Breast Carcinoma Arising in Fibroadenoma in a 15-Year-Old Girl;Diagnosis and Treatment Challenge

Breast cancer in adolescents occurring in fibroadenomas is extremely rare. We report a case of right breast cancer in a 15-year-old female student diagnosed in 2020. This is the youngest reported case of breast cancer arising within fibroadenomas in the literature. The teenager has no personal or family history of cancer or known hereditary disease. Currently, there is no consensus on the management of breast cancer arising from adenofibromas in adolescents. Clinically, the tumor was inflammatory with axillary lymph node involvement (T4dN1M0). The fine-needle aspiration cytologic was suspicious of malignancy. The patient received four courses of neoadjuvant chemotherapy with 5-fluorouracil®, doxorubicin® and cyclosphosphamide®, followed by radical right mastectomy. The histological result of the surgical specimen is a non-specific carcinoma with a therapeutic effect greater than fifty percent. The patient received three courses of adjuvant chemotherapy with paclitaxel®. The adolescent underwent radiation therapy at her chest wall of 50 Gy and regional lymph node of 46 Gy. After radiotherapy, hormone therapy with Tamoxifene® at 20 mg per day was started. At 16 months from radiotherapy, there is no recurrence. The reconstruction of the right breast is planned in a few months.

Breast-conserving therapy and modified radical mastectomy for primary breast carcinoma:a matched comparative study

Background- To compare two types of therapy for primary breast carcinoma, breast-conserving therapy （BCT） and modified radical mastectomy （MRM）, in a matched cohort study. Methods： A series of 1,746 patients with primary breast cancer treated with BCT or MRM in a single Chinese institute between January 2000 and February 2009 were analyzed retrospectively to compare their outcomes with respect to the incidence of local recurrence （LR）, distant metastasis, and survival. The patients were matched with regard to age at diagnosis, spreading to axillary lymph nodes, hormone receptor status, the use of neoadjuvant chemotherapy and maximal tumor diameter. The match ratio was 1：1, and each arm included 873 patients. Results： The median follow-up period was 71 months. The 6-year disease-free survival （DFS） and 6-year distant disease-free survival （DDFS） rates differed significantly between two groups. The 6-year local recurrence-free survival （LRFS） rates were 98.2% [95% confidence interval （CI）： 0.973-0.989] in the BCT group and 98.7% （95% CI： 0.980-0.994） in the MRM group （P=0.182）, respectively. DFS rates in BCT and MRM groups were 91.3% （95% CI： 0.894-0.932） and 86.3% （95% CI： 0.840-0.886） （P〈0.001）, respectively, whereas the DDFS rates in BCT and MRM groups were 93.6% （95% CI： 0.922-0.950） and 87.7% （95% CI： 0.854-0.900） （P〈0.001）, respectively. Conclusions： BCT in eligible patients is as effective as MRM with respect to local tumor control, DFS and DDFS, and may result in a better outcome than MRM in Chinese primary breast cancer patients.

Conservative Treatment of Breast Cancer and Oncoplasty at the Teaching Hospital Mother and Child of Jeanne Ebori Foundation in Libreville (Gabon)

Introduction: Breast cancer is currently the most common malignant tumour in women worldwide. Objective: To evaluate conservative treatment of breast cancer and oncoplasty at the teaching hospital Mother and Child of Jeanne Ebori Foundation (CHUMEFJE). Patients and methods: This is an observational, descriptive study, which took place from August 2019 to December 2021 at CHUMEFJE. Data were collected using patients’ medical records, and operative and pathological anatomy reports. Results: Conservative treatment and oncoplasty were performed in 12 (34.2%) patients. Of these patients, 8 (66.7%) benefited from an external technique and 2 (16.7%) from a pamectomy. Post-operative complications were dominated by lymphocele in 5 (41.6%) patients. Ten (83.3%) patients were satisfied with the post-operative aesthetic result. At the time of updating the records, 1 (8.3%) patient had died and 11 (91.7%) were alive. Conclusion: Conservative treatment and oncoplasty are giving satisfactory results at the CHUMEFJE in Libreville.

Effect of Breathing on Exposed Lung Volumes and Doses in Patients with Breast Carcinoma Receiving Radiotherapy

Introduction: This study evaluates the changes in the lung volume (LV) exposed radiation during the breath cycle and whether these volume differences have an effect on both lung and target doses in breast carcinoma patients. Material and Methods: Ten patients with left breast carcinoma underwent breast conservative surgery or mastectomy receiving radiotherapy (RT) (breast or chest wall and regional lymph nodes) were included. For this study, planning computerized tomography (CT) images were obtained during deep inspiration (DI) and end of expiration (EE), besides free breathing (FB) to simulate breath cycles. Three-dimensional conformal or intensity-modulated RT planning was done to obtain dose-volume information using CT series taken FB, DI and EE. The treatment plan was done with FB images and exported to the DI and EE scans and re-calculated. Volume changes and calculated dose differences according to breath cycles were compared. Results: There were significant differences in the whole LV, ipsilateral LV and contralateral LV between FB-DI and EE-DI while no significant difference was seen between FB and EE. V20 was lower during DI than FB and EE but the difference was not significant. There was no significant variation in whole breast dose although significant dose variations were observed in mean MI, supraclaviculary and level III axillary lymph node doses between breath cycles. Conclusion: Breath cycle had no significant effect on whole breast dose although significantly changed regional lymph node doses in patients with breast carcinoma receiving whole breast and regional lymph nodes radio-therapy. V20 dose was lower during DI than FB and EE, but the difference was not significant.

Familial versus Sporadic Breast Cancer: Different Treatments for Similar Tumors?

Objective: It is unclear if and to what extent family history of breast/ovarian cancer or BRCA1/2-mutation carriership influences breast cancer treatment strategy. We investigated whether treatment differed between patients from BRCA1/2 families and those unselected for family history. Methods: We included 478 BRCA1/2-related patients referred for genetic testing before or after diagnosis. Two references were used: 13,498 population-based and 6896 hospital-based patients. Surgical treatment and adjuvant chemotherapy use was analyzed using logistic regression models, stratified by tumor size, nodal status, age at and period of diagnosis, and estrogen receptor status (ER). Results: BRCA1/2 cases aged 35 - 52 years at diagnosis and/or with tumors < 2 cm were more likely to have undergone a modified radical mastectomy (Odd Ratios (OR) ranging from 2.8 to 5.1) compared to the references. This effect was most pronounced in patients treated after 1995 (OR 5.7 to 10.3). Compared to the reference groups, chemotherapy was more often administered to BRCA1 and ER-negative BRCA1/2-cases irrespective of age and nodal status (OR 1.9 to 24.3). Conclusion: After 1995 treatment of BRCA1/2-associated patients consisted notably of more mastectomies and adjuvant chemotherapy than their population-based counterparts with the same tumor characteristics. There is a need to be aware of such differences in daily practice and interpretation of survival studies on BRCA1/2 mutation carriers.

Presentation of Axillary Metastases from Occult Breast Carcinoma

Axillary presentation from occult breast cancer is uncommon and continues to be a diagnostic and therapeutic challenge to physicians. Once the diagnosis of adenocarcinoma metastatic to an axillary lymph node has been confi rmed, a preoperative workup should be done. The current experience is based on several relatively small retrospective reviews and case reports. It is diffi cult to determine the best management of occult breast cancer. However, treatment of axillary lymph node dissection is recommended for local control and complete staging information. Treatment of breast should be a choice between breast conservation with whole-breast radiotherapy and mastectomy. Adjuvant systemic treatment should be offered.

Treatment outcomes of occult breast carcinoma and prognostic analyses

Background The surgical management of occult breast cancer is controversial.We compared the outcomes of different treatments of occult breast cancer and evaluated the potential prognostic factors for overall survival and recurrence.Methods We retrospectively reviewed 77 patients who presented to our hospital from 1968 to 2011 with a diagnosis of occult breast cancer.Patients were divided into three groups：42 patients （63％） were treated with modified radical mastectomy＋axillary lymph node dissection （ALND）,16 patients （24％） were treated with ALND＋postoperative radiotherapy,and 9 patients （13％） with only ALND.Survival analyses were undertaken to compare the efficacy of these three treatments.Results Of the 77 patients with occult breast cancer,2 patients were lost to follow-up and 8 patients refused surgical treatment：67 patients （90.4％） were included in this analysis.The median follow-up was 62.2 （0.6-328.0）months.Kaplan-Meier analyses showed no significant difference in overall survival and recurrence-free survival between the three groups （P=0.494 and 0.397,respectively）.The prevalence of local recurrence was 11.9％ for the mastectomy＋ALND,18.8％ for ALND＋radiotherapy,and 11.1％ for ALND-only groups,and those for distant recurrence were 2.4％,12.5％,and 11.1％,respectively.Compared with progesterone receptor-negative subjects,progesterone receptor-positive patients had better overall survival and lower recurrence rates （P=0.057 and 0.062,respectively）.Conclusions There was no significant difference in outcomes between mastectomy and breast-preserving surgery.Expression of the progesterone receptor should be taken into account when evaluating the prognosis of occult breast cancer.

Bilateral involvement in patients with granulomatous mastitis: Surgical treatment and case report

Introduction: Granulomatous mastitis (GM) is a rare benign histopathologic lesion, associated with tissue inflammation, architectural distortions and heterogeneous parenchymal inflammation upon radiological evaluation. The treatment of GM is controversial, and currently, there is no consensus about the most appropriate therapy. Case Presentation: We presented a unique, atypical GM case with a prolonged disease course that ultimately led to a bilateral mastectomy. A conservative therapeutic approach and limited or wide surgical excisions have failed to prevent unfavorable outcomes in both the initial presentation and recurrent disease. Conclusions: There’re no clear data in the literature delineating persistent recurrences of GM after conservative treatment and multiple surgeries. Obtaining a disease-free surgical margin might be an important prognostic factor for a lasting relapse-free clinical resolution.

Parallel pathways:A chronicle of evolution in rectal and breast cancer surgery

In this editorial,we have analyzed the historical evolution of rectal and breast cancer surgery,focusing on the progressive reduction of demolitive approaches and the increasing use of more conservative strategies,accompanied by a growing emphasis on perioperative treatments aimed at enhancing surgical outcomes.All of these changes have been made possible due to an increased awareness and understanding of oncological diseases and improved perioperative treatments.

DUCTAL CARCINOMA IN SITU OF THE BREAST

Objective: To investigate the clinical characteristics, treatment and prognosis of ductal carcinomain situ (DCIS) of the breast. Methods: Clinicopathological and follow-up data were collected in 52 patients with DCIS. Results: The clinic data showed that 50 patients had signs of breast lumps or/and nipple discharges, 2 patients presented abnormal mammography; 2 patients had lymph node involved; and 14 patients were accompanied with intraductal papillomatosis. All patients were received surgical therapy. The follow-up data showed 1 patient locally recurred after lumpectomy, and was underwent mastectomy again, then cured. There were no patients died of DCIS. Conclusion: Mastectomy should be a standard surgical mode, and the prognosis of DCIS was favorable, but mammography for screening of asymptomatic women should be strengthened to find DCIS.

Effect of Breast Conserving Sentinel Lymph Node Biopsy(SLNB)and Modified Radical Mastectomy on Patients with Early Breast Cancer

Objective:To study the clinical effect of breast conserving combined with sentinel lymph node biopsy and modified radical mastectomy in patients with early breast cancer.Methods:Female patients with early breast cancer in clinical stage I and II were selected as the main objects of this study,the study period started from July 2017 to July 2020.In the breast conserving and sentinel lymph node biopsy patients,50 cases were randomly selected as the experimental group;50 cases in the modified radical mastectomy patients were randomly selected as the control group.The clinical intervention effect of the two groups was analyzed.Results:the perioperative indexes of the experimental group were shorter than those of the control group,the patients recovered faster,the incidence of complications in the experimental group was lower,and the quality of life scores of the experimental group were significantly higher than those of the control group,and the difference was statistically significant,the intervention effect of the experimental group was also better.Conclusion:The application of breast conserving and sentinel lymph node biopsy in the treatment of early breast cancer can promote the recovery of patients,shorten the operation time and reduce the rate of complications,which has significant clinical significance.

BREAST CONSERVING THERAPY IN STAGE T_1 & T_2 BREAST CANCER PATIENTS

Objective: To investigate the effect of breast-conservation therapy in early stage breast cancer. Methods: A total of 234 early stage breast carcinoma patients received breast conserving treatment in our hospital. After the operation, they underwent adjuvant chemotherapy and radiotherapy. All of these patients desired to preserve their breasts. Results: After median follow-up of 29.46 months (range from 3 to 100 months), 3 cases had local relapse and 8 cases had distant metastasis. The overall survival rate of 5 year was 96.7%, and the disease free survival rate of 5 year was 87.85%. Conclusion: For early stage breast carcinoma patients, classic quadrantectomy, axillary dissection and post-operative adjuvant chemotherapy and radiotherapy lead to excellent local control and good survival.

Is breast conservative surgery a reasonable option in multifocal or multicentric tumors?

The incidence of multifocal(MF) and multicentric(MC) carcinomas varies widely among clinical studies,depending on definitions and methods for pathological sampling.Magnetic resonance imaging is increasingly used because it can help identify additional and conventionally occult tumors with high sensitivity.However,false positive lesions might incorrectly influence treatment decisions.Therefore,preoperative biopsies must be performed to avoid unnecessary surgery.Most studies have shown higher lymph node involvement rates in MF/MC tumors than in unifocal tumors.However,the rate of local recurrences is usually low after breast conservative treatment(BCT) of MC/MF tumors.It has been suggested that BCT is a reasonable option for MC/MF tumors in women aged 50-69 years,with small tumors and absence of extensive ductal carcinoma in situ.A metaanalysis showed an apparent decreased overall survival in MC/MF tumors but data are controversial.Surgery should achieve both acceptable cosmetic results and negative margins,which requires thorough preoperative radiological workup and localization of lesions.Boost radiotherapy techniques must be evaluated since double boosts might result in increased toxicity,namely fibrosis.In conclusion,BCT is feasible in selected patients with MC/MF but the choice of surgery must be discussed in a multidisciplinary team comprising at least radiologists,surgeons and radiotherapists.

Synchronous breast cancer and breast lymphoma:two case reports and literature review

Synchronous breast cancer and breast lymphoma are rare. It is of high rate of misdiagnosis in clinical practice. Here we present two cases with this presentation. They are both middle-aged women, with stage I invasive ductal carcinoma of the breast. One patient happened to have primary breast lymphoma （PBL）; the other was secondary breast lymphoma （SBL）. Their pathology and immunohistochemistry （IHC） findings supported the diagnosis of multiple primary carcinoma. Both patients had a surgery. Then they both received CHOP regime chemotherapy and subsequent endocrine therapy.

Perioperative Interstitial Brachytherapy as a Boost in Breast Cancer Conserving Therapy

Background: The aim of breast-conserving treatment (BCT) in breast cancer, consisting of wide local excision (WLE) and radiotherapy, is to obtain local control of disease as well as an optimal cosmetic result. The application of perioperative brachytherapy allows more precise deposition of the boost radiation dose to the lumpectomy cavity plus margins in a shorter period of time, as compared to external beam radiotherapy. The aim of the present study was to analyze the oncological outcome of interstitial brachytherapy in our patient population of patients with early-stage breast cancer. Patients and Methods: 107 breasts in 105 patients with T1-2 breast cancer were treated between 1996 and 2009 with BCT, including WLE combined with perioperative brachytherapy using Iridium-192 (15 Gy with low dose rate or 9 Gy with high dose rate) followed by whole breast irradiation (50 Gy). Outcomes analyzed included treatment toxicity (according to Common Terminology Criteria for Adverse Events), local recurrence rate, and disease-free and overall survival. Results: Median follow-up of patients still alive was 6.3 years (range 2.0 - 14.5). Mean age was 50.2 years (+/- S.D. 10.5). Mean tumor diameter was 15 mm (+/- S.D. 8 mm. Acute complications consisted of grade 1 and 3 complications, respectively n = 8 and n = 1. Late complications consisted of grade 1 or 2, respectively n = 25 and n = 2. Only three patients (2.8%) developed a local recurrence with a median time to recurrence of 9.3 years (range 3.3 - 9.3). Five- and ten-year local recurrence free survival was 99% and 91%, respectively. Five- and ten-year disease-specific and overall survival was 95% and 84% versus 92% and 78%, respectively. Conclusions: Treatment-related toxicity after brachytherapy for breast cancer was mild. The local recurrence rate is low. Therefore, brachytherapy is a good alternative to conventional radiation boost as a part of breast irradiation in breast conserving treatment in early stage breast cancer.

Current aspects of therapeutic reduction mammaplasty for immediate early breast cancer management: An update

Breast-conservation surgery(BCS) is established as a safe surgical treatment for most patients with early breast cancer. Recently, advances in oncoplastic techniques are capable of preserving the breast form and quality of life. Although most BCS defects can be managed with primary closure, the aesthetic outcome may be unpredictable. Among technical options, therapeutic reduction mammaplasty(TRM) remains a useful procedure since the BCS defect can be repaired and the preoperative appearance can be improved, resulting in more proportional breasts. As a consequence of rich breast tissue vascularization, the greater part of reduction techniques have based their planning on preserving the pedicle of the nipple-areola complex after tumor removal. Reliable circulation and improvement of a conical shape to the breast are commonly described in TRM reconstructions. With an immediate approach, the surgical process is smooth since both procedures can be carried out in one operative setting. Additionally,it permits wider excision of the tumor, with a superior mean volume of the specimen and potentially reduces the incidence of margin involvement. Regardless of the fact that there is no consensus concerning the best TRM technique, the criteria is determined by the surgeon's experience, the extent/location of glandular tissue resection and the size of the defect in relation to the size of the remaining breast. The main advantages of the technique utilized should include reproducibility, low interference with the oncological treatment and long-term results. The success of the procedure depends on patient selection, coordinated planning and careful intra-operative management.

Breast Conserving Surgery: Has the Standard of Care Enhanced Outcomes for Patients?

Breast Conserving Surgery (BCS) is a rapidly emerging field increasingly adopted to facilitate breast conservation and preserve breast aesthetics. Since the publication of the Randomized Controlled Trials (RCTs) of Breast Conserving Surgery versus mastectomy in early breast cancer, the adoption of BCS for breast cancer patients’ surgical management has been comprehensive. A computerized bibliographic search was performed on PubMed/MEDLINE, Embase, Google Scholar and Cochrane library databases. This article aims to perform a thorough review of new data regarding invasive cancer and margins while evaluating patient outcomes related to BCS after neoadjuvant chemotherapy focusing on margins, imaging evaluation, the extent of resection, and local regional recurrence outcomes. The growth pattern and biopsy of Ductal Carcinoma In Situ (DCIS) differ from invasive cancer, impacting margins. It is essential to understand how the Society of Surgical Oncology (SSO) DCIS margin guideline has influenced practice. Early breast cancer surgical management should be unique to each patient, driven by evidence-based medicine, and focused on specific clinical, histological, and molecular characteristics of the tumor. Conclusion: The current management for early breast cancer should be tailored and evidence-based to each patient based on the clinical, histological and molecular characteristics of the tumor. Presumably, the standard of care in BCS has enhanced the outcomes for this patient population. This review made by peers will help surgeons to stay up to date with the current literature and help them manage breast cancer while improving multiple clinical parameters such as Disease-Free Survival (DFS), Recurrence-Free Survival (RFS) and most importantly Overall Survival (OS).

Clinicopathological characteristics,treatments,and prognosis of breast ductal carcinoma in situ with microinvasion:A narrative review

Background:Ductal carcinoma in situ with microinvasion(DCIS-MI)is defined as ductal carcinoma in situ(DCIS)with a microscopic invasive focus≤1 mm in the longest diameter.The current literature is controversial concerning the clinical prognostic features and management of DCIS-MI.This narrative review described recently reported literature regarding the characteristics,treatment,and prognosis of it.Methods:Searching PubMed for relevant articles covering the period of 1982 to 2021 using the following terms by MeSH and free-word:breast cancer,microinvasion,DCIS,DCIS-MI,and invasive ductal carcinoma(IDC).Results:DCIS-MI tends to express more aggressive pathological features such as necrosis,HER2+,ER-or PR-,and high nuclear grade.The overall prognosis of DCIS-MI is typically good,however,some indicators such as young age,HR-,HER2+and multimicroinvasive lesions,were associated with worse prognoses.And there are also conflicting results on the differences between the prognoses of DCIS-MI and DCIS or T1a-IDC.Postoperative chemotherapy and anti-HER2 therapy still have uncertain benefits and are more likely to be used to treat high-risk patients who are HR-orHER2+to improve the prognosis.Conclusion:DCIS-MI has more aggressive pathological features,which may suggest its biological behavior is worse than that of DCIS and similar to early IDC.Although the overall prognosis of DCIS-MI is good,when making decisions about adjuvant therapy clinicians need to give priority to the hormone receptor status,HER2 expression and axillary lymph node status of patients,because these may affect the prognosis and treatment response.

Mastectomy—A Critical Review

History of breast cancer dates back to at least 1600 B.C. and treatment methods have undergone significant progress over the last hundred years. We are moving away from frighteningly radical, and towards increasingly more conservational breast cancer surgery. And while mastectomy is no longer a first-line choice for all breast cancers, it is still an important and, really, an essential procedure to discuss and research about. Different types and techniques exist and evidence regarding each is vast-with novel techniques appearing even nowadays. For example, robotic surgery is increasingly more common in many surgical specialties and procedures, and mastectomy is no exception. With several high-profile celebrities recently discussing their experiences of breast cancer and mastectomies, this article covers a multitude of essential aspects relevant to this topic, in turn, hopefully, helping patients and doctors deal with the diagnosis and plan the treatment accordingly. Current breast cancer care and mastectomy trends are also discussed here, giving the readers an up-to-date overview of how breast cancer can and should be managed.

基于美学需求的个案护理模式对乳腺癌保乳切除术后患者心理状态和瘢痕的影响

目的:探究基于美学需求的个案护理模式对乳腺癌保乳切除术后患者心理状态和瘢痕的影响。方法:选择2019年2月-2022年2月笔者医院行乳腺癌保乳切除术的106例患者,按随机数表法分为观察组(n=53)和对照组(n=53)。对照组采用常规护理模式,观察组采用基于美学需求的个案护理模式。比较两组护理干预前后心理状态[焦虑自评量表(Selfrating anxiety scale,SAS)、抑郁自评量表(Self-rating depression scale,SDS)、自尊量表(Rosenberg senesteem scale,RSES)]、生活质量[乳腺癌生存质量测评量表(Functional assessment of cancer therapy-breast,FACT-B)]、瘢痕[温哥华瘢痕量表(Vancouver scar scale,VSS)]及并发症发生情况。结果:干预后,两组的SAS、SDS均低于干预前,且观察组均低于对照组(P<0.05),而两组RSES评分高于干预前,且观察组高于对照组(P<0.05);术后1、3、6个月,观察组的VSS评分均低于对照组(P<0.05);干预后,两组的FACT-B各项评分均高于干预前,且观察组的生理状况、社会/家庭状况、情感状况、功能状况、附加关注状况均高于对照组(P<0.05);观察组并发症发生率为22.64%,显著低于对照组的43.40%(P<0.05)。结论:基于美学需求的个案护理模式能够改善乳腺癌保乳切除患者术后心理状态,减轻术后瘢痕,并能提高患者的生活质量。