In Situ Ductal Carcinoma Arising in Benign Phyllodes Tumor in 19-Year Old Patient: A Case Report.

Phyllodes tumors are fibroepithelial lesions and malign forms are rare neoplasms with lower than 1% of all primary breast tumors. Malign forms are usually behaves like sarcomas because they occur in the stroma of the breast. Also proliferation of epithelium occurs and even it is less often, the epithelial component of phyllodes tumors can transform into malignancy too. This epithelial malignancies are usually in the form of infiltrative carcinomas and non-invasive tumors arising in benign phyllodes tumors are much rarer but can be seen. Literature include very few cases about this situation and cases are usually old woman. We report a 19-year old patient who was diagnosed with ductal carcinoma in situ arising in benign phyllodes tumor of the breast.

Comparison of outcomes of standard and oncoplastic breast-conserving surgery.

PURPOSE: The aim of this study is to determine and to compare the oncological outcomes of bilateral reduction mammoplasty to standard breast-conserving surgery for breast cancer. METHODS: One hundred sixty-two patients who received a quadrantectomy because of breast cancer (group 1) and 106 breast cancer patients with macromastia who underwent breast-conserving surgery via bilateral reduction mammoplasty (group 2) between 2003 and 2010 were enrolled in this study. RESULTS: The mean follow-up time was 37 months for group 1 and 33 months for group 2. Surgical margins were wider than 2 mm in 82.7% and 10 mm in 76.5% of the patients in group 1. Eleven percent of patients had positive surgical margins in this group. When compared to group 2, the rates were 89%, 84%, and 8.4%, respectively. Three patients (1.8%) in group 1 and one patient (0.9%) in group 2 had local recurrence of the disease and received a mastectomy. No statistical significances were noted for either local recurrence or overall survival between the two groups. CONCLUSION: Bilateral reduction mammoplasty has some advantages as compared to the standard conventional breast-conserving surgery techniques without having any unfavorable effects on surgical margin confidence, local recurrence, and survival rates.

Complications of completion versus total thyroidectomy.

INTRODUCTION: The objective of this study was to analyze the complication rates after completion thyroidectomy and compare them with primary total benign and malign thyroidectomy causes in total of 647 patients. PATIENTS AND METHODS: Among 647 patients, there were 159 receiving completion thyroidectomy for differentiated thyroid cancer (DTC) (Group 1); 217 patients receiving total thyroidectomy for DTC (Group 2) and 271 given total thyroidectomy for benign diseases (Group 3). RESULTS: When groups were compared for complications, there were no significant difference except temporary hypocalcemia between completion thyroidectomy and total thyroidectomy for DTC. When the total thyroidectomies were compared (Group 2 and 3), there were no significant difference observed except unilateral temporary RLN palsy. CONCLUSION: With improvements in surgical technique and experience, complication rates of thyroidectomy performed for benign or malign diseases are reduced. In spite of the improvement in surgical experience, temporary RLN palsy and hypoparathyroidism are the main complications in completion thyroidectomies which need special attention. To evaluate the patients more carefully in preoperative period and performing adequate thyroidectomy appears more logical.

Intraglandular flap technique for tumors located in the upper outer quadrant of the breast.

UNLABELLED: We applied the intraglandular flap technique with racquet incision for tumors located in the upper outer quadrant of medium to small size breasts of 47 patients. It is an easy and safe technique with respect to cosmetic results, surgical margins, and complications. BACKGROUND: The intraglandular flap is a volume replacement technique in which glandular tissue is used to close the tissue defect. We applied the intraglandular flap technique with racquet incision for tumors located in the upper outer quadrant of medium to small size breasts of 47 patients. In this report, we present our preliminary results of this technique. PATIENTS AND METHODS: The intraglandular flap technique using a racquet incision was used on 47 consecutive breast cancer patients with T1 and T2 tumors, and analyzed prospectively. RESULTS: The median age of the patients was 46.5 (range, 24-63 years). The mean tumor size was 2.53 ± 0.8 cm. The volume of the resected specimen was 185 ± 29 cm(3). The mean length of incision was 9.68 ± 1.8 cm. The mean distance from the tumor to the nearest surgical margin was 1.65 ± 0.4 cm. Fat necrosis was evident in 8 patients (17%) and hematoma in 2 patients (4.2%). The other complications like seroma, glandular, and flap necrosis were not observed. DISCUSSION: Intraglandular flap technique with racquet incision used for tumors located in the upper outer quadrant of patients with medium and small breasts is an easy and safe technique with respect to cosmetic results, surgical margins and complications. The learning period of this technique is quite short. When used in patients with dense breasts the incidence of fat necrosis was found to be low.

Early complications of a reduction mammoplasty technique in the treatment of macromastia with or without breast cancer.

UNLABELLED: This study was planned to investigate the early postoperative complications of reduction mammoplasty done for benign or malignant reasons on 286 patients. Minor and major complication rates were 16.3% and 1.9%, respectively.There was no significant difference in terms of complications between the patients with and those without breast cancer. Body mass index was found to be the only factor associated with the complication rates. BACKGROUND: This study was planned to investigate the early postoperative complications after reduction mammoplasty applied either for benign or malignant reasons and reliability of the technique with respect to wound healing. PATIENTS AND METHODS: Two hundred and eighty-six reduction procedures were evaluated prospectively. Fifty-two patients underwent reduction mammoplasty for macromastia and 101 for macromastia with breast cancer. The wound complications were evaluated in 2 groups, as minor and major complications. Seroma, hematoma, surgical site infection, delayed wound healing, and minor wound dehiscence were included in the minor complication group. Severe complications, such as necrosis of nipple-areola complex and major incisional wound dehiscence, were included in the major complications group. RESULTS: Mean (SD) age of the patients was 48.8 ± 10.3 years, mean (SD) body mass index was 29 ± 3.3 kg/m(2), and mean (SD) weight of resected specimen was 958 ± 72 g. Mean (SD) preoperative and postoperative volumes for each breast were 1245 ± 75 cm(3) and 436 ± 27 cm(3), respectively. Minor and major complication rates were 25/153 (16.3%) and 3/153 (1.9%), respectively. There was no significant difference in terms of complications between the patients with and without breast cancer. Body mass index was found to be the only factor associated with the complication rates. DISCUSSION: Reduction mammoplasty is a surgical technique that has satisfactory cosmetic results in the treatment of macromastia. This technique also is safe in the treatment of breast cancer patients with macromastia and does not increase complication rates.

Prognostic factors determining survival in differentiated thyroid cancer.

BACKGROUND: Differentiated thyroid cancer (DTC) is among the most curable cancers. We evaluated the prognoses of patients with DTC from an iodine-deficient area. MATERIALS AND METHODS: Four hundred twenty-two patients with thyroid cancer who underwent surgery between 1992 and 2000 at the Ankara Oncology Hospital were evaluated. Three hundred eighty-two patients with DTC were included. Gender, age, histopathological type, tumor size, capsular invasion and vascular invasion, distant metastasis, TNM, and AMES-MACIS scoring were analyzed. RESULTS: The 10-year disease-free survival rate was 72% and the overall survival rate was 88%. Age >/=45 years at presentation, follicular thyroid cancer, tumor extension beyond the thyroid capsule, vascular invasion, distant metastasis, increasing tumor size, stage, and high MACIS-AMES scores were found to be statistically significant adverse prognostic factors in univariate analysis for DFS and OAS. Multivariate analysis for DFS and OAS confirmed that distant metastasis, follicular thyroid cancer, tumor extension beyond the thyroid capsule, vascular invasion, primary tumor size, TNM stage, and high MACIS score were independent prognostic factors. CONCLUSION: In DTC patients, in addition to traditional risk factors, prognostic factors, such as vascular invasion and capsular invasion, need to be evaluated; not only for achieving an adequate therapeutic approach, but also for avoiding overtreatment of low-risk patients.

The incidence of hyperthyroidism in patients with thyroid cancer in an area of iodine deficiency.

BACKGROUND: The incidence of hyperthyroidism among thyroid malignancy varies greatly depending on the geographical area and iodine intake. The aim of the study was to evaluate the association of hyperthyroidism and thyroid cancer (TC) in an iodine deficient area. PATIENTS AND METHODS: Medical records of 422 patients who underwent operation for TC between 1992 and 2000 in Ankara Oncology Hospital were reviewed. The characteristics of TC patients with hyperthyroidism were analyzed in respect to gender, age, histopathological type, thyroid function status, tumor size, extrathyroidal invasion, local recurrences, distant metastasis, AMES and MACIS scoring. RESULTS: In the present patient series, among 422 patients with TC, hyperthyroidism was found in 12 patients (2.8%). None of the patients had Graves' disease. Of 12 patients with hyperthyroidism, 9 patients had papillary carcinoma, 1 patient had follicular carcinoma and 2 patients had follicular variant of papillary carcinoma. The tumor was in the active nodule in 5 patients. CONCLUSION: The existence of hyperthyroidism among patients with differentiated TC is a clinical entity. Patients with hyperthyroidism and nodules require a careful approach in order to establish or exclude the possibility of TC especially in formerly iodine deficient areas.

Prognostic significance of apex axillary invasion for locoregional recurrence and effect of postmastectomy radiotherapy on overall survival in node-positive breast cancer patients.

Postmastectomy irradiation substantially reduces the risk of locoregional recurrences (LRR) of breast carcinoma. However, debates continue on the prognostic factors for radiotherapy and the effect of radiotherapy on overall survival. The present study was undertaken to investigate the prognostic significance of level III positive nodes, along with the other factors for LRR, and to evaluate the effect of postmastectomy radiotherapy on overall survival among node-positive breast carcinoma treated systemically. Data from 549 consecutive node-positive breast cancer patients who underwent modified radical mastectomy and received adjuvant systemic therapy were studied retrospectively. Prognostic factors for LRR and the effect of postmastectomy radiotherapy on overall survival were analyzed. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. The 5-year locoregional recurrence rate is 7%. Apical invasion was found to be an independent prognostic factor for LRR (HR 2.6, CI 1.29-5.35) along with a finding of 4 or more positive nodes and T3 tumor. Adjuvant radiotherapy decreased LRR and improved survival significantly. Apical invasion, 4 or more positive axillary lymph nodes, and T3 tumor are the predictors of LRR, and patients with these adverse factors are candidates for adjuvant radiotherapy. Postmastectomy radiotherapy improves overall survival.

Prognostic factors affecting survival and disease-free survival in lymph node-negative breast carcinomas.

BACKGROUND AND OBJECTIVES: The objective of this study was to identify the patients who are at low or high-risk by defining the prognostic factors in node-negative breast carcinomas. METHODS: Medical records of 384 consecutive breast cancer patients with negative axillary lymph nodes who had been operated on between January 1994 and January 1997 at our hospital were retrospectively reviewed. Several clinical and pathological characteristics of patients were categorized. Univariate analyses of survival and disease-free survival (DFS) were performed by the Kaplan-Meier method and the log-rank test. Independent prognostic and predictive factors affecting survival and DFS were assessed by Cox proportional hazard method. RESULTS: 5-year survival and DFS were 91.4 and 85.7%, respectively. Size, grade, age, and lymphovascular invasion (LVI) were the prognostic factors that independently affected survival and DFS. Tamoxifen improved survival and DFS. While age younger than 35 was an adverse factor for both survival and DFS, age older than 49 was a detrimental factor for DFS. CONCLUSIONS: Patients who have a tumor with size greater than 2 cm, with histologic grade 3, with LVI, and patients with age under 35 or older than 49 have poorer prognosis among node-negative breast carcinomas, and are candidates for adjuvant therapy.

Risk factors for breast cancer in Turkish women with early pregnancies and long-lasting lactation--a case-control study.

A hospital-based case-control study was carried out among 504 women with breast cancer and 610 controls to analyse the risk factors for breast cancer in Turkey. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for each risk factor were obtained from logistic regression analysis. Risk factors for breast cancer were found to be long-term lactation (> or = 5 years versus never OR 0.31, 95% CI 0.12-0.79), young age at menarche (< 15 years versus > or = 15 OR 1.72, 95% CI 1.30-2.28), late age at first full-term pregnancy (> or = 30 versus < 20 OR 2.86, 95% CI 1.32-6.21), oral contraceptive use (ever versus never OR 1.51, 95% CI 1.10-2.08), positive family history (positive versus negative OR 2.81, 95% CI 1.35-5.82), and menstrual irregularity (yes versus no OR 1.61, 95% CI 1.05-2.49). The results of the present study will lead to a better understanding of the risk factors for breast cancer in a developing country.