Primary de novo malignant peripheral nerve sheath tumor of the breast mimicking mastitis. Report of a case and review of the literature.

Malignant peripheral nerve sheath tumor (MPNST) is a rare tumor representing <0.1% of malignant breast tumors. Here, we report a case of sporadic MPNST of the breast in a 45-year-old woman with a fast-evolving painful mass in the right breast associated with edema, redness, and increased local temperature, simulating mastitis. This presentation has not been reported. A review of the literature since 1992 has revealed 15 MPNST cases, including the present one with sufficient data for analysis. All the cases were women. The ages ranged from 16-60 years (mean 40.5 years). Duration of symptoms varied from four days to 15 years (mean 2.7 years). Tumor size ranged from 2.5-30 cm (mean 10.9 cm). 64.3% of tumors were well-circumscribed. Tumors were graded as grade 1 (7.7%), grade 2 (38.5%), and grade 3 (53.8%). Three (20%) cases showed histopathological peculiarities. Simple mastectomy was performed in four (26.7%) cases, radical mastectomy in six (40%) cases, and simple excision in five (33.3%) cases. There were no metastases in the six cases where axillary dissection was performed. Seven (53.8%) patients received adjuvant therapy, including chemotherapy and∕or radiotherapy. Local recurrence was observed in two (16.7%) patients. Distant metastasis was detected in one patient (7.7%) affecting the lung 11 months after radical mastectomy. The follow-up was available for 10 patients (mean 2.2 years, median 1 year). One patient (10%) died of the disease. At the last follow-up, 80% of patients were still alive. The main differential diagnosis includes nonpleomorphic spindle cell tumors.

Tratamiento de la macromastia sintomática en una unidad de mama. Resultados de la reducción mamaria evaluados mediante el cuestionario BREAST-Q / Treatment of symptomatic macromastia in a breast unit. Outcomes analysis of breast reduction using BREAST-Q

Introducción: El BREAST-Q (módulo reducción mamaria) es un cuestionario específico y validado para evaluar la reducción mamaria en el tratamiento de la macromastia sintomática, ofreciendo información sobre la calidad de vida y grado de satisfacción de las pacientes. Métodos: Estudio prospectivo de una cohorte de 34 pacientes tratadas mediante reducción mamaria bilateral, en una unidad de mama en 2017-2020, que fueron encuestadas con la versión adaptada al castellano del BREAST-Q. Las pacientes cumplimentaron el cuestionario en el mes previo a la cirugía y después de esta. Los cambios de las puntuaciones pre- y postoperatorias en los diferentes dominios se analizaron mediante la prueba de rangos con signo de Wilcoxon. La significación estadística fue determinada con valores de p<0,05. Resultados: El tiempo medio desde la cirugía a la encuesta postoperatoria fue 16 (DE 9) meses. Complicaciones o secuelas posquirúrgicas sucedieron en 14 (42%) pacientes con 23 eventos. Las puntuaciones preoperatorias, medianas y rango intercuartílico, en la satisfacción con las mamas (28, 26), bienestar psicológico (33, 14), físico (42, 19) y sexual (34, 14) mejoraron en la encuesta postoperatoria a (82, 15), (81,29), (82, 30) y (90, 38), respectivamente, con significación estadística, p<0,001. Conclusiones: La primera aplicación del BREAST-Q versión en castellano para españolas a pacientes con macromastia tratadas quirúrgicamente en una unidad de mama demuestra que la reducción mamaria mejora la calidad de vida de las pacientes y, que estas están muy satisfechas con el resultado de la cirugía y su cirujano, aunque la información recibida es mejorable. (AU)

Introduction: The BREAST-Q (breast reduction module) is a specific and validated questionnaire to evaluate breast reduction in the treatment of symptomatic macromastia, offering information on their quality of life and degree of satisfaction. Methods: Prospective study of a cohort of 34 patients treated by bilateral breast reduction in a breast unit in 2017–2020 surveyed with the Spanish version of BREAST-Q version 2. The statistical study to assess the effect of reduction, changes from the pre to postoperative scores of the domains were performed using the Wilcoxon signed rank test. Statistical significance was determined with P values <.05. Results: The mean time elapsed from surgery to the postoperative survey was 16 (SD 9) months. Post-surgical complications or sequelae occurred in 14 (42%) patients with 23 events. The preoperative scores, median and interquartile range, in satisfaction with the breasts (28, 26), psychological (33, 14), physical (42, 19) and sexual (34, 14) well-being improved in the postoperative survey to (82, 15), (81, 29), (82, 30) and (90, 38), respectively. These changes were statistically significant, P<.001. Conclusions: The first application of the BREAST-Q in its version in Spanish for Spanish women in patients with symptomatic macromastia treated surgically in a breast unit shows that breast reduction improves the quality of life of patients and that they are very satisfied with the outcome of the surgery and its surgeon, although the information received should clearly be improved. (AU)

Treatment of symptomatic macromastia in a breast unit. Outcomes analysis of breast reduction using BREAST-Q.

INTRODUCTION: The BREAST-Q (breast reduction module) is a specific and validated questionnaire to evaluate breast reduction in the treatment of symptomatic macromastia, offering information on their quality of life and degree of satisfaction. METHODS: Prospective study of a cohort of 34 patients treated by bilateral breast reduction in a breast unit in 2017-2020 surveyed with the Spanish version of BREAST-Q version 2. The statistical study to assess the effect of reduction, changes from the pre to postoperative scores of the domains were performed using the Wilcoxon signed rank test. Statistical significance was determined with p values ​​<0.05. RESULTS: The mean time elapsed from surgery to the postoperative survey was 16 (SD 9) months. Post-surgical complications or sequelae occurred in 14 (42%) patients with 23 events. The preoperative scores, median and interquartile range, in satisfaction with the breasts (28, 26), psychological (33, 14), physical (42, 19) and sexual (34, 14) well-being improved in the postoperative survey to (82, 15), (81.29), (82, 30) and (90, 38), respectively. These changes were statistically significant, p < 0.001. CONCLUSIONS: The first application of the BREAST-Q in its version in Spanish for Spanish women in patients with symptomatic macromastia treated surgically in a breast unit shows that breast reduction improves the quality of life of patients and that they are very satisfied with the outcome of the surgery and its surgeon, although the information received should clearly be improved.

Can anesthetic effects and pain treatment influence the long-term prognosis of early-stage lymph node-negative breast cancer after breast-conserving surgery?

BACKGROUND: Breast cancer is currently the leading cause of women's death. It is crucial to further improve the approach to treatment and the long-term survival rate of breast cancer patients, and to reduce the rates of recurrence and metastasis. It has been reported that the possibility of tumor metastasis depends on the metastatic potential of the tumor and the host defense against tumor metastasis, in which cellular immunity and the function of natural killer (NK) cells are critical to maintaining this balance. Surgical stress response and postoperative pain inhibit perioperative immune function in patients and increase the likelihood of dissemination and metastasis of cancer cells after cancer surgery. The study aims to investigate the effect of anesthetic factors and pain treatment on the long-term prognosis of patients with early stage lymph node negative breast preservation surgery. METHODS: A total of 337 patients with early-stage lymph node negative breast cancer (ASA I-II) who had undergone successful breast-conserving surgery in our hospital were included in this retrospective analysis. Cases were divided into general anesthesia with postoperative analgesia group (GA + PCA), general anesthesia without postoperative analgesia group (GA), epidural anesthesia with postoperative analgesia group (EA + PCA), and epidural anesthesia without postoperative analgesia group (EA). The 5-year survival rate and 5-year disease-free survival were recorded in the 4 groups. RESULTS: The general condition and length of hospital stay of the patients were not statistically different between the 4 groups. However, the 5-year survival rate and 5-year disease-free survival rate of the 4 groups were statistically different. The 5-year survival rate and 5-year disease-free survival rate were the lowest in the GA group, while the EA + PCA group had the highest 5-year disease-free survival rate. The 5-year survival rate and 5-year disease-free survival rate in the GA + PCA group were significantly higher than those in the GA group. The 5-year disease-free survival rate in EA group was significantly higher than GA group. CONCLUSIONS: Epidural anesthesia and postoperative pain treatment maybe beneficial to the long-term prognosis of patients with early-stage lymph node-negative breast cancer.

Reduction mammaplasty technique. The pheasant tail nymph of the oncoplastic / La técnica de reducción mamaria. La ninfa faisán de la cirugía oncoplástica mamaria

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Oncoplastic breast conserving surgery with tailored needle-guided excision.

BACKGROUND: Breast conserving surgery (BCS) administered with oncoplastic approach (OBCS), when it is required, is currently the gold standard for the treatment of early breast cancer. Wire-guided localization (WL) is the most popular technique used to help surgeon in breast cancer excision. Currently, a universal and undeniable goal is to minimize the rate of positive margins and re-excision operation after BCS improving cosmetic outcome and decreasing health care costs. This study is aimed to report our experience combining OBCS and tailored WL as surgical approach for early breast cancers. METHODS: We performed a retrospective study on 148 breast cancer patients who were treated with OBCS and tailored WL, which consists in individualization of the number and location of wires depending on patient particularities, in our Breast Unit from March 2013 to December 2015. A multivariate analysis was used to determine the association between clinic-pathologic variables, which can be known preoperatively, and margin status. RESULTS: The rate of affected margins was 13.5% and 10.8% patients underwent re-interventions for oncologic reasons. Multifocality was strongly associated with involved margins [odds ratio (OR) 4.67]. CONCLUSIONS: OBCS together with tailored WL obtains an acceptable rate of positive margins and high rate of final BCS.

Centrally necrotizing breast carcinoma: a rare histological subtype, which was cause of misdiagnosis in an evident clinical local recurrence.

Centrally necrotizing carcinoma is a rare subtype of breast carcinoma, which is characterized by an extensive central necrotic zone accounting for at least 70% of the cross-sectional area of the neoplasm. This central necrotic zone, in turn, is surrounded by a narrow rim of proliferative viable tumor cells. We report an unusual clinical situation in which a patient whose evident breast mass suggested an ipsilateral local recurrence and for which numerous attempts to confirm the histological diagnosis had failed. The patient was treated with a radical mastectomy based on clinical suspicion of breast cancer recurrence after an undesirable delay. In this case, the narrow rim of viable malignant tissue had a thickness of 0.5 to 8 mm, and the centrally necrotizing carcinoma had a central zone with a predominance of fibrosis. The special features of this case led to a misdiagnosis and to an evident clinical local recurrence.

Long-term results of breast conservation and immediate volume replacement with myocutaneous latissimus dorsi flap.

BACKGROUND: Published long-term outcomes of oncoplastic breast-conserving surgery are scarce and, specifically, aesthetic outcomes assessed with an objective method have not previously been published. METHODS: A cohort of 41 patients treated with a quadrantectomny and immediate reconstruction using a myocutaneous latissimus dorsi flap were analyzed and their aesthetic outcomes were evaluated objectively by BCCT.core software. RESULTS: At the end of a 58-month follow-up from the date of initial diagnosis, one patient (2.4%) developed an ipsilateral recurrence, six patients developed distant metastases and three patients died (7.3%) without ipsilateral recurrence, one of them presenting hepatic metastases at the time of the initial diagnosis. We were able to evaluate aesthetic results in 23 patients, 3 assessed as excellent, 12 good and 8 fair. CONCLUSION: This oncoplastic volume replacement technique obtained a good local control and satisfactory and stable aesthetic results which have maintained unchanged after a long period of time.

Incorporating the surgical treatment of symptomatic macromastia into a Breast Cancer Unit: could this be a useful management policy?

Oncoplastic Breast Surgery (OBS) is becoming an integral part of breast cancer management, but training is difficult and not easily available. We propose a bold management policy: the introduction of the reduction mammaplasty into a Breast Cancer Unit (BCU) as treatment for symptomatic macromastia. This management policy could bring about clear advantages both to patients (larged-breasted patients and those with a breast cancer) and surgeons.

Treatment of symptomatic macromastia in a breast unit.

BACKGROUND: Patients suffering from symptomatic macromastia are usually underserved, as they have to put up with very long waiting lists and are usually selected under restrictive criteria. The Oncoplastic Breast Surgery subspeciality requires a cross-specialty training, which is difficult, in particular, for trainees who have a background in general surgery, and not easily available. The introduction of reduction mammaplasty into a Breast Cancer Unit as treatment for symptomatic macromastia could have a synergic effect, making the scarce therapeutic offer at present available to these patients, who are usually treated in Plastic Departments, somewhat larger, and accelerating the uptake of oncoplastic training as a whole and, specifically, the oncoplastic breast conserving procedures based on the reduction mammaplasty techniques such as displacement conservative techniques and onco-therapeutic mammaplasty. This is a retrospective study analyzing the outcome of reduction mammaplasty for symptomatic macromastia in our Breast Cancer Unit. METHODS: A cohort study of 56 patients who underwent bilateral reduction mammaplasty at our Breast Unit between 2005 and 2009 were evaluated; morbidity and patient satisfaction were considered as end points. Data were collected by reviewing medical records and interviewing patients. RESULTS: Eight patients (14.28%) presented complications in the early postoperative period, two of them being reoperated on. The physical symptoms disappeared or significantly improved in 88% of patients and the degree of satisfaction with the care process and with the overall outcome were really high. CONCLUSION: Our experience of the introduction of reduction mammaplasty in our Breast Cancer Unit has given good results, enabling us to learn the use of different reduction mammaplasty techniques using several pedicles which made it possible to perform oncoplastic breast conserving surgery. In our opinion, this management policy could bring clear advantages both to patients (large-breasted and those with a breast cancer) and surgeons.