The Wire and Beyond: Recent Advances in Breast Imaging Preoperative Needle Localization.

Many patients with breast cancer are candidates for breast conservation therapy. This group includes individuals with small nonpalpable tumors detected at screening mammography and those with sufficient tumor shrinkage after neoadjuvant chemotherapy. Breast conservation surgery often requires the use of an imaging-guided preoperative localization procedure, during which a device is placed within or adjacent to the target lesion to guide the surgeon intraoperatively. For decades, wire localization has been the standard for preoperative localization in breast imaging. With this method, a wire is placed in the breast percutaneously, with the distal wire segment positioned adjacent to the abnormality and the proximal wire segment remaining outside the breast. Because of the external component of the wire, the patient must be compliant, and care must be taken to not disturb the wire's position before surgery. Scheduling flexibility is also limited because the wire localization must be performed on the same day as the subsequent surgery. More recently, the available options for performing preoperative localization have expanded greatly and now include the use of nonwire devices such as radioactive and magnetic seeds, radar reflectors, and radiofrequency identification tags. Nonwire localization devices can be placed days in advance of the surgery, at the patient's convenience, to avoid wire-related challenges and complications. They are placed percutaneously within or adjacent to the target breast lesion and detected intraoperatively by using a probe outside the breast.©RSNA, 2019.

Breast cancer in a patient with Kindlers syndrome.

Breast Cancer (BC) has associated risk factors and genetic factors like BRCA1, and BRCA2. Many benign and malignant disease processes are found concurrently with BC and believed to be additional risk factors like gall bladder stones (cholelithiasis), hypertension, diabetes mellitus, cerebrovascular lesions, arthritis, spine and spinal cord degenerative lesions, infertility, depression, sleep disturbances, obesity, autoimmune diseases (SLE), and thyroid diseases. There are some malignant disease associations like synchronous or metachronous ovarian, colonic and endometrial tumours with Breast cancer. Kindler Syndrome (KS) is a rare autosomal recessive genetic disorder manifesting as generalized dermatoses, described in 1954 by Theresa Kindler. KS is associated with acral skin blistering inducible by trauma, mucosal inflammation, photosensitivity, progressive pigmentation, telangiectasia, and skin atrophy (Poikiloderma). Repeated and progressive inflammation and subsequent fibrosis leads to ectropion, esophageal, anal, urethral, and vaginal stenosis and dryness. About 100 cases of Kindler syndrome have been reported in literature so far some from Arab World as well. Pathobiology of Kindler syndrome is not well understood. There are defects in KIND1 gene on chromosome 20. This gene expresses itself in basal keratinocytes, where it encodes a protein, called Kindlin 1. We report the second only case of Kindler's syndrome having breast cancer. These very very rare combinations have diagnostic issues, management restrictions, prognostic and follow up implications.

[DELAYED AND PRIMARY RECONSTRUCTION OF MAMMARY GLAND IN PATIENTS WITH THE BREAST CANCER].

Immediate and late follow­up results of oncoplastic operations, performed in 75 patients, suffering mammary gland cancer (MGC), including in 22­a delayed, and in 53­primary reconstruction of the breast, were analyzed. In 66 patients musculo­ cutaneous flaps on nutrient pedicle, taken up from the back and abdominal wall tissues, with underlying mammary gland endoprosthesis,were applied as a transplant. Ductal invasive MGC was diagnosed in 70 patients, invasive lobular one ­ in 5. After delayed reconstruction of the breast 81.8% patients have survived five years, and after primary reconstruction ­ 73.6%. Performance of oncoplastic operations in patients, suffering MGC, have permitted to achieve satisfactory immediate and late follow­up results of treatment, it constitutes essential element in complex of rehabilitation measures after performance of radical mastectomy.

Acellular dermal matrix masking detection of recurrent breast carcinoma: a novel complication.

Acellular dermal matrix (ADM) use in prosthetic breast reconstruction has become increasingly popular. Several benefits have been reported with this technique including diminished donor-site morbidity and improved aesthetic outcomes. Recently, in an effort to ascertain the overall safety and efficacy of this approach, an emphasis has been placed on identifying potential postoperative complications. This report describes a unique complication experienced with ADM use in which ADM conceals the detection of recurrent breast carcinoma.

Invasive micropapillary carcinomas arising 42 years after augmentation mammoplasty: a case report and literature review.

BACKGROUND: There has been no definitive consensus regarding the causal relationships between foreign bodies in the breast and carcinogenesis. This report describes the first case of invasive micropapillary carcinomas after augmentation mammoplasty. Multiple tumors located in immediate contact with the siliconomas suggested a causal link between the siliconomas and carcinomas. CASE PRESENTATION: This report presents the case of a 64-year-old female who underwent liquid silicone injections for augmentation mammoplasty 42 years previously. Eight years before admission, siliconomas of the left breast were removed due to pain and discomfort. The patient visited the hospital for further treatment of newly diagnosed carcinoma of the left breast. Images showed multiple tumors located in various areas of the left breast. The pathological findings of the left breast showed each tumor to be solitary and not continuous with the others. The tumors were diagnosed to be invasive micropapillary carcinomas, and they all came into immediate contact with the residual siliconomas. The siliconomas were therefore suspected to have played a causative role in the development of the breast cancer. CONCLUSION: This rare case of multiple invasive micropapillary carcinomas following augmentation mammoplasty provides evidence that siliconomas may lead to carcinomas. Although a causal relationship was not established unequivocally, we review evidence that suggest silicone gel may cause cell damage responsible for carcinoma development.

Male breast cancer with mandibular metastasis. A case report.

Female breast cancer is one of the major causes of death among women while male breast cancer is relatively uncommon and accounts for about 1% of all breast cancers in both sexes. Influencing factors are: gynecomasty, familiarity for male breast cancer, Jewish and African-American male population. From the histological point of view, it is not different from the female breast cancer, except for the infiltrant ductal carcinoma, but with a much severe prognosis. Breast cancer metastases to the jaws are rare, only 1%; the most common sites of metastases are: lungs(59-69%), liver (58-65%), bone (44-71%), pleura (23-37%), brain (9-22%) and kidney (4-17%). At present, based on a literature research (May 2006), there have been just two other case reports of male breast cancer metastasis to the maxillofacial region, both to the mandible. The case of a 69-year-old white man who in 2001 underwent a radical mastectomy due to ductal breast cancer is reported. In 2005 the patient was referred to our department by his oncologist for multiple oral fistula. A mandibular TC revealed osteolytic lesions and the patient underwent mandibular surgery to remove the lesions and clean up the area. The histological examination was consistent with that of a metastatic deposit of adenocarcinoma of the breast. In June 2006 the patient died due to worsening of the general clinical conditions, in particular due to ascites and hepatic insufficiency.

Flap Fixation Using Tissue Glue or Sutures Appears to Reduce Seroma Aspiration After Mastectomy for Breast Cancer.

BACKGROUND: Up to 90% of patients undergoing breast cancer surgery suffer from seroma formation, which can cause discomfort and various complications after mastectomy. This retrospective observational cohort study aimed to elucidate whether flap fixation with fibrin sealant (ARTISS) tissue glue reduces seroma formation and seroma aspiration after mastectomy when compared with flap fixation using Vicryl sutures and when compared with a conventional wound closure technique. METHODS: All patients undergoing mastectomy due to invasive breast cancer or ductal carcinoma in situ were eligible for inclusion. From May 2012 to March 2013, all patients undergoing mastectomy in 2 large breast cancer centers were treated using flap fixation with Vicryl sutures. From September 2013 to March 2014, all patients undergoing mastectomy were treated with flap fixation using ARTISS tissue glue. The data were retrospectively analyzed and compared with a "drain-only" group that was not treated with flap fixation (May 2011-March 2012). RESULTS: A total of 230 women who underwent mastectomy were retrospectively analyzed in this trial; 88 patients were included in the drain-only group (DO), 92 patients were included in the flap fixation group using Vicryl sutures (FF-1), and 50 patients were included in the flap fixation group using ARTISS tissue glue (FF-2). There was significantly less seroma formation in the group after flap fixation using sutures (P = .006). There were significantly fewer patients who required seroma aspiration in the FF-1 group (P = .001) and the FF-2 group (P = .001) after undergoing mastectomy and sentinel node biopsy or modified radical mastectomy. CONCLUSION: This study suggests that flap fixation after mastectomy using ARTISS tissue glue or sutures reduces postoperative seroma aspiration. As a result, flap fixation might lead to less patient discomfort. A randomized, prospective trial should be performed to verify these results.

Correlation between elevated intratumoral thymidine phosphorylase and prognosis of node-positive breast carcinoma undergoing adjuvant doxifluridine treatment.

We determined intratumoral thymidine phosphorylase (dThdPase) activity in 213 patients with T2N0M0 or T2N1M0 breast cancer. After surgery doxifluridine, an intermediate metabolite of capecitabine, and tamoxifen were given by mouth. According to dThdPase activity the examined patients were classified as: A, high activity group; tumors with the activity not less than the mean value and B, low activity group; tumors with activity less than the mean value. Group A had a better prognosis than group B in node-positive patients (disease-free survival, p=0.0446; overall survival, p=0.0788). Intratumoral dThdPase activity might be a useful marker for predicting responsiveness to doxifluridine treatment in the adjuvant setting.

Subcutaneous mastectomy for primary breast cancer and ductal carcinoma in situ.

Subcutaneous mastectomy (SCM) has been performed in 323 patients with invasive breast cancer or ductal carcinoma in situ (DCIS) over the last 20 years. This paper assesses the oncological safety of this operation with particular reference to local recurrences (LR) in the skin flaps. LR was assessed in the 134 patients who did not receive post-operative irradiation to the flaps and were followed up for a minimum of 30 months. The rates of LR were similar for SCM (16%) and for women who underwent simple mastectomy without post-operative irradiation (SM) for invasive cancer (14%) over the same time period, both overall and after prognostic stratification. In DCIS LR was only found in women treated with SCM. Four of the five recurrences (from 33 women) were in the nipple and later in the series patients with microscopic tumour involvement in the nipple received prophylactic irradiation to the nipple only; five patients treated in this way have not suffered LR. Subcutaneous mastectomy followed by insertion of a prosthesis is a safe alternative to mastectomy, since it carries no higher risk of LR. It is the simplest form of reconstruction in those proceeding to silicone implant and has the potential of achieving an excellent cosmetic result. Failure does not compromise the chance of more complex reconstruction procedures.

Internal mammary silicone lymphadenopathy mimicking recurrent breast cancer.

This case describes a unique complication of silicone breast implantation that is previously undocumented. Internal mammary silicone lymphadenopathy mimicking breast cancer recurrence represents an important new clinical entity. The diagnosis and management of this clinical enigma are challenging. In our patient, videothoracoscopy proved to be minimally invasive and allowed complete resection of the entire chain of pathologic nodes. Explantation of the silicone prostheses and complete capsulectomy are indicated. Light microscopy alone can suggest the diagnosis of silicone lymphadenopathy. Infrared spectral analysis can be a helpful adjunct to allow an unequivocal diagnosis.

Late capsular hematoma after breast reconstruction with polyurethane-covered implants.

We report two patients who developed late hematomas after breast reconstruction with polyurethane-covered implants. Although the cause of these hematomas is not absolutely clear, they are believed to have been caused by the intense, highly vascular inflammatory response that polyurethane coating is known to elicit. The development of late hematoma has not been previously stressed in the literature as a late complication of polyurethane-covered breast implants.

Immediate breast reconstruction for breast carcinoma using the periareolar approach.

Skin-sparing mastectomy with immediate breast reconstruction has shown to be oncologically safe while providing dependable aesthetic results. However, flap inset into the skin defect of the excised biopsy site and nipple-areola complex often results in a patchlike effect and transverse scars. By keeping the mastectomy incision solely around the areola, all breast skin can be preserved. Thus, in immediate breast reconstruction with replacement of the nipple and areola by a small skin island from a deepithelialized TRAM flap or latissimus dorsi muscle flap, the scar is kept at the natural border between areola and breast skin. Reconstruction of the nipple-areola complex further helps to camouflage the incision line. This may result in the best possible aesthetic outcome after mastectomy to date. The technique has been used in 17 breast cancer patients (intraductal cancer, n = 5; T1/T2 ductal cancer, n = 13) with good to excellent results. No local or distant recurrences have been seen; however, mean follow-up time is short (10 months). As the procedure of choice, a free TRAM flap was performed in nine patients for immediate reconstruction. The other eight patients were too slim for an autologous reconstruction; therefore, a latissimus dorsi muscle flap with a small skin island and a silicone implant were used. There were no major complications in either group. In contrast to traditional skin-sparing mastectomy, all breast skin is preserved with the periareolar approach. Therefore, special surgical expertise is required to ensure tumor free margins, especially with respect to the skin overlying the tumor. If these requirements are met, excellent results in breast reconstruction are amenable with adequate oncologic safety.

Chest wall resection for extrapulmonary tumor.

Despite progress in early detection of breast cancer, a minority of women continue to present with extensive disease which may necessitate chest wall resection. Between 1992 and 1996, 14 patients were treated by surgical resection of the chest wall and reconstruction by the LSU Sections of Surgical Oncology and Plastic Surgery. Indications included resection of primary tumor, resection of recurrent tumor, and resection of radiation therapy induced damage to the chest wall. We report chest wall excision and reconstruction with no operative mortality and minor surgical morbidity in 21% of cases. Local control was achieved in 13 of 14 cases. Additionally we report uniform success in the palliation of ulcerating, painful, or infected chest wall lesions. Approximately 25% of patients treated for breast cancer and followed up for more than 6 months have remained free of disease. Chest wall resection is a useful modality in selected patients with extensive disease.

[The mental foramen syndrome]. / A foramen mentale syndroma.

The authors outline an extraordinary rare case of metastatic mandible carcinoma. The examined patient who earlier had a mastectomy due to breast carcinoma showed signs of the foramen mentale syndrome (numbness, pain, swelling) also on the right side after 5 years. The process of the generalized malignant tumour was first indicated by the mandibula metastatic tumour of the foramen mentale syndrome.

[Prophylactic use of icatibant before tracheal intubation of a patient with hereditary angioedema type III. (A literature review of perioperative management of patients with hereditary angioedema type III)]. / Uso profiláctico de icatibant en un caso de angioedema hereditario tipo III. (Revisión de la literatura sobre manejo perioperatorio en pacientes con angioedema hereditario tipo III).

Type III hereditary angioedema is a rare familial disorder that has recently been described as a separate condition. Triggers for episodes of angioedema include surgery, dental procedures, and tracheal intubation maneuvers. Since episodes affecting the upper airway are potentially life-threatening, prophylactic treatment is recommended in these situations. The use of icatibant (Firazyr(®)), for prevention of angioedema prior to tracheal intubation, is reported in a patient with type iii hereditary angioedema. A literature review on the anesthetic management of this condition was conducted.

Adjuvant chemotherapy in older women with breast cancer: who and what?

A 73-year-old woman has been diagnosed with a mammographically detected grade 3, 2.2-cm invasive ductal carcinoma that is sentinel lymph node negative, estrogen receptor positive (80%), progesterone receptor negative, and human epidermal growth factor receptor 2 negative (0 by immunohistochemistry). A gene expression assay (Oncotype DX, Genomic Health, Redwood City, CA) showed a recurrence score of 28. Except for well-controlled hypertension and some aches and pains in her hands and knees, she has no other major illnesses. Her medications include an antihypertensive, vitamin D, and calcium. She discontinued cigarette smoking 20 years ago and has an occasional glass of wine. She describes her health as good, is fully functional, drives, has had no falls, and provides the majority of care for her sick husband. Her blood pressure is 146/88, her body mass index is 29.7, and her physical examination is normal. She is aware of the benefits and risks of adjuvant endocrine therapy and has been referred to discuss the role of chemotherapy.