Do big breasts disadvantage women with breast cancer?

The present study was undertaken in order to discover whether patients with breast cancer in large breasts experienced a delay in the detection of their cancer due to the bulk of the breast and consequently presented with more advanced tumours compared with women with small breasts. Mastectomy specimens were weighed and their dimensions measured, in particular recording breast mass and breast thickness (anterior-posterior depth). Tumour diameter, the number of involved lymph nodes and the oestrogen and progesterone receptor levels were measured as prognostic indices. Although there was no difference in receptor status of tumours from large and small breasts, on presentation, patients with big breasts had larger tumours and more involved lymph nodes than women with small breasts, whether breast size was assessed by weight or thickness. Women with large breasts may therefore be expected to fare worse than those with small breasts.     

Mediastinal metastases of extrathoracic tumors--important findings in mediastinoscopy

From 700 mediastinoscopies performed between 1976 and 1985, 11 revealed metastases from extrathoracic malignancies. Primary tumours were eventually located in the gastrointestinal tract (5), the breasts (2), the kidneys (2) and the thyroid gland (1). All lymphatics join within the mediastinum. Therefore mediastinal secondaries from tumours of all body regions may be encountered. Mediastinoscopy facilitates safe biopsy and histological diagnosis. It is essential for adequate therapy.     

Infected meme implants: Salvage reconstruction with latissimus dorsi myocutaneous flaps and silicone implants

Polyurethane-coated breast implants are used more frequently in recent years both in augmentation and reconstruction. Postoperative infection may lead to serious complications with formation of foreign body granulomas. A case is presented with such a complication that required multiple operations and wide excision of reconstructed breasts necessitating major myocutaneous flaps to salvage the breasts.     

What about the other breast? A review of a series of bilateral breast carcinomas

The BreastScreen Queensland Brisbane Southside BreastScreen Service reports on a study of 10 cases of bilateral breast carcinomas from a total cancer population of 217 cases. All cases were patients of screening examinations that were recalled for a suspicious lesion in one breast. Two cases were mammographically suspicious of bilateral tumours. In eight cases, tumours were ultrasonically visible in both breasts and in two further cases, the suspicion of bilateral malignancy was raised by the presence of bilateral microcalcification. It is not the purpose of this paper to provide a statistical analysis of the occurrence of bilateral breast cancer. This is a radiological paper from a breast screening service reporting on findings that conventional wisdom may find unusual. The incidence of bilateral breast malignancy in the study was found to be somewhat higher than expected. These cases have been diagnosed by the utilization of a particularly high standard of ultrasound and mammography, performed and interpreted by diagnosticians possessing an elevated level of suspicion of the possible presence of a second primary lesion. It is therefore proposed that an increased rate of diagnosis of bilateral tumours is possible with an evolution of assessment protocols, combined with quality ultrasound and mammography.     

Use of thermography in the differential diagnosis of phylloides tumour

Thermography can be used as a method of diagnosing breast masses. We report our results of its use in the differential diagnosis of fibroadenoma from phylloides tumours (n = 47 and 20 respectively). Thermographic resolution (Th) and the difference in temperature between the tumour and a similar zone in the contralateral breast (delta 2) were compared. Thermograms were class Th1 (with a similar thermal pattern in both breasts without hypervascularization or hot points) and Th2 (with hypervascularization or a hot area with a thermal difference with the same area in the opposite breast (delta 2) of less than 2 degrees C) in most (95.7 per cent) of the patients with fibroadenoma and were class Th5 (having one or more pathological sign) in 85 per cent of the patients with phylloides tumours. Patients with phylloides tumours had a mean delta 2 of 2.99 degrees C whereas most of the patients with a fibroadenoma showed no difference in temperature. Their mean delta 2 was 0.2 degrees C (P less than 0.0005). We conclude that thermography helps in differential diagnosis between a fibroadenoma and a phylloides tumour.     

Circumareolar Dermo-Glandular Plication: A New Concept for Correction of Breast Ptosis

Circumareolar dermo-glandular plication is the latest advancement of the periareolar dermopexy with a retromammary mastopexy technique I published in 1969. Rather than a technique, the new concept is a procedure which originates new techniques covering multiple indications, i.e. for all conditions combined with ptosis: for mastopexy in ptotic breasts, for hypertrophic or hypoplastic breasts with resection or implant augmentation, respectively; for subcutaneous mastectomy, gynecomastia, asymmetries, and tuberous breasts. It is useful for reoperations to correct secondary ptosis as well as to reduce the length of the scar in vertical techniques. The corresponding techniques are described. The procedure has proved to be safe and reliable in over 200 patients with the following advantages: no full thickness skin incision or excisions are performed; only the epidermis is excised. Except for hypertrophies, the skin is not dissected from the gland, nor the gland from the pectoralis fascia, which increases vascular safety and preserves NAC innervation; the dermoglandular unit of the breast through Cooper's ligaments is stabilized by a single or multiple plications. The scar is only circumareolar, reducing psychological stress and discomfort and achieving an early recovery and patient satisfaction. The inconveniences are puckering and some widening of the periareolar scar, which requires a secondary revision in approximately 50% of the cases, also frequently necessary in conventional techniques. There is a tendency to flattening of the NAC and periareolar bulging with tendency to a ``tomato breast appearance.' The prevention of the latter is described.     

On the etiology of glomus tumours

Summary Three unusual cases of solitary glomus tumours of the glomangioma type are described, and the etiology of solitary and multiple glomus tumours is discussed. This paper points out that the clinical entity of solitary glomus tumour is morphologically not a uniform structure, but has a varying histological appearence. Three histological types: mucous hyaline, solid and angiomatous (glomangiomas) have been described. The present findings of transition forms between solitary and multiple glomus and the reported variable relationship of multiple glomus tumours to the vascular system imply the possibility that the majority of solitary and a part of multiple glomus tumours arise by modification of the glomus bodies. The other theory which seeks to explain formation of the glomus tumours through the nevoid malformation of cutaneous blood vessels, seems to be relevant for the multiple glomus tumours with established vascular anastomoses and for the angiomatous forms of solitary glomus presented in this publication.Presented in part at the Fifth Meeting of the International Workshop on Vascular Anomalies (Hemangiomas and Vascular Malformations in the Field of Plastic Surgery), Milano, Italy. May 25th–26th 1984     

Morphologic Study of Nipple-Areola Complex in 600 Breasts

To investigate the morphologic characteristics of the nipple-areola complex, the diameter of the nipple-areola complex and the height of the nipple in 300 adult women (600 breasts) were measured using micrometer calipers. Furthermore, the morphologic characteristics were classified into four types by visual observation. Mean diameter of the areola was 4.0 cm, mean diameter of the nipple was 1.3 cm, and mean height of the nipple was 0.9 cm. From the morphologic point of view, the elevated plateau type without constriction (IIs) was most commonly found, being present in 60.2% of breasts. Inverted nipples (III) were found in 3.5% and unclassified type (IV) such as multiple or divided nipples was found in 0.3%. Because women have become sensitive about the appearance of their breasts and there is increasing cosmetic interest following surgery for breast carcinoma, operations on the nipple-areola complex are now common. When a surgeon counsels a patient and designs a reconstruction method prior to operation, these data may be helpful.     

Bilateral extensive ductitis obliterans manifested by bloody nipple discharge in a patient with long-term diabetes mellitus

Abstract:  Ductitis obliterans or mastitis obliterans is a rare late manifestation of mammary ductal ectasia. We describe a long-term diabetic patient who presented with bilateral bloody nipple discharge and poorly defined nodularities around the nipple of both breasts. The ductography showed multiple segments of irregular ductal narrowing and intraluminal filling defects in both breasts. The bilateral resection of the sub-areolar portion of the breast showed exuberant fibrous obliteration of the large- and medium-sized ducts by granulation tissue associated with few histiocytes. Ductal dilatation and intraductal accumulation of histiocytes was also present. This represents a late and florid form of mammary ductal ectasia. Differential diagnostic considerations including fibrocystic changes, diabetic sclerosing lymphocytic lobulitis, idiopathic granulomatous lobular mastitis, and periductal mastitis (Zuska disease) are discussed. Accurate diagnosis can help avoid or limit radical surgeries in this group of patients.     

Pituitary macro adenoma and vestibular schwannoma: a case report of dual intracranial pathologies

The concurrent presence of multiple primary brain tumours with different histological characteristics is very rare. A case of dual intracranial benign tumours comprising pituitary adenoma and vestibular schwannoma is described. The aetiology and genetic association of these pathologies is explored and the literature of multiple intracranial tumours of different cell types is reviewed.     

Metastatic carcinoma of breast simulating Crohn's disease

A 52-year-old female had radical surgery on both breasts in 1971 and 1973 for infiltrating lobular carcinoma of the breast. One year later, multiple metastases simulating Crohn's disease were found radiologically and intraoperatively in the colon and small bowel. The pathological examination revealed multiple areas of linitis plastica type carcinoma in the colon and small bowel. Review of the breast slides showed that the original breast carcinoma was morphologically identical to the metastatic lesions. The literature is reviewed and arguments are presented to attest that signet-ring-cell carcinoma of the breast is a distinct entity, which not too infrequently metastasizes to the gastrointestinal tract.     

Determination of the presence and extent of pure ductal carcinoma in situ by mammography and magnetic resonance imaging

The purpose of this study was to compare the ability of magnetic resonance imaging (MRI) and mammography to determine the presence and extent of ductal carcinoma in situ (DCIS). Retrospective review of medical records of women who underwent MRI and mammographic examination during a 23-month period revealed 39 sites of pure DCIS in 33 breasts of 32 women. No invasive or microinvasive tumor was found. Women ranged in age from 34 to 79 years (mean age 53 years). In these 33 breasts, both MRI and mammography were done before surgery. Reports and images of mammography and MRI were reviewed to determine if each study was positive for the presence of single or multiple sites of DCIS and the imaging patterns associated with these sites. Of 33 breasts involved, DCIS was discovered by MRI alone in 21 (64%), by both MRI and mammography in 8 (24%), and by mammography alone in 1 (3%); in 3 breasts (9%), DCIS was found at mastectomy without findings on mammography or MRI. MRI had significantly higher sensitivity than mammography for DCIS detection (29/33=88% versus 9/33=27%, p<0.00001). Multiple sites of disease were present in five breasts; these were better demonstrated with MRI in three, mammography in one, and equally by both in one. The predominant enhancement pattern of DCIS on MRI was linear/ductal in 18 of 29 breasts (62%); mammography found calcifications associated with DCIS in 8 of 9 (89%). The nuclear grade of DCIS found with MRI and mammography was similar; size of lesions was larger on MRI; breast density did not impact results. In this study, MRI was significantly more sensitive than mammography in DCIS detection. In women with known or suspected DCIS, MRI may have an important role to play in assessing the extent of disease in the breast.     

Multicentric tracheobronchial and oesophageal granular cell myoblastoma.

Two patients with multiple intrathorcic granular cell myoblastomas are described. In one case multiple tumours were present in the major airways and oesophagus. The patient presented with recurrent pulmonary infections and stridor due to airway obstruction. In the other case dysphagia caused by multiple oesophageal granular cell myoblastomas was the major symptom. Granular cell myoblastoma is a rare tumour of neurogenic origin with a characteristic histological appearance. The pattern of multiple tracheobranchial and oesophageal tumours is uncommon and forms the basis of this report.     

Multiple fibroadenomas of the breast: a problem of uncertain incidence and management.

A case is presented of multiple fibroadenomas of the breasts in a young Caucasian woman followed over a period of 10 years. A total of 22 individual lesions have been identified. Review of the literature gives little guidance regarding incidence, natural history and management of this condition. It is proposed that a register be set up to obtain basic data on this rare condition. The authors would be willing to collate cases submitted to such a register.     

自体脂肪颗粒移植隆乳的临床效果

目的探讨自体脂肪颗粒移植隆乳术的方法和临床效果。方法采用注射器于脂肪堆积部位抽吸自体脂肪颗粒,经反复冲洗后移植于乳腺后间隙,每次单侧移植50～100ml,间隔3～6个月,共2～6次。结果接受注射自体脂肪颗粒移植的107例中,91例末次移植后经6个月至3年随访,均表现乳房丰满,形态完美,效果满意;其中13例21侧乳房首次注射后2～9个月内出现散在的小硬结,8例11侧乳房首次注射后8～17个月内出现散在的小钙化灶。结论自体脂肪颗粒移植隆乳术效果基本满意,是一种切实可行的隆乳方法,但其术后效果受多因素影响,少数病例术后出现并发症,需继续临床观察。     

Multiple giant fibroadenomas in an adolescent female breast

Fibroadenomas are the commonest breast masses requiring surgery in the adolescent female, but multiple and giant tumours are rare. This case report describes the history and management of a teenager who had multiple giant fibroadenomas in one breast, eventually requiring mastectomy and reconstruction. The literature is reviewed. Tumours in this age group are almost always benign, even the giant and phyllodes tumours. Malignant tumours are extremely rare. Management should involve excision with skin reduction if necessary. The breast should be preserved if at all possible.     

Pseudomonas cepacia induced septic shock after propofol--a case report

We report a healthy young female who developed septic shock and multiple organ failure soon after receiving a cosmetic surgery for augmentation of breasts under general anesthesia. Blood cultures yielded the growth of pseudomonas cepacia. We describe the clinical course and investigate the causes of the septic shock. Contamination of propofol, the intravenous anesthetic agent, was suspected.     

Machine learning to predict individual patient-reported outcomes at 2-year follow-up for women undergoing cancer-related mastectomy and breast reconstruction (INSPiRED-001)

BackgroundWomen undergoing cancer-related mastectomy and reconstruction are facing multiple treatment choices where post-surgical satisfaction with breasts is a key outcome. We developed and validated machine learning algorithms to predict patient-reported satisfaction with breasts at 2-year follow-up to better inform the decision-making process for women with breast cancer.MethodsWe trained, tested, and validated three machine learning algorithms (logistic regression (LR) with elastic net penalty, Extreme Gradient Boosting (XGBoost) tree, and neural network) to predict clinically important differences in satisfaction with breasts at 2-year follow-up using the validated BREAST-Q. We used data from 1553 women undergoing cancer-related mastectomy and reconstruction who were followed-up for two years at eleven study sites in North America from 2011 to 2016. 10-fold cross-validation was used to train and test the algorithms on data from 10 of the 11 sites which were further validated using the additional site's data. Area-under-the-receiver-operating-characteristics-curve (AUC) was the primary outcome measure.ResultsOf 1553 women, 702 (45.2%) experienced an improved satisfaction with breasts and 422 (27.2%) a decreased satisfaction. In the validation set (n = 221), the algorithms showed equally high performance to predict improved or decreased satisfaction with breasts (all P > 0.05): For improved satisfaction AUCs were 0.86–0.87 and for decreased satisfaction AUCs were 0.84–0.85.ConclusionLong-term, individual patient-reported outcomes for women undergoing mastectomy and breast reconstruction can be accurately predicted using machine learning algorithms. Our algorithms may be used to better inform clinical treatment decisions for these patients by providing accurate estimates of expected quality of life.     

Familial polyposis coli associated with carcinoma of the uterine cervix

Familial polyposis coli is a heterogeneous disease with a broad spectrum of clinical manifestations including not only multiple polyposis of the small bowel, but also multiple primary tumours, such as carcinoma of the ampulla of Vater, subcutaneous tumours, bone tumours, central nervous system tumous and gynaecological malignancies. This report is of two brothers with familial polyposis, each showing peculiar distinctive features. In one case, polyposis was diagnosed during emergency surgery for ileo-colic intussusception. The patient later developed a tumour of the uterine cervix. Polyposis coli was identified late in the second patient who showed an evolution towards colonic adenocarcinoma with multiple hepatic metastases. The possible association of familial polyposis and extracolonic malignancies has already been emphasized in the literature. In this report we wish to stress the advisability of periodic gynaecological check-ups in affected patients.     

Manifestations and management of osteochondromas: a retrospective analysis of 382 patients

Osteochondromas represent the most common primary bone tumours; they reportedly represent 20-50% of all benign bone tumours and 10-15% of all bone tumours. Malignant transformation is their most severe complication. However, deformities and interference with major joint function are the most frequent complaints in patients with hereditary multiple osteochondroma. Treatment should therefore aim not only at surgical resection of the masses but also at prevention of deformities. This article reports observations made on 69 patients with hereditary multiple osteochondroma and 313 patients with solitary osteochondroma, with a mean follow-up of 13.4 years.