Partial breast reconstruction for an inferomedial breast carcinoma using an omental flap.

BACKGROUND: Various oncoplastic techniques are used for partial reconstruction after breast-conserving surgery (BCS), but treatment of an inferomedial breast carcinoma (IMBC) can be difficult, especially in a small breast. We review our experience with immediate partial breast reconstruction after BCS for an IMBC using a laparoscopically harvested omental flap (OF). METHODS: The subjects were 24 patients with an IMBC who underwent immediate partial breast reconstruction with the OF between April 2002 and June 2009. A wide excision (>20% of the breast tissue) was performed through a skin incision along the medial inframammary fold. The pedicled OF was harvested laparoscopically and used to fill the dead space in the inferomedial quadrant. RESULTS: The mean follow-up period was 35 months. The mean tumor size was 3.2 cm. The mean volume of resected breast tissue was 180 g and the mean extent of resection was 40%. The complication rate was 12.5% and all were minor and treated conservatively. Laparoscopy-associated complications did not occur, except for one minor injury of the gastroepiploic artery. The surgical margin was positive in only 1 patient (4.2%) and neither local nor systemic recurrence has occurred to date in any patients. Cosmetic outcomes were mostly satisfactory, with minimal donor-site scars in the abdominal wall. Cosmetic failure occurred in 1 patient (4.2%) due to an inadequate OF volume. CONCLUSIONS: Laparoscopic harvesting of the OF is a safe procedure with minimal donor-site morbidities and deformities. This approach is an option for immediate partial reconstruction after BCS for an IMBC.

Carcinosarcoma of the duodenum: Report of a case.

This report describes a case of carcinosarcoma of the duodenum. Carcinosarcoma of the duodenum is a very rare tumor. A 72-year-old man was referred to the hospital because of appetite loss. Endoscopy demonstrated an irregularly depressed lesion (type 3) in the descending portion of the duodenum opposite to the ampulla of Vater. Computed tomography showed a thickened duodenal wall and swelling of the abdominal para-aortic lymph nodes. A biopsy specimen revealed a well-differentiated adenocarcinoma. A diagnosis of duodenal carcinoma was made (cT3, cN1, cM1, cStage IV according to the TNM classification). A subtotal stomach-preserving pancreatoduodenectomy and a lymph node resection were performed. On microscopic examination, adenocarcinoma cells and spindle type sarcoma cells were observed separately in the descending portion of the duodenum opposite to the ampulla of Vater. The adenocarcinoma cells were stained with antibodies against epithelial markers keratin and carcinoembryonic antigen for immunohistochemical analyses. In contrast, the sarcoma cells were stained with antibodies to vimentin and smooth muscle actin. The pathological diagnosis of a true duodenal carcinosarcoma was thus made.