VIRGINAL RECURRENT GIGANTOMASTIA (BREAST HYPERTROPHY). A CASE REPORT.

Virginal gigantomastia (VGM) is a benign disease of the breasts without a clearly established etiology. The treatment of VGM remains a problem. The conservative treatment is not effective while surgery is too traumatic. Most specialists recommend subcutaneous mastectomy with immediate implant reconstruction or reduction mammoplasty. The reduction mammoplasty with adjuvant hormone therapy is a variant of treatment of young patients with a risk of recurrence. We present a case of a patient with VGM who was operated in 2014. Reduction mammoplasty was performed. After 9 years, the patient had a relapse and second surgery, resection of the breasts with reduction mammoplasty. Tissues with cysts, fibrosis, hamartomas, and fibroadenomas were dissected. Histopathology revealed extensive fibrosis with hamartomas and fibroadenomas. The immunohistochemical examination of the breast tissue showed a high level (70%) of estrogen and progesterone receptors expression. We prescribed hormone therapy with tamoxifen 10 mg per day. Dynamic monitoring of the treatment result and control of the disease remission was carried out. Breast-conserving surgery performed in such patients can help alleviate the psychological, social, and physical disorders caused by VGM.

CLINICAL SIGNIFICANCE OF BRCA1 GENE SEQUENCING AND ITS PROMOTER METHYLATION TESTING IN THE SEARCH STRATEGY FOR THERAPEUTIC TARGETS IN BREAST CANCER TREATMENT.

BACKGROUND: Currently, there is a great interest in the genetic testing of BRCA1 and BRCA2 due to the fact that for patients with breast cancer (BC) with pathogenic variants of these genes, the use of the PARP inhibitors could be also provided in addition to implemented treatment protocols. The aim of this study was to characterize the molecular genetic structure of the BRCA1 gene in BC patients without progenitor germline mutations taking into account the methylation state of the promoter region. MATERIALS AND METHODS: The study involved 210 patients with newly diagnosed BC. The most common germline pathogenic variants of the BRCA1 (185delAG, 5382insC, 4153delA, T300G) and BRCA2 (6174delT) genes were identified in the peripheral blood. A subgroup of 14 patients without progenitor pathological variants of the BRCA1 and BRCA2 genes and with a family history of cancer was randomly selected. For them, BRCA1 gene sequencing by Sanger and hypermethylation of the BRCA1 gene promoter region were analyzed. RESULTS: The following frequencies of BRCA1 mutations were determined in the general group: 5382insC - 8.6%, 4153delA - 0.5%, T300G - 0.5%. The analysis of the BRCA1 gene by Sanger sequencing revealed 11 BRCA1 gene variants in 10 out of 14 BC patients. All of them, according to the currently available data, were defined as "benign" and not clinically relevant. The frequency of the detection of hypermethylation of the BRCA1 gene promoter region in the randomly selected group of patients was 14.3%. CONCLUSIONS: In BC patients, not only common mutations but also the methylation status of the BRCA1 gene promoter region in the peripheral blood should be determined. The whole-genome sequencing of the BRCA1 gene may be the last step in determining the genetic characteristics of BC patients carried out to optimize the treatment and improve survival thanks to the higher prevalence of the progenitor mutations and hypermethylation of the BRCA1 gene promoter.

Prevalence of BRCA1 and BRCA2 genes promoter hypermethylation in breast cancer tissue.

BACKGROUND: Recent advances in the treatment of breast cancer (BC) have been related to the personalization of therapy. The methylation status of the promoter regions of tumor suppressor genes such as BRCA1 and BRCA2 is supposed to be useful as a prognostic factor in BC patients. AIM: To investigate the frequency of hypermethylation in the promoter regions of BRCA1 and BRCA2 genes in tumor tissue of BC patients, and the relation of hypermethylation to the clinical course of the disease. MATERIALS AND METHODS: Molecular genetic studies were performed on 50 BC tissue samples in order to determine the methylation status of the promoter regions of the BRCA1 and BRCA2 genes. RESULTS: Hypermethylation of the BRCA1 promoter region was detected in 34% of BC cases, hypermethylation of the BRCA2 promoter region - in 50% of cases, and hypermethylation of the promoter region of both genes - in 20% of cases. A significant increase in the incidence of hypermethylation of the BRCA2 promoter region was found in the group of patients older than 56 years, mainly in patients with triple-negative breast cancer and without family history of BC. CONCLUSIONS: The high frequency of hypermethylation in the promoter regions of BRCA1 and BRCA2 genes, as well as their co-methylation in tumor tissue of BC patients has been detected.

The impact of locoregional treatment on survival of patients with primary metastatic breast cancer.

The aim of the study was to investigate the impact of primary tumor locoregional treatment (surgery or/and radiotherapy) on overall survival in patients with primary metastatic breast cancer (PMBC). MATERIALS AND METHODS: This retrospective study included 295 wo-men aged from 23 to 76 years with PMBC. Among the 295 patients, the effect of locoregional treatment of primary tumor on survival outcomes was evaluated in 177 women with distant metastases at diagnosis of breast cancer. 35 patient received breast surgery (group 1), 95 patients with PMBC - radiotherapy (group 2) and 47 patients - combination of breast surgery and radiation (group 3). The remaining 118 patients didn't receive surgery or/and radiotherapy (group 4). All patients received systemic cytotoxic chemotherapy. RESULTS: The groups of patients with PMBC did not differ significantly by age, menstrual function, ER status, Her2 receptor status, site of metastasis and number of metastatic lesions. 2- and 5-year overall survival in patients of group 1 was 54 and 32%, group 2 - 47 and 8%, group 3 - 73 and 18%, whereas in patients from group 4 - 26 and 9%, respectively. The median survival of patients who underwent surgery was 36 months, patients with PMBC who received radiotherapy - 24 months, patients who obtained combination of breast surgery and radiation - 30 months vs 18 months in patients who did not undergo primary tumor locoregional treatment. CONCLUSIONS: The results of this study showed a favourable effect of locoregional treatment in patients with PMBC.

[Local hyperthermia by means of ballon-type electrodes in combined therapy of patients with locally spread cancer of the mouth mucosa and lower lip]. / Lokal'naia gipertermiia ballonchikovymi élektrodami v kombinirovannom lechenii mestnorasprostranennogo raka slizistoi obolochki rotovoi polosti i nizhnei guby.

Modification of the standard chemo- and radiotherapy with local hyperthermia gives evident positive results in treatment of patients with local cancer of tunica mucosa of mouth and lower lip. Since this area having uneven complex surface needs to develop radiofrequency emitting special applicators. We have used catheters with ballons filled with hypertonic solution as electrodes to adapt the mouth cavity. An electric field creating between these ballons and high surface adjustability makes this system come in useful.

[Remote results of the treatment for stage I-II breast cancer]. / Viddaleni resul'taty likuvannia raku hrudnoï zalozy I-II stadii.

A retrospective analysis was carried out of an 8-year survival in a series of 410 patients presenting with stage I-II breast cancer. Results are assessed of different combinations of a multiple-modality treatment involving surgical, chemotherapeutical, radiation, and hormonal methods. It is pointed out that adjuvant chemotherapy can make the results better. Other methods do not exert statistically significant effect on survival of patients.

[Clinical effectiveness of nadroparin calcium in the surgical treatment of breast cancer]. / Otsenka klinicheskoi éffektivnosti primeneniia nadroparina kal'tsiia pri khirurgicheskom lechenii raka molochnoi zhelezy.

The report deals with an assessment of frequency of fatal thromboembolic complications after surgery for breast cancer, in particular, frequency and severity of the side-effects of calcium nadroparin treatment as a component of surgical preparation. Considering the low incidence of thromboembolic complications in such patients and the side-effects of anti-coagulant therapy, it is suggested that decisions be made on a strictly individual basis under stringent clinical control.

[Anesthesiologic management in experimental surgical interventions on the heart and major blood vessels]. / Anesteziologicheskoe obespechenie éksperimental'nykh operativnykh vmeshatel'stv na serdtse i magistral'nykh sosudakh.

On 26 mongrel dogs with a mass of 8-26 kg, 5 methods of anesthesiologic maintenance of operative interventions on the heart and major vessels were studied. An optimal method has been found.