Multifocal Tumorous Pseudoangiomatous Stromal Hyperplasia Presenting as Asymmetric Bilateral Breast Enlargement.

PASH is a benign proliferation of stromal myofibroblasts that affects mostly premenopausal women and typically shows estrogen and progesterone receptor expression, allowing speculation regarding a hormonal cause. It usually presents as an incidental finding on a mammogram or as a palpable mass. We present a case of diffuse asymmetrical massive breast enlargement in a premenopausal woman with history of previous multiple PASH excisions for recurrent lesions, caused by multifocal tumorous PASH virtually replacing the breast parenchyma. Immunohistochemistry examination showed no hormone receptor expression. Despite its benign nature, such presentation of PASH is managed with bilateral mastectomy and immediate reconstruction with expanders for cosmetic and comfort reasons, while tumor excision or expectant management is deemed to lead to recurrence and progression. Although a hormonal origin is speculated based on hormone expression studies and typical patient profile, this case showed 0 % estrogen/progesterone expression in the final histology specimen.

Impact of trastuzumab treatment beyond disease progression for advanced/metastatic breast cancer on survival - results from a prospective, observational study in Germany.

OBJECTIVES: Evidence suggests that continued trastuzumab therapy beyond progression (TBP) may provide additional survival benefit. Within the framework of an observational prospective study of patients with advanced/metastatic breast cancer receiving trastuzumab in routine clinical practice, we had the opportunity to examine the effect of TBP in a large population. PATIENTS AND METHODS: Among a total of 1843 trastuzumab-treated patients, a sub-cohort of 418 fulfilled the selection criteria for the TBP analysis: 261 continued trastuzumab and 157 discontinued. Logrank tests and Cox models were used to compare survival and identify prognostic factors. RESULTS: Survival from progression was significantly longer in those patients continuing trastuzumab treatment beyond disease progression (TBP: median 22.1 months; no TBP: median 14.9 months; HR = 0.64; P = 0.00021). In addition to TBP, a positive endocrine receptor status, a longer relapse-free interval, no visceral metastasis, no concomitant chemotherapy during first-line treatment, and first-line response were independently significant prognostic variables for longer survival on multivariate analysis. CONCLUSION: The hitherto limited evidence for TBP benefit from randomized studies was confirmed. While a number of strong disease-related predictors for survival after first progression could be identified, the positive effect of trastuzumab continuation retained statistical significance in a multivariate model.

Yoga for Patients with Early Breast Cancer and its Impact on Quality of Life - a Randomized Controlled Trial.

The aim of this prospective, randomized, controlled trial was to investigate the impact of yoga on newly diagnosed patients with early breast cancer in the immediate postoperative phase. 93 women newly diagnosed with early breast cancer were randomized into an intervention group (IG) and a control group (waiting group, WG). The IG started yoga immediately after the operation. The WG started yoga 5 weeks after surgery. Both groups attended yoga classes twice weekly for 5 weeks. Quality of life (QoL) was evaluated using the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires before the intervention, immediately after the operation and after 3 months. After 3 months the patients were asked whether yoga improved their physical activity and whether they wished to continue with yoga. The overall QoL (p = 0.002) and the functional status (p = 0.005) increased significantly in the IG, while physical symptoms decreased over time in both groups. 86 % of patients in the IG and only 59 % of patients in the WG (p = 0.04) confirmed a positive change in their physical activity through yoga. More women in the IG intended to continue with yoga (p = 0.03). Early initiation of yoga as a supportive treatment in cancer had a positive impact on QoL. Teaching yoga allowed patients to practice yoga by themselves, enhanced the patients' QoL and was found to improve physical activity.

[Can the high-resolution 13-MHz ultrasonography facilitate the preoperative localization and marking of microcalcification clusters?]. / Kann die hochauflösende 13-MHz-Sonographie die präoperative Lokalisation und Markierung von Mikroverkalkungsgruppen erleichtern?

PURPOSE: The value of 13 MHz ultrasound regarding the preoperative localisation in combination with mammography were investigated into. MATERIAL AND METHOD: Out of 112 mammaographically detected calcifications, 30 (30 patients) were clusters of microcalcifications. Out of these, 23 were classified as suspicious of malignancy and were preoperatively localised with a 7.5 and 13 MHz probe. Upon marking the skin, a fine needle was inserted, and after due correction blue dye or coal solution was instilled. RESULTS: Following mammographically shown position, 23 clusters of microcalcifications could be localised using the 13 MHz probe. A localisation with the 7.5 MHz probe was impossible in all cases. A single correction of the needle's site was necessary with 35% (8/23) of patients. The maximum distance of the needle's tip in case of misposition measured 11 mm. CONCLUSION: Giving a known mammographic position and a sonographic perceptibility of clusters of microcalcifications in a maximal depth of penetration of 2 cm, 13 MHz high resolution ultrasound examination in combination with mammography prove to be a valuable means in facilitating the preoperative localisation.

[Surgical technique of subcutaneous/skin preserving tumor-adapted mastectomy]. / Operative Technik der subkutanen/hautsparenden tumoradaptierten Mastektomie.

Subcutaneous mastectomy as a procedure to prevent breast cancer has been abandoned because of the insufficient resection of breast tissue and the high rate of complications. Including the recent experiences in reconstructive breast surgery the subcutaneous mastectomy allows a degree of tissue resection comparable to total mastectomy with a lower rate of complications. Surgical technique, our own results and new indications for subcutaneous mastectomy are presented.

[Fibromatosis of the breast]. / Fibromatose der Brust.

Fibromatosis of the breast is a rare benign mesenchymal transformation of the connective tissue, the origin of which is probably situated in the fascia of the pectoral muscle and the Cooper's ligaments. In the clinical and radiological examination, it is difficult to differentiate between a mammary carcinoma or other malignant tumours of the breast. Only histological examination can lead to the final diagnosis. Large-scale excision of these tumours, which have a tendency to relapse, is the therapy of choice. The diagnostic problems are shown in a case of a 26-year old patient.

[Primary reconstruction in breast-saving cancer surgery]. / Primäre Rekonstruktion in der brusterhaltenden Krebschirurgie.

Breast-conserving therapy in mammary carcinoma is an alternative to the more radical forms of therapy when the tumors are small. The cosmetic results obtained are not always satisfactory. Correction of deformities of this kind in breasts which have been subjected to post-operative radiation is difficult and dangerous. Consequently, reconstruction of the mammary gland should be included in the primary operation. The technical possibilities for doing so are listed. It seems to be justifiable from an oncological point of view.