A novel nipple-areola complex involvement predictive index for indicating nipple-sparing mastectomy in breast cancer patients.

BACKGROUND: Nipple-sparing mastectomy (NSM) is increasingly used in breast cancer patients, as it offers better cosmetic outcomes and improves quality of life. Nipple-areola complex (NAC) involvement must be accurately determined to identify which patients may be candidates for NSM. We aimed to identify the predictors of NAC involvement and develop a clinical predictive model to determine the patients for whom NAC preservation may be considered. PATIENTS AND METHODS: Patients (n = 168) with primary operable breast cancer who underwent subcutaneous mastectomy for breast reconstruction at Saitama Medical Center from July 2013 to December 2017 were selected from the hospital's surgical database. RESULTS: The clinicopathological factors of tumor size ≧ 4 cm (p < 0.001), nipple-to-tumor distance (NTD) < 1 cm by mammography (p = 0.002), NTD < 1 cm by magnetic-resonance imaging (MRI) (p < 0.001), nipple contrast findings by MRI (p < 0.001), tumor in central portion (p < 0.001), multicentric/focal lesion (p < 0.001), and clinical node involvement (p = 0.014) were significantly associated with the presence of NAC involvement. Each predictor was scored 0 or 1. A score of 0-3 points was defined as low risk, 4 points as intermediate risk, and 5-7 points as high risk. Using these classification criteria, NAC involvement rate was determined to be 3.5% in low-risk, 68.7% in intermediate-risk, and 90.0% in high-risk specimens. A significant correlation was observed between the risk group and NAC involvement (p < 0.001). CONCLUSION: This nipple-areola complex involvement predictive index can be used to determine the appropriate indication for NSM in breast cancer patients who request NAC preservation with more oncological safety.

Unexpected massive hemorrhage following the removal of a pleural drainage tube.

We herein describe a case in which a massive hemorrhage unexpectedly occurred after the removal of a pleural drainage tube which had been in place for five days. One possible explanation for that event was the damage of the intercostal artery during tube insertion into the thoracic cavity. This is an extremely rare but severe complication. Therefore, the present report provides useful information for physicians who treat patients with respiratory diseases.

Chest wall reconstruction with a latissimus dorsi musculocutaneous flap via the pleural cavity.

This report presents the case of a 79-year old woman who developed radionecrosis after irradiation following a radical mastectomy at the age of 50 and complicated lung adenocarcinoma in the left upper lobe. Chest wall resection and reconstruction were performed simultaneously with left upper lobectomy, and a latissimus dorsi musculocutaneous flap was used for reconstruction via the left pleural cavity after lobectomy. The flap was well adapted to the defect of the chest wall. This clinical course indicates that a transpleural musculocutaneous flap can be a reconstructive procedure for such patients showing chest wall radionecrosis complicated with an intrathoracic disease.

Multiple lung adenocarcinomas and AAH treated by surgical resection.

Atypical adenomatous hyperplasia (AAH) is often found in the lungs of patients with multiple primary lung adenocarcinoma; however, treatment for such patients has not been clearly defined. This report presents a case of multiple primary lung adenocarcinoma with multiple AAH treated by surgery. A 55-year-old man underwent two operations in 3 years and 8 months. Thirteen tumorous lesions were resected; 10 lesions were diagnosed as primary lung adenocarcinoma and the others as AAH. Two years and 6 months after the second operation, radiographic examination showed no evidence of tumor recurrence. The clinical course indicates that surgery can be a treatment strategy for synchronous or metachronous lung carcinoma with AAH.

Gastric tube-to-pleural fistula seventeen months after esophagectomy: successful endoscopic treatment of an unusual complication.

A gastric tube-to-pleural fistula is an uncommon late complication of esophagectomy. In this report, a 71-year-old man who developed gastric tube-to-pleural fistula 17 months after esophagectomy with intrathoracic reconstruction using a gastric tube is presented. Chest radiograph on admission showed massive right pleural effusion, which demonstrated empyema on chest drainage. Further imaging studies confirmed a gastric tube-to-pleural fistula that had no connection to the airway. We chose endoscopic intervention as a less invasive procedure and successfully treated the patient by plugging fibrin glue into the fistula under endoscopy. Review of the literature and discussion of the clinical features, differential causes, and treatment options of this rare and severe condition are presented.