Using an anterolateral thigh flap in autologous breast reconstruction as a salvage procedure in a patient with adult-onset Still's disease: A case report.

The deep inferior epigastric artery perforator (DIEP) flap is an excellent option for microsurgical breast reconstruction. In selected cases, e.g. in case of previous abdominoplasty, other autologous options like transverse upper gracilis (TUG) or superior gluteal artery perforator (sGAP) flaps can be considered. The anterolateral thigh (ALT) flap is reported to be used as a salvage procedure in selected cases of breast reconstruction, where other flaps were not available or failed. We present a case of a 41-year-old woman who was undergoing bilateral breast reconstruction after bilateral mastectomies following implant-based mastopexie and multiple infections. She also suffered from an adult onset Still's disease (AOSD) and was thus immunosuppressed. Microsurgical breast reconstruction was performed in a two-stage procedure. The left breast was reconstructed using a TUG flap. On the right side the TUG reconstruction failed due to vascular anomaly, so an ALT flap was successfully used instead. The whole procedure was accompanied by a multidisciplinary approach including a rheumatological complex treatment and enabled a successful bilateral breast reconstruction in this challenging case.

Evaluation of Quality of Life (BREAST-Q) and Scar Quality (POSAS) after Breast Augmentation.

This study examines the effects of breast augmentation on women who underwent surgery in Germany regarding their quality of life (QOL) and scar quality using patient-reported surveys. The purpose of this study was to determine if there is an increase in women's QOL after surgery compared with preoperative, and to evaluate their postoperative scar quality. Methods: A prospective monocentric study was conducted on 50 women who underwent breast augmentation with nanotextured silicone-filled implants between October 2018 and December 2020. Of these women, 21 (42%) participated in the preoperative survey (BREAST-Q), and 50 (100%) participated in the postoperative survey (BREAST-Q and POSAS). We used the BREAST-Q questionnaire to measure patients' QOL and the Patient and Observer Scar Assessment Scale to determine the scar quality. Results: Psychosocial well-being increased by 34.3 points according to the Q-score, sexual well-being increased by 35.7, and satisfaction with breasts increased by 48.8. Physical well-being decreased by 12 points. The Patient and Observer Scar Assessment Scale mean scores, according to the patient/observer, are 3.8/2.5 for inframammary scars and 4.4/3.1 for periareolar scars. Conclusions: In this study, we discovered that aesthetic breast augmentation with nanotextured silicone-filled breast implants is associated with significantly higher scores for patient satisfaction, which indicates an improvement in women's QOL.

[Bilateral pedicled gracilis muscle flap and bilateral gluteus muscle flap for multiple-stage reconstruction of vagina, pelvis and perineal region]. / Bilaterale gestielte M. gracilis-Lappenplastik und bilaterale M. gluteus-Rotationslappenplastik zur mehrzeitigen Rekonstruktion der Vagina, des kleinen Beckens sowie der Perinealregion.

Plastic reconstructions of oncological anorectal defects often prove to be very difficult and lead to prolonged hospitalisation due to severe bacterial contamination, neoadjuvant radiotherapy and chemotherapy and difficult anatomical conditions. There is no common standard for plastic reconstruction in such cases. We present a patient diagnosed with distal rectal cancer with infiltration of the anus and vagina, who underwent radical tumour resection of the rectum and anus as well as partial resection of the vagina. A severe necrotising infection occurred post-surgery, which resulted in an extensive defect of the pelvis and perineal region. This article provides a retrospective clinical evaluation and photographic documentation of the reconstruction of the vagina, pelvis and perineal region with a bilateral gracilis and gluteus muscle flap.

p16 overexpression and 9p21 deletion are linked to unfavorable tumor phenotype in breast cancer.

Overexpression of the p16 tumor suppressor, but also deletion of its gene locus 9p21, is linked to unfavorable tumor phenotype and poor prognosis in breast cancer. To better understand these contradictory observations, and to clarify the prognostic impact of p16 expression and 9p21 deletion, a tissue microarray (TMA) with 2,197 breast cancers was analyzed by fluorescence in-situ hybridization and immunohistochemistry (FISH) for 9p21 deletion and p16 expression. p16 immunostaining was weak in 25.6%, moderate in 7.1%, and strong in 12.7% of 1,684 evaluable cancers. Strong p16 staining was linked to advanced tumor stage (p = 0.0003), high-grade (p < 0.0001), high tumor cell proliferation (p < 0.0001), negative hormone receptor (ER/PR) status (p < 0.0001 each), and shorter overall survival (p = 0.0038). 9p21 deletion was found in 15.3% of 1,089 analyzable breast cancers, including 1.7% homozygous and 13.6% heterozygous deletions. 9p21 deletion was linked to adverse tumor features, including high-grade (p < 0.0001) and nodal positive cancers (p = 0.0063), high cell proliferation (p < 0.0001), negative hormone receptor (ER/PR) status (p ≤ 0.0006), and HER2 amplification (p = 0.0078). Patient outcome was worse in 9p21 deleted than in undeleted cancers (p = 0.0720). p16 expression was absent in cancers harboring homozygous 9p21 deletions, but no difference in p16 expression was found between cancers with (59.2% p16 positive) and without heterozygous 9p21 deletion (51.3% p16 positive, p = 0.0256). In summary, p16 expression is unrelated to partial 9p21 deletion, but both alterations are linked to aggressive breast cancer phenotype. High-level p16 expression is a strong predictor of unfavorable disease course in breast cancer.

Cytoplasmic accumulation of ELAVL1 is an independent predictor of biochemical recurrence associated with genomic instability in prostate cancer.

BACKGROUND: ELAVL1 is an RNA binding protein involved in translation control, which might have a regulatory role in prostate cancer progress. METHODS: To evaluate its impact and relationship with key genomic alterations, ELAVL1 expression was analyzed by immunohistochemistry on a tissue microarray containing 12,427 prostate cancers. RESULTS: The analysis revealed a mild to moderate predominantly nuclear immunostaining in normal prostate epithelium and an often higher both cytoplasmic and nuclear expression in cancer cells. Weak, moderate, and strong cytoplasmic ELAVL1 staining was found in 43%, 18%, and 3% of 10,478 interpretable tumors. Strong ELAVL1 staining was linked to high Gleason grade, advanced pathological tumor stage, positive nodal status, and PSA recurrence (P < 0.0001 each). A combined analysis of the effect of nuclear and cytoplasmic ELAVL1 expression on PSA recurrence revealed that the association with patient outcome was entirely driven by cytoplasmic staining. ELAVL1 positivity was more frequent in cancers harboring TMPRSS2:ERG fusions found by FISH (78%) or showing immunohistochemical ERG expression (74%) than in cancers without ERG rearrangement (63%) or ERG expression (58%, P < 0.0001 each). Strong cytoplasmic ELAVL1 staining was further linked to presence of PTEN, 5q21, 6q15, and 3p13 deletions (P < 0.0001 each), an observation consistent with cytoplasmic ELAVL1 accumulation in case of genomic instability. The prognostic role of ELAVL1 expression was independent of Gleason grade, T stage, N stage, surgical margin status, and preoperative PSA, irrespective of whether preoperative or postoperative variables were used for modeling. CONCLUSION: Our study identifies cytoplasmic accumulation of ELAVL1 as a predictor of adverse clinical behavior of prostate cancer independent of established clinico-pathological parameters.