Bilateral breast cancer in a male patient with hepatocellular carcinoma. A case report.

Male breast cancer accounts for about 1% of all breast cancers and bilateral breast cancer in men is therefore a rare event. Data in literature indicate that approximately 20% of these tumours are due to a probable alteration in the oestrogen metabolism. Hepatocellular carcinoma (HCC) on the other hand, is a much more frequent tumour and in 70-80% of cases is associated with cirrhosis. The proven concomitance of cirrhosis and gynecomastia in HCC or previous intake of oestrogen in breast cancer, would indicate possible involvement of the hormonal metabolism in the appearance of the two neoplastic forms. To our knowledge a case with these two malignant diseases in the same male patient is an exceptional event, rarely reported in literature. The fact that the breast cancer was bilateral in a male patient, the diverse histogenesis of the two breast cancers and the association with HCC in cirrhosis, led us to investigate into any common eziopathogenetic elements.

One-step intraoperative radiotherapy optimizes conservative treatment of breast cancer with advantages in quality of life and work resumption.

BACKGROUND: Intraoperative radiotherapy (IORT) could be not-inferior to external beam radiotherapy (EBRT) in selected patients, but toxicities, self-perception of body image, quality of life, and resumption of work or daily activities have been poorly explored. The aim of the present study was to compare these outcomes between EBRT, IORT full-dose (IORT-f) and IORT boost (IORT-b). METHODS: 443 consecutive patients, candidates for breast-conserving surgery, were included: EBRT was performed in 220 patients (49.7%), IORT-f in 140 patients (31.6%), and IORT-b in 83 patients (18.7%). Radiotherapy-related toxicities were registered. Patients were evaluated at 6 months for Body Image after Breast Cancer Questionnaire (BIBCQ) to assess possible changes in self-perception of body image and limitations. A second questionnaire explored the impact of EBRT, IORT-f and IORT-b on resumption of work and normal daily activities. RESULTS: EBRT had a higher risk of breast fibrosis and retraction (OR 3.58, 95% CI 1.024-12.526, p = 0.046) and breast edema (OR 6, 95% CI 2.077-17.335, p = 0.001) compared to IORT-f, but a lower risk of seroma compared to IORT-b (OR 0.36, 95% CI 0.166-0.785, p = 0.01). The BIBCQ scores showed a better outcome in arm concerns with IORT-f (-3.3) vs. IORT-b (-1.3, p = 0.002) and EBRT (-1.7, p = 0.006), although biased by the lower rate in axillary dissections. Return to daily activities occurred after 70.6 days with EBRT vs. 41 days with IORT-f (p < 0.0001) and 53.3 days with IORT-b (p = 0.07), without any effect of age or axillary dissection. CONCLUSION: IORT could reduce adverse effects, allowing faster resumption of job and houseworks.

Short commentaries on data published by Petit et al. on locoregional risk after lipofilling in breast cancer patients.

Lipofilling is becoming part of the breast reshaping after quadrantectomy or mastectomy in breast cancer patients, but there are open questions of its safety.

Hepatic metastases from breast cancer.

The prognosis of patients with hepatic metastasis from breast cancer treated with systemic or regional chemotherapy is disappointing. When technically feasible, liver resection offers the best results. Eighteen patients out of 22 submitted to laparotomy underwent radical liver resection. Median follow-up from liver resection was 36 months. The median time interval between breast cancer diagnosis and disease recurrence was 35 months. Median disease-free survival and overall survival from liver resection were 66 and 74 months, respectively. Median survival time from breast cancer surgery was 88.5 months. Surgical treatment of liver metastases should be carried out on young and older patients alike when site of metastases is the liver alone. Neoadjuvant treatment and preoperative diagnostic laparoscopy should be planned in future experience.

B and C hepatitis viruses, HLA-DQ1 and -DR3 alleles and autoimmunity in patients with hepatocellular carcinoma.

BACKGROUND/AIMS: Hepatitis B and C involvement in hepatocellular carcinoma has been well established, but as yet not that of the human lymphocyte antigen (HLA) complex. To study viral, HLA and tumour interrelationships, 105 patients were evaluated for prevalence of viral markers and 161 patients, including 99 of the previous ones, for HLA allele frequency; the other 52 patients served as controls. METHODS: Immunoassays, molecular assays, microlymphocytotoxicity. RESULTS: Positivity for hepatitis B surface antigen and/or hepatitis C antibodies in 89% cirrhotic, 44% non-cirrhotic vs. 92% control patients (cirrhotic; all hepatitis C antibody positives were viraemic). Recurrent HLA alleles: HLA-Cw7 and -DQ1 in cirrhotic and control patients, HLA-Cw7, -B8 and -DR3 in non-cirrhotic patients compared with healthy controls (Pc=0.0000074, 0.000025, 0.0025, 0.00027 and 0.043, respectively). CONCLUSIONS: Viral data suggest a high chronic infection rate for cirrhotic patients. Recurrent HLA-Cw7 is compatible with natural killer cell activity inhibition to virus-infected and tumour cells by HLA C molecules. Recurrent HLA-DQ1 and -DR3 suggest the existence of an autoimmune condition with cell destruction in cirrhotic and without cell destruction in non-cirrhotic patients as a consequence of autoreactive DQ-restricted T-helper (Th)1 and DR-restricted Th2 cells response, respectively. HLA-B8-DR3 linkage disequilibrium was possible. Thus, autoimmunity may have contributed to hepatocellular carcinoma development in these patients.