Charlotte Vaysse

Latissimus dorsi flap invasion by ductal breast carcinoma after lipofilling.

Summary: Autologous fat grafting is commonly performed in reconstructive breast surgery but also increasingly in breast augmentation surgery. On the international level, we are witnessing an important increased confidence for this procedure. Nevertheless, it continues to raise questions on the risks of cancer. A 66-year-old patient benefited from a lipofilling to improve a latissimus dorsi flap breast reconstruction, 7 years after initial cancer management. Two years later, constant pain in the flap leads to reoperation. The flap showed a major retraction with histologically massive infiltration of the muscle by an undifferentiated carcinoma of breast origin. The tumor cells were displayed directly in contact with lipofilling inside the muscle. Without establishing any causal link between these 2 events, this case raises the question once more of the risks of breast cancer and encourages us to continue being careful.

Autologous Fat Grafting for Cosmetic Breast Augmentation: A Systematic Review

BACKGROUND Breast augmentation is one of the most popular aesthetic surgical procedures. The only potential alternative is autologous fat grafting (AFG), which is not new in principle. This procedure has been used on native breasts since 2009, following the recommendations of some learned societies. OBJECTIVES We performed a systematic review to determine the current worldwide status of fat grafting for aesthetic breast augmentation. METHODS A systematic review of the literature following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis criteria was conducted using the PubMed, EmBASE, and Cochrane library databases. This protocol was registered at the National Institute for Health Research, Prospective Register of Systematic Reviews. RESULTS A total of 42 articles published between 1987 and July 2014 were included. Most of the studies had a low level of evidence, with only one level 2 study, published by Spear (2014), a prospective cohort study which included 10 patients. The publications were from North America, Europe, and Asia. The indications were aesthetic augmentation (92.4%) and congenital malformation (7.6%). Two cases of cancer were reported among the 2023 patients included (0.09%), with a mean follow-up of 22 months, although the follow-up was insufficient for medium- and long-term cancer diagnoses. CONCLUSIONS AFG seems to be a major tool in this field, but we must remain cautious about its systematization for this indication. Preoperative patient selection is essential but underreported. AFG appears particularly relevant in breast malformations. We believe that this method should be practiced within the scope of a national or international registry with proper follow-up of patients.

Key contribution of eIF4H-mediated translational control in tumor promotion

Dysregulated expression of translation initiation factors has been associated with carcinogenesis, but underlying mechanisms remains to be fully understood. Here we show that eIF4H (eukaryotic translation initiation factor 4H), an activator of the RNA helicase eIF4A, is overexpressed in lung carcinomas and predictive of response to chemotherapy. In lung cancer cells, depletion of eIF4H enhances sensitization to chemotherapy, decreases cell migration and inhibits tumor growth in vivo, in association with reduced translation of mRNA encoding cell-proliferation (c-Myc, cyclin D1) angiogenic (FGF-2) and anti-apoptotic factors (CIAP-1, BCL-xL). Conversely, each isoform of eIF4H acts as an oncogene in NIH3T3 cells by stimulating transformation, invasion, tumor growth and resistance to drug-induced apoptosis together with increased translation of IRES-containing or structured 5′UTR mRNAs. These results demonstrate that eIF4H plays a crucial role in translational control and can promote cellular transformation by preferentially regulating the translation of potent growth and survival factor mRNAs, indicating that eIF4H is a promising new molecular target for cancer therapy.

Erratum: Inflammation of mammary adipose tissue occurs in overweight and obese patients exhibiting early-stage breast cancer

Growing evidence indicates that adiposity is associated with breast cancer risk and negatively affects breast cancer recurrence and survival, a paracrine role of mammary adipose tissue being very likely in this process. In contrast to other adipose depots, occurrence of a sub-inflammatory state of mammary adipose tissue defined by dying adipocytes surrounded by macrophages forming crown-like structures in overweight and obese subjects, remains only partially described. In a general population of breast cancer patients (107 patients) mostly undergoing breast-conserving surgery, we found a positive association between patient’s body composition, breast adipocytes size, and presence of crown-like structures in mammary adipose tissue close to the tumor. Overweight (BMI: 25.0–29.9 kg/m2) and obese (BMI ≥ 30.0 kg/m2) patients have 3.2 and 6.9 times higher odds ratio of crown-like structures respectively, compared with normal weight patients. The relatively small increase in adipocyte size in crown-like structures positive vs. negative patients suggests that mammary adipose tissue inflammation might occur early during hypertrophy. Our results further highlight that body mass index is an adequate predictor of the presence of crown-like structures in mammary adipose tissue among postmenopausal women, whereas in premenopausal women truncal fat percentage might be more predictive, suggesting that mammary adipose tissue inflammation is more likely to occur in patients exhibiting visceral obesity. Finally, the presence of crown-like structures was positively associated with systemic markers such as the Triglyceride/High-density lipoprotein-cholesterol ratio serum C-reactive protein and glucose/(HbA1c) glycated Haemoglobin. These compelling results demonstrate that excess adiposity, even in overweight patients, is associated with mammary adipose tissue inflammation, an event that could contribute to breast cancer development and progression.Immunology: Weight tied to inflammation in fat surrounding tumorOverweight and obese women with breast cancer show more inflammation in their mammary fat tissue, creating an environment favorable to tumor growth. In a study performed at the Oslo University Hospital, Norway, Charlotte Vaysse and colleagues characterized the fat cells found close to the breast tumors of 107 patients with early-stage disease. The researchers showed that overweight and obese women were more likely to have clusters of pro-inflammatory macrophage cells within the fat tissue close to the tumors than normal weight women. They further divided the patients according to whether they’d gone through menopause or not, and found that body mass index was a good predictor of fat cell inflammatory status in postmenopausal women, whereas belly fat percentage was a more accurate measure for premenopausal women. The inflammation brought on by excess weight may contribute to breast cancer development and progression.

Early stage (IA-IB) primary carcinoma of the fallopian tube: case-control comparison to adenocarcinoma of the ovary

Objective Early stage primary carcinoma of the fallopian tube (PCFT) is an uncommon condition when strict criteria are applied. The aim of this study was to compare the outcome stage IA-IB PCFT to a matched group of ovarian cancer (OC). Methods Between 1990 and 2008, 32 patients with stage IA-IB of PCFT were recorded in the database of three French Institutions. A control group of patients with OC was constituted. Results Eleven eligible PCFT cases and 29 OC controls fulfilled the stringent inclusion criteria. Median follow-up was 70.2 months. Five-year overall survival was 83.3% (95% confidence interval [CI], 27.3 to 97.5) for PCFT and 88.0% (95% CI, 66.9 to 96.0) for OC (p=0.93). In the subgroup of patients with grade 2-3, the outcome was similar in PCFT compared to OC patients (p=0.75). Five-year relapse-free survival was respectively 62.5% (95% CI, 22.9 to 86.1) and 85.0% (95% CI, 64.6 to 94.2) in the PCFT and OC groups (p=0.07). In the subgroup of patients (grade 2-3), there was no difference between PCFT and OC (p=0.65). Conclusion The findings did not reveal any difference in prognosis between early stage of PCFT and OC when grade is taken into account. Management of PCFT should mirror that of ovarian carcinoma.

Burn injury to a Reconstructed Breast via a Cigarette Causing Implant Exposure. The Importance of the Patient's Education

A 49-year-old woman benefited from a breast reconstruction with tissue expander after mastectomy and radiotherapy. One year later, the patient fell asleep with a cigarette in her hand. Incidentally, the cigarette is fallen into her cleavage. At the moment, she did not feel the burning. In 1 week, she had suffered a full thickness burn measuring 5 9 7 cm in size and she presented a complete implant exposure (Fig. 1). The burn was debrided and the prosthesis had to be removed. The patient then benefited from a breast reconstruction with latissimus dorsi flap, which gave satisfactory results. We have not been able to integrate a prosthesis in the same operative time because of the breast high inflammatory background generated by the burn (Fig. 2). Similar cases with hot water bottle have ever been reported in literature but this is the first report of full thickness burn injury via a cigarette. Compared to burn injury to a flap as DIEP or TRAM as reported by Gowaily, the gravity of this case is due to the exposure of the implant which necessitated its removal. Following a mastectomy, the sensory nerves to the breast and surrounding skin are damaged, mainly branches from the third to the sixth lateral intercostal nerves, and anterior intercostal nerves. In our case, the sensibility alteration appears to be multiple. It results not only of initial mastectomy but also of tissue expansion and radiotherapy. The problematic of the lack of sensitivity secondary to breast reconstruction by tissue expander is to take into consideration. During the reconstruction via expander, benchmarks for the submuscular dissection are congruent with those of the mastectomy, but the dissection is extended above the level of the future areola, which may partly explains the hypoesthesia observed in the regions above the areola.

Laparoscopic observation of the diaphragm undersurface in the staging of peritoneal carcinomatosis: comparison of three optical systems

OBJECTIVES Endoscopy is a key tool in the diagnosis and management planning of peritoneal carcinomatosis. The aim of this study was to determine which type of endoscope is the most efficient for comprehensive staging of the upper abdomen peritoneal surface. METHODS From April 2010 to February 2011, endoscopies were performed on five human female fresh-frozen cadavers. Three endoscopes (rigid 0°, 30° and flexible) were used consecutively and compared. RESULTS The diaphragmatic areas explored with the flexible endoscope were significantly larger than those with the other two. On average, 135 (range 66-225), 168 (range 96-306), and 201 (range 128-399)cm(2) were observed using the 0°, 30°, and flexible laparoscopes, respectively. The p value obtained using the exact Wilcoxon test for paired data was 0.0019 between the 0° and 30° endoscopes and between the 30° and flexible endoscopes. The 30° endoscope was consistently better than the 0° endoscope for the observation of the diaphragm and spleen undersurface. CONCLUSION Flexible endoscopy seemed to be the most efficient for the evaluation of peritoneal carcinomatosis. However, due to a poorer image, the need for considerable practice, and the high equipment and maintenance cost of the flexible endoscope, the rigid 30° endoscope seems to be the best compromise.

Discovery of a neuroendocrine tumor of the caecum by mammary metastasis using 18F‐DOPA‐PET

Neuroendocrine tumors (NET) develop from the diffuse endocrine system. These are rare tumors that can affect diverse organs. We present here the case of a 42‐year‐old female patient in whom a NET of the breast was discovered that was likely not of mammary origin. The main challenge was finding the primary tumor using immunohistochemistry and specific medical imaging modalities for NET. The primary tumor was localized at the last ileal loop upstream of the Bauhin valve thanks to the use of 18F‐DOPA‐PET. Ileocaecal resection by laparoscopy was performed. A WHO grade 2 NET of the ileum measuring 2.2 cm × 1.5 cm was found that infiltrated the submucosa with six metastatic lymph nodes of the eight removed (6N+/8).

Lymphatic vasculature requires estrogen receptor alpha signaling to protect from lymphedema

Objective— Estrogens exert beneficial effect on the blood vascular system. However, their role on the lymphatic system has been poorly investigated. We studied the protective effect of the 17&bgr; estradiol—the most potent endogenous estrogen—in lymphedema—a lymphatic dysfunction, which results in a massive fluid and fat accumulation in the limb. Approach and Results— Screening of DNA motifs able to mobilize ERs (estrogen receptors) and quantitative real-time polymerase chain reaction analysis revealed that estradiol promotes transcriptional activation of lymphangiogenesis-related gene expression including VEGF (vascular endothelial growth factor)-D, VEGFR (VEGF receptor)-3, lyve-1, and HASs (hyaluronan synthases). Using an original model of secondary lymphedema, we observed a protective effect of estradiol on lymphedema by reducing dermal backflow—a representative feature of the pathology. Blocking ER&agr; by tamoxifen—the selective estrogen modulator—led to a remodeling of the lymphatic network associated with a strong lymphatic leakage. Moreover, the protection of lymphedema by estradiol treatment was abrogated by the endothelial deletion of the receptor ER&agr; in Tie2-Cre; ER&agr;lox/lox mice, which exhibit dilated lymphatic vessels. This remodeling correlated with a decrease in lymphangiogenic gene expression. In vitro, blocking ER&agr; by tamoxifen in lymphatic endothelial cells decreased cell–cell junctions, inhibited migration and sprouting, and resulted in an inhibition of Erk but not of Akt phosphorylation. Conclusions— Estradiol protection from developing lymphedema is mediated by an activation of its receptor ER&agr; and is antagonized by tamoxifen. These findings reveal a new facet of the estrogen influence in the management of the lymphatic system and provide more evidence that secondary lymphedema is worsened by hormone therapy.

Consequences of delayed diagnosis of acute gastrointestinal intussusception, secondary to endometriosis

Ileocecocolic intussusception due to cecal endometriotic lesion is extremely rare, with symptoms that are often non‐specific, and delay in receiving support is resented by patients. We report the case of a 39‐year‐old woman who presented with major complications as a result of delayed diagnosis of cecal endometriosis. She experienced a diagnostic error that led to medical abortion for intractable vomiting, for which the pregnancy had been considered the only cause, resulting in secondary infertility. Six years later, she developed acute bowel intussusception after surgical treatment of rectal endometriosis requiring emergency surgery with ileocecal resection. After review of the literature, we draw attention to the major consequences of delay in diagnosis in the present case. Consequently, cecal location must not be missed in the diagnostic workup of gastrointestinal endometriosis.