ABSTRACT
INTRODUCTION: Hidradenitis suppurativa (HS) is a chronic inflammatory disease of the skin and soft tissues most commonly affecting the axilla and groin. It presents as recurrent inflamed lesions, abscesses, draining sinus tracts, and scars. Treatment focuses on preventing progression of disease and managing symptoms. There are limited guidelines discussing the treatment of HS during pregnancy as well as the surgical treatment of HS of the breast in young women who desire future lactation. PRESENTATION OF CASE: We present a case of a thirty-six-year-old female with HS of the breast during pregnancy. Her condition was recalcitrant to steroid injections, TNF blocker, antibiotics and incision and drainage. She developed numerous active, infected large interconnected lesions in her right breast. The decision was made to perform total excision of the infected area in the right breast. She underwent primary closure of the wound one week after excision and was able to successfully breast feed after this treatment. DISCUSSION: Treatment of HS includes both medical and surgical modalities and varies based on the severity of disease. In this patient, definitive but conservative pre-partum treatment was necessary to avoid milk fistula or chronic abscess formation, as the patient's desire was successful postpartum lactation. CONCLUSION: This report describes the successful surgical management of a pregnant woman with severe HS of the breast. This represents an alternative management method in an extreme case of HS, where aggressive medical management was contraindicated.
ABSTRACT
INTRODUCTION: Primary small cell neuroendocrine carcinoma of the breast (SCNCB) is a very uncommon type of breast cancer. Histology and morphology are virtually indistinguishable from small cell neuroendocrine carcinomas of the lung (SCNCL), mandating a search for a primary site elsewhere in the body. There is no standard approach to treatment as there are only a limited number of cases reported in the literature. This report summarizes a case of primary SCNCB and presents a review of the literature. PRESENTATION OF CASE: A 65-year-old female presented to her gynecologist with a right breast mass. After biopsy, she was diagnosed with a primary SCNCB with regional lymph node involvement. She was treated with chemotherapy and radiation therapy with a good clinical response. DISCUSSION: Due to the rare nature of this tumor, no standard treatment exits. Case reports have described breast conserving therapy combined with neoadjuvant or adjuvant chemotherapy as well as chemoradiation therapy alone for metastatic disease. Both chemotherapy regimens, those used to treat SCNCL and invasive breast cancer, have been described in these reports. CONCLUSION: Primary SCNCB is a very rare type of breast cancer with no standard treatment. Further research is needed to better understand the behavior of this rare tumor in order to develop a standard approach to treatment.
ABSTRACT
Importance: In the United States from 2009 to 2013, the incidence of breast cancer was the highest of any cancer and the death rate was second to that of lung cancer. Approximately 5% to 10% of breast cancers are inheritable. Observations: BRCA1 and BRCA2 germline mutations account for up to 30% of inheritable breast cancers and are the most commonly assessed mutations in patients presenting with early-onset breast cancer, triple-negative breast cancer, bilateral breast cancer, and a family history of breast cancer. Less common non-BRCA mutations have also been identified and contribute to hereditary breast cancer syndromes. Although established in BRCA mutations, indications and interpretations of genetic testing in non-BRCA mutations are not well defined. Furthermore, costs associated with genetic testing are highly variable and dependent on laboratory pricing, insurance coverage, and individual risk factors. Conclusions and Relevance: Genetic testing is a powerful tool that allows for the detection of BRCA and non-BRCA germline mutations in individuals with high risks of breast cancer, which in turn aids in the individualization of treatment. Given the magnitude of this disease, it is of great benefit for physicians, including general surgeons, to understand the indications, interpretations, and costs associated with genetic testing in patients with breast cancer. Cost is an especially important part of the genetic testing process and point of discussion with patients.
