Alejandro Martin Sanchez

Oxidized regenerated cellulose in breast surgery: experimental model

BACKGROUND Breast-conserving surgery (BCS) combined with postoperative radiotherapy has become the gold standard of locoregional treatment in patients with early-stage breast cancer. When large tumor resections are needed in small medium size breasts, oncoplastic procedures (OPP) have been introduced to improve the cosmetic result; but in several cases, OPP may be not sufficient to accomplish this purpose. Oxidized regenerated cellulose (ORC, Tabotamp fibrillar; Johnson & Johnson; Ethicon) has been reported to be useful in OPP to optimize the cosmetic results after OPP. However, no ultrastructural study is available on the use of ORC as a filler in BCS. MATERIALS AND METHODS A BCS cavity was simulated in both groin regions in 24 consecutive Wistar rats. The right groin underwent soft tissue displacement and ORC implantation, whereas the left groin was treated only by soft tissue displacement (control side). Rats were sacrificed at 10, 20, and 30 wk to evaluate volume retainment and microscopic features (vascularization, fibrosis, cell population, inflammation, liponecrosis, and capsule formation). RESULTS The use of ORC was characterized by diffuse fibrosis and homogeneous neovascularization within the construct, with no capsule formation and no inflammation. Volume retainment was similar in the 20- and 30-wk specimens (mean 80.4%, standard deviation, 6.65 and mean 79.9%, standard deviation, 6.51). CONCLUSIONS Implanted ORC was well integrated within the soft tissue with diffuse fibrosis, angiogenesis, and absence of capsule formation. Preliminary results confirmed that this biomaterial could further contribute to optimize cosmetic results in the oncoplastic surgical spectrum of breast-conservation therapy.

Update of current evidences in breast cancer multidisciplinary management

Breast cancer is acknowledged as an international priority in health care. It is currently the most common neoplasm and leading cause of cancer death in women worldwide, with demographic trends indicating a continuous increase in incidence.

Metastatic giant malignant phyllodes tumor of the breast

complex mass with cystic and solid areas and minimal internal vascularity (Figure 1B). Ultrasound-guided core needle biopsy of the lesion was performed. Histology showed dilated lymphatic channels and the possibility of a lymphangioma was raised. Complete surgical excision of the lesion was then performed. Final histology showed a multiloculated lesion comprising cystic to irregular vascular spaces, containing proteinaceous material, lined by flattened endothelial cells (Figure 2). Few stromal lymphocytes were noted. No malignancy was identified. A diagnosis of lymphangioma was made. Lymphangiomas are benign, occasionally locally aggressive, tumors of the lymphatic system. Most common sites of occurrence are the head and neck region (75%) and the axilla (20%). Other rarer sites include the retroperitoneum, mediastinum, inguinal regions, breast, and pelvic cavity. Exact etiology of this tumor is still debated, but a few of the proposed etiologies include congenital miscommunication between lymphatic and venous pathways, aberrant lymphatic growth, and tissue sequestration during development. Some have suggested that trauma and infection might play a role in the onset and aggravation of this tumor. While in children, it is associated with some chromosomal anomalies like trisomy 13, 18, 21; in adults, it is proposed to be related to delayed proliferation of cell rests. Adult lymphangiomas are rare. Axillary lymphangioma in an adult is even rarer with less than 10 cases reported till date.

Penile cancer metastasizing to the breast: a case report

BackgroundPenile cancer is a relatively uncommon cancer in developed nations. Metastatic disease is rare, but lymphatic or vascular spreading has been previously reported to the liver, lungs, bones, brain, heart and skin.Case presentationWe report a case of a 49-year-old white man with a penile squamous cell carcinoma previously treated with partial penectomy and bilateral inguinal lymph node dissection, followed by adjuvant therapy. Three years after treatment, the primitive neoplasm metastasized to the breast, presenting as a painful lump. Differentials of a secondary versus a malignant primary tumor were considered and in view of a diagnostic dilemma the lesion was excised.ConclusionsThis case is unusual in its site of metastatic progression as well as in its pattern of clinical presentation. Awareness of such a condition by physicians is mandatory in order to make an early diagnosis and start prompt and correct therapeutic planning.