Paving the way for changing perceptions in breast surgery: a systematic literature review focused on oncological and aesthetic outcomes of oncoplastic surgery for breast cancer.

BACKGROUND: The emphasis on aesthetic outcomes and quality of life after breast cancer surgery has motivated breast surgeons to develop oncoplastic breast conserving surgery (OPS). Training programs are still rare in most countries, and there is little standardization, which challenges the scientific evaluation of these techniques. This systematic review aims to assess oncological and cosmetic outcomes of OPS. METHODS: After a strict selection process with precise inclusion and exclusion criteria, oncologic and aesthetic outcomes of oncoplastic surgery were searched, using the MEDLINE database up to September 30th, 2017. Available published literature was classified in levels of evidence. After a thorough screening process, only studies with the best level of evidence were included on selection. Systematic reviews and meta-analyses were not included for methodological reasons. RESULTS: Titles and abstracts of 2.854 citations were identified and after screening 15 prospective studies including 1.391 patients were reviewed and scored in detail. Local relapse was found in 2.8% of cases with a wide range of follow-up (from 6 to 74 months). Close margins were retrieved in 11% of cases and positive margins in 9.4% of cases. Mastectomy was implemented in 6.9% of breast cancer patients to whom OPS was performed. Good cosmetic outcomes were detected in 90.2% of patients undergoing OPS, leaving open issues for who should perform cosmetic evaluation and which method should be used. CONCLUSION: Tumor margins, mastectomy rates, and cosmetic outcomes of OPS have to be further improved by standardizing various aspects of OPS. Research efforts should focus on level I evidence assessing both oncological and aesthetic outcomes of OPS and survival rates.

Non small cell lung cancer metastasized to the breast and treated with modified radical mastectomy: a case report.

Breast metastasis from extra-mammary malignancy is extremely rare with an incidence from 0.4% to 1.3%. Several types of malignancies that most commonly metastasize to the breast include leukemia, lymphoma, and melanoma. AIM: We report a case of a 57-year-old male with a history of non-small cell lung cancer (NSCLC) who manifested a left breast mass, two years and four months after the initial diagnosis and treatRomament of NSCLC. METHOD: Physical examination revealed a poorly defined mass in the upper outer quadrant of the left breast, suspicious for breast cancer. After mammography results, the patient underwent Fine Needle Aspiration that was indicative of cancer. He underwent then modified radical mastectomy and axillary lymph node dissection. Histology and immunohistochemical analyses were conducted, that revealed a NSCLC that metastasized to the left breast. RESULTS: Finally, the prognosis of the patient was poor, as NSCLC relapsed from IIB to stage IV. CONCLUSIONS: An accurate differentiation of metastasis to the breast from primary breast cancer is of paramount importance because the therapeutic approach and prognosis of the two differ significantly.

Similar immunity profiles in patients with meningioma and glioma tumors despite differences in the apoptosis and necrosis of circulating lymphocyte and monocyte populations.

AIM: The present study aims to compare the host immune responses induced by benign (meningiomas) and malignant (gliomas) brain tumors. METHODS: Peripheral blood samples from 8 meningioma and 7 glioma patients collected pre- and post operatively were assessed for cell-mediated immunity, humoral immunity and IL-6, IL-8 and TNF-a expression. Apoptosis and necrosis of circulating lymphocytes and monocytes were evaluated by Annexin/PI, while DNA analysis was applied to trace circulating cells with an abnormal DNA content. RESULTS: Cell-mediated immunity was similar in the two groups either pre- or post- operatively. However, differences in the apoptosis and necrosis of circulating lymphocytes and monocytes were observed. Menigioma patients were characterized by increased percentage of apoptotic lymphocytes and necrotic monocytes pre-operatively and apoptotic monocytes postoperatively. In contrast glioma patients showed an increase in necrotic monocytes postoperatively. Humoral immunity and cytokine expression were at comparable levels both pre- and post-operatively. IL-6 expression was significant elevated after surgery in both groups. Circulating aneuploid cells were identified in three glioma patients pre-operatively, by DNA analysis. CONCLUSION: The presented data indicate that meningioma and glioma tumors trigger comparable systemic host immunity response mediated by impairments in cell-mediated immunity due to alternations in apoptosis and necrosis that also influence their shift towards the Th2 immunity profile. Moreover, the presented evidences on the circulation of aneuploid cells in glioma patients may substantiate further the immunosuppressive phenotype detected in these patients and offer a mechanism for the rare cases that extra- neural dissemination was observed without previous surgical intervention.