Current controversies in the treatment of ductal carcinoma in situ of the breast.

The incidence of ductal carcinoma in situ (DCIS), a noninvasive form of breast cancer, has increased markedly in recent decades, and DCIS now accounts for approximately 20% of breast cancers diagnosed by mammography. Laboratory and patient data suggest that DCIS is a precursor lesion for invasive cancer. Controversy exists with regard to the optimal management of DCIS patients. In the past, mastectomy was the primary treatment for patients with DCIS, but as with invasive cancer, breast-conserving surgery has become the standard approach. A mini-review of the management of ductal carcinoma in situ is presented, and the roles and dilemmas of surgery, radiotherapy and endocrine therapy are discussed.

[Progresses in the treatment of early breast cancer. A mini-review]. / Evoluzioni nel trattamento chirurgico del carcinoma mammario precoce.

The treatment of breast cancer has undergone continuous and profound changes over the last three decades; breast conservation therapy has been progressively validated as a safe alternative to radical mastectomy for patients with early stage breast cancer. Several large trials have shown that overall survival time of patients treated with conservative surgery and axillary dissection followed by radiation therapy is equivalent to that of patients treated with modified radical mastectomy, with better cosmetic outcomes and acceptable rates of local recurrence. Improvements in diagnostic work-up and the wider diffusion of screening programs have allowed the detection of smaller, often non palpable tumours, furtherly facilitating the widespread use of tumour localization and breast conserving techniques. Since the removal of negative lymph nodes is useless, eventually harmful and plays no therapeutic role in breast cancer patients, techniques for staging of the axilla have also gradually evolved toward less aggressive approaches, such as lymphatic mapping and sentinel node biopsy. The introduction of "onco-plastic techniques", that combine the concepts of oncological and plastic surgery of the breast, achieve the goal of allowing more extensive excisions while improving the aesthetic results, and eventually patient's quality of life. The present work will highlight potential benefits as well as unresolved issues of the above mentioned therapeutic options, with special emphasis on technical aspects of conservative surgery in the treatment of early breast cancers.

Synchronous bilateral breast carcinoma in a 50-year-old man with 45,X/46,XY mosaic karyotype: report of a case.

We report a case of synchronous bilateral breast cancer in a patient with ambiguous external genitalia attributed to a 45,X/46,XY mosaicism. To our knowledge, this represents the first such case ever to be reported. Mammography, ultrasonography, computed tomography, and magnetic resonance imaging all showed bilateral suspicious breast masses with microcalcifications. There were no radiological findings of muscle invasion or axillary lymphadenopathy. The patient was successfully treated by bilateral radical modified mastectomy followed by external irradiation and adjuvant endocrine therapy. Histological examination revealed a bilateral ductal carcinoma in situ, with a cribriform and papillary pattern and microfoci of infiltrating ductal carcinoma. The hormonal profile revealed high levels of follicle-stimulating hormone and luteinizing hormone, and low levels of testosterone. Testicular sonography revealed small hypoechoic testicles with bilateral microlithiasis. This case shows that 45,X/46,XY men may have an increased risk of breast cancer and must be followed up carefully.

Metastatic tumors of the umbilicus: report of two cases and review of the literature.

An umbilical nodule may be an early or late sign of metastatic spread from an internal malignancy. Usually it appears when the internal malignancy is widely disseminated and has been previously diagnosed. More rarely, such a nodule is the first sign of disease and eventually results in the diagnosis of the primary tumor. We present two cases which document examples of both events, in order to focus on the most relevant aspects of this condition.

Use of a new type of PTFE mesh in laparoscopic incisional hernia repair: the continuing evolution of technique and surgical expertise.

We present the results of our first 44 laparoscopic incisional hernia repairs. This study examines the effectiveness of this technique in patients presenting with a first-time or recurrent incisional hernia. From October 2001 to November 2002, a total of 45 consecutive patients underwent laparoscopic incisional hernia repair with a new form of expanded polytetrafluoroethylene (ePTFE) mesh. Patient data, preoperative, intraoperative, and postoperative records, were recorded and analyzed. Mean defect size was 84 cm2, mean mesh size was 311 cm2, mean surgical time was 65 minutes, and mean hospital stay was 2.25 days. Postoperative complications occurred in four patients (9.1%). The laparoscopic approach is a safe, effective, and relatively complication-free option in the management of first-time and recurrent incisional hernias. The use of modified ePTFE mesh with a dual surface in incisional hernia repair enables early tissue attachment, reduces adhesions, and could reduce the incidence of recurrences.