Breast cancer (BC) is the most common malignancy to affect females. The first suggestions of BC and its treatment date back to Ancient Egypt, 1500-1600 B.C. Throughout history, the management of BC ...has evolved from extensive radical mastectomy towards less invasive treatments. Radical mastectomy was introduced by W.S. Halsted in 1894, involving the resection of the breast, regional lymph nodes, pectoralis major and minor. Despite its mutiloperative lymphatic mapping and the concept of sentinel lymph node (SLN) biopsy (SLNB) have been developed. SLNB has replaced axillary lymph node dissection (ALND) to be the standard procedure for axillary staging in patients with clinically node-negative BC. Many women have since been spared ALND, including those with negative SLNB or with SLNs involved with micrometastases (0.2-2 mm in size). In the last decade, evidence gathered from new clinical trials suggests that ALND may be safely omitted even in BC patients with 1 or 2 positive SLNs if adjuvant radiotherapy is delivered.ating effect, it had been the main surgical approach to BC patients until 1948, when Patey and Dyson proposed its modified form that conserved pectoralis major and minor and the level III of axillary lymph nodes. The latter was associated with less postoperative morbidity and improved quality of life. The idea of limited breast tissue resection was introduced in the 1970s by Umberto Veronesi and led to further minimizations of surgery in BC patients until breast conservation became the standard of care for early-stage disease. In the 1990s, intra
Karcinom dojke je najčešći maligni tumor u žena. Prvi zapisi o karcinomu dojke i njegovom liječenje datiraju iz drevnog Egipta 1500-1600 godina pr.n.e. Terapijski pristup bolesti mijenjao se kroz povijest te je nekadašnji invazivni, kao npr. radikalna mastektomija, s vremenom zamijenjen manje invazivnim kirurškim metodama. W.S. Halsted 1894. godine predstavlja metodu radikalne mastektomije. Ona uključuje potpunu resekciju dojke, regionalnih limfnih čvorova te velikog i malog pektoralnog mišića. Unatoč čestim postoperacijskim komplikacijama, zauzimala je glavno mjesto među kirurškim modalitetima liječenja karcinoma dojke sve do 1948. godine kada su Patey and Dyson predstavili modificiranu radikalnu mastektomiju kojom su se, za razliku od radikalne, sačuvali pektoralni mišići te pazušni limfni čvorovi lože III, te postoperacijske komplikacije smanjene, uz poboljšanje kvalitete života bolesnica. Ideju ograničene resekcije tkiva dojke predstavlja Veronesi 70-ih godina 20. stoljeća, nakon čega je i dalje nastavljeno smanjenje opsega i radikalnosti kiruških zahvata. Konačno, poštedna operacija dojke postaje standard u liječenju žena s ranim stadijem karcinoma dojke. Koncept biopsije limfnog čvora čuvara kod karcinoma dojke nailazi na svekoliku prihvaćenost, a njegovim usvajanjem mnoge su bolesnice pošteđene radikalnih disekcija aksilarnih limfnih čvorova, od onih čiji je nalaz biopsije limfnog čvora čuvara bio negativan, do onih s mikrometastazom u istome (malim tumorskim depozitom veličine 0.2-2 mm), dok zaključci novijih studija iz posljednjih deset godina, sugeriraju da i u žena kojima su biopsijom utvrđena metastaza u jednome do dva limfna čvora čuvara disekcija aksilarnih limfnih čvorova može se također izbjeći bez štetnih posljedica, uz primjenu adjuvantne radioterapije.
A torsion of the vermiform appendix with a mesoappendiceal lipoma is a rare condition. It is also a rare cause of acute abdomen, as such, the condition is diagnosed during surgery. This case report ...presents a 70-year-old male patient with lower right abdominal pain and signs of acute abdomen with an increased peripheral blood leukocyte count. An ultrasound examination revealed a mass of 9.6 cm2, which was suggested to be a perityphlitic abscess. An emergency operation was indicated, as the patient had clinical signs of acute abdomen. Laparotomy via a pararectal incision revealed the cause of the pain to be a torsion of the vermiform appendix caused by a mesoappendiceal lipoma. The apex of the appendix was perforated, which caused circumscript peritonitis. Both an appendectomy and an extirpation of the tumor were performed, and a surgical drain was placed in the wound, yielding an excellent postoperative clinical outcome.
Background: Angiosarcomas are highly aggressive and malignant blood vessel tumors. Rarely, angiosarcomas develop in the breast following conservative therapy, namely radiotherapy. Case Report: A ...70-year-old female patient presented with dark purple discoloration of the skin of the right breast. 6 years earlier, the patient had undergone conservative surgery for invasive ductal carcinoma of the right breast. According to the breast-conserving surgery protocol, the patient had been treated with radiotherapy to the residual breast tissue. The patient's annual mammograms and ultrasound findings were normal. The skin lesion was superficially localized mostly at the border between the upper and lower medial quadrants of the breast (between 2 and 4 o'clock) and above the areola. The borders were uneven; the dimensions were 7 cm × 4 cm. The mammogram was classified as Breast Imaging Report and Data System (BI-RADS) 2. Ultrasound examination showed a well-vascularized structure, although the etiology was unclear. A tissue biopsy revealed angiosarcoma. The patient underwent radical simplex mastectomy. Following surgery, the patient underwent chemotherapy. Tests excluded metastases for a follow-up period of 5 years. Conclusion: Angiosarcomas that develop after radiotherapy following breast-conserving surgery are sporadic, but it is important to take this possible incident into consideration during treatment.
The authors have provided an in-depth review of the history of saline and silicone gel-filled breast implants. In the history of medicine, no devices have been more scrutinized and thoroughly studied ...than breast implants. Although we as plastic surgeons recognize and appreciate the benefits that our patients derive from these devices, society as a whole continues to remain skeptical. The reasons for this are complex and multifactorial but appear to be fueled by the media, oppositional organizations, and several trial lawyers. Prior to 1990, when the silicone gel implant controversy began, there were only eight indexed publications that dealt with the issue of silicone gel breast implants. Since 1990, there have been more than 500 indexed publications dealing with silicone gel implants. At the time of the moratorium in 1992, we as plastic surgeons did not have a leg to stand on because there was a paucity of scientific evidence to support our observations that silicone breast implants were safe and effective devices.
Background: Sarcoidosis is an idiopathic multisystemic disease that affects young to middle aged adults, with higher incidence in women. Although it may involve the breast parenchyma, primary ...sarcoidosis of the breast is very rare. It occurs in less than 1% of cases. In a differential diagnosis it may potentially be considered a malignancy. Case Report: We report a case in which breast sarcoidosis was the first clinical manifestation of systemic disease in a 54-year-old woman who presented with wide erythematous skin changes associated with palpable induration. Considering the fact that physical examination and the results of mammography, ultrasound and magnetic resonance imaging were inconclusive and unable to rule out malignancy, biopsy was performed. Pathohistological diagnosis showed a non-necrotizing granulomatous inflammation without elements of breast cancer. Sarcoidosis was confirmed with elevated level of angiotensin-converting enzyme in the sera and characteristic chest multislice computed tomography findings. The bronchoalveolar lavage was infiltrated with lymphocytes. Conclusion: Breast sarcoidosis has diverse and nonspecific imaging characteristics. Carcinoma must always be excluded by core needle biopsy. Achieving correct diagnosis is mandatory so that adequate corticosteroid therapy can be applied as early as possible. A multidisciplinary approach is of utmost importance in the diagnostic workup.
Purpose
Based on the risk of locoregional recurrence (LRR), postmastectomy radiotherapy (PMRT) is recommended in T1-T2pN1 breast carcinoma (BC). We aimed to elucidate our institutional strategies ...underlying selection of these patients for PMRT. In the no-PMRT subset, we compared various lymph node (LN) staging systems’ abilities to predict 5‑year overall and locoregional-free survival (OS/LRFS).
Methods
We retrospectively enrolled 548 women with T1-T2pN1 BC undergoing mastectomy and axillary LN dissection. Depending on PMRT delivery, the participants were divided into the PMRT and no-PMRT groups. Predictors of OS/LRFS were calculated for the no-PMRT group only. Based on Cox regression modelling, the number of positive LNs (PLN), negative LNs (NLN), LN ratio (LNR), log odds of PLN (LODDS), and modified LNR (mLNR) were modelled, each respectively, with OS model covariates (age, grade III, lymphovascular invasion LVI, tumor size, hormone receptor HR status) and LRFS model covariates (age, grade III, LVI). The C‑statistic, Akaike information criterion, and likelihood ratio χ
2
of the models were compared.
Results
Median follow-up was 60.5 (18–82), 61 (28–82), and 60 (18–80) months for the entire cohort, PMRT, and no-PMRT group, respectively. The PMRT and no-PMRT groups had comparable OS (
p
= 0.235). LRFS was better (
p
= 0.030) in the PMRT group comprising 105 subjects (19.16%) who were younger, more likely to have a higher-grade, HR−, HER2+ tumors, more PLNs, fewer NLNs, Ki-67 ≥ 20%, LVI, and extranodal extension (
p
≤
0.001). In the no-PMRT group, LNR-based OS/LRFS models exhibited superior prognostic performance.
Conclusion
In early-stage BC patients undergoing mastectomies, LN dissections and no PMRT, we propose LNR-based multivariable models to predict OS/LRFS with superior accuracy.
The severe remodeling of endometrial stroma during blastocyst adhesion and trophoblast invasion initiates at maternal-fetal interface the reaction of evolutionary old heat shock response, in which ...heat shock proteins, as molecular chaperons, monitor the configurations of newly synthesized proteins and prevent the formation of functionless aggregates of misfolded proteins, targeting them to degradation by a the ubiquitin-proteasome system. In addition, the endoplasmic reticulum (ER)-resident HSPs, such as gp96/GRP94 may, after binding to CD91 and TLRs, elicit antigen-specific and antigen-unspecific immune responses, owing to its peptide-chaperoning capacity and ability to activate APCs. Considering these properties, we examined tissue expression of gp96 at the maternal-fetal interface and in the maternal liver and spleen on the 16th day of undisturbed syngeneic pregnancy and after the treatment with peptidoglycan monomer linked with zinc (PGM-Zn). The data showed that in undisturbed pregnancy the gp96, CD91 and TLR2 were markedly expressed on extravillous and villous trophoblast. PGM-Zn enhanced these findings, as well as the number of uterine natural killer cells and local NFκB immunoreactivity. Gp96 expression arose also in the maternal spleen and liver, where an accumulation of NKT cells or γδT lymphocytes was seen. The data point to roles of gp96 in maintenance of proteostasis and local and systemic immune balance in pregnancy complicated by infection.
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