More options for adjuvant treatment of HER2-positive breast cancer: How to choose wisely?

Human epidermal growth factor receptor 2-positivity (HER2) has a prognostic and predictive role in breast cancer. Trastuzumab, an anti-HER2 therapy, has a crucial role in a curative setting in Stage I, II and III breast cancer. In recent years, more anti-HER2 agents have been tested in clinical trials. Newer dosing strategies and combination approaches give us a plethora of options to treat a patient with early-stage and locally advanced breast cancer. It has led to the possibility of providing a risk-adapted treatment for patients with HER2-positive breast cancer. In order to reduce overtreatment and protect patients from adverse effects, a deescalation framework can be used in patients at lower risk for recurrence. Similarly, in those with greater risk for recurrence, escalation of therapy can be considered with the goal of achieving a cure. In this narrative review, we aim to provide a critical appraisal of the recent research findings in the management of early-stage and locally advanced breast cancer.

Idiopathic Granulomatous Mastitis: A Clinical Puzzle in Breast Lump Cases.

Idiopathic granulomatous mastitis (IGM) is a rare benign disease, characterized by chronic inflammation and granulomatous disease process. A middle aged lady with breast lump for six months with equivocal mammographic and ultrasound results underwent lumpectomy and biopsy. Ruling out all other possible granulomatous diseases and malignancy, a diagnosis of IGM was made. IGM becomes clinically significant as it closely mimics carcinoma breast and some inflammatory and infectious pathology.

Cowden syndrome with Lhermitte- Duclos disease presenting as ataxia.

Cowden syndrome or multiple hamartoma syndrome is a rare genodermatosis of autosomal dominant inheritance characterized by multiple hamartomatous lesions of ectodermal, mesodermal and endodermal origin. A 45-year-old man presented to us with a history of dural arteriovenous fistula and intracerebral bleed in the past with gradually progressive difficulty in walking. Magnetic resonance imaging (MRI) of the brain showed a heterogeneous lesion in the cerebellum which was diagnosed as adult Lhermitte-Duclos disease which is considered a component of Cowden syndrome. On examination we found florid skin and mucosal manifestations of Cowden syndrome. A family history of thyroid malignancy was also present. Using the Cleveland Clinic web calculator, the patient had an 82% chance of having a phosphatase and tensin homologue (PTEN) mutation.