Predictive factors of drainage volume and drain duration after the inframammary approach to nipple-areolar-complex sparing mastectomy and implant-based breast reconstruction

Background@#The placement of a closed suction drain is indispensable for preventing serious infections; however, closed suction drains are inevitably accompanied by increases in local infections, pain, and length of hospital stay, and delays in breast cancer treatment including postoperative chemotherapy and radiotherapy. We analyzed predictive factors of total drainage volume and duration. @*Methods@#Among patients who were diagnosed with primary breast cancer between January 2016 and December 2017, we retrospectively analyzed those who underwent immediate implant-based breast reconstruction. Factors that could affect the total volume and duration of drainage, including lipo-prostaglandin E1 use, preoperative chemotherapy, resected breast issue weight, age, body mass index (BMI), serum white blood cell count, erythrocyte sedimentation rate, and C-reactive protein (CRP) level, were analyzed. @*Results@#The mean volume and duration of drainage were 1,213.6 mL and 14.8 days respectively. BMI and CRP on postoperative day (POD) 1 were correlated with the total drainage volume. Age, BMI, and resected breast tissue weight were correlated with the drainage duration. Multiple regression analysis showed that CRP level on POD 1, age, and resected breast tissue weight significantly affected the drainage duration. Multiple regression analysis also showed that the total drainage volume was significantly affected by BMI and CRP level on POD 1. @*Conclusions@#The factors found to affect the duration of drainage in patients undergoing implant-based breast reconstruction were CRP on POD 1, age, resected breast tissue weight, and BMI. The CRP level on POD 1 and BMI influenced the total volume of drainage.

Retrospective review of 108 breast reconstructions using the round block technique after breast-conserving surgery: Indications, complications, and outcomes

Background@#Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. @*Methods@#All breast reconstructions using the round block technique after BCS were included in this analysis. Patients’ data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. @*Results@#In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. @*Conclusions@#Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nipple-tumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

Factors affecting mastectomy specimen density in direct-to-implant breast reconstruction

BACKGROUND: Direct-to-implant breast reconstruction following nipple-sparing mastectomy is becoming increasingly common. The weight of the breast specimen informs implant selection. However, specimens of the same weight may have different volume. Therefore, identifying the factors affecting the density of breast specimens may facilitate the selection of implants with an appropriate volume. METHODS: From December 2015 to May 2018, 108 patients underwent direct-to-implant reconstruction following nipple-sparing mastectomy. The weight of the breast specimens was measured using an electronic scale in the operating room. Furthermore, the volume of specimens was measured using the water displacement technique. Multiple regression analysis was performed on factors that can affect breast density, such as menopause, neoadjuvant chemotherapy (CTx), age, body mass index, and diabetes mellitus. RESULTS: The average density of breast specimens in patients older than 50 years (n=36) was 0.96±0.04 g/mL, which was significantly lower than the 1.01±0.08 g/mL observed in patients younger than 50 years (n=72) (P=0.007). The mean density of breast specimens in patients who underwent neoadjuvant CTx (n=25) was 0.96±0.06 g/mL, which was significantly lower than the value of 1.00±0.08 g/mL in those who did not (n=83). CONCLUSIONS: It is advisable to select an implant slightly larger than the mastectomy specimen weight in patients older than 50 years or in those who have undergone neoadjuvant CTx.

Clinicopathological Factors Associated with Remnant or Regrowth of Benign Breast Tumor after Previous Vacuum-Assisted Core Biopsy

PURPOSE: We sometimes encounter remnant or regrowth of benign breast tumors diagnosed as Breast Imaging-Reporting and Data System (BI-RADS) C4 in follow-up breast ultrasound after previous vacuum-assisted core biopsy (VACB). We aimed to evaluate the factors that influence remnant or regrowth tumors at post-VACB site or adjacent tissue. METHODS: From January 2010 to December 2015, we analyzed 647 cases on follow-up. Patients were divided into two groups; group A was defined as patients without recurrent masses on breast ultrasonography during the follow-up period, and group B was defined as those with recurrent masses diagnosed as more than BI-RADS C4 on ultrasonography. RESULTS: Fibrocystic changes, proliferative disease without atypia, intraductal papilloma, apocrine cell change, atypical ductal hyperplasia, sclerosing adenosis, and radial scars were observed in 89.5% (n=579), 15.9% (n=103), 15.3% (n=99), 5.3% (n=34), 5.7% (n=37), 7.6% (n=49), and 6.3% (n=41) of patients, respectively. During the follow-up period, 85 patients were diagnosed as group B. Group B was significantly associated with proliferative diseases without atypia, sclerosing adenosis, and microcalcifications compared to group A (p=0.008, p=0.007, and p=0.001, respectively). After adjustment for confounding variables, group B was more significantly associated with proliferative breast diseases than group A (hazard ratio [HR], 0.558; 95% confidence interval [CI], 0.343–0.907; p=0.018). Furthermore, group B was more significantly associated with intraductal papilloma (HR, 0.571; 95% CI, 0.342–0.953; p=0.032). CONCLUSION: Previously diagnosed proliferative diseases without atypia or microcalcification at first VACB were significantly associated with recurrent breast tumor. Intraductal papilloma was also significantly associated with tumor regrowth.

Molecular Targets for Treatment of Breast Cancer / 한국유방암학회지

Advances in molecular biology have made it possible to understand the tumor biology of breast cancer at the molecular level and have revealed molecular targets for the therapy of breast cancer. Nowadays, targeting agents are used as mono-therapy or as combined therapy with other anti-cancer drugs for the treatment of breast cancer. Much more efforts is also being made in the development of better therapeutic agents targeting molecules having an important role in tumor biology. In this article, promising molecules for targeted therapy are reviewed for their roles in the pathophysiology and the treatment of breast cancer. We also introduce and summarize new preclinical agents, developed or on developing, with preliminary results from clinical trials. Given the progress currently being made, targeted therapy could become a main strategy for the treatment of breast cancer in the near future.

Carcinoid Tumor Arising within a Tailgut Cyst: A Case Report

Tailgut cysts are rare congenital lesions. They are believed to develop from remnants of the embryonic hindgut. Malignancy in tailgut cyst is extremely unusual. We experienced a case of a carcinoid tumor arising within a tailgut cyst at the presacral space. A 40-year-old woman was admitted for acute anal pain. Digital rectal examination revealed a 2-cm-sized submucosal tumor in the posterior midline rectum 4 cm above the anal verge. On sigmoidoscopic examination, the overlying rectal mucosa seemed to be intact. We performed a transanal incisional biopsy. The pathological diagnosis of the tumor biopsy revealed a malignant neuroendocrine tumor. The patient underwent an abdominoperineal resection. The tumor proved to be mutilocular cysts with a solid component. The cysts were diagnosed as tailgut cysts that were lined by a variety of epithelial types, including inner columnar cells, outer cuboidal cells, and transitional cells. The solid component in the cysts was confirmed as a carcinoid tumor on microscopic examination. Six months after the operation, she was found to have liver and brain metastases.

Fine Needle Aspiration Cytology of Eccrine Acrospiroma of the Breast: Report of a Case Misdiagnosed as Ductal Carcinoma / 대한세포병리학회지

Eccrine acrospiroma is a rare adnexal tumor of the skin. When the clinical presentation is that of a breast lump, diagnosis can be difficult. Also, most of the cytopathologists are not familiar with the cytologic features of this tumor and this is responsible for diagnostic pitfalls. We experienced a case of eccrine acrospiroma of the right breast in a 41-year-old female, misdiagnosed by fine needle aspiration cytology(FNAC). FNAC was characterized by tight clusters or sheets of small round cells, polygonal cells, and spindle cells and tubule like structures within clusters. Myoepithelial cells were not noted in the clusters. The diagnosis of eccrine acrospiroma was confirmed by histology.

A Case of Intussusception of the Cecum and Appendix Due to Endometriosis Mistaken as a Cecal Tumor / 대한산부인과학회잡지

We report a case of intussusception of the cecum and appendix arising in pericecal endometriosis that are mistaken as a cecal tumor preoperatively. At the other OBGY clinic, the 1st lapalotomy was performed for management of leiomyoma but pelvic organs were adhesion severely and palpation mass in the cecum and appendix. The patient was transfer to our hospital for evaluation and treatment of mass. We investigated to intestine closely and diagnosis was cecal tumor colonoscopically. Total hystrectomy and iliocecectomy was performed successfully and discovered intussusception of the cecum and appendix due to endometriosis mistaken as a cecal tumor in operative field. Postoperatively, this case was diagnosed in pericecal endometriosis histologically.

Clinical Analysis of the Favorable Type of Breast Cancer - Medullary , Mucinous , Papillary and Tubular Carcinoma / 대한암학회지

PURPOSE: The favorable types of the breast cancer - medullary, mucinous, papillary and tubular carcinoma are uncommon subtypes and their incidences in different series ranges between 2.0% and 8.0%, 1% and 2%, 0.3% and 3%, less than 2% of all breast cancers, respectively. In westem countries these subtypes have been reported to have good prognosis and slow growth rate. Clinically, these tumors have lower frequency of axillary nodal involvement and better 5-year or 10-year surviral rate than the other common types of breast cancer. MATERIALS AND METHODS: To determine the clinical characteristics and to evaluate the correlation between the progrostic factors and survival rate of these tumors, the medical records of 83 women with medullary, mucinous, papillary and tubular carcinoma treated at Korea Cancer Center Hospital between Jan. 1987 and Dec. 1997 were reviewed retrospectively. RESULTS: The incidences of medullary, mucinous, papillary and tubular carcinoma were 0.51%, 1.45%, 0.71% and 0.14% of all breast cancer, respectively. There were 1 case of local recurrence and 5 cases of systemic relapse during the follow-up (median follow-up peroid of 56 months). Overall 5-year survival and 10-year survival rate were 98.5% and 94.2%, respectively. No significant difference in overall survival rate was detected according to histologic types of these tumors but disease-free survival was significantly lower in papillary carcinoma than the other types of these tumors (p=0.042). Standard prognostic factors of breast cancer such as tumor size, lymph node status, age of the patient and ER status did not affect the prognosis of these tumors. CONCLUSION: Medullary, mucinous, papillary and tubular carcinoma revealed very excellent prognosis in this study regardless of tumor size, lymph node status, age of the patients and ER status.