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PubMed2004

[Skin sparing mastectomy and immediate breast reconstruction].

OBJECTIVE: To investigate the results of skin sparing mastectomy and immediate breast reconstruction with transverse rectus abdomins musculotaneous (TRAM) flap or latissimus dorsi musculocutaneous flap plus placement of a mammary implant. METHODS: From June 1997 to June 2002, 11 patients were proven to have ductal carcinoma in situ or huge breast carcinoid by pathological examination. The site of the biopsy incision was around the areola. The patients underwent mastectomy with skin sparing by a circumareolar incision and immediate breast reconstruction with TRAM flap or latissimus dorsi musculocutaneous flap plus placement of mammary implant. Autogenous tissue was used to fill the skin envelop. The second stage operation of nipple-areola reconstruction was performed on the replaced skin. RESULTS: Eleven patients were followed up 1 month to 6 years. The operative result was good and all patients had no relapse. The reconstructed breast achieved good results in shape, colour, sensation, symmetry and incision scar. CONCLUSION: The skin sparing mastectomy and immediate autograft tissue breast reconstruction is an ideal reconstructive method for the patients with breast ductal carcinoma in situ or huge breast carcinoid in condition that there were strict operative indication and relapse can be prevented.

Adult↗
PubMed1992

[Hypertension as risk factor for increased rate of side effects in the framework of breast carcinoma irradiation].

The rate of radiation-induced side-effects is dependent from exogenous technical and endogenous factors. Widespread endogenous factors are arterial hypertension and other cardiovascular diseases. 130 breast cancer patients were retrospectively evaluated for side-effects to estimate the influence of arterial hypertension. All were treated with mastectomy and irradiation (telecobalt) and consecutively followed. 79 patients had normal blood pressure, 51 showed arterial hypertension. Hypertension proved to be the strongest endogenous factor for the development of side-effects. In contrast to the patients with normal blood pressure those with hypertension showed significant more arm lymphedema (p less than 0.005) and telangiectasia (p less than 0.0001). Other endogenous factors, like cardiovascular diseases or obesity, taken together led only to a higher rate of subcutaneous fibrosis (p less than 0.002). Patients with arterial hypertension should receive axillary radiation only for strict indications and perhaps with a reduced dosage.

Breast Neoplasms↗
PubMedDate not supplied

Volume corrected mitotic index (M/V index), mitotic activity index (MAI), and histological grading in breast cancer.

A prospective study on breast cancer was started in 1975, and ended in 1987 allowing a mean follow-up of 12.4 years. At the operation tumor size was registered, and after axillary evacuation axillary status was defined histologically. In 1989-1990 volume corrected mitotic index (M/V index), and mitotic activity index (MAI) were estimated, and histological grading performed from archival paraffin sections. In univariate survival analysis axillary node status (p less than 0.0001), M/V index (p less than 0.0001), MAI (p = 0.0001), and tumor size (p = 0.0009), histological grade (p = 0.0195), and irregularity of nuclei (p = 0.0167) predicted survival, recurrence free survival, and breast cancer survival. In a multivariate survival analysis axillary node status, M/V index, tumor size and tubular growth pattern showed independent prognostic value in the order of significance. In the separate analysis of infiltrative ductal or lobular carcinomas the M/V index was the most important prognosticator. The results suggest that the M/V index is more powerful in predicting survival than the mitotic activity index (MAI) in breast cancer. Obviously this is due to better control of variation factors associated with field size and area of epithelium by the M/V index.

Axilla↗
PubMed1991

[Bilateral signet ring cell carcinoma of the breast: case report].

Signet ring cell carcinoma of the breast is a rare type of tumor characterized by the presence of numerous cells containing large intracellular and little extracellular amounts of mucin. These tumors show an unusual metastatic pattern, involving serosal surfaces and have a poor prognosis with a mean survival time of 50 months. This paper reports the case of a 39 year old woman with a bilateral signet ring cell carcinoma who developed metastases in bone, lung and peritoneum. Combined surgery, radiotherapy and chemotherapy was used but the patient died 2 years and 3 months after diagnosis.

Adenocarcinoma, Mucinous↗
PubMed2006

[Angiosarcoma of the breast: a case report and literature review].

Sarcoma of the breast is a rare tumor (makes up 0.5 to 1% of all malignant breast tumors). In literature, only isolated cases of primary angiosarcoma of the breast were described. Secondary angiosarcomas are more frequently diagnosed in women and mostly in patients who underwent breast-conserving surgery and were treated by radiotherapy. In this article a very rare case of angiosarcoma of the breast is presented. The tumor in the breast was diagnosed after breast trauma. After surgery the diagnosis of hematoma was made. Nine months after surgery tumor spread was observed in subdermal layer, lymph nodes, and lungs. After review of histopathology slides the likely diagnosis of angiosarcoma of the breast was made. The effect of chemotherapy and radiotherapy was only partial and short. The tumor extended further to the lungs, pleura, and peritoneum. A patient from the time of diagnosis survived for 8 months. The mean survival of patients with angiosarcoma of the breast, described in literature, ranges from 13 to 22 months, and the treatment in this case most likely could not have an effect on survival of the patient.

Adult↗
PubMed1991

[Neuroendocrine tumors of the mammary gland. Current evaluation apropos of a case].

The authors report a case of infiltrating non-mucinous neuroendocrine breast tumor of both nesidioid and carcinoid type, exclusively composed of argyrophil cells and showing estrogen receptors. By comparing it to those published in literature, they conclude that there are two types of breast tumors with argyrophil cells: one very rare, exclusively composed of neuroendocrine cells, which may present all of the morphological, functional, evolutive aspects and particularly the carcinoid pattern of diffuse endocrine system tumors; the other is more common, composite, reminiscent according to the abundance of their neuroendocrine components, either of the features of diffuse endocrine system tumors, or of those of conventional adenocarcinomas. Their findings help to explain that the combined hormonoreceptive and hormonosecreting nature of these tumors is the particular property of their neuroendocrine cells comparable to that of the pituitary gland. In the composite tumors, these cells are associated in symbiosis with the epithelial glandular cells which are of ectodermal origin. Such an association, also observed in other parts of the body, is not fortuitous but functional and thus could contra-indicate antiestrogen hormonetherapy.

Aged↗
PubMed1991

Salvage mastectomy after failed breast-conserving therapy for carcinoma of the breast.

The indications, technique and complications of salvage mastectomy in 25 patients with local recurrence after breast-conserving therapy for carcinoma of the breast have been reviewed. Two patients required myocutaneous flaps to repair the defect, and six patients (24%) suffered wound infection or breakdown. Subsequent local relapse occurred in a total of five patients, two of whom died with uncontrolled chest wall skin nodules.

Axilla↗
PubMedDate not supplied

Progesterone-binding cyst protein (PBCP) in operable breast cancer: correlations with prognostic factors and predictive value for effect of adjuvant tamoxifen treatment.

Progesterone-binding cyst protein (PBCP) is a secretory protein which has been found in varying concentrations and incidence in cytosols from benign breast tumors, primary breast cancer and metastasis. In order to evaluate its correlation to other prognostic factors, PBCP was analysed in tumor cytosols from 386 women with stage I and stage II breast cancer. The incidence of PBCP negative (i.e. PBCP = 0) tumors was significantly decreased in node negative patients as compared to node positive (p = 0.012). An inverse correlation between estrogen receptor content and PBCP was found (p = 0.001). In a multivariate analysis PBCP category was found to be an independent predictor of the likelihood of axillary nodal involvement (p = 0.015). In spite of this association, PBCP did not reach statistical significance as an independent prognostic factor with regard to relapse-free survival. To evaluate PBCP category as a possible predictive factor for response to adjuvant endocrine treatment, a subpopulation of node positive patients with ER positive tumors was analysed; in patients with PBCP negative tumors, adjuvant treatment with tamoxifen proved to increase the relapse-free survival significantly (p = 0.011). We suggest that PBCP may have a place among other biochemical parameters in breast cancer, to provide an extended basis for understanding of tumor biology and a better selection of patients for endocrine treatment.

Analysis of Variance↗
PubMed1990

Treatment options and recurrence potential for cystosarcoma phyllodes.

The surgical treatment and outcome of 31 women with a pathologic diagnosis of cystosarcoma phyllodes at Roswell Park Memorial Institute were reviewed. Surgical excision was performed upon 20 patients with a mean tumor size of 4.5 centimeters (range of 1.0 to 9.0 centimeters). Mastectomy was performed initially upon 11 patients with a mean tumor size of 15 centimeters (range of 3 to 40 centimeters). Local recurrence was seen in five patients treated by excision and one patient treated by mastectomy. All patients retreated by repeat excisions were controlled; one patient retreated with mastectomy died with local recurrence and distant disease. Routine axillary dissections were not performed. Involvement of the axillary lymph nodes occurred in one patient and was associated with advanced systemic disease. Local recurrences did not imply associated systemic spread and were controlled in five of six patients by repeat excision or mastectomy. Although the benign behavior of this tumor is commonly emphasized, four of the patients we studied died of malignant spread of cystosarcoma phyllodes.

Adolescent↗
PubMed1990

Mastectomy and breast reconstruction preserving the nipple.

Total mastectomy and immediate reconstruction using the latissimus dorsi myocutaneous flap with nipple preservation has been performed in 87 women. The palpable tumours were all more than 3 cm from the nipple. No recurrence in the preserved nipple was seen in 63 women who underwent the procedure for tumour recurrence after previous radiotherapy. Nipple recurrence occurred in 3 out of 24 women (12%) where the indication was multifocal disease and no radiotherapy was given. This non-irradiated group should either not have the nipple preserved or should undergo postoperative electron field therapy to the nipple-areolar complex.

Adult↗
PubMed1990

[Carcinoma of the male breast. Review of the literature and case series contribution].

Following and exhaustive review of the literature on this topic, the paper reports the results of the treatment of 16 patients with male breast cancer. From an analysis of findings, it was observed that diagnosis is frequently delayed (mean 1 year), disease is at a locally advanced stage in the majority of patients, and there is a considerable variety of treatments in relation to the long recruitment period for the study. The difficulties of performing radical surgery which does not necessitate complex reconstructive surgery has led to the use of Limberg's flap in the last 3 cases treated. Mean survival rate was 8 years for stage 1, 4 years for stage 2, 3 years for stage 3 and 2.5 years for stage 4.

Adenocarcinoma↗
PubMedDate not supplied

[Immediate reconstructive approach in neoplastic pathology and "high risk" of the breast].

One of the most important aims in oncology should be the quality of life, even in the cases of limited life expectancy. With this objective, the Authors report their experience of immediate breast reconstruction after surgical treatment for neoplasms and "high risk" lesions. In 76 cases they analyzed aesthetic results and morbidity. In immediate reconstruction after Patey mastectomies, the tissue expanders offered good cosmetic results with an acceptable complication rate in comparison with more complex methods as myocutaneous flaps. These flaps represent the alternative in selected cases of Halsted mastectomies, where the mutilation is not acceptable to the patient. In "high risk" lesions surgical approach, namely subcutaneous mastectomy, may be proposed in selected cases only. The Authors emphasize that subcutaneous mastectomy with an immediate submuscular reconstruction offer good aesthetic results especially in small size breasts with mild ptosis. The capsular contracture is however significant in 25% of the patients treated with these techniques.

Adult↗
PubMed1990

[Prognosis and treatment of advanced breast cancer from the surgical viewpoint].

Twenty-four patients with advanced mammary carcinoma (stage T4) were treated between 1983-1986 at the Department of Surgery of the University of Bochum, Marienhospital Herne 1. The primary surgical treatment was supported in 18 cases by an ablatio modified from Patey, the ablatio simplex were performed on 4 patients; while a thoracical-epigastric flap was applied to one patient. Because of the high percentage (16.6%) of advanced breast cancer on all our breast cancer patients, we feel obliged to show the survival time of different under-groups by an interdisciplinary making follow up examination. So we believe to give a better and more different statement on the prognosis of the advanced breast cancer.

Adult↗