[Breast cancer during pregnancy and the postpartum period: challenging diagnosis of an aggressive disease]. / Borstkanker tijdens en na de zwangerschap.

Breast cancer is the most common malignancy diagnosed during pregnancy. Breast cancer during pregnancy or within the first postpartum year is commonly described as Pregnancy-Associated Breast Cancer (PABC). PABC often exhibits poorer histopathologic features and has a worse prognosis when compared to young breast cancer patients without a current or recent pregnancy. Here, we describe two cases of PABC in which the presenting symptoms of the patients were interpreted as pregnancy-related changes, causing a diagnostic delay. Therefore, we argue that every pregnant or postpartum woman with changes in the breast must be thoroughly evaluated to exclude the possibility of a malignancy. In case of any suspicion, patients must be referred to a breast cancer center for further evaluation.

Pregnancy-associated breast cancer: the influence of gestational age.

Whether pregnancy-associated breast cancer (PABC) arise before or during pregnancy and whether this histopathology is affected by gestational age are currently unclear. The present study assesses the influence of gestational age and lactation on the histopathologic profile of PABC. We identified 744 patients with PABC (defined as breast cancer during pregnancy or 6 months following delivery). Histopathologic features were compared between pregnant and postpartum patients. We found that age at diagnosis was 34.2 years, and a majority of cancers were diagnosed during pregnancy (71.3%). Within pregnant patients, tumors were significantly more often estrogen receptor (ER)-negative in second and third trimesters (57.4%), as compared to first trimesters (41.9%) (P = 0.036). Similarly, a progesterone receptor (PR)-negative status was reported significantly less often within first trimesters (38.0%) compared to second and third trimesters (57.1%) (P = 0.032). For human EGF receptor 2 status, no significant differences were observed between gestational trimesters or lactating vs non-lactating patients. In postpartum patients, grade III tumors were found in over 80%, with high percentages of ER-negative tumors reaching 63% in those lactating vs 49% in non-lactating patients. This study demonstrates the varying histopathologic profile of PABC by gestational age and lactation status. Second- and third-trimester cancers display most typically the common ER/PR-negative phenotype, which is commonly reported in the literature. The increased ER-negative status and percentage grade III tumors in lactating vs non-lactating patients also suggest the presence of additional factors further diversifying histology. This indicates the need for clear definitions of PABC and the role of potential subgroups, which may provide a stepping stone for further in-depth research into PABC-carcinogenesis.

Receptor status of breast cancer diagnosed during pregnancy: A literature review.

The definition of PABC is inconsistently given as either breast cancer diagnosed exclusively during pregnancy, or combined with breast cancer diagnosed within six months to five years after delivery, and sometimes even longer. The longer away from the delivery date breast cancer is diagnosed, the less clear this association with pregnancy may become. Therefore, breast cancer diagnosed during pregnancy (BCdP) may not necessarily be the same disease entity as PABC. This review aims to provide an overview of BCdP receptor status, as this has not been assessed before. BCdP tumors were predominantly ER negative (56.6 %), PR negative (57.2 %) or both ER and PR negative (47.9 %). Moreover, HER2-overexpression was seen in 33.2 % of BCdP patients and 27.6 % had triple negative disease. This predominantly ER and PR negative profile with more often HER2 overexpression is aggressive and distinct from non-pregnant similar-aged patients, warranting future comparative research.

The clinical course and treatment of black mamba (Dendroaspis polylepis) envenomations: a narrative review.

CONTEXT: The black mamba (Dendroaspis polylepis) is, due to its extremely toxic venom, one of the most dangerous snake species in Sub-Saharan Africa. A D. polylepis bite is a medical emergency and requires adequate action to prevent severe complications. However, there are no comprehensive reviews available based on clinical cases, and no readily accessible guidelines for standardized treatment. Therefore, we aim to provide an overview regarding the currently available clinical literature on D. polylepis envenomations; in order to promote knowledge on symptomatology and treatment options. METHODS: We searched for cases reporting humans bitten by D. polylepis in PubMed, Embase, Scopus, and Sabinet. We searched the reference lists of all eligible articles for additional articles. After quality assessment, 29 cases were included in this review. We used descriptive analysis to create an overview of the collected parameters. DISCUSSION: Among the included case reports and case series, D. polylepis envenomations most frequently resulted in decreased respiratory function, sweating and paralysis. The onset of symptoms usually occurred within 60 minutes. Neurological symptoms occurred more often than symptoms of autonomic dysfunction. In the reported cases most patients (26/29) received antivenom and most survived (25/29). We recommend the reporting of additional structured case reports to improve future analyses on the clinical course of envenomations, in order to improve public health response to D. polylepis envenomations.