Internal Mammary Sentinel Lymph Nodes in Breast Cancer - Effects on Disease Prognosis and Therapeutic Protocols - A Case Report.

BACKGROUND: The main prognostic factor in early staged breast cancer is the axillary lymph node metastatic affection. Sentinel lymph node biopsy, as a staging modality, significantly decreases surgical morbidity. The status of internal mammary lymph nodes gains an increased predictive role in grading breast carcinomas and modulation of postoperative therapeutic protocols. If positive, almost always are associated with worse disease outcome. Nevertheless, the clinical significance of internal mammary lymph node micrometastases has not been up to date precisely defined. AIM: To present a case of female patient clinically diagnosed as T1, N0, M0 (clinical TNM) ductal breast carcinoma with scintigraphic detection of internal mammary and axillary sentinel lymph nodes. METHODS: Dual method of scintigraphic sentinel lymph node detection using 99mTc-SENTI-SCINT and blue dye injection, intraoperative gamma probe detection, radioguided surgery and intraoperative ex tempore biopsy were used. CASE REPORT: We present a case of clinically T1, N0, M0 ductal breast cancer with scintigraphic detection of internal mammary and axillary sentinel lymph nodes. Intraoperative ex tempore biopsy revealed micrometastases in the internal mammary node and no metastatic involvement of the axillary sentinel lymph node. CONCLUSION: Detection of internal mammary lymph node metastases improves N (nodal) grading of breast cancer by selecting a high risk subgroup of patients that require adjuvant hormone therapy, chemotherapy and/or radiotherapy.

Extreme gigantomastia in pregnancy: case report--my experience with two cases in last 5 years.

We present an extreme case of gigantomastia in pregnancy during the second gemelar pregnancy of a 30-year-old woman. Her first pregnancy was 8 years ago, was also gemelar and she delivered with caesarean section. From the beginning of her current pregnancy, the patient noted steady growth of both of her breasts that reached enormous dimensions at the end of the pregnancy. This kind of breast changes did not occur during her first pregnancy. The patient also suffered from myasthenia gravis that was in remission during this pregnancy, without any therapy. The patient was in the 38 weeks of gestation, and a delivery with caesarean section was performed in line with the reduction of her breasts. The main reasons that led me to perform these two interventions as one act were the fact that puerperal mastitis could develop on these enormous breasts, further the small regression of these huge breasts during the bromocriptine treatment, as well as the intention to avoid other operative traumas, considering possibility of exacerbation of myasthenia gravis. I had already performed bilateral reduction mammaplasty with free areola-nipple graft, when a tissue with total weight of 20 kg (2 × 10 kg) was removed. The patient had an excellent post-operation recovery course.

Indications for VATS or open decortication in the surgical treatment of fibrino-purulent stage of parapneumonic pleural empyema.

Open and Video-Assisted Thoracoscopycal pleural decortications are proved and effective surgical procedure in the surgical treatment of pleural empyema in the fibrinopurulent stage. Early referral to surgery gives a better chance of success in VATS pleural decortications than open decortications. Pleural morphology, biochemistry and biology can also affect the outcome of the surgical treatment of pleural empyema. The aim of this paper is to compare the results of VATS and open decortications of the pleura according to the preoperative morphological and biochemical conditions of the pleura and the pleural cavity as well as postoperative morphological and functional improvement in patients with parapneumonic, fibrinopurulent pleural empyema. Two different approaches (VATS and open pleural decortications) were analyzed in 37 patients divided into two groups. The biochemical analysis of pleural fluid (LDH, glucose, pH and albumins) and the pleural thickness of the chest CT scan were measured. The success of the operations was measured by plain chest X-ray and functional tests after 3 months postoperatively. The group with VATS pleural decortications showed a significantly (p<0.001) lower pleural LDH level and pleural thickness and significantly higher levels (p<0.001) of glucose and albumins than the group with opened pleural decortications. The differrences in the pleural pH were not significant. Postoperative chest X-rays at discharge were significantly better in VATS pleural decortications. FEV1 and FVC, predicted and 3 months after operation, were not significantly different between the two groups. VATS and open decortications are safe and effective for the majority of patients. When VATS pleural decortications cannot be performed due to an obliterated pleural space, open pleural decortication still remains an effective procedure that allows acceptable functional and morphological results. Preoperative determination of pleural LDH, glucose, and albumins, as well as the thickness of pleural peel on CT scan, enables better evaluation of the pleural condition and a more exact indication of the right procedure.

Extreme gigantomastia in pregnancy: case report and review of literature.

We present an extreme case of Gigantomastia in pregnancy in a 24-year old woman, gravida 2, in a 28 weeks' of gestation, with a total breast weight of 33 kg, complicated by infection, ulcerations and subsequent hemorrhage. Thorough laboratory analyses did not reveal any hint as to the cause of this enormous breast enlargement. Gynecological examinations and ultrasound revealed a viable, progressive normal fetus. The severity of the problem is further emphasized by the patients' breathing problems and even big difficulty in standing and walking. We performed bilateral simple mastectomy as a life-saving procedure to prevent fatal complications. The procedure finished without any complications or large amount of blood loss. There are less than 100 cases of gravid gigantomastia reported, but never to such extreme breast weight. Etiology remains uncertain, and controversy exists in therapeutic modality. According to the literature the most reliable conservative treatment is bromocriptine therapy, but if the condition progresses surgical intervention, in the form of reduction mammoplasty or simple mastectomy, is the treatment of choice.