[Cytosteatonecrosis after breast reconstruction by fat flap with or without ischemic preconditioning]. / Cytostéatonécrose après reconstruction mammaire par lambeau graisseux avec ou sans préconditionnement ischémique.

INTRODUCTION: Cytosteatonecrosis (CTN) is a frequent postoperative complication after breast autologous reconstruction using DIEP (deep inferior epigastric perforator) flap. CTN radiological diagnostic reveals different types of lesions, as nodes or extended fat necrosis, which become in some cases infected, or pass for tumor recurrence after breast cancer treatment. CTN is caused by intraoperative ischemia of the flap, and no current method can prevent postoperative CTN development after DIEP breast reconstruction. Mechanical ischemic preconditioning, consisting in intraoperative briefs consecutive cycles of ischemia reperfusion using vascular clamp upon the graft pedicle, is used in transplantation surgery. This procedure improves the graft tolerance towards ischemic surgical lesions. The aim of this retrospective observational study was to assess PCIM effects on CTN development after DIEP surgery, comparing CTN occurrence after breast reconstruction using DIEP flap with or without intraoperative PCIM. MATERIAL AND METHODS: All patients breats reconstructed using DIEP flap between novembre 2020 and may 2022, presenting 6 months postoperative breast echography were retrospectively included. Primary outcome was the ultrasonic existence of CTN, according to the Wagner classification. Clinical data, postoperative outcomes such as infection, hematoma or surgical revision, and length of stay in hospital were also recorded. RESULTS: Twenty nine patients among which 8 PCIM were included. CTN occurrence rate after PCIM (25%) was quite lower than CTN rate without PCIM (71,4%), although the difference was not significant (P=0,088). Other postoperative complications rates were not significantly different with or without PCIM. CONCLUSION: PCIM seems to improve CTN occurrence after DIEP breast reconstruction, improving fat flap tolerance to ischemic perioperative lesions. Those preliminary results need to be confirmed with clinical prospective study.

[Multivisceral pancratic cytosteatonecrosis found at autopsy]. / Cytostéatonécrose multiviscérale d'origine pancréatique, de découverte autopsique.

INTRODUCTION: Pancreatic cytosteatonecrosis is a rare condition associated with various pancreatic diseases such as acute or chronic pancreatitis and pancreatic cancer. We report a case of pancreatic cytosteatonecrosis discovered at autopsy. OBSERVATION: This is a young man, 29 years old, alcoholic, non-smoker, who consulted for abdominal pain, vomiting, fever (38°). Renal ultrasound showed signs of acute renal failure, with severe anemia at 6g/dl and hyperleukocytosis. Lipasemia has not been tested. The treatment combined hemodialysis, punctures of effusions, analgesics, antibiotics and diuretics. The death occurred after 45 days of hospitalization. The medical autopsy requested showed an abdominal cavity dotted with multiple whitish, chalky, "candle-stained" nodules scattered throughout the peritoneum. Microscopy confirmed the diagnosis by showing large areas of adiponecrosis associated with polymorphic, diffuse leukocyte infiltrates and calcifications. CONCLUSION: This observation is original by the discovery at autopsy of one of the major complications of acute pancreatitis. This situation is dramatic because the death could be avoided. You have to think about it in order to ask for the dosage of lipasemia. The "digestion" of pancreatic enzymes are responsible for intra-pancreatic and peri-pancreatic complications. Chronic alcoholism and cholelithiasis are the main risk factors.

[Neonatal cytosteatonecrosis complicated by major hypercalcemia]. / Cytostéatonécrose néonatale compliquée d'hypercalcémie majeure.

We here report the case of a female infant with perinatal asphyxia requiring resuscitation. She was referred with sclerema neonatorum which had been observed by parents on her tenth day of life. The lesions appeared as hard erythematous nodular plaques, suggesting neonatal cytosteatonecrosis in the gluteal region. Patient's evolution was marked by progressive hypercalcemia reaching a peak of 128 mg/L (80-110 mg/L) for which re-hospitalization was required 1 month after birth. Renal ultrasound showed medullary nephrocalcinosis. Treatment was based on hyperhydration associated with diuretics, corticosteroids and abstention from vitamin D administration as well as on clinical and laboratory monitoring of serum calcium levels. A month later, cutaneous lesions were regressing and calcium levels were normalizing. The patients is still undergoing ultrasound monitoring.

[Rare benign breast tumors including Abrikossoff tumor (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma: Guidelines for clinical practice]. / Prise en charge des tumeurs du sein bénignes épidémiologiquement rares de type Abrikossoff (tumeur à cellules granuleuses), adénomatose érosive du mamelon, cytostéatonécrose, fibromatose mammaire (tumeur desmoïde), galactocèle, hamartome, hémangiome, lipome, papillomatose juvénile, hyperplasie stromale pseudo-angiomateuse (PASH), et tumeur syringomateuse du mamelon: recommandations.

OBJECTIVES: To provide guidelines for clinical practice from the French College of Gynaecologists and Obstetricians (CNGOF), based on the best evidence available, concerning rare benign breast tumors: Abrikossoff (granular cell tumor), erosive adenomatosis of the nipple, cytosteatonecrosis, fibromatosis (desmoid tumor), galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma. METHODS: Bibliographical search in French and English languages by consultation of Pubmed, Cochrane and international databases. RESULTS: For erosive adenomatosis of the nipple, surgical excision is recommended to exclude Paget's disease or cancer (grade C). When surgery is performed for breast desmoid tumor or syringomatous adenoma, free margins are recommended (grade C). Without clinico-radio-histologic discordance, surgical abstention may be proposed for Abrikossoff tumor (granular cell tumor), cytosteatonecrosis, galactocele, hamartoma, hemangioma, lipoma, juvenile papillomatosis, pseudoangiomatous hyperplasia, and syringomatous adenoma (grade C).