonodal, 1 edema do músculo peitoral, 2 tumor desmoide e 1 herniação da cápsula fibrosa. Conclusão: Estima-se que existam 50 milhões de mulheres com próteses de mama no mundo. Com base nesse dado, o número de complicações ditas "não usuais" passa a ser um desafio diagnóstico para o cirurgião plástico e o radiologista.

Introduction: Breast prosthesis implantation is one of the most performed surgeries in the world. Over time, different materials were used to reconstitute breast volume. Despite technical and surgical improvements and the safety of current implants, patients are faced with potential "unusual" complications: intracapsular and extracapsular ruptures, late hematomas and contour deformity, intra-nodal silicone, or herniation of the fibrous capsule. Magnetic resonance imaging (MRI) is the most useful imaging modality for investigating these complications. Method: This is a series of cases in which so-called "unusual" changes were reported, due to their low frequency or lack of mention in the literature, after surgeries to include a silicone prosthesis. The data were collected from the personal experience of one of the authors in his private clinic, in the city of Brasília-DF, between April 2015 and March 2023. Results: A total of 211 patients were evaluated, and less frequent changes were found in the MRI of 12 patients (5.68%), of which: 5 with a large amount of pericapsular fluid, 3 with capsular granuloma, 1 late seroma with hemorrhagic content, 1 intra and extracapsular rupture, 1 nodule close to the implant's fibrous capsule, 2 axillary lymph node disease ipsilateral, 1 intra-nodal silicone, 1 pectoral muscle edema, 2 desmoid tumor and 1 herniation of the fibrous capsule. Conclusion: It is estimated that there are 50 million women with breast implants in the world. Based on this data, the number of so-called "unusual" complications becomes a diagnostic challenge for the plastic surgeon and radiologist.

Evaluación de la expresión de PD-L1 e infiltración linfocitaria intratumoral en carcinoma de mama invasivo triple negativo / Evaluation of PD-L1 expression and intratumoral lym phocytic infiltration in triple-negative invasive breast car cinoma

Resumen Introducción : El endofenotipo de cáncer de mama triple negativo (TNBC) es uno de los menos frecuentes y sin diana terapéutica, por tanto, se plantea estudiar la correlación del punto de control inmunológico PD-L1 con el establecimiento de microambiente tumoral evaluado por la infiltración linfocitaria intratumoral estromal (TILs) y su importancia en la práctica clínica. Métodos : Se realizó un estudio retrospectivo de casos y controles, con 31 casos de carcinoma infiltrante de la mama triple negativo y 57 controles no pareados de endofenotipo Luminal A, Luminal B y HER-2 atendidos en un año. Se evaluaron las variables: tipo y grado his tológico, expresión PD-L1 con el clon 22C3, TILs, invasión linfovascular, tamaño tumoral, compromiso de ganglios linfáticos y metástasis. El análisis estadístico se ejecutó con la prueba de chi cuadrado y prueba de coeficiente de correlación de Spearman. Resultados : Se encontró una correlación negativa estadísticamente significativa entre TILs y PD-L1 (rho - 0.106, p 0.025), indicando que a mayor expresión de PD-L1, es menor la infiltración linfocitaria intratumo ral. En los grupos de TILs B (10-40% TILs) y C (40-90% TILs) donde se presenta marcado infiltrado inflamatorio intratumoral se evidenció mayor número de pacientes negativos para PD-L1 (CPS <10) con 16 y 10 casos res pectivamente. Para los casos TNBC se logró identificar un coeficiente de asociación negativa (rho -0.378) y con significancia estadística (p 0.01). Discusión : Se estableció la asociación de TNBC, TILs y expresión de PDL1, lo cual es importante para la instau ración de terapias diana y el desarrollo de la medicina de precisión.

Abstract Introduction : Triple negative breast cancer endophe notype (TNBC) is one of the least frequent and without therapeutic target; therefore we propose to study the correlation of PD-L1 immune checkpoint with the es tablishment of tumor microenvironment assessed by intratumoral stromal lymphocyte infiltration (TILS) and its importance in clinical practice. Methods : A retrospective case-control study was performed, with 31 cases of triple-negative infiltrat ing breast carcinoma and 57 unmatched controls of Luminal A, Luminal B and HER-2 endophenotype seen in one year. The following variables were evaluated: histologic type and grade, PD-L1 expression with clone 22C3, TILS, lymphovascular invasion, tumor size, lymph node involvement and metastasis. Statistical analysis was performed with the chi-square test and Spearman correlation coefficient test. Results : a statistically significant negative correlation was found between TILS and PD-L1 (rho - 0.106, p 0.025), indicating that the higher the expression of PD-L1, the lower the intratumoral lymphocytic infiltration. In the TILS B (10-40% TILS) and C (40-90% TILS) groups where there was a marked intratumoral inflammatory infiltrate, a greater number of patients were negative for PD-L1 (CPS <10) with 16 and 10 cases, respectively. For TNBC cases a negative association coefficient was identified (rho -0.378) with statistical significance (p 0.01). Discussion : The association between TNBC, TILS and PDL1 expression was established, which is important for the establishment of target therapies and the develop ment of precision medicine.