scholarly journals 1093 Pyoderma Gangrenosum Complicating Surgery for Breast Cancer in A Patient with Insulin Treated Diabetes. A Case Report

2021 ◽  
Vol 108 (Supplement_6) ◽  
Author(s):  
C Croitoru ◽  
C McGoldrick ◽  
G Irwin
Keyword(s):  
Breast Cancer ◽  
Pyoderma Gangrenosum ◽  
Immune Modulation ◽  
Lymph Node Biopsy ◽  
Wound Debridement ◽  
Initial Surgery ◽  
Immediate Implant ◽  
The Right

Abstract Aim Although rare, Pyoderma Gangrenosum (PG) occurs as a significant complication of breast surgery. The early manifestations are similar to necrotising wound infection, so diagnosis and correct management are often delayed. Method We present the case of a 51-year-old female, diagnosed with multifocal right breast cancer, who underwent right sentinel lymph node biopsy and bilateral skin-spearing, nipple-sacrificing mastectomies with immediate implant reconstruction (patient’s choice). Her medical history included type 2 diabetes on insulin, hypertension, and obesity. One week postoperatively the right breast wound showed signs of not healing. After 5 weeks of conservative management including input from tissue viability, wound debridement and negative pressure wound therapy (NPWT), the phenomenon of pathergy raised the clinical suspicion of PG which was confirmed histologically. Results A multidisciplinary approach was instituted. The patient was started on steroid and non-steroid immune modulation therapy. She underwent further wound debridement, implant removal with NPWT and she received Tamoxifen as adjuvant chemotherapy had to be delayed. The wound healed 27 weeks after initial surgery. Conclusions Pyoderma Gangrenosum is an ulcerative skin disorder of unknown aetiology which is associated with systemic illnesses. It needs to be recognised and requires aggressive systemic therapy. There is little information about its long-term evolution.

scholarly journals Breast Cancer during Pregnancy—Current Paradigms, Paths to Explore

Cancers ◽  
2019 ◽  
Vol 11 (11) ◽  
pp. 1669 ◽  
Author(s):  
Ayelet Alfasi ◽  
Irit Ben-Aharon
Keyword(s):  
Breast Cancer ◽  
Well Being ◽  
Developed Countries ◽  
Lymph Node Biopsy ◽  
Current Data ◽  
Long Term Effects ◽  
Long Term Outcomes ◽  
Risk Benefit Assessment ◽  
Long Term Follow Up

Breast cancer is the most common form of malignancy in pregnant women. The prevalence of pregnancy-associated breast cancer (PABC) is up to 0.04% of pregnancies and is expected to rise in developed countries. PABC represents a unique clinical scenario which requires a delicate balance of risks and benefits for both maternal and fetal well-being. Currently, there is paucity of data regarding the short- and long-term outcomes of in-utero exposure to anti-neoplastic agents. In general, when possible, treatment for PABC should follow the same guidelines as in non-pregnant patients. Surgery, including sentinel lymph node biopsy, is possible during all trimesters of pregnancy. Radiotherapy is contraindicated during pregnancy, although it might be considered in highly selected patients based on risk–benefit assessment. Evidence supports that administration of chemotherapy may be safe during the second and third trimesters, with cessation of treatment three weeks prior to expected delivery. Currently, hormonal therapy and anti-HER2 agents are contraindicated during pregnancy and should be postponed until after delivery. Prematurity is associated with worse neonatal and long-term outcomes, and thus should be avoided. While current data on the long-term effects of anti-neoplastic treatments are reassuring, grade of evidence is lacking, hence additional large prospective studies with long-term follow-up are essential to rule out any treatment-induced adverse effects.

scholarly journals Internal Mammary Sentinel Lymph Node Biopsy in Clinically Axillary Lymph Node-Positive Breast Cancer: Diagnosis and Implications for Patient Management

2019 ◽  
Vol 27 (2) ◽  
pp. 375-383 ◽  
Author(s):  
Peng-Fei Qiu ◽  
Rong-Rong Zhao ◽  
Wei Wang ◽  
Xiao Sun ◽  
Peng Chen ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Therapeutic Strategy ◽  
Lymph Node Biopsy ◽  
Axillary Lymph ◽  
Nodal Staging ◽  
Node Biopsy ◽  
Initial Surgery ◽  
Internal Mammary

Abstract Background Routine performance of internal mammary sentinel lymph node biopsy (IM-SLNB) remains a subject of debate due to no clinical relevance in breast cancer, because it was performed only in clinically axillary lymph node (ALN)-negative patients. In this study, IM-SLNB was performed in clinically ALN-positive patients, and its impact on nodal staging and therapeutic strategy were subsequently analyzed. Methods Clinically ALN-positive patients who underwent IM-SLNB were enrolled in this prospective study. Statistical analysis was performed using Chi square test, Mann–Whitney U and logistic regression models with a significance level of 0.05. Results Among the 352 recruited patients, the internal mammary sentinel lymph node (IMSLN) visualization rate of patients who received initial surgery and neoadjuvant systemic therapy (NST) was 71.9% (123/171) and 33.1% (60/181), respectively. The 183 patients who underwent IM-SLNB successfully had the average time duration of 7 min and the median IMSLN number of 2. There were 87 positive IMSLNs in all the 347 removed IMSLNs, which were mainly concentrated in the second (50.6%) and third (34.5%) intercostal space. The IMSLN metastasis rate was 39.8% (initial surgery) and 13.3% (NST), respectively. All of the 183 IM-SLNB patients received more accurate nodal staging, 57 of whom had stage elevated, which might have prompted modifications to the therapeutic strategy. Conclusions IM-SLNB should be routinely performed in clinically ALN-positive patients, and thus more accurate nodal staging and perfect pathologic complete response definition could be put forward. The identification of IMLN metastases by IM-SLNB might potentially influence therapeutic strategies.

scholarly journals Breast cancer and pyoderma gangrenosum: a complication after conservative surgery and radiotherapy

Mastology ◽  
2020 ◽  
Vol 30 ◽  
Author(s):  
Flávia Kuroda ◽  
Cicero Urban ◽  
Erica Mendes ◽  
Anelise Rocha Raymundo ◽  
Alessandra Amatuzzi Cordeiro Fornazari ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Early Diagnosis ◽  
Pyoderma Gangrenosum ◽  
Adjuvant Radiotherapy ◽  
Treatment Effectiveness ◽  
Conservative Surgery ◽  
Neutrophilic Dermatosis ◽  
Systemic Diseases ◽  
Pathergy Phenomenon

Pyoderma gangrenosum (PG) is a rare, ulcerative, and painful neutrophilic dermatosis of unknown cause associated with systemic diseases and/or pathergy phenomenon in 30% of cases. We report the case of a breast cancer patient submitted to oncoplastic conservative surgery followed by adjuvant radiotherapy, with long-term progression to PG. It’s rare and challeng ing nature reinforces the need for early diagnosis to increase treatment effectiveness and reduce morbidity.

scholarly journals Pregnancy-associated breast cancer – Case report

Mastology ◽  
2020 ◽  
Vol 30 (Suppl 1) ◽  
Author(s):  
Vanessa Monteiro Sanvido ◽  
Mary Miyazawa Simomoto ◽  
Afonso Celso Pinto Nazário
Keyword(s):  
Breast Cancer ◽  
Case Report ◽  
Lymph Node ◽  
Sentinel Lymph Node ◽  
Histological Grade ◽  
Percutaneous Biopsy ◽  
Lymph Node Biopsy ◽  
Node Biopsy ◽  
Axillary Lymphadenectomy ◽  
The Right

Introduction: Mammographic screening is recommended yearly after the age of 40; however, many pregnant women are younger and should undergo the test. In these cases, anamnesis and clinical examination of the breasts are essential to detect any breast change. In case of clinical suspicion, it is recommended to undergo mammography with abdominal protection, and breast ultrasound is the examination of choice to assess the extension of the injury and guide the percutaneous biopsy. Breast surgery is safe, and can be performed in the three trimesters of pregnancy. It is important to emphasize the importance of the type of surgery according to gestational age. The reference axillary surgery during pregnancy is axillary lymphadenectomy. However, some articles present the safety of the sentinel lymph node biopsy. The use of technetium (Tc-99m) with lymphoscintigraphy is an acceptable technique, with fetal exposure to radiation inferior to the teratogenic limit of 50 mGv. Objective: To emphasize the importance of mammary propedeutics during pregnancy. Case report: 37 year-old patient, primiparous, of 34 weeks, referred a nodule in the right breast for 1 year. She denies having family history of carcinoma. At clinical examination, she presented with turgid breasts, absence of palpable nodules and negative axilla. Current mammography with presence of architectural distortion in the inferolateral quadrant of the right breast, and ultrasound with irregular and spiculated 2 cm nodule , both BIRADS category 5. Percutaneous biopsy showed invasive breast carcinoma of no special type, histological grade 2, and immunohistochemical with positive hormone receptors (estrogen and progesterone receptor with 90%), negative HER2 and Ki 67 of 20%> The conduct was conserving surgery (excision of the breast injury and radio-guided sentinel lymph node biopsy) on the 36th week of pregnancy. The intraoperative assessment of the sentinel lymph node showed presence of macrometastasis and, as a consequence of the exclusion of pregnancy in the ACOSOG Z0011 study, the patient was submitted to axillary lymphadenectomy. The definitive anatomopathological result was invasive breast carcinoma of no special type, histological grade 3, measuring 2.1 cm, and 1 lymph node compromised by macrometastasis of 15 dissected nodes (pT2 pN1a). The multidisciplinary team chose to wait for delivery, from 2 to 4 weeks, and a Cesarean section was performed after 40 weeks of pregnancy. The chemotherapy was scheduled to begin 4 weeks after delivery. The patient was referred to genetic counselling. Conclusions: The treatment of breast cancer during pregnancy is challenging for the multidisciplinary team, which must focus on maternal and fetal well-being. Therapy should be carried out similarly to non-pregnant patients, respecting the procedures that are allowed in each gestational trimester. It is important to mention how essential it is to not delay the treatment, in order to not compromise the patient’s prognosis.

scholarly journals Invasive Cancer Confined to the Nipple of the Conserved Breast: A Case Report

2020 ◽  
Vol 13 (3) ◽  
pp. 1125-1130
Author(s):  
Miyuki Kitahara ◽  
Yasuo Hozumi ◽  
Naoto Takeuchi ◽  
Satoko Ichinohe ◽  
Mitsuki Machinaga ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Local Recurrence ◽  
Ductal Carcinoma ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Invasive Cancer ◽  
Breast Cancer Patients ◽  
Skin Changes ◽  
True Recurrence ◽  
The Right

Invasive breast cancer deriving from the milk duct and lobule that develops in the nipple is extremely rare, except in Paget’s disease and skin cancer. This is the second reported case of the development of invasive cancer confined to the nipple after breast-conserving surgery. A 69-year-old woman visited our department due to redness, swelling, and bloody discharge of the right nipple in the last month. A needle biopsy was suggestive of invasive ductal carcinoma; we performed a removal surgery of the right residual breast tissue and a second sentinel lymph node biopsy. She underwent these procedures 10 years previously as well. Thus, we diagnosed the present lesion as a local recurrence, but it was unknown whether the lesion was a true recurrence or second cancer, namely, metachronal ipsilateral breast cancer. The present case helps promote awareness that invasive cancer rarely develops in the nipple after conserving surgery. Patients should be encouraged to visit a medical facility if experiencing skin changes and swelling of the nipple. Additionally, breast cancer patients must be carefully selected for breast-conserving surgery; failure to do so may later result in nipple-specific local recurrence.

scholarly journals Long-Term Outcomes of Sentinel Lymph Node Biopsy for Ductal Carcinoma in Situ

2019 ◽  
Vol 3 (4) ◽  
Author(s):  
Peiyin Hung ◽  
Shi-Yi Wang ◽  
Brigid K Killelea ◽  
Sarah S Mougalian ◽  
Suzanne B Evans ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Carcinoma In Situ ◽  
Ductal Carcinoma ◽  
Breast Cancer Mortality ◽  
Breast Conserving Surgery ◽  
Lymph Node Biopsy ◽  
Long Term Outcomes ◽  
Node Biopsy

Abstract The use of sentinel lymph node biopsy (SLNB) for ductal carcinoma in situ (DCIS) is controversial. Using population-cohort data, we examined whether SLNB improves long-term outcomes among patients with DCIS who underwent breast-conserving surgery. We identified 12 776 women aged 67–94 years diagnosed during 2001–2013 with DCIS who underwent breast-conserving surgery from the US Surveillance, Epidemiology, and End Results-Medicare dataset, 1992 (15.6%) of whom underwent SLNB (median follow-up: 69 months). Tests of statistical significance are two-sided. Patients with and without SLNB did not differ statistically significantly regarding treated recurrence (3.9% vs 3.7%; P = .62), ipsilateral invasive occurrence (1.4% vs 1.7%, P = .33), or breast cancer mortality (1.0% vs 0.9%, P = .86). With Mahalanobis-matching and competing-risks survival analyses, SLNB was not statistically significantly associated with treated recurrence, ipsilateral invasive occurrence, or breast cancer mortality (P ≥ .27). Our findings do not support the routine performance of SLNB for older patients with DCIS amenable to breast conservation.

Solitary thymic metastasis of breast cancer 13 years after surgery

2017 ◽  
Vol 25 (6) ◽  
pp. 469-471
Author(s):  
Akira Fukunaga ◽  
Yuji Sasamura ◽  
Akio Takada ◽  
Yoshihiro Murakami ◽  
Hirotake Abe ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Mediastinal Mass ◽  
Left Breast ◽  
Pathological Examination ◽  
Anterior Mediastinal Mass ◽  
Term Survival ◽  
Initial Surgery ◽  
Appropriate Treatment ◽  
Resected Tumor

A 59-year-old woman was noted to have an anterior mediastinal mass on computed tomography at a regular follow-up 13 years after initial surgery for left breast cancer. Magnetic resonance imaging showed an anterior mediastinal mass. A total thymectomy with excision of surrounding lymphoid tissue was performed. Pathological examination of the resected tumor confirmed the diagnosis of thymic metastasis from breast cancer. The patient has been alive for 6 years after thymectomy. Metastases to the thymus are rare, but long-term survival can be expected with appropriate treatment.

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