Adjuvant therapy for hormone receptor-positive breast cancer: Perspective from a survey on breast cancer physicians' acceptance of practice-changing data

A cross-sectional online survey was conducted.A high proportion of the Chinese breast cancer(BC)physician respondents(n=77)would prescribe extended adjuvant endocrine therapy(AET)with aromatase inhibitors(AI)beyond 5 years for postmenopausal females with BC,especially those with higher risk.Respondents with≥15 years of clinical experience were more likely to prescribe a longer duration of AET for low-risk patients.Half of the respondents considered intermittent letrozole as an acceptable option.Most respondents would prescribe adjuvant chemotherapy to genomic high-intermediate risk[Oncotype DX recurrence score(RS)21-25]females aged≤50 years regardless of the clinical risk classification.

Breast cancer: Epidemiology, risk factors and screening

Breast cancer is a global health concern with a significant impact on the well-being of women. Worldwide, the past several decades have witnessed changes in the incidence and mortality of breast cancer. Additionally,epidemiological data reveal distinct geographic and demographic disparities globally. A range of modifiable and non-modifiable risk factors are established as being associated with an increased risk of developing breast cancer.This review discusses genetic, hormonal, behavioral, environmental, and breast-related risk factors. Screening plays a critical role in the effective management of breast cancer. Various screening modalities, including mammography,ultrasound, magnetic resonance imaging(MRI), and physical examination, have different applications, and a combination of these modalities is applied in practice. Current screening recommendations are based on factors including age and risk, with a significant emphasis on minimizing potential harms to achieve an optimal benefits-to-harms ratio. This review provides a comprehensive insight into the epidemiology, risk factors, and screening of breast cancer. Understanding these elements is crucial for improving breast cancer management and reducing its burden on affected individuals and healthcare systems.

Breast reconstruction:Review of current autologous and implantbased techniques and long-term oncologic outcome

Implant-based reconstruction is the most common method of breast reconstruction.Autologous breast reconstruction is an indispensable option for breast reconstruction demanding keen microsurgical skills and robust anatomical understanding.The reconstructive choice is made by the patient after a discussion with the plastic surgeon covering all the available options.Advantages and disadvantages of each technique along with long-term oncologic outcome are reviewed.

Early prediction of pathological outcomes to neoadjuvant chemotherapy in breast cancer patients using automated breast ultrasound

Objective： Early assessment of response to neoadjuvant chemotherapy （NAC） for breast cancer allows therapy to be individualized. The optimal assessment method has not been established. We investigated the accuracy of automated breast ultrasound （ABUS） to predict pathological outcomes after NAC. Methods： A total of 290 breast cancer patients were eligible for this study. Tumor response after 2 cycles of chemotherapy was assessed using the product change of two largest perpendicular diameters （PC） or the longest diameter change （LDC）. PC and LDC were analyzed on the axial and the coronal planes respectively. Receiver operating characteristic （ROC） curves were used to evaluate overall performance of the prediction methods. Youden＇s indexes were calculated to select the optimal cut-off value for each method. Sensitivity, specificity, positive and negative predictive values （PPV and NPV） and the area under the ROC curve （AUC） were calculated accordingly.Results： ypT0/is was achieved in 42 patients （14.5%） while ypT0 was achieved in 30 patients （10.3%） after NAC. All four prediction methods （PC on axial planes, LDC on axial planes, PC on coronal planes and LDC on coronal planes） displayed high AUCs （all〉0.82）, with the highest of 0.89 [95% confidence interval （95% CI）, 0.83-0.95] when mid-treatment ＆BUS was used to predict final pathological complete remission （pCR）. High sensitivities （85.7%-88.1%） were observed across all four prediction methods while high specificities （81.5%-85.1%） were observed in two methods used PC. The optimal cut-off values defined by our data replicate the WHO and the RECIST criteria. Lower AUCs were observed when mid-treatment ABUS was used to predict poor pathological outcomes. Conclusions：ABUS is a useful tool in early evaluation of pCR after NAC while less reliable when predicting poor pathological outcomes.

Combined molybdenum target X-ray and magnetic resonance imaging examinations improve breast cancer diagnostic efficacy

BACKGROUND Early-stage breast cancer patients often lack specific clinical manifestations,making diagnosis difficult.Molybdenum target X-ray and magnetic resonance imaging(MRI)examinations both have their own advantages.Thus,a combined examination methodology may improve early breast cancer diagnoses.AIM To explore the combined diagnostic efficacy of molybdenum target X-ray and MRI examinations in breast cancer.METHODS Patients diagnosed with breast cancer at our hospital from March 2019 to April 2021 were recruited,as were the same number of patients during the same period with benign breast tumors.Both groups underwent molybdenum target X-ray and MRI examinations,and diagnoses were given based on each exam.The single(i.e.,X-ray or MRI)and combined(i.e.,using both methods)diagnoses were counted,and the MRI-related examination parameters(e.g.,T-wave peak,peak and early enhancement rates,and apparent diffusion coefficient)were compared between the groups.RESULTS In total,63 breast cancer patients and 63 benign breast tumor patients were recruited.MRI detected 53 breast cancer cases and 61 benign breast tumor cases.Molybdenum target X-ray detected 50 breast cancer cases and 60 benign breast tumor cases.The combined methodology detected 61 breast cancer cases and 61 benign breast tumor cases.The sensitivity(96.83%)and accuracy(96.83%)of the combined methodology were higher than single-method MRI(84.13%and 90.48%,respectively)and molybdenum target X-ray(79.37%and 87.30%,respectively)(P<0.05).The combined methodology specificity(96.83%)did not differ from singlemethod MRI(96.83%)or molybdenum target X-ray(95.24%)(P>0.05).The Twave peak(169.43±32.05)and apparent diffusion coefficient(1.01±0.23)were lower in the breast cancer group than in the benign tumor group(228.86±46.51 and 1.41±0.35,respectively).However,the peak enhancement rate(1.08±0.24)and early enhancement rate(1.07±0.26)were significantly higher in the breast cancer group than in the benign tumor group(0.83±0.19 and 0.75±0.19,respectively)(P<0.05).CONCLUSION Combined molybdenum target X-ray and MRI examinations for diagnosing breast cancer improved the diagnostic sensitivity and accuracy,minimizing the missedand misdiagnoses risks and promoting timely treatment intervention.

A multicenter hospital-based diagnosis study of automated breast ultrasound system in detecting breast cancer among Chinese women

Objective： The automated breast ultrasound system（ABUS） is a potential method for breast cancer detection;however, its diagnostic performance remains unclear. We conducted a hospital-based multicenter diagnostic study to evaluate the clinical performance of the ABUS for breast cancer detection by comparing it to handheld ultrasound（HHUS） and mammography（MG）.Methods： Eligible participants underwent HHUS and ABUS testing; women aged 40–69 years additionally underwent MG. Images were interpreted using the Breast Imaging Reporting and Data System（BI-RADS）.Women in the BI-RADS categories 1–2 were considered negative. Women classified as BI-RADS 3 underwent magnetic resonance imaging to distinguish true-and false-negative results. Core aspiration or surgical biopsy was performed in women classified as BI-RADS 4–5, followed by a pathological diagnosis. Kappa values and agreement rates were calculated between ABUS, HHUS and MG.Results： A total of 1,973 women were included in the final analysis. Of these, 1,353（68.6%） and 620（31.4%）were classified as BI-RADS categories 1–3 and 4–5, respectively. In the older age group, the agreement rate and Kappa value between the ABUS and HHUS were 94.0% and 0.860（P〈0.001）, respectively; they were 89.2% and0.735（P〈0.001） between the ABUS and MG, respectively. Regarding consistency between imaging and pathology results, 78.6% of women classified as BI-RADS 4–5 based on the ABUS were diagnosed with precancerous lesions or cancer; which was 7.2% higher than that of women based on HHUS. For BI-RADS 1–2, the false-negative rates of the ABUS and HHUS were almost identical and were much lower than those of MG.Conclusions： We observed a good diagnostic reliability for the ABUS. Considering its performance for breast cancer detection in women with high-density breasts and its lower operator dependence, the ABUS is a promising option for breast cancer detection in China.

Exercise for fatigue in breast cancer patients: An umbrella review of systematic reviews

Objective:To evaluate evidence from published systematic reviews about the effectiveness of exercise interventions on fatigue management in breast cancer patients.Methods:PubMed,Web of Science,the Cochrane Library,the Cumulative Index of Nursing and Allied Health(CINAHL),Embase databases,the China National Knowledge Infrastructure(CNKI),the Wanfang database,the China Biomedical Literature Database(CBM),and the VIP database were searched to identify relevant systematic reviews.The reviews which assessed exercise interventions on cancer-related fatigue(CRF)in breast cancer patients were included.Quality of evidence was evaluated by the Grade of Recommendation,Assessment,Development,and Evaluation(GRADE)tool.The Assessment of Multiple Systematic Reviews(AMSTAR)appraisal tool was used to evaluate the methodological quality of included systematic reviews.Results:Twenty-four systematic reviews met all the inclusion criteria.The overall mean score for AMSATR is 7.38 and ranged from 4 to 10 points.In addition,21 reviews arrived at positive conclusions,which exercises could reduce CRF,and 3 obtained that exercise does not affect fatigue.As for GRADE,8 of the reviews were graded as'moderate',2 of the studies were'very low',and the others were'low'.Conclusions:Aerobic and resistance exercise can be regarded as beneficial to CRF in breast cancer patients,and limited evidence exists that yoga had an effect on reducing fatigue.The quality of the current systematic review is still far from satisfactory.

Evaluation of menopausal status among breast cancer patients with chemotherapy-induced amenorrhea

Objective： In patients with chemotherapy-induced amenorrhea （CIA）, the menopausal status is ambiguous anddifficult to evaluate. This study aimed to establish a discriminative model to predict and classify the menopausalstatus of breast cancer patients with CIA.Methods： This is a single center hospital-based study from 2013 to 2016. The menopausal age distribution andaccumulated incidence rate of CIA are described. Multivariate models were adjusted for established and potentialconfounding factors including age, serum concentration of estradiol （E2） and follicle-stimulating hormone （FSH）,feeding, pregnancy, parity, abortions, and body mass index （BMI）. The odds ratio （OR） and 95% confidenceinterval （95% CI） of different risk factors were estimated.Results： A total of 1,796 breast cancer patients were included in this study, among whom, 1,175 （65.42%） werepremenopausal patients and 621 （34.58%） were post-menopause patients. Five hundred and fifty patients wereincluded in CIA analysis, and a cumulative CIA rate of 81.64% was found in them. Age （OR： 1.856, 95% CI：1.732-1.990）, serum concentration of E2 （OR： 0.976, 95% CI： 0.972-0.980） and FSH （OR： 1.060, 95% CI：1.053-i.066）, and menarche age （OR： 1.074, 95% CI： 1.009-1.144） were found to be associated with the patients＇menopausal status. According to multivariate analysis, the discriminative model to predict the menopausal status isLogit （P）=-28.396＋0.536Age-0.014E2＋0.031FSH. The sensitivities for this model were higher than 85%, and itsspecificities were higher than 89%.Conclusions： The discriminative model obtained from this study for predicting menstrual state is important forpremenopausal patients with CIA. This model has high specificity and sensitivity and should be prudently used.

Sarcoidosis imitating breast cancer metastasis:a case report and literature review

Sarcoidosis is a benign systematic granulomatous disorder of unknown etiology and is associated with various malignancies.However, granulomatous and metastatic lymph node lesions are difficult to distinguish even when using precise and modern diagnostic methods, such as positron emission tomography. Thus, histological verification is the only method that can be used to accurately describe the nature of this disease. In this article, we report a case of non-luminal HER-2/neu-positive breast cancer in a patient without history of sarcoidosis and suspected to have metastatic disease.

Breast adenoid cystic carcinoma arising in microglandular adenosis:A case report and review of literature

BACKGROUND Breast adenoid cystic carcinoma(AdCC)is a rare invasive carcinoma composed of epithelial and myoepithelial cells.Microglandular adenosis(MGA)is a rare benign proliferative lesion consisting of small,uniform,and round glands formed by a single layer of epithelial cells and basement membrane without a myoepithelial cell layer.MGA may progress to atypical MGA and carcinoma arising in MGA.Among various invasive carcinomas from MGA,AdCC has been rarely reported.Here,we report a case of AdCC arising in MGA.CASE SUMMARY A 59-year-old woman was diagnosed with a newly developed density on a routine mammogram.The density was similar to or slightly lower than that of the breast parenchyma.Sonography showed an irregular mass with a slightly higher echo than that of fat.Magnetic resonance imaging showed an irregular mass with a similar T1 signal intensity and a slightly higher T2 signal intensity compared to muscles or the breast parenchyma.The lesion showed heterogeneous internal enhancement with an initially slow and delayed persistent enhancing pattern.Microscopically,the tumor was composed of invasive AdCC,in situ AdCC,and MGA.AdCC is composed of basaloid and ductal epithelial cells forming cribriform or solid sheets,or haphazardly scattered small cribriform or tubular glands.MGA showed small glands with a single epithelial lining and retained lumen.S-100 staining was strongly positive in MGA area.The patient underwent breast-conserving surgery with sentinel lymph node biopsy.CONCLUSION Breast AdCC arising in MGA showed unique imaging findings that was different from usual invasive cancer.

IMMEDIATE BREAST RECONSTRUCTION WITH LATISSIMUS DORSI MUSCULOCUTANEOUS FLAP: A SUITABLE OPTION FOR CHINESE WOMEN AFTER MASTECTOMY

Objective： To discuss the suitable immediate breast reconstruction modalities for Chinese patients by comparing the pedicled transverse rectus abdominis myocytaneous flap （TRAM） reconstruction with latissimus dorsi myocytaneous flap （LTD） reconstruction plus implants or not after mastectomy due to breast cancer. Methods： From Jan. 2000 to Jul. 2005, 74 staged 0-II patients （mean age 39） were performed immediate breast reconstruction with autologous tissue either using LTD flaps or pedicled TRAM flaps with supplemental implants when necessary after mastectomy due to breast cancer and the charts were reviewed. Results： The age, marriage and menses status did not affect the selection of modalities and the need of implants. In 74 patients, 62 cases （83.8%） were performed LTD reconstruction with 13 implants and 12 cases received TRAM with 1 implant. The difference in need of implants or not between the two modalities had no statistical significance （P=0.442, Fisher＇ exact test）. Aesthetic results judged as good or fair were in 88% patients and the cosmetic effects between LTD and TRAM groups or implant and non-implant groups had no differences. All reconstructions were successful, with 4.1% cumulative locoregional recurrence and 100% overall survival by following up to 66 months （median 9 months）. The DFS and RFS between the two modalities had no significant differences by log rank test. Conclusion： Immediate autologous tissue reconstruction makes it possible to regain the natural and symmetric contour of breast without increased local recurrence. The LTD flap reconstruction is a suitable option for most Chinese women as well as the pedicled TRAM flap.

THE CLINICAL COURSE AND TREATMENT RESULTS OF LUNG METASTASES FROM BREAST CANCER

Objective: To analyze the clinical course and treatment result of lung metastases from breast cancer Method: 122 cases with lung metastases from breast cancer were treated with chemotherapy or chemotherapy plus endocrine therapy, response was assessed according to WHO criteria and survival rate estimated using the life Table Results: The median time from initial treatment of primary tumor to lung metastases was 22 months Sites of common consecutive metastases were lung, liver and bone The overall response rate was 48% with a CR rate of 15% Compared to non DDP encompassing regimen, the CR rate was higher in DDP based chemotherapy (7% versus 21%, P <0 05) with a longer median survival time (MST) The PR rate was higher in regimens containing anthracycline (48%) than in those without anthracycline (20%, P <0 01) The response rate was similar between chemotherapy and chemotherapy plus endocrine therapy ( P >0 05) No difference in MST was observed between patients receiving anthracycline and non anthracycline encompassing regimens The 1 , 3 , 5 , and 10 year survival rate was 77%, 22%, 11%, and 10%, respectively Conclusion: Size of primary tumor, the length of disease free interval, the number of lung metastases may provide additional information for predicting patients survival after treatment of lung metastases Combination chemotherapy, especially DDP based chemotherapy may prolong survival time of patients with lung metastases from breast cancer

MULTIVARIATE ANALYSIS OF BONE METASTASES IN BREAST CARCINOMA

Objective： To investigate the risk factors of bone metastases in breast carcinoma. Methods： By cross sectional study, the data of 225 breast cancer patients who were inpatients in four hospitals in Hangzhou were analyzed. All patients underwent total body bone scan with single photon emission computed tomography （SPECT） at least once during 1995 to 2000. Results： All patients were followed-up to 294 months after operation, bone metastases were found in 113 cases, suspected bone metastases 3 cases, with a bone metastases rate of 50.9% （113/222）. Multivariate analysis by Cox＇s proportional hazards regression model showed that there were four risk factors of bone metastases in breast cancer： （1） clinical stage, Ⅰ～Ⅳ stages with a hazard ratio of bone metastases of 1.945, 95% confidence interval 1.396～2.710; （2） number of invaded axillary lymph nodes, with a hazard ratio of 1.039, 95% confidence interval 1.0142～1.068; （3） skeletal complications （yes vs. no）, with a hazard ratio of bone metastases of 1.722, 95% confidence interval 1.060～2.796; （4） age at the time of surgery or diagnosis, with a hazard ratio of 2.048, 95% confidence interval 1.123～3.876 for patients of age 40～50 y versus patients bellow 40 y of age and 2.837, 95% confidence interval 1.473～5.465 for patients of age above 50 y versus patients of ages between 40 and 50. Kaplan-Meier curves showed that for patients with more than 5 invasive axillary lymph nodes, compared with those with 1～5, the bone metastasis rates increased significantly （x^2 =6.3319, P=0.012）. Conclusion： The clinical stage, number of metastatic axillary lymph nodes, age at the time of operation and skeletal complications are essential risk factors of bone metastases.

Morphologic and texture features in classifying the malignant and benign breast nodules in ultrasonography

Objective To develop a computer-aided diagnosis(CAD)system with automatic contouring and morphologic and textural analysis to aid on the classification of breast nodules on ultrasound images.Methods A modified Level Set method was proposed to automatically segment the breast nodules(46malignant and 60benign nodules).Following,16morphologic features and 17texture features from the extracted contour were calculated and principal component analysis(PCA)was applied to find the optimal feature vector dimensions.Fuzzy C-means classifier was utilized to identify the breast nodule as benign or malignant with selected principal vectors.Results The performance of morphologic features was 78.30%for accuracy,67.39%for sensitivity and 86.67%for specificity,while the latter was 72.64%,58.70%and 83.33%,respectively.After the combination of the two features,the result was exactly the same with the morphologic performance.Conclusion This system performs well in classifying the malignant breast nodule from the benign breast nodule.

Spatholobus suberectus column extract inhibit estrogen receptor positive breast cancer

OBJECTIVE To investigate the inhibitory effects of Spatholobus Suberectus Column Extract(SSCE)on estrogen receptor positive(ER+)breast cancer cel MCF-7and its possible molecular mechanism.METHODS MCF-7cells were cultured without estrogen and with 17-β-estrogen(10-8mol·L-1),respectively,then treated with SSCE(0,40,80,160,320μg·m L-1).MTT assay was employed to evaluate cell viability.Flow cytometry assays were performed to underlying apoptosis and detecting cel cycle of MCF-7 cells treated with SSCE(0,80,160,320μg·mL-1).Wound healing assays was conducted to detect the migration ability.Dual luciferase reporter system was used to detect the activity of p-ERα,p-ERβpresented in intra-nuclear estrogen response element(ERE).Western blotting assay was employed to identify the expression of protein such as Bax,Bcl-2,p-ERα,p-ERβ,ERK1/2,p-ERK1/2,AKT,p-AKT,m TOR,p-m TOR,PI3K,p-PI3K.RESULTS It showed that SSCE(80,160and 320μg·mL-1)significantly decreased the viability of MCF-7.SSCE also triggered apoptosis,arrested cell cycle at G0/G1phase,inhibited migration.Dual luciferase reporter system showed that SSCE suppressed intra-nuclear p-ER activity,Western blotting analysis confirmed that SSCE did repress the expression of phosphorylated-ER alpha(p-ERα),ERK1/2,p-ERK1/2,AKT,p-AKT,pmT OR,PI3K,p-PI3K,which indicate that SSCE suppress MAPK PI3K/AKT signal pathway.CONCLUSION Our result showed that SSCE cause ER+MCF-7 cells apoptosis,G0/G1phase arresting,migration decreasing,via hypo-active of ER,suppress MAPK PI3K/AKT pathway.

EXPRESSION OF E-CADHERIN/CATENIN COMPLEX IN BREAST CANCER

Objective： To detect the expressions of E-cadherin, α-catenin and β-catenin and analyze the relationship between Ecadherin-catenin adhesion complex and clinicopathological features in breast cancer. Methods： The expressions of E-cadherin, α-cadherin and β-catenin in specimens of 54 breast cancer, 21 normal breast tissues around tumor, 15 breast hyperplasia of usual type and 15 breast atypical hyperplasia were detected by immunohistochemical method. Results： In 21 normal breast tissues, E-cadherin and α-catenin were expressed on cell membrane of ductal and acinic cells, showing cellular contour and border among cells. The staining character of the three proteins in breast hyperplasia of usual type was the same as that in normal breast tissue. In breast atypical hyperplasia, the abnormal expression rates of E-cadherin, α-catenin and β-catenin were 6.7%, 13.3% and 26.7%, respectively. The total abnormal expression rate of E-cadherin-catenin complex was 33.3%. In breast cancer, the abnormal expression rates of E-cadherin, α＋catenin and β-catenin were 51.9%, 63.0% and 61.1%, respectively. The total abnormal expression rate of E-cadherin-catenin complex was 88.9%. Abnormal expression of E-cadherin and α-catenin were significantly correlated with histological grade. Abnormal expressions of α-catenin and β-catenin were significantly correlated with TNM staging, axillary lymph nodes metastasis and postoperative distant metastasis. Abnormal expression of E-cadherin-catenin complex was correlated with TNM staging, histological grade and axillary lymph nodes. Abnormal expression of β-catenin was negatively correlated with expression of HER-2. COX multiple factor analysis showed that E-cadherin or α-catenin or β-catenin was not independent prognostic indicator. Conclusion： Abnormal expressions of E-cadherin, α-catenin and β-catenin frequently occur in breast cancer. Abnormal expression of E-cadherin-catenin complex is correlated with differentiation disturbance and metastasis. Combined measurement of E-caherin, α-catenin and β-catenin may improve accuracy and sensitivity of predicting metastasis and prognosis of breast cancer.

THE MAMMOGRAPHIC CALCIFICATIONS IN BREAST CANCER

Objective: This study was performed to exam the relativeship between mammographic calcifications and breast cancer. Methods: All of the 184 patients with breast diseases underwent mammography before either an open biopsy or a mastectomy. The presence, morphology, and distribution of calcifications visualized on mammograms for breast cancer were compared with the controls who remained cancer free. Statistical comparisons were made by using the x 2 test. Results: Of the 184 patients with breast diaeases, 93 malignant and 91 benign lesions were histologically confirmed. Calcifications were visualized on mammograms in 60 (64%)of 93 breast cancers and 26(28%)of 91 non breast cancers. The estimated odds ratio (OR) of breast cancer was 4.5 in women with calcifications seen on mammo grams, compared with those having none ( P < 0.01). Of the 60 breast carcinomas having mammographic calcifi cations, 28 (47%) were infiltrating ductal carcinomas. There were only 8 (24%) cases with infiltrating ductal cancers in the group of without calcifications seen on the mammograms ( P <0.05). Conclusion: Our finding sug gests that mammographic calcification appears to be a risk factor for breast cancer. The granular and linear cast type calcification provide clues to the presence of breast cancer, especially when the carcinomas without associated masses were seen on mammograms.

Papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis and breast cancer: A case report

BACKGROUND The recognized pattern of cervical lymph node metastasis(CLNM)of papillary thyroid carcinoma involves a stepwise route.Contralateral lymph node skip metastasis is very rare.In addition,the patient in our case report also suffered from a breast carcinoma accompanied by left supraclavicular lymphadenopathy,which made it difficult to distinguish the origin of the CLNM.Based on this case,we recommended that more detailed physical and imaging examinations are needed for patients with uncommon cervical lymphatic metastasis of primary cancer.CASE SUMMARY A 53-year-old women was admitted to the hospital for a neck mass in the left cervical region that had existed for 2 mo.The neck mass was suspected to be an enlarged lateral LN originating from papillary thyroid microcarcinoma of the contralateral thyroid lobe,according to ultrasound and ultrasound-guided fine needle aspiration biopsy.The patient underwent total thyroidectomy and radical cervical LN dissection.Postoperative pathology confirmed the diagnosis of papillary thyroid microcarcinoma with contralateral lymphatic skip metastasis.Unfortunately,a breast cancer was discovered 4 mo later,which was accompanied by ipsilateral supraclavicular LN metastasis.She accepted neoadjuvant chemotherapy and subsequent left modified radical mastectomy for treatment.The patient is currently receiving postoperative radiotherapy,and no local recurrence was observed in the 6-mo follow-up after surgery.CONCLUSIONWe present a rare case of papillary thyroid microcarcinoma with contralateral lymphatic skipmetastasis and breast cancer with supraclavicular lymphatic metastasis.

Sun-burn induced upper limb lymphedema 11 years following breast cancer surgery: A case report

BACKGROUND Upper arm lymphedema is a common complication one year after breast cancer surgery,which profoundly impacts patients'quality of life.CASE SUMMARY We reported a case of lymphedema induced by prolonged sun exposure 11 years after breast cancer surgery.CONCLUSION Breast screening,patient education and follow-up after hospital discharge could help to prevent upper-arm lymphedema.

LOCALIZATION OF TYPE I AND TYPE Ⅲ PROCOLLAGEN mRNAs IN BREAST SCIRRHOUS CARCINOMA BYIN SITU HYBRIDIZATION

Scirrhous carcinoma is charactertzed by reinarkable amount of collagen fibrils, mainly type I and type III collagens. The origin of collagens is still under debate.cDNA fragments of type I and type III procollagens were subcloned into Gemini pGEM vectors to synthesize the 35Slabeled cRNA probes. By in situ hybridization, we have found the fibroblasts surrounding the tumor cells and cords contained abundent type I and type III procollagen mRNAs which decreased with the distance of fibroblasts from the tumor cells. In all freshly prepared tissues, the tumor cells also contained significant pro α1 (I) and pro α1 (III) mRNAs, but no or little pro α2 (I) mRNA. The results indicated that type I and type III collagens in human scirrhous carcinoma of breast are mainly produced by fibroblasts. Tumor cells also perticipate in the disposition of collagen fibrils, probably type I trimer and type III collagens in accordance with what was observed in biochemical