Federica Chiesa

Oncoplastic techniques in the conservative surgical treatment of breast cancer: an overview.

Abstract:  Conservative surgery has become a well‐established alternative to mastectomy in the treatment of breast cancer. However, in case of larger lesions or small‐size breasts, the removal of adequate volumes of breast tissue to achieve tumor‐free margins and reduce the risk of local relapse may compromise the cosmetic outcome, causing unpleasant results. In order to address this issue, new surgical techniques, so‐called oncoplastic techniques, have been introduced in recent years to optimize the efficacy of conservative surgery both in terms of local control and cosmetic results. This article discusses the indications, advantages, and limitations of these techniques and their results in terms of local recurrence and overall survival. 

Early onset lactating adenoma and the role of breast MRI: a case report

IntroductionLactating adenoma is a benign condition, representing the most prevalent breast lesion in pregnant women and during puerperium; in this paper, a case of a woman with lactating adenoma occurring during the first trimester of pregnancy is reported. There have been no reports in the literature, according to our search, focusing on magnetic resonance imaging findings in cases of lactating adenomas. Also the early onset of the lesion during the first trimester of pregnancy is quite unusual and possibly unique.Case presentationWe report the case of a primiparous 30-year-old Caucasian woman, who noted an asymptomatic lump within her left breast during the 9th week of gestation, slightly increasing in size over the next few weeks. Ultrasound demonstrated a hypoecoic solid mass, hypervascularized and measuring 4 cm. On magnetic resonance imaging, performed in the first month after delivery, the lesion appeared as an ovoidal homogeneous mass, with regular margins and a significant contrast enhancement indicative of a giant adenoma.ConclusionMagnetic resonance imaging could play an important role in the differential diagnosis of pregnancy-related breast lumps, particularly during puerperium, thus avoiding unnecessary surgical biopsies.

Breast MRI in a Case of “Early Onset” Lactating Adenoma

lesion. Biopsy of that lesion showed sheets of plasma cells including immature and binucleated forms, consistent with the diagnosis of plasmacytoma with no evidence of carcinoma. Serum protein electrophoresis revealed a sharp band in the near gamma region (M protein) consistent with IgA kappa paraproteinaemia (Fig. 3), while no Bence Johns proteins were detected in her urine. Skeletal survey revealed a single rounded lytic lesion at the left parietal convexity (Fig. 4). Her bone marrow sample detected the presence of plasmacytoma (Fig. 5) with increased number of plasma cells of 18% (normal < 1.2%). Collectively, all supported the diagnosis of multiple myeloma. Ultrasound guided liver biopsy confirmed the diagnosis of metastatic carcinoma from the breast. The patient’s treatment plan consisted of seven cycles of FEC. Her clinical and radiological evaluation suggested almost complete regression of the breast and axillary mass and regression of liver and lung lesions at 2 years follow-up. The diagnosis of dual malignancy in a patient at the time of first presentation is rare. Recognizing both malignancies at the time of presentation and before initiation of treatment is crucial since the management of these co-existing malignancies is different.

Solid papillary carcinoma of the breast with an associated Cytokeratin 7- negative Paget's disease of the nipple. Report of a first case

Solid papillary carcinoma (SPC) is a rare neoplasm of the breast showing a distinct morphology, neuroendocrine differentiation and should be divided into invasive and in situ subtype according to the current 2012 WHO classification of breast tumors. Here, we describe a case of a pure SPC, invasive‐type, in a 31‐years old female with an associated mammary Pagets disease (MPD) of the nipple showing a rare, CK7‐negative immune phenotype, which has not been reported so far. This unusual differential diagnosis should be added to the rare condition of CK7‐negative Pagets disease of the breast and complement a new feature to the characterization of SPC.