Synchronous multiple primary malignant neoplasms in breast,kidney,and bilateral thyroid:A case report

BACKGROUND Multiple primary malignant neoplasms(MPMNs)are rare,while synchronous MPMNs(SMPMNs)are even less common.Owing to the progression of medical technology and the extension of life expectancy,its incidence is gradually increasing.CASE SUMMARY Although reports of breast and thyroid dual cancers are common,cases of an additional diagnosis of kidney primary cancer within the same individual are rare.CONCLUSION We present a case of simultaneous MPMN of three endocrine organs,reviewing the relevant literature to enhance our understanding of SMPMNs while emphasizing the increasingly important need for accurate diagnosis and multidisciplinary management whenever this challenging situation arises.

Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)

Breast cancer is the most common cancer among women worldwide.It has been estimated that about 416000 new cases and over 117000 deaths of breast cancer occurred in China in 2020.Among the new cases of breast cancer diagnosed each year,3-10%have distant metastasis at the time of initial diagnosis.In addition,approxi-mately 30%of patients with early-stage breast cancer may eventually experience recurrence or metastases.The 5-year survival rate of patients with advanced breast cancer is only 20%with a median overall survival of 2-3 years.Although advanced breast cancer remains incurable at present,new therapeutic options and multidisci-plinary treatment could be utilized to alleviate symptoms,improve quality of life,and prolong patients’survival.The choice of treatment regimens for patients with advanced breast cancer is very important,and the optimal treatment strategy beyond the first-and second-line therapy is often lacking.Herein,the China Advanced Breast Cancer Guideline Panel discussed and summarized recent clinical evidence,updated the guidelines for the diag-nosis and treatment of advanced breast cancer based on the 2020 edition,and formulated the“Guidelines for diagnosis and treatment of advanced breast cancer in China(2022 edition)”for clinicians’reference.

Violence against Women with Breast Neoplasms

The aim of this study is to assess the occurrence and type of violence suffered by women with breast cancer in the High Complexity Care Unit of a municipality in the South of Minas and patients in a support group of the University of the South of Minas Gerais. For that aim, a descriptive-exploratory methodology was applied through the quantitative method. Data were collected through a semi-structured form applied in individual interviews over a period of three months. We interviewed 57 patients and among those, 20 women （35.08%） reported having experienced some form of violence at some stage of their life, and the most frequently mentioned was the psychological violence followed by physical aggression. Although it was possible to identify that violence against affected these women, complaints against the aggressor were not affected.

The accuracy of magnetic resonance imaging and ultrasound in evaluating the size of early-stage breast neoplasms

Objective Breast cancer is the most frequently diagnosed cancer in women. Accurate evaluation of the size and extent of the tumor is crucial in selecting a suitable surgical method for patients with breast cancer. Both overestimation and underestimation have important adverse effects on patient care. This study aimed to evaluate the accuracy of breast magnetic resonance imaging(MRI) and ultrasound(US) examination for measuring the size and extent of early-stage breast neoplasms.Methods The longest diameter of breast tumors in patients with T_(1–2)N_(0–1)M_0 invasive breast cancer preparing for breast-conserving surgery(BCS) was measured preoperatively by using both MRI and US and their accuracy was compared with that of postoperative pathologic examination. If the diameter difference was within 2 mm, it was considered to be consistent with pathologic examination.Results A total of 36 patients were imaged using both MRI and US. The mean longest diameter of the tumors on MRI, US, and postoperative pathologic examination was 20.86 mm ± 4.09 mm(range: 11–27 mm), 16.14 mm ± 4.91 mm(range: 6–26 mm), and 18.36 mm ± 3.88 mm(range: 9–24 mm). US examination underestimated the size of the tumor compared to that determined using pathologic examination(t = 3.49, P < 0.01), while MRI overestimated it(t =-6.35, P < 0.01). The linear correlation coefficients between the image measurements and pathologic tumor size were r = 0.826(P < 0.01) for MRI and r = 0.645(P < 0.01) for US. The rate of consistency of MRI and US compared to that with pathologic examination was 88.89% and 80.65%, respectively, and there was no statistically significant difference between them(χ~2 = 0.80, P > 0.05).Conclusion MRI and US are both effective methods to assess the size of breast tumors, and they maintain good consistency with pathologic examination. MRI has a better correlation with pathology. However, we should be careful about the risk of inaccurate size estimation.

Current status of ultrasound-guided surgery in the treatment of breast cancer

The primary goal of breast-conserving surgery(BCS) is to obtain tumour-free resection margins. Margins positive or focally positive for tumour cells are associated with a high risk of local recurrence, and in the case of tumour-positive margins, re-excision or even mastectomy are sometimes needed to achieve definite clear margins. Unfortunately, tumour-involved margins and re-excisions after lumpectomy are still reported in up to 40% of patients and additionally, unnecessary large excision volumes are described. A secondary goal of BCS is the cosmetic outcome and one of the main determinants of worse cosmetic outcome is a large excision volume. Up to 30% of unsatisfied cosm-etic outcome is reported. Therefore, the search for better surgical techniques to improve margin status, excision volume and consequently, cosmetic outcome has continued. Nowadays, the most commonly used localization methods for BCS of non-palpable breast cancers are wire-guided localization(WGL) and radioguided localization(RGL). WGL and RGL are invasive procedures that need to be performed pre-operatively with technical and scheduling difficulties. For palpable breast cancer, tumour excision is usually guided by tactile skills of the surgeon performing "blind" surgery. One of the surgical techniques pursuing the aims of radicality and small excision volumes includes intraoperative ultrasound(IOUS). The best evidence available demonstrates benefits of IOUS with a significantly high proportion of negative margins compared with other localization techniques in palpable and non-palpable breast cancer. Additionally, IOUS is non-invasive, easy to learn and can centralize the tumour in the excised specimen with low amount of healthy breast tissuebeing excised. This could lead to better cosmetic results of BCS. Despite the advantages of IOUS, only a small amount of surgeons are performing this technique. This review aims to highlight the position of ultrasoundguided surgery for malignant breast tumours in the search for better oncological and cosmetic outcomes.

Histopathological Features of Invasion of Breast Invasive Ductal Carcinoma and Safety of Breast-conserving Surgery

In order to investigate the relationship between the extent of tumor invasion and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and histologic grading in breast invasive ductal carcinoma as well as the optimal extent of excision during the breast-serving surgery, the clinical data of 104 patients with breast invasive ductal carcinoma who had received modified radical mastectomy were analyzed. The correlation analysis on invasive extent, which was evaluated by serial sections at an interval of 0.5 cm from 4 different directions taking the focus as the centre, and the tumor size, axillary lymph nodes metastasis, Her-2 gene overexpression, and his- tologic grading was processed. There was a significant correlation between invasive extent and tumor size （r=-0.766, P〈0.01）, and lymph nodes metastases 0=0.574, P〈0.01）, but there was no significant correlation between invasive extent and Her-2 expression （r=-0.106, P〉0.05）, and histologic grading （r=-0.228, P〉0.05）. The 100% negative rate of infiltration in patients without nipple discharge with tumor size 〈2, 2-3 and 〉3 cm was obtained at 1.5, 2.0 and 2.5 cm away from the tumor respectively. It is concluded that the performance of breast-serving surgery in patients with breast invasive ductal carcinoma should be evaluated by tumor size in combination with axillary lymph nodes involvement to decide the possibility of breast-serving and the secure excision extent.

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.

Trends in outpatient breast cancer surgery among Medicare fee-for-service patients in the United States from 1993 to 2002

The practice of outpatient breast cancer surgery has been controversial in the United States. This study aimed to update time trends and geographic variation in outpatient breast cancer surgery among elderly Medicare fee-for-service women in the United States. Using the 1993-2002 linked Surveillance, Epidemiology and End Results (SEER)-Medicare claims data and the Area Resource Files, we identified 2 study samples, including the women whose breast cancers were the first-ever-diagnosed cancer at age 65 years or older from 9 regions continuously covered by the SEER registries since 1993. The first sample included the women receiving unilateral mastectomy for stage 0-IV cancer; the second included the women receiving the breast-conserving surgery with lymph node dissection (BCS/LND) for stage 0-II cancer. The proportions of patients receiving outpatient surgery increased from 3.2% to 19.4% for mastectomy and from 48.9% to 77.8% for BCS/LND from 1993 to 2002. We observed substantial geographic variation in the average proportion of the patients receiving outpatient surgery in the studied areas across the 10-year period, ranging from 3.9% in Connecticut to 27.2% in Utah for mastectomy and from 54.7% in Hawaii to 78.1% in Seattle, Washington, for BCS/LND. As the popularity of outpatient breast cancer surgery continues to grow, more evidence-based analyses related to quality and outcomes of outpatient breast cancer surgery among various populations are needed in order to facilitate the public debates about state and federal mandated health benefit legislations.

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.

Granular cell tumor of the breast:A case report and review of literature

BACKGROUND Granular cell tumor(GCT)of the breast(GCTB)is a rare neoplasm that can exhibit malignant characteristics both clinically and radiologically.This tumor can also coexist and colocalize with breast carcinoma.CASE SUMMARY We present a patient with this uncommon tumor and discuss the diagnostic and therapeutic approaches in order to further the knowledge of GCTB and prevent misdiagnosis and overtreatment.The characteristics of the tumor,methods of diagnosis,therapy and postoperative pathological outcomes were analyzed,and relevant literatures of GCTs were reviewed.The patient underwent surgery after core needle biopsy,and the excised neoplasm was sent for pathological examination.Histological analysis revealed nests of cells with abundant pink granular cytoplasm,confirming the diagnosis of GCTB.CONCLUSION As manifestations of GCT and malignancy can mimic each other,a careful histological examination is essential before major surgery.Treatment consisting of complete excision with close clinical follow-up is recommended.

Axillary Sentinel Lymph Node Biopsy for Breast Cancer and Melanoma Patients after Previous Axillary Surgery: A Systematic Review

Objective: Sentinel lymph node biopsy (SLNB) is a validated staging technique for breast carcinoma. Some women are exposed to have a second SLNB due to breast cancer recurrence or a second neoplasia (breast or other). Due to modified anatomy, it has been claimed that previous axillary surgery represents a contra-indication to SLNB. Our objective was to analyse the literature to assess if a second SLNB is to be recommended or not. Methods: For the present study, we performed a review of all published data during the last 10 years on patients with previous axilla surgery and second SLNB. Results: Our analysis shows that second SLNB is feasible in 70%. Extra-axillary SNs rate (31%) was higher after radical lymph node dissection (ALND) (60% - 84%) than after SLNB alone (14% - 65%). Follow-up and complementary ALND following negative and positive second SLNB shows that it is a reliable procedure. Conclusion: The review of literature confirms that SLNB is feasible after previous axillary dissection. Triple technique for SN mapping is the best examination to highlight modified lymphatic anatomy and shows definitively where SLNB must be performed. Surgery may be more demanding as patients may have more frequently extra-axillary SN only, like internal mammary nodes. ALND can be avoided when second SLNB harvests negative SNs. These conclusions should however be taken with caution because of the heterogeneity of publications regarding SLNB and surgical technique.

Surgical Procedures,Pathological Features and Prognosis in Young Women with Breast Cancer in China--a Single Institute Experience

Objective:To compare the differences in surgical procedures,pathological features and prognosis between young and elderly women with breast cancer in China.Methods:A retrospective study compared the data of surgical procedures,pathological features and prognosis of 61 cases of young females(≤40 years)and 507 cases of elderly females(>40 years),treated in our department from August 2011 to July 2018.This data was analyzed using SPSS 23.0 program.Results:10.74% of total cases,in this period of time,involve young females.In terms of surgical procedures,24.59%of young patients underwent breast conserving surgery(8.48% elderly,respectively),and 13.11%underwent reconstruction surgery(1.18% elderly,respectively),with statistically significant differences existing between the two groups(P<0.05).Progesterone receptor(PR)expression in young women was significantly higher than in elderly females(P<0.05).There were no significant differences between the two groups in the proportion of invasive ductal carcinoma(IDC),axillary lymph node metastasis(ALNM),expression of estrogen receptor(ER),human epidermal growth factor receptor-2(HER-2)and Ki-67,but the lymphatic metastasis stage showed an increasing rate with younger age.No significant difference was found in 3-year disease-free survival(DFS)and overall survival(OS).Conclusion:The selection rate of breast conserving and reconstructive surgery in young women with breast cancer is significantly higher than that in elderly women.The younger the patient,the more frequently the PR positive expression,and the more likely ALNM to occur.The 3-year prognosis of the young and elderly patients is similar.

Oncologic Outcomes of Breast Cancer Patients Treated with Oncoplastic Surgery

Background: The impact of breast appearance after breast cancer surgical treatment on patients’ quality of life led to the development of the oncoplastic approach. However, studies reporting oncologic results associated with this treatment strategy are scarce. This cross-sectional study was designed to assess oncologic outcomes among patients who underwent oncoplastic surgery. Methods: A total of 190 breast cancer patients who underwent breast-conserving surgery were enrolled. Fifty of them underwent oncoplastic surgery and 140 had none breast reconstruction procedure (control group). All surgeries were performed by the same surgical team. Results: Groups were similar with regard to staging, histological type, grade of the tumor, presence of intraductal component, hormone receptors and nodal commitment. Patients in oncoplastic surgery group had larger tumors (ρ = 0.001) and more lymphovascular invasion (ρ = 0.047). Further, a higher proportion of them underwent chemotherapy (ρ = 0.030). Follow-up time of control group was longer (ρ = 0.05), and these patients also had a longer relapse-free survival time (ρ = 0.001). Local recurrence rate was 5.8% (11/190) and it was significantly greater in the oncoplastic surgery group (8/11, ρ = 0.001). Time to local recurrence after surgery was longer in oncoplastic surgery group (ρ = 0.002). Overall, patients in oncoplastic surgery group were younger (ρ = 0.001), but at the time of local recurrence, patients in oncoplastic surgery group were older than those in control group (ρ = 0.0002). Conclusions: Among the studied patients, local recurrence rate was greater in those who underwent oncoplastic surgery.

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.

三阴型乳腺癌基于组织学、免疫组化分型的分析

目的探讨基于组织学、免疫组化的三阴型乳腺癌(triple-negative breast cancer,TNBC)分型标准,为完善TNBC分型治疗提供理论依据。方法根据组织学特点和免疫组化标志物AR、CD8、FOXC1的表达对TNBC进行分型,比较TNBC亚型的临床病理特征、预后差异。结果93例TNBC中腔面雄激素受体型23例(24.7%),免疫调节型24例(25.8%),基底样免疫抑制型39例(42.0%),间充质型7例(7.5%)。TNBC亚型的临床病理特征:pT分期(P=0.030)、组织学分级(P<0.001)、肿瘤间质淋巴细胞浸润模式(P<0.001)、PD-L1(P<0.001)、HER2低表达(P=0.024)差异均有统计学意义;各亚型间的无瘤生存率差异无统计学意义(P>0.05)。单因素分层生存分析:亚型间pT1分期的无瘤生存率差异有统计学意义(P=0.011),其余临床病理特征均为非独立预后因素。结论TNBC基于组织学、免疫组化分型的临床病理特征有差异,有望替代复杂基因表达谱分型,为TNBC分型和靶向治疗提供理论依据。

曲妥珠单抗联合氟维司群治疗晚期乳腺癌患者疗效安全性及预后影响

目的探讨曲妥珠单抗联合氟维司群治疗晚期乳腺癌患者疗效、安全性及对预后的影响。方法回顾性分析2016年6月至2017年4月于我院诊疗人表皮生长因子受体-2(HER2)阳性,雌激素受体(HR)+型晚期乳腺癌绝经女性患者60例作为研究对象,2组患者均已接受乳腺癌的常规手术,化疗和(或)放疗,靶向治疗(曲妥珠单抗)及内分泌治疗(他莫昔芬),其中,30例为使用曲妥珠单抗治疗的基础上联合氟维司群进行内分泌治疗的患者,作为研究组,同时期采用氟维司群内分泌治疗的30例患者作为对照组,2组患者均治疗6个月,6个月后2组均给予曲妥珠单抗和氟维司群的治疗。比较2组患者的治疗效果、不良反应、乳腺癌扩增性抗原1(AIB1)、激活转录因子3(ATF3)以及生活质量之间的差异;随访3年,对比2组术后生存期。结果①通过对所有患者的随访,随访率为97%(58/60),观察组患者的总生存期(OS)及无进展生存期(PFS)均显著高于对照组(P<0.05);②2组患者出现肝功能异常、低热、乏力等差异无统计学意义(P>0.05);③经过治疗后,2组患者的AIB1、ATF3水平显著降低,且观察组患者AIB1、ATF3水平显著低于对照组(P<0.05);④经过治疗后,2组患者的生理功能、生理职能、躯体疼痛、一般健康、精力、社会功能、情感职能、心理健康、总分显著升高,且观察组患者的生理功能、生理职能、躯体疼痛、一般健康、精力、社会功能、情感职能、心理健康、总分等均高于对照组(P<0.05);⑤治疗后,2组患者治疗客观有效率和疾病控制率差异有统计学意义,相较于对照组,研究组均较高(P<0.05)。结论晚期乳腺癌患者采用曲妥珠单抗治疗基础上联合氟维司群治疗,可以改善患者的AIB1、ATF3水平,提升患者的临床治疗效果和生活质量。

超声乳腺影像报告和数据系统联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤

目的观察超声乳腺影像报告和数据系统(BI-RADS)联合患者年龄鉴别良性与交界性/恶性乳腺叶状肿瘤(PTB)的价值。方法回顾性分析74例经乳腺超声检查及术后病理证实的PTB女性患者共76个病灶,包括良性57个、交界性14个及恶性5个,比较3种病变患者年龄及其超声BI-RADS分类,观察以单一年龄、超声BI-RADS及其联合鉴别诊断价值。结果良性、交界性及恶性PTB之间,患者年龄及超声BI-RADS分类差异均有统计学意义(P=0.026、0.015)。以44.5岁、超声BI-RADS 4B类及其联合鉴别良性与交界性/恶性PTB的敏感度分别为94.74%、36.84%及73.68%,特异度分别为56.36%、87.27%及72.73%,曲线下面积分别为0.769、0.649及0.780。结论超声BI-RADS分类联合患者年龄有助于鉴别良性与交界性/恶性PTB。

乳腺癌综合治疗的疗效随访

目的观察经免疫组织化学分型的乳腺癌综合治疗疗效,为临床治疗提供参考。方法随访山西省肿瘤医院2010年1月至2012年12月治疗的1240例乳腺癌患者,其中导管型883例;人表皮生长因子受体-2(HER-2)型260例;三阴性乳腺癌(TNBC)97例。保乳术(BCS)或术前新辅助化疗,或术后放化疗的共275例;改良根治术(IRM)和术前新辅助化疗,或术后放化疗的共965例。BCS和IRM后,均行术后常规患侧全乳房、全胸壁调强放疗(IMRT)和锁骨淋巴引流区放疗,DT约50 Gy。腋窝淋巴转移阳性者,补照腋窝区DT 60~70 Gy。雌激素受体(ER)阳性者,行辅助性内分泌治疗。HER-2阳性者,加用曲妥珠单克隆抗体靶向药物治疗。结果BCS和IRM患者的五年生存率分别是81.8%和78.2%(P>0.05),其中腋窝淋巴结无转移者为91.8%;1~3个淋巴结转移者为74.0%;4个以上转移者为63.0%。4个以上淋巴结转移者和无转移者五年生存率差异具有统计学意义(P<0.01)。导管型五年生存率为98.0%;HER-2型为37.7%;TNBC型为17.5%。结论导管型对内分泌治疗敏感,预后最好;HER-2型对抗HER-2靶向药物有效,预后居中;TNBC型具有较强的侵袭性,且对内分泌和靶向药物治疗效果有限,预后最差。免疫组织化学分型和腋窝淋巴结转移数的多少,是影响预后的重要因素之一。

乳腺癌发病与中医体质及辨证分型的相关性研究

目的探讨乳腺癌发病与中医体质及辨证分型的相关性。方法选取2021年1月至2023年6月在安徽医科大学第一附属医院就诊的108例乳腺癌患者为观察组,另选取同期在该院进行体检的80例健康妇女为对照组。统计所有受试者的一般资料、中医体质及中医辨证分型,采用多因素logistic回归分析乳腺癌发病的危险因素,以Spearman法分析中医体质与辨证分型的相关性。结果108例乳腺癌患者中,以气虚质(18.52%)、气郁质(16.67%)、血瘀质(13.89%)占比较高,2组间平和质、气虚质、血瘀质、气郁质分布比例比较,差异有统计学意义(P<0.05),其他体质分布比例差异无统计学意义(P>0.05);多因素logistic回归分析结果显示,平和质为乳腺癌发病的保护因素,气虚质、气郁质为乳腺癌发病的危险因素(P<0.05);108例乳腺癌患者中,辨证分型最多为气血亏虚证(56.48%),其后依次为肝郁痰凝证(18.52%)、冲任失调证(16.67%)、肝肾阴虚证(8.33%);气虚质与气血亏虚证呈正相关(P<0.05);阴虚质与肝肾阴虚证呈正相关(P<0.05);血瘀质与冲任失调证呈正相关(P<0.05);气郁质与肝郁痰凝证呈正相关(P<0.05)。结论气虚质、气郁质为乳腺癌的易感体质,乳腺癌中医体质与辨证分型存在相关性,在一定程度上影响疾病证型的发生及发展。