Caracterización del cáncer de mama en el hombre. Experiencia del Hospital Británico de Buenos Aires / Characterization of breast cancer in men. Experience of the British Hospital of Buenos Aires

Introducción: El cáncer de mama en el hombre es una patología poco frecuente, que representa el 1% de todos los tumores malignos masculinos y menos del 1% de todos los carcinomas mamarios, cuyas dos características fundamentales son la aparición tardía y la presentación en estadios avanzados. Objetivo: Presentar los 38 casos tratados en el Servicio de Mastología del Hospital Británico de Buenos Aires y comparar los hallazgos con publicaciones anteriores. Material y método: Estudio retrospectivo de pacientes tratados por cáncer de mama en el Servicio desde enero del 1973 a mayo del 2018. Resultados: Edad media 63,9+12.8 años. Tamaño tumoral: 1,9 +0.9 cm. Se realizó Mastectomía radical modificada en 61% de los pacientes. Tipo histológico más frecuente: Ductal Infiltrante en 89,5% de los casos. Hallazgos que concuerdan con publicaciones de otros centros. Discusión: La presentación ocurre en edades avanzadas. La demora en la consulta y la falta de educación sanitaria condicionan las posibilidades de curación. Conclusiones: El cáncer de mama masculino se presenta a avanzada edad, con una importante demora en la consulta y en estadios avanzados. En la actualidad su manejo se extrapola de conductas llevadas a cabo en mujeres.

Introduction: Breast cancer in male patients in an uncommon disease, which represents 1% of all male malignancies and less than 1% of all breast carcinomas, whose two fundamental characteristics are evident: the late appearance and the presentation in advanced stages. Objective: To present the 38 cases treated in the Mastology Service of the British Hospital of Buenos Aires and compare the findings with previous publications. Material and method: Retrospective study of patients treated for breast cancer in the Servic between january 1973 to may 2018. Results: Average age was 63,9 ± 12,8 years. Tumor size: 1.9 ± 0.9 cm. A Modified radical mastectomy was performed in 61% of patients. Most frequent histological type was Infiltrating Ductal Carcinoma in 89,5% of cases. Findings that match publications from other centers. Discussion: Presentation occurs at advanced ages. The delay in consultation and the lack of health education determine the possibilities of healing. Conclusions. Male breast cancer occurs at an advanced age, with a significant delay in the consultation. At present, its management is extrapolated from guidelines carried out in women.

Reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba / Immediate Breast Reconstruction at the National Institute of Oncology and Radiobiology of Cuba

RESUMEN Introducción: La reconstrucción mamaria inmediata disminuye el impacto psicológico del cáncer de mama y mejora la calidad de vida de las pacientes. Objetivo: Evaluar la simetría en la reconstrucción mamaria inmediata en el Instituto Nacional de Oncología y Radiobiología de Cuba. Método: Se realizó un estudio analítico y prospectivo, de cohorte incidente, en el Servicio de Cirugía Reconstructiva del Instituto Nacional de Oncología y Radiobiología de 2014 al 2017. Se incluyeron 41 pacientes que consintieron participar en el estudio. Se recogieron variables demográficas y onco-reconstructivas. Se utilizó un software creado en la institución para evaluar la simetría mamaria. Los datos se recogieron de la historia clínica. Se aplicaron el test de Chi-cuadrado corregido y la razón de momios para el análisis estadístico. Resultados: El 30,2 por ciento de mujeres reconstruidas pertenecieron al grupo de 30 a 39 años; el 46,3 por ciento tenían sobrepeso. La mejor simetría se encontró con las técnicas oncoplásticas (31,7 por ciento), seguida de la mastectomía ahorradora de piel. La técnica de expansión tisular con la mastectomía presentó mayores complicaciones (63,6 por ciento) y menor simetría. La necrosis parcial de piel fue la mayor complicación en 7,3 por ciento y estuvo relacionadas con las técnicas ahorradoras de piel. Conclusiones: Evaluar de forma objetiva la simetría mamaria permitió conocer la efectividad de las técnicas quirúrgicas reconstructivas. Con las técnicas de cirugía oncoplástica y mastectomía ahorradora de piel se obtuvieron los mejores resultados estéticos y pocas complicaciones. La expansión mamaria inmediata con una mastectomía radical modificada no ofrece ninguna ventaja(AU)

ABSTRACT Introduction: Immediate breast reconstruction reduces the psychological impact of breast cancer and improves the quality of life of patients. Objective: To assess symmetry in immediate breast reconstruction at the of Cuba. Method: An analytical and prospective study of incident cohort was carried out in the reconstructive surgery service at the National Institute of Oncology and Radiobiology (INOR), from 2014 to 2017. Forty-one patients who consented to participate in the study were included. Demographic and oncoreconstructive variables were collected. A software created in the institution was used to assess breast symmetry. The data were collected from the medical histories. The corrected chi-square test and odds ratio were applied for statistical analysis. Results: 30.2 percent of women who received reconstruction belonged to the age group 30-39 years; 46.3 percent were overweight. The best symmetry was found with oncoplastic techniques (31.7 percent), followed by skin-sparing mastectomy. The tissue expansion technique with mastectomy presented greater complications (63.6 percent) and less symmetry. Partial skin necrosis was the major complication, accounting for 7.3 percent of the cases, and was related to skin-sparing techniques. Conclusions: Objectively evaluating breast symmetry allowed us to know the effectiveness of reconstructive surgical techniques. With oncoplastic surgery and skin-sparing mastectomy techniques, the best aesthetic outcomes and few complications were obtained. Immediate breast expansion with a modified radical mastectomy offers no benefit(AU)

Infecciones del sitio operatorio posterior a mastectomía radical modificada, análisis epidemiológico en una clínica oncológica / Surgical site infections after modified radical mastectomy, epidemiological analysis at an oncology center

Introducción.La tasa de incidencia de infecciones del sitio operatorio asociadas a cirugías mamarias varía desde el 6 hasta el 38 %. Se presentan la incidencia local y el perfil microbiológico de las infecciones en una clínica oncológica.Métodos.Se trata de un estudio de cohorte, prospectivo, descriptivo, durante un periodo de un año en el Instituto Médico de Alta Tecnología, IMAT Oncomédica, de mujeres con diagnóstico de cáncer de mama, que presentaron infecciones del sitio operatorio después de la mastectomía. Resultados.Se encontraron 335 cirugías registradas y la incidencia de infecciones del sitio operatorio fue del 3,38 %, todas en mastectomías radicales con reconstrucción. Se obtuvo crecimiento bacteriano en el 77 % de los cultivos, principalmente de cocos Gram positivos, con predominio de Staphylococcus aureus sensible a la meticilina (SAMS). Los bacilos Gram negativos representaron el 40 %. Se administraron cefalosporinas de primera generación como profilaxis antibiótica prequirúrgica, la cual fue correcta en el 31 % de los casos. En el 50 % de las pacientes infectadas se practicó el baño prequirúrgico y se cumplió el protocolo institucional. Conclusiones. La incidencia encontrada de infecciones del sitio operatorio es menor que la reportada en otras series. Staphylococcus aureus sensible a la meticilina fue el microorganismo responsable más frecuente. El cum-plimiento de la profilaxis con cefalosporina y baño prequirúrgico es fundamental para disminuir la incidencia de infecciones del sitio operatorio

Introduction.The incidence rate of surgical site infection associated with breast surgeries ranges from 6% to 38%. We present the local incidence and microbiological profile of infections in an oncology clinic.Methods. Prospective, descriptive cohort study over a one-year period of women diagnosed with breast cancer at Instituto Médico de Alta Tecnología, IMAT Oncomédica, and have developed surgical site infection after mastectomy.Results. 335 registered surgeries were found. The incidence of surgical site infection was 3.38%, all of them in radical mastectomies with reconstruction. Bacterial growth was obtained in 77% of crops. Gram-positive were the main microorganisms responsible, predominantly methicillin-sensitive Staphylococcus aureus (SAMS). Gram-Negative bacilli accounted for 40%. First generation cephalosporins were administered as presurgical antibiotic prophylaxis, which was correct in 31% of cases. In 50% of infected patients, the pre-surgical bath was performed and the institutional protocol was complied with.Conclusion. Our incidence of surgical site infection was lower than reported in other series. SAMS was the most common responsible microorganism. Compliance with cephalosporin and pre-surgical bath prophylaxis is critical to reducing the incidence of operative site infections.

Perfil epidemiológico de mulheres mastectomizadas em um serviço de referência localizado no Vale do Taquari/RS / Epidemiological Profile of Mastectomized Women in a Reference Service Located in Vale do Taquari/RS / Perfil epidemiológico de mujeres mastectomizadas en un servicio de referencia localizado en el Valle del Taquari/RS

Justificativa e Objetivos: O câncer de mama é o de maior incidência entre as mulheres no país, sendo a cirurgia a principal medida de tratamento, associada ou não a terapias adjuvantes. O objetivo deste trabalho é verificar o número e identificar o perfil epidemiológico de mulheres diagnosticadas com câncer de mama que realizaram mastectomia radical modificada em um hospital de referência, localizado no Vale do Taquari, no Rio Grande do Sul. Métodos: Estudo epidemiológico retrospectivo, de abordagem quantitativa, no qual foram averiguados 329 prontuários. As variáveis analisadas foram: idade, município de encaminhamento, escolaridade e raça. Resultados: Foram realizadas 150 cirurgias de mastectomia radical entre janeiro de 2008 a junho de 2016, identificando-se mulheres de maioria branca, com baixa escolaridade, na faixa etária superior a 50 anos, provenientes de 29 municípios da região estudada. Conclusão: O perfil epidemiológico da população atendida na referida região segue as características locorregionais e nacionais. Dada a alta incidência de câncer de mama em brasileiras, o número acentuado de mulheres com baixa escolaridade acometidas e, o impacto da doença na qualidade de vida, sugere-se a realização de estudos que verifiquem a evolução pós-operatória, reabilitação clínica, física, psicológica e social após cirurgia de mastectomia radical.(AU)

Background and Objectives: Breast cancer is the one with the highest incidence among women in the country, with surgery being the main measure of treatment, associated or not with adjuvant therapies. The aim is to verify the number and identify the epidemiological profile of women diagnosed with breast cancer who underwent radical modified mastectomy at a referral hospital, located in Vale do Taquari, Rio Grande do Sul. Methods: Retrospective epidemiological study, in which 329 medical records were investigated. The analyzed variables were: age, municipality of referral, schooling and race. Results: 150 radical mastectomy surgeries were performed between January 2008 and June 2016, identifying mostly white women with low schooling in the age group over 50 years of age from 29 municipalities in the region studied. Conclusion: The epidemiological profile of the population served in this region follows the locoregional and national characteristics. Given the high incidence of breast cancer in Brazilians, the high number of women with low schooling affected, and the impact of the disease on quality of life, it is suggested to carry out studies that verify the postoperative evolution, clinical rehabilitation, physical, psychological and social after radical mastectomy surgery.(AU)

Justificación y Objetivos: El cáncer de mama es el de mayor incidencia entre las mujeres en el país, siendo la cirugía la principal medida de tratamiento, asociada o no a terapias adyuvantes. El objetivo de este trabajo es verificar el número e identificar el perfil epidemiológico de mujeres diagnosticadas con cáncer de mama que realizaron mastectomía radical modificada en un hospital de referencia, localizado en el Valle del Taquari, en Rio Grande do Sul/Brasil. Métodos: Estudio epidemiológico retrospectivo, enfoque cuantitativo, en el que se verificaron 329 registros. Las variables analizadas fueron: edad, municipio de encaminamiento, escolaridad y raza. Resultados: Se realizaron 150 cirugías de mastectomía radical entre enero de 2008 a junio de 2016, identificándose mujeres de mayoría blanca, con baja escolaridad, en la franja etaria superior a 50 años, provenientes de 29 municipios de la región estudiada. Conclusiones: El perfil epidemiológico de la población atendida en la referida región sigue las características locorregionales y nacionales. Dada la alta incidencia de cáncer de mama en las brasileñas, el número acentuado de mujeres con baja escolaridad acometidas y, el impacto de la enfermedad en la calidad de vida, se sugiere la realización de estudios que verifiquen la evolución post-operatoria, rehabilitación clínica, física, psicológica y social tras cirugía de mastectomía radical.(AU)

Invasive ductal carcinoma in a 51-year-old male: Case report

@#Male breast cancer (MBC), which constitutes only 1% of all breast cancer cases worldwide, is associated with mutations in the BRCA1 and BRCA2 genes, Klinefelter’s syndrome and a positive family history of breast or ovarian malignancy. Patients with MBC typically present with a palpable subareolar mass, with or without nipple involvement. MBC can be identified by mammography and/or ultrasonography. The definitive diagnosis is made through core needle biopsy and cytology. Breast cancer in men are typically low-grade, and usually estrogen- and progesterone-receptor positive. The surgical treatment of choice is usually a modified radical mastectomy. Hormone therapy, can be used as first-line treatment for hormone-receptor positive MBC, and as adjuvant or palliative therapy for advanced cases. The use of adjuvant cytotoxic chemotherapy has been shown to reduce cancer recurrence and improve overall survival. We present the case of a 51-year-old male who came in due to an enlarging right breast mass that had been removed twice in the past eight years. We were able to establish that the patient had MBC, for which he subsequently underwent a modified radical mastectomy

Comparison of Breast Conserving Surgery Followed by Radiation Therapy with Mastectomy Alone for Pathologic N1 Breast Cancer Patients in the Era of Anthracycline Plus Taxane-Based Chemotherapy: A Multicenter Retrospective Study (KROG 1418) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We compared the oncologic outcomes of breast-conserving surgery plus radiation therapy (BCS+RT) and modified radical mastectomy (MRM) under anthracycline plus taxane-based (AT) regimens and investigated the role of adjuvant radiation therapy (RT) in patients with pathologic N1 (pN1) breast cancer treated by mastectomy. MATERIALS AND METHODS: We retrospectively reviewed the medical records of 2,011 patients with pN1 breast cancer who underwent BCS+RT or MRM alone at 12 institutions between January 2006 and December 2010. Two-to-one propensity score matching was performed for balances in variables between the groups. RESULTS: The median follow-up duration for the total cohort was 69 months (range, 1 to 114 months). After propensity score matching, 1,074 patients (676 in the BCS+RT group and 398 in the MRM-alone group) were analyzed finally. The overall survival, disease-free survival, locoregional failure-free survival, and regional failure-free survival (RFFS) curves of the BCS+RT group vs. MRM-alone group were not significantly different. The subgroup analysis revealed that in the group with both lymphovascular invasion (LVI) and histologic grade (HG) III, the BCS+RT showed significantly superior RFFS (p=0.008). Lymphedema (p=0.007) and radiation pneumonitis (p=0.031) occurred more frequently in the BCS+RT group than in the MRM-alone group, significantly. CONCLUSION: There are no differences in oncologic outcomes between BCS+RT and MRM-alone groups under the AT chemotherapy regimens for pN1 breast cancer. However, BCS+RT group showed superior RFFS to MRM-alone group in the patients with LVI and HG III. Adjuvant RT might be considerable for pN1 breast cancer patients with LVI and HG III.

Resultados del tratamiento quirúrgico del cáncer de mama en mujeres hasta 40 años de edad / Outcome of surgical treatment of breast cancer in women under 40 years of age

Introducción: El cáncer de mama es el más frecuente y la principal causa de muerte por cáncer en la mujer. Es de peor pronóstico en las mujeres jóvenes por presentar una histología más agresiva y mayor índice de recidivas. Objetivo: Evaluar los resultados del tratamiento quirúrgico del cáncer de mama en mujeres hasta 40 años de edad en el Hospital Clínico Quirúrgico Hermanos Ameijeiras. Método: Se realizó un estudio descriptivo, longitudinal, retrospectivo y prospectivo en el período de mayo de 2005 a mayo de 2015. Se estudiaron 79 mujeres hasta 40 años que fueron operadas por diagnóstico de cáncer de mama. Resultados: Se encontró que 83,5 por ciento tenían entre 35 y 40 años, con solo 4 casos por debajo de los 30 años (5,1 por ciento). El 38,4 por ciento negaron historia familiar de cáncer. Las manifestaciones clínicas más frecuentes fueron la presencia de nódulos no dolorosos en 93,7 por ciento y nódulo de consistencia dura en 44,3 por ciento. Predominaron los tumores en estadio I con 48,1 por ciento, seguido del estadio II con 32,9 por ciento. La técnica quirúrgica más empleada fue la Mastectomía Radical Modificada en 58 casos (73,4 por ciento). En 37 pacientes (46,8 por ciento) hubo recaída de la enfermedad. Durante el seguimiento hubo 11 fallecidas (13,9 por ciento). El tiempo medio de supervivencia global fue de aproximadamente 9 años con una variación entre 7 y 10 años. El tiempo medio de supervivencia libre de enfermedad fue de 5,5 años con una variación entre 5 y 6 años para un intervalo de confianza del 95 por ciento. Conclusiones: En las mujeres menores de 40 años el cáncer de mama es de peor pronóstico por presentar una histología más agresiva y mayor índice de recidivas(AU)

Introduction: Breast cancer is the most frequent cancer and the main cause of death for cancer in women. It has a worse prognosis in young women due to more aggressive histology and higher recurrence rate. Objective: To assess the results of the surgical treatment of breast cancer in women up to 40 years of age in Hermanos Ameijeiras Clinical-Surgical Hospital. Method: A descriptive, longitudinal, retrospective and prospective study was carried out in the period from May 2005 to May 2015. Results: 79 women aged up to 40 years with a diagnosis of breast cancer who underwent surgery were studied. It was found that 83.5 percent were between 35 and 40 years old, with only 4 cases below 30 years (5.1 percent). 38.4 percent referred no family history of cancer. The most frequent clinical manifestations were the presence of non-painful nodules in 93.7 percent and nodule of hard consistency in 44.3 percent. The tumors in stage I predominated, with 48.1 percent, followed by other in stage II, with 32.9 percent. The most widely used surgical technique was modified radical mastectomy, in 58 cases (73.4 percent). In 37 patients (46.8 percent), there was relapse of the disease. During the follow-up, 11 patients (13.9 percent) deceased. The average time of overall survival was approximately 9 years, with a variation between 7 and 10 years. The mean time of disease-free survival was 5.5 years, with a variation between 5 and 6 years, which represents a 95 percent confidence interval. Conclusions: In women under 40 years of age, breast cancer has a worse prognosis due to a more aggressive histology and higher recurrence rate(AU)

Percepção das Mulheres sobre sua Funcionalidade e Qualidade de Vida após Mastectomia / Women Perception of their Functionality and Quality of Life after Mastectomy / Percepción de las Mujeres sobre su Funcionalidad y Calidad de Vida después Mastectomía

Introdução: No Brasil, o diagnóstico do câncer de mama ocorre geralmente em fase avançada, culminando com tratamentos mais agressivos que levam a maiores sequelas funcionais e psicológicas, que interferem negativamente na qualidade de vida. Objetivo: Compreender e descrever a percepção das pacientes sobre o impacto do tratamento oncológico e a contribuição da fisioterapia na recuperação da sua qualidade de vida e funcionalidade. Método: Trata-se de um estudo qualitativo no qual foram incluídas 29 mulheres submetidas à mastectomia radical modificada, que apresentaram restrição da amplitude de movimento de membro superior. As pacientes realizaram dez atendimentos fisioterapêuticos e, ao final, foram submetidas a entrevistas semiestruturadas, categorizadas em relação aos efeitos do tratamento oncológico, limitações pós-cirúrgicas, conceito de qualidade de vida e impacto do tratamento fisioterapêutico no retorno às atividades de vida diária. Resultados: Após o tratamento, as pacientes relataram melhora da capacidade funcional, emocional e autoestima, possibilitando sua reinserção social e retorno às atividades de vida diária. Conclusão: Por meio dos relatos, foi possível concluir que a reabilitação promoveu resultados positivos na qualidade de vida e funcionalidade e ter uma percepção mais ampla sobre o impacto do adoecimento e do tratamento oncológico no cotidiano dessas mulheres, subsidiando assim caminhos para o aperfeiçoamento do cuidado fisioterapêutico a essa população.

Introduction: In Brazil, the breast cancer diagnosis usually occurs an advanced stage, culminating in more aggressive treatments that lead to greater functional and psychological sequelae that interfere negatively in the quality of life. Objective: This study aimed to understand and describe the patients' perception about the impact of cancer treatment and the contribution of physiotherapy to recovery their quality of life and functionality. Method: It ́s a qualitative study with twenty-nine women, underwent modified radical mastectomy and who presented a restriction of the range of motion of the upper limb. The patients underwent ten physiotherapeutic sessions and, in the end, they were submitted to semi-structured interviews, categorized in relation to the effects of oncological treatment, post-surgical limitations, concept of quality of life and impact of physical therapy on return to daily activities of daily living. Results: After the treatment, the patients reported functional, emotional and self-esteem improvement, allowing their social reinsertion and return activities of daily living. Conclusion: Through the reports, it was possible to conclude that the rehabilitation promoted positive results in the quality of life and functionality and we could have a broader perception about the impact of the illness and oncological treatment in the daily life of these women, thus subsidizing ways to improve the physiotherapeutic care to this population.

Introducción: En Brasil, el diagnóstico del cancro de mama ocurre generalmente, en fase avanzada, culminando con tratamientos más agresivos que llevan a mayores secuelas funcionales y psicológicas que interfieren negativamente en la calidad de vida. Objetivo: Comprender y describir la percepción de las pacientes sobre el impacto del tratamiento oncológico y la contribución de la fisioterapia en la mejora de su calidad de vida y funcionalidad. Método: Se trata de un estudio cualitativo en el que se incluyeron 29 mujeres, sometidas a la mastectomía radical modificada, que presentaron restricción de la amplitud de movimiento de miembro superior. Las pacientes realizaron diez atendimientos fisioterapéuticos y, al final, fueron sometidas a entrevistas semiestructuradas, categorizadas en relación a los efectos del tratamiento oncológico, limitaciones postquirúrgicas, concepto de calidad de vida e impacto del tratamiento fisioterapéutico en el retorno a las actividades de vida diaria. Resultados: Después del tratamiento, las pacientes reportaron mejoría de la capacidad funcional, emocional y autoestima, posibilitando su reinserción social, retorno a las actividades de vida diaria. Conclusión: Por medio de los relatos, fue posible concluir que la rehabilitación tuvo resultados positivos en la calidad de vida y funcionalidad y tener una percepción más amplia sobre el impacto de la enfermedad y del tratamiento oncológico en el cotidiano de esas mujeres, subsidiando así caminos para perfeccionar el cuidado fisioterapéutico a esta población.

Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation

PURPOSE: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. MATERIALS AND METHODS: One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters—Dnear-max (D2), Dnear-min (D98), Dmean, V95, and V107—homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy (V5), 20 Gy (V20), and 55 Gy (V55) and that of heart receiving 5 Gy (V5), 25 Gy (V25), and 45 Gy (V45) were extracted from dose-volume histograms and compared. RESULTS: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung (V20, 22.09% vs. 30.16%; V55, 5.16% vs. 10.27%; p < 0.001) and heart (V25, 4.59% vs. 9.19%; V45, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume (V5 lung, 61.48% vs. 51.05%; V5 heart, 31.02% vs. 23.27%; p < 0.001). CONCLUSIONS: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.

Tumor neuroendocrino primario de mama en un hombre / Primary neuroendocrine breast tumor found in a man

El cáncer de mama en hombres es una entidad poco frecuente y muy poco estudiada. Su pronóstico y manejo aun distan de lo ideal y de lo que se ha logrado en cáncer mamario en mujeres. Los tumores neuroendocrinos de la mama son aún más raros. Su comportamiento tiende en la mayoría de los casos a ser incierto y su manejo controversial. El reporte de caso se trata de un paciente masculino de 67 años, con historia de aparición de masa en mama derecha, con diagnóstico inicial de tumor mal diferenciado, con posterior inmunohistoquimica que informa tumor neuroendocrino primario de la mama. El diagnóstico temprano de cáncer de mama en hombres implica un verdadero reto para los sistemas de salud. Debemos conocer más sobre su fisiopatología y factores de riesgo(AU)

The early diagnosis of breast cancer in men represents a real challenge for the health systems. Therefore, our knowledge about its physiopathology and risk factors must be expandedBreast cancer in men is a rare and poorly studied malady. The prognosis and management is far from being ideal and from the achievements of the female breast cancer treatment. Even rare are neuroendocine breast tumors. In most of cases, its behavior is uncertain and its management is controversial. This was the report of a male patient aged 67 years, with history of right breast mass, initially diagnosed as a poorly differentiated tumor with later immunohistochemical test that reported the existence of a primary neuroendocrine breast tumor(AU)

Fulminant course in a case of malignant phyllodes tumor

We present the case of a 31-year-old woman with an inflammatory and ulcerative malignant phyllodes tumor in her right breast. A right modified radical mastectomy and transverse rectus abdominis myocutaneous (TRAM) flap were performed. A month after the initial operation, several masses recurred at the superior margin and deep margin of the TRAM flap. Wide excision was performed, but masses recurred at the inferior margin and in both lung fields 2 weeks after the second operation. Six weeks after the second operation, the patient died due to progression of dyspnea and respiratory failure.

Oncologic safety of breast-conserving surgery in breast cancer patients under the age of 35

PURPOSE: Breast-conserving surgery (BCS) shows no difference in survival rates compared with total mastectomy. So, BCS is considered standard breast surgery with modified radical mastectomy. But in patients who received BCS, there is a risk of local recurrence in their long term follow up periods. Especially, BCS of young age is controversial regarding oncologic safety because of local recurrence. In this study, we struggle to confirm the oncologic safety of BCS compared with total mastectomy under the age of 35 in South Korea.METHODS: All patients who underwent surgery for breast cancer were 5,366 at Severance Hospital, Yonsei University Health System, from January 1981 to April 2008. Of them, patients younger than 35 years old were 547. We excluded patients who received chemotherapy before surgery and included only stage 1 and 2 patients who identified through the pathology after surgery. Finally, we got 367 patients; total mastectomy was performed in 245 and BCS, in 122. We compared clinicopathological characteristics and oncologic outcomes between two groups using SPSS program.RESULTS: In patients received BCS, a local recurrence rate was 7.7% at 5 years and up to 20.3% at 10 years. In patients received total mastectomy, a local recurrence rate was 1.9% over 10 years (P<0.001). However, there was no difference in 5-year and 10-year overall survival rates between two groups (P=0.689). Adjuvant chemotherapy decreased local recurrence rate in BCS patients (P=0.019).CONCLUSION: So, we concluded that BCS under the age of 35 has oncologic safety with undergoing chemotherapy.

Methicillin-Resistant Staphylococcus Aureus Following Leech Application at a Congested Flap after a Mastectomy

Medical leech therapy is a treatment for the venous congestion of tissue flaps, grafts, and replants. We report a case of methicillin-resistant Staphylococcus aureus (MRSA) following leech application at a congested flap after mastectomy. A 45-year-old woman had an invasive ductal carcinoma. Modified radical mastectomy was performed. The chest wall defect was reconstructed with a local rotation flap. On postoperative day (POD) 1, congestion and color change were observed, and 10 medical leeches were applied to the congested area. On POD 4, another 10 medical leeches were applied. On POD 12, wound necrosis progressed and a pus-like discharge appeared. A wound swab culture revealed MRSA. Debridement was carried out on POD 15. From POD 16, vancomycin and piperacillin/tazobactam were injected for 18 days. The wound culture on POD 18 also revealed MRSA. A split-thickness skin graft was performed on POD 28. MRSA has not been clearly identified in the literature as a leech enteric bacterium. Although MRSA may have come from another source, the present case raises the possibility of MRSA infections following leech application at congested flaps. When medical leeches are applied at the congestion site of a flap, an aseptic cradle will be helpful. Vancomycin irrigation may be needed if infection occurs.

Chronic Myeloid Leukemia with a Complex Variant ‘Ph’ Translocation That Develops in Breast Carcinoma, Postchemotherapy: A Rare but Treatable Entity / 한국유방암학회지

We report a case of chronic myeloid leukemia (CML) that developed after postoperative chemotherapy with cyclophosphamide, doxorubicin and 5-fluorouracil (CAF) for breast cancer. A 55-year-old woman was diagnosed with invasive ductal carcinoma which was treated with a modified radical mastectomy followed by six cycles of CAF chemotherapy. Nine years later, she developed CML and locoregional recurrence. Her breast recurrence showed strong estrogen receptor, weak progesterone receptor and strong human epidermal growth factor 2 (score 3+) expression. Her secondary CML in the chronic phase showed a complex variant translocation (CVT) involving chromosomes 9, 22, and 17. Considering that the HER2/neu gene is also located on chromosome 17, this secondary CML in chronic phase with CVT is indeed a rare occurrence. We discuss the associated genetic factors and the possible role of breast cancer chemo/radiotherapy in the development of such CML as well as its treatment and prognosis compared with de novo CML.

Metachronous Cancer of Breast and Adenocarcinoma of Cervix: A Rare Case Report

The occurrence of a second primary cancer in a cancer survivor is well documented. It may be synchronous or metachronous. Incidence of metachronous cancer involving cervix is 0.82% to 1.33%. One such metachronous cancer is that of breast and cervix. We present a case of a woman who received tamoxifen for invasive ductal cancer of breast following a modified radical mastectomy and subsequently developed adenocarcinoma of cervix after six month of tamoxifen therapy. The role of tamoxifen in pathogenesis of cervical cancer and that of human papillomavirus infection in pathogenesis of both cancer of cervix and breast cancer has been well recognized. In our patient, the adenocarcinoma of cervix (rare occurrence) which is likely due to six month of tamoxifen therapy is a perplexing question. Women diagnosed and treated for breast cancer need to be followed up for development of other metachronous gynecological cancers.

Postmastectomy Radiotherapy in Patients with pT1-2N1 Breast Cancer Treated with Taxane-Based Chemotherapy: A Retrospective Multicenter Analysis (KROG 1418) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate the impact of postmastectomy radiotherapy (PMRT) on loco-regional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) in pT1-2N1 patients treated with taxane-based chemotherapy. MATERIALS AND METHODS: We retrospectively reviewed the medical data of pathological N1 patients who were treated with modified radical mastectomy and adjuvant taxane-based chemotherapy in 12 hospitals between January 2006 and December 2010. RESULTS: We identified 714 consecutive patients. The median follow-up duration was 69 months (range, 1 to 114 months) and the 5-year LRRFS, DFS, and OS rates were 97%, 94%, and 98%, respectively, in patients who received PMRT (PMRT [+]). The corresponding figures were 96%, 90%, and 96%, respectively, in patients who did not receive PMRT (PMRT [–]). PMRT had no significant impact on survival. Upon multivariable analysis, only the histological grade (HG) was statistically significant as a prognostic factor for LRRFS and DFS. In a subgroup analysis of HG 3 patients, PMRT (+) showed better DFS (p=0.081). CONCLUSION: PMRT had no significant impact on LRRFS, DFS, or OS in pT1-2N1 patients treated with taxane-based chemotherapy. PMRT showed a marginal benefit for DFS in HG 3 patients. Randomized studies are needed to confirm the benefit of PMRT in high risk patients, such as those with HG 3.

Prognostic Significance of Inner Quadrant Involvement in Breast Cancer Treated with Neoadjuvant Chemotherapy / 한국유방암학회지

PURPOSE: In the present study, we aimed to evaluate the initial tumor location as a prognostic factor in breast cancer patients treated with neoadjuvant chemotherapy (NAC). METHODS: Between March 2002 and January 2007, a total of 179 patients with stage II/III breast cancer underwent NAC followed by breast surgery. Using physical and radiologic findings, patients were grouped by their initial tumor location into inner/both quadrant (upper/lower inner quadrant involvement +/− multicentric tumor involving outer quadrant; n=97) and outer quadrant (n=82) tumor groups. All patients received neoadjuvant docetaxel/doxorubicin chemotherapy. One hundred two patients underwent modified radical mastectomy and 77 patients underwent breast-conserving surgery. Adjuvant radiotherapy (RT) and hormonal therapy were administered after surgery when indicated. While 156 patients underwent postoperative RT, 23 did not. The median follow-up duration was 61.1 (12–106) months. RESULTS: The 5-year disease-free survival (DFS) and overall survival rates of all patients were 74.8% and 89.9%, respectively. Patients with inner/both quadrant tumors had lower 5-year DFS than those with outer quadrant tumors (67.7% vs. 83.4%, respectively; hazard ratio [HR]=1.941, p=0.034). A nodal ratio >25% was also an independent adverse prognostic factor for DFS (HR=3.276; p<0.001). There was no significant difference in DFS (p=0.592) after RT on the internal mammary node (IMN). Treatment failed in 44 out of 179 patients (24.6%), of which 27 patients had inner/both quadrant tumors. Twenty-one out of 27 patients had distant failures. CONCLUSION: Among breast cancer patients treated with NAC, those with inner/both quadrant tumors had lower DFS than those with outer quadrant tumors. More aggressive neoadjuvant and/or adjuvant chemotherapy with IMN RT is required for improved disease control and long-term survival.

Unilateral hypoglossal nerve palsy after endotracheal intubation for general anesthesia in a difficult airway patient: A case report

Hypoglossal nerve palsy after general anesthesia is an exceptionally rare complication, which has varied etiology. We present a case of unilateral hypoglossal nerve palsy resulting from repeated airway intervention for general anesthesia. A 57-year-old woman was scheduled to undergo modified radical mastectomy. During endotracheal intubation, the patient had Cormack's grade III-a severe airway condition. After the first intubation attempt failed, the intubation was attempted a second time using a stylet inside the endotracheal tube with cricoid pressure; this attempt was successful. In the evening of the operation day, the patient complained of dysarthria and dysphagia. Physical examination revealed deviation of the tongue to the right, which may have been caused by traumatic hypoglossal nerve injury. This case reviews the pathophysiology, prevention, and management of hypoglossal nerve palsy.

Dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia for appropriate surgical field visibility during modified radical mastectomy with i-gel®: a randomized control study / 대한마취과학회지

BACKGROUND: Modified radical mastectomy is associated with appreciable blood loss, while endotracheal intubation leads to elevated hemodynamic responses. The present study aimed to evaluate the clinical efficacy of dexmedetomidine infusion as an anesthetic adjuvant to general anesthesia during modified radical mastectomy with I-Gel. METHODS: Sixty adult consenting female patients, of American Society of Anesthesiologists physical status 1 to 2 and aged 4,065 years, were blindly randomized into two groups of 30 patients each. The patients in Group I received intravenous dexmedetomidine at a loading dose of 1 µg/kg over 10 min, followed by maintenance infusion of 0.4 to 0.7 µg/kg/h, while patients in Group II were administered an identical amount of saline infusion until 15 min prior to the end of surgery. The primary end point was bleeding at the surgical field and hemodynamic changes; requirement of isoflurane, intraoperative fentanyl consumption and recovery time were assessed as secondary outcomes. RESULTS: The patients receiving dexmedetomidine infusion showed significantly less bleeding at the surgical field (P < 0.05). A statistically significant reduction was also observed in the percentage of isoflurane required (0.82 ± 0.80%) to maintain the systolic blood pressure between 100 and 110 mmHg in patients receiving dexmedetomidine infusion compared with the Group II (1.50 ± 0.90%). The mean intraoperative fentanyl consumption in patients in the Group I was also significantly lower compared with that of the Group II (38.43 ± 5.40 µg vs. 75.12 ± 4.60 µg). The mean recovery time from anesthesia did not show any clinically significant difference between the groups. CONCLUSIONS: Dexmedetomidine infusion can be used safely to decrease the bleeding at the surgical field with smooth recovery from anesthesia.

Effects of propofol-based total intravenous anesthesia on recurrence and overall survival in patients after modified radical mastectomy: a retrospective study / 대한마취과학회지

BACKGROUND: The optimal combination of anesthetic agent and technique may have an influence on long-term outcomes in cancer surgery. In vitro and in vivo studies suggest that propofol independently reduces migration of cancer cells and metastasis. Thus, the authors retrospectively examined the link between propofol-based total intravenous anesthesia (TIVA) and recurrence or overall survival in patients undergoing modified radical mastectomy (MRM). METHODS: A retrospective analysis of the electronic database of all patients undergoing MRM for breast cancer between January 2007 and December 2008 was undertaken. Patients received either propofol-based TIVA (propofol group) or sevoflurane-based anesthesia (sevoflurane group). We analyzed prognostic factors of breast cancer and perioperative factors and compared recurrence-free survival and overall survival between propofol and sevoflurane groups. RESULTS: A total of 363 MRMs were carried out during the period of the trial; 325 cases were suitable for analysis (173 cases of propofol group, and 152 cases of sevoflurane group). There were insignificant differences between the groups in age, weight, height, histopathologic results, surgical time, or postoperative treatment (chemotherapy, hormonal therapy, and radiotherapy). The use of opioids during the perioperative period was greater in propofol group than in sevoflurane group. Overall survival was no difference between the two groups. Propofol group showed a lower rate of cancer recurrence (P = 0.037), with an estimated hazard ratio of 0.550 (95% CI 0.311-0.973). CONCLUSIONS: This retrospective study provides the possibility that propofol-based TIVA for breast cancer surgery can reduce the risk of recurrence during the initial 5 years after MRM.