Prognostic factors in triple-negative breast cancer: a retrospective cohort

SUMMARY OBJECTIVE: Triple-negative breast cancer (TNBC) is characterized by lack of estrogen receptor, progesterone receptor, and human epidermal growth factor receptor 2 (HER2) expression and accounts for 15-20% of all breast cancers. This study aims to analyze prognostic factors related to a reduction in overall survival (OS), disease-free survival (DFS), and risk of mortality and recurrence in TNBC. METHODS: This is a retrospective observational cohort study. Medical records of 532 patients with breast cancer diagnosed from 2007 to 2020 were analyzed. Of these patients, 93 (17%) were women with TNBC. Ten medical records were excluded, and the final sample was composed of 83 women with TNBC. OS and DFS were estimated by the Kaplan-Meier model. Univariate analysis (log-rank test) and multivariate analysis (Cox regression) were used to examine prognostic factors related to a statistically significant reduction (p<0.05) in OS and DFS and increased risk of mortality and tumor recurrence. RESULTS: Smoking, advanced clinical stage, larger tumor size, angiolymphatic invasion, positive sentinel lymph node, axillary node involvement, higher cancer burden, surgical treatment with mastectomy, and recurrence were related to a significant decrease in OS and/or DFS and increased risk of mortality and/or recurrence in TNBC. The 10-year OS and DFS was around 61 and 65%, respectively. CONCLUSIONS: Advanced clinical stage, positive sentinel lymph node, axillary node involvement, surgical treatment with mastectomy, and higher residual cancer burden were related to a significant reduction in OS and DFS and increased risk of mortality and recurrence in TNBC.

Low-grade carcinoma in situ in fibroadenoma: a case report

Fibroadenomas are the most common benign breast neoplasms. In rare cases, a carcinoma may develop within a fibroadenoma. The aim of this study was to report a case of low-grade carcinoma in situ in a fibroadenoma. A 31-year-old female, G0P0A0 and without family history of cancer, arrives at the service with an expressive breast lump growth along the year year. Core biopsy, histopathological and immunohistochemical studies showed an in-situ carcinoma in a fibroadenoma. Surgical resection was performed with a safety margin, and anatomopathological study and immunohistochemistry of the surgical specimen confirmed the core biopsy diagnosis. Currently, the patient is under annual clinical follow-up with mammography and breast ultrasound and no evidence of neoplastic disease. Although this is a rare event and few cases are described in the literature, carcinomas in situ can occur in a fibroadenoma.

Pathogenic variants in BRCA1/2 genes among patients with triple-negative breast cancer: a case series

Triple-negative breast cancer (TNBC) is an uncommon molecular subtype (representing 15%­20% of breast cancers) characterized by the non-expression of estrogen receptor, progesterone receptor, and human epidermal growth receptor factor 2. More aggressive and lethal, TNBC is often associated with pathogenic variants in BRCA1/2 genes. This study aimed to describe a series of seven cases of patients with TNBC and pathogenic variants in BRCA1/2 genes. All patients were female and under 50 years of age at diagnosis. Four of them presented a family history of breast cancer and/or other neoplasms. The predominant clinical stage was IIB, and the main anatomopathological stage was pT2pN0M0. The mean tumor size in the series was 2.5 cm (1.0 to 3.2 cm). Ki-67 was > 30% in all patients. Three cases (43%) had pathological complete response, and only one presented extensive residual disease after neoadjuvant chemotherapy. Six patients showed pathogenic variants in BRCA1 (86%) and one in BRCA2+ (14%). After a mean follow-up of 38 months (19 to 68 months), five patients were alive and without neoplastic disease, and two progressed to metastasis.

Bilateral risk-reducing mastectomy in a patient over 50 years of age: case report with an emphasis on the psychological aspect in the face of serious complications

Malignant breast neoplasia is the main cause of cancer mortality in women in Brazil, after non-melanoma skin cancer, and about 5 to 10% of these cases are associated with family inheritance; BRCA1 and BRCA2 genes are the most frequently mutated. In this sense, there has been a paradigm shift in medical practice regarding breast cancers in recent years, with the implementation of risk-reducing surgical procedures, such as bilateral mastectomy and salpingo-oopherectomy, which still have controversies in the indication, in addition to fears and sufferings of patients, before and after the procedure. A 54-year-old female patient has been undergoing routine examinations since 2009 (49 years), as she has a family history of breast cancer. In May 2014 (54 years old), the patient underwent genetic research, discovering the pathogenic 648delT mutation in heterozygosity in the BRCA1 gene. Although complementary exams did not indicate any neoplasia, the patient wanted to undergo risk-reducing surgery. After interprofessional discussion with the patient, bilateral risk-reducing mastectomy and salpingo-oophorectomy were performed. The patient had a postoperative infection, and one of the silicone prostheses was removed from her breast. In 2015 (55 years old), she underwent a new prosthesis inclusion, evolving without complications. Currently, she is being followed up and without evidence of active cancer disease. Despite the complication with the prosthesis, there was an improvement in psychological aspects that bothered her, referring to a reduction in anxiety and fear of cancer. Although beneficial, risk-reducing mastectomy has associated risks, especially in patients with advanced age and comorbidities. However, with an appropriate approach and focused on the complexities of each person, it is possible to provide the patient with a better overall psychological experience, as demonstrated in this case reported.

Retalho toracoabdominal para reconstrução de tumor de mama localmente avançado, em paciente com mutação de BRCA1 / Thoracoabdominal flap for locally advanced breast tumor reconstruction in a patient with BRCA1 mutation

O presente estudo objetiva relatar a técnica do retalho toracoabdominal pós-mastectomia por tumor localmente avançado em paciente com mutação de BRCA1. Foi realizada a mastectomia com ressecção de quase todo o músculo peitoral maior à esquerda, com linfonodectomia axilar homolateral e reconstrução do grande defeito da parede torácica com retalho toracoabdominal fasciocutâneo, baseado nas artérias intercostais posteriores.

This case report describes the application of the thoracoabdominal flap technique after locally advanced tumor mastectomy in a patient with breast cancer 1 (BRCA1) mutation. The mastectomy included resection of nearly the entire left pectoralis major muscle, with homolateral axillary lymphadenectomy and reconstruction of the large chest wall defect with a fasciocutaneous thoracoabdominal flap based on the posterior intercostal arteries.

Seroma tardio no dorso após reconstrução de mama com retalho de músculo grande dorsal e quimioterapia com docetaxel / Delayed seroma following autologous latissimus flap breast reconstruction and chemotherapy with docetaxel

Relatamos o caso de uma paciente do sexo feminino, 43 anos, que se submeteu a uma mastectomia radical modificada seguida por reconstrução imediata com retalho de músculo grande dorsal e prótese. Recebeu quimioterapia adjuvante com doxorrubicina, ciclofosfamida e docetaxel, seguida de radioterapia. Paciente desenvolveu um seroma na área doadora do retalho 14 meses após a cirurgia. A formação de seroma no sítio doador durante o pós-operatório imediato é uma complicação comum após rotação de músculo grande dorsal, contudo, não é usual que a secreção de fluidos se acumule tanto tempo depois da cirurgia.

We reported the case of a 43-year-old female patient who underwent a modified radical mastectomy followed by immediate reconstruction with latissimus dorsi flap and prosthesis. After surgery, she was treated with adjuvant chemotherapy including doxorubicin, cyclophosphamide and docetaxel, followed by radiotherapy. Fourteen months after surgery, she developed a delayed seroma at the donor site. Despite the seroma formation in immediate or acute postoperative to be a common complication after latissimus dorsi muscle harvest, it is unusual the accumulation of fluid secretion in the donor-site so long after the surgery procedure.

Grau de satisfação após mastectomia com reconstrução mamária

Introdução: A reconstrução mamária imediata ou tardia após tratamento cirúrgico do câncer de mama já esta bem estabelecida na literatura. Não altera o prognostico da paciente e pode ser realizado imediatamentena maioria dos casos. Objetivo: avaliar a qualidade de vida de pacientesoperadas de câncer de mama que se submeteram a reconstruçãomamaria. Pacientes e Métodos: Foram avaliadas, retrospectivamente,51 mulheres com câncer de mama que submeteram- se a mastectomia ou tratamento conservador e reconstrução da mama. A avaliação foi realizada através de um questionário qualitativo desenvolvido para avaliar os sentimentos destas mulheres em relação ao procedimento reconstrutivo e o impacto sobre a qualidade de suas vidas e auto-estima. Os questionários foram oferecidos durante consultas de retorno para reavaliação e puderam ser respondidos em casa e depois devolvidos se assim desejassem. Foram colhidas informações gerais como idade, ocupação, estado civil e nível de atividade física. O grau de satisfação foi avaliado em vários quesitos com numeração de 1 (plenamente insatisfeita) até 5 (completamente satisfeita) do questionário. O protocolo do presenteestudo foi encaminhado e aprovado pelo Comitê de Ética em Pesquisa do Hospital São Marcos. Resultados: As pacientes apresentam como características gerais uma média de idade de 50,5 anos, 43,1% se autodeclararam empregadas e 31,3% sedentárias. Entre os principais índices o de maior positividade foi o de pacientes que optariam plenamente pela reconstrução secom 92% de plena satisfação, 90% nunca se arrependeram pela decisão da reconstrução, 91,8% acreditam queo procedimento ajuda a enfrentar o câncer de mama, 68% sentem o corpo completamente normal. Conclusão: A auto-avaliação estética das pacientes pós-cirurgia reconstrutora foi positivo o que ressalta a importância deste procedimento para melhoria da qualidade de vida das pacientes.

Introduction: Immediate or late breast reconstruction after breast cancer surgical treatment is already wellestablished in the literature. It doesn?t change patient?s prognosis and can be performed immediately in mostcases. Objectives: To assess life quality of breast cancer operated patients who underwent breast reconstruction. Patientes and Methods: There were retrospectively studied 51 women with breast cancer who underwent mastectomy or conservative treatment and breast reconstruction. The evaluation was conducted through a qualitativequestionnaire designed to assess the feelings of these women regarding the reconstructive procedure and the impact on the quality of their lives and their self-esteem. The questionnaires were offered during return consults and they could be answered at home and then returnedif so desired. There were collected general information such as age, occupation, marital status and of physical activity level. The satisfaction level was assessed in secom veral questions of the questionnaire, with numbering from 1 (fully unsatisfied) to 5 (completely satisfied). This study?s protocol was submitted and approved by the Ethics Committee of São Marcos Hospital. Results: The patients presented, as general characteristics, 50.5 year-old average age, 43.1% self-reportedemployees and 31.3% sedentary ones. Among the main indices, the most positive was that of patients who opt for reconstruction with 92% of full satisfaction, besides 90% never regretted the decision of the reconstruction, 91.8% believe that the procedure helps to address breastcancer, 68% feel the body completely normal. Conclusion: The aesthetic self-assessment of patients after reconstructive surgery was positive, which highlights the importance of this procedure to improve theirlife quality.

Síndrome de Poland / Poland syndrome

A síndrome de Poland é uma rara anomalia congênita, não hereditária, que se manifesta em adolescentes pela ausência ou deficiência do desenvolvimento de uma das mamas. Pode estar associada também a falhas no desenvolvimento dos músculos grande e pequeno peitoral, assim como de outros músculos adjacentes. Antes do desenvolvimento puberal, nota-se assimetria na região torácica pela ausência dos músculos peitoral maior e menor. Apresenta-se um caso de síndrome de Poland, cuja amastia foi tratada com retalho miocutâneo do músculo grande dorsal e prótese de silicone.

Poland syndrome is a rare, non-inherited, congenital anomaly which manifests itself in adolescence by the absence or deficit of the development of a breast. It can also be linked to failures in the development of pectoralis minor and pectoralis major muscles, as well as other adjacent ones. Before the pubertal development, there is an asymmetry at the thoracic region due to the absence of those muscles. We present a Poland's syndrome case whose amastia was treated with a myocutaneous flap of the latissimus dorsi muscle and with a silicone prosthesis.