Mario Casales Schorr

Are the Pure In Situ Breast Ductal Carcinomas and Those Associated With Invasive Carcinoma the Same

It has been reported that pure ductal carcinoma in situ of the breast has morphologic differences from the in situ component of the invasive ductal carcinoma, as well estrogen and progesterone receptors expression according to their cytokeratin expression. However, there is no data comparing other tumor markers without using the cytokeratin expression. The objective of this study is to compare the expression of estrogen receptor (ER) and progesterone receptor (PR), HER-2/neu, p53, and Ki67 between pure ductal in situ carcinoma (pDCIS) and the in situ component of the invasive ductal carcinoma (DCIS+IDC) of the breast, and the in situ component to the invasive component of the same tumor (DCIS+IDC). The immunohistochemistry expression of the tumor markers was performed in 45 cases of pDCIS and DCIS+IDC, yielding a total of 90 cases. Statistical analysis was carried out using Fisher exact test, having a P<0.05, and Kappa index (κ) to assess intratumoral concordance. In DCIS+IDC, the in situ and invasive components did not show a significant difference and Kappa index (κ) was high (0.7-1) for positive and negative expression. ER and PR were significantly different between the pDCIS and DCIS+IDC (ER: 86.7 vs. 66.7% P=0.04; PR: 80% vs. 55.6% P=0.02). These findings suggest that in situ component of DCIS+IDC and pDCIS are distinct conditions.

The effect of neoadjuvant chemotherapy on hormone receptor status, HER2/neu and prolactin in breast cancer.

AIMS AND BACKGROUND Histological and immunohistochemical findings may vary in cases of breast cancer. Possible changes in tumor markers between biopsies performed before and after neoadjuvant chemotherapy are controversial and pose a challenge when a clinical decision is needed. The objectives of the present study were: (i) to compare the immunohistochemical expression of estrogen, progesterone and prolactin receptors and HER-2/neu in breast cancer before and after neoadjuvant chemotherapy; and (ii) to correlate the expression of these tumor markers with partial tumor response to neoadjuvant chemotherapy. METHODS AND STUDY DESIGN Immunohistochemical staining for breast tumor markers was performed in 90 cases of breast cancer. Statistical analysis was carried out using Fishers exact test, McNemars test, Spearmans correlation and the Kappa index with linear weighting (k). RESULTS Agreement between markers before and after neoadjuvant chemotherapy was fair to moderate (k = 0.37-0.51). The immunohistochemical expression of HER-2/neu and prolactin receptors showed a significant, albeit weak correlation before and after neoadjuvant chemotherapy (HER-2/neu, rho = 0.34; P = 0.0009; k = 0.35 [95% CI, 0.19-0.51]). Prolactin status changed in 28/90 cases (P = 0.001; McNemars test), whereas no changes were found in estrogen or progesterone receptors. No association was found between tumor marker expression and tumor response. CONCLUSIONS It seems prudent to reevaluate immunohistochemical markers such as HER-2/neu after neoadjuvant chemotherapy, since the findings will guide the strategy for implementation of adjuvant systemic treatment. No correlation was found between the tumor markers analyzed in the present study and partial tumor response to neoadjuvant chemotherapy.

Case7 Immediate Definitive Prosthesis Technique

Patient: 32 years old with positive family history. She has had previous aesthetic subglandular breast implant augmentation 10 years ago.

Part I Reconstruction Technique for Total Mastectomy

Nowadays breast reconstruction is considered as an essential part of breast cancer treatment planning. Breast cancer surgery is not limited only to oncological procedure but also reconstructive procedure. The planning and type of mastectomy would determine the choice and timing of reconstructive procedure. Moreover, mastectomy is not restricted to only conventional mastectomy which usually means removal of the entire breast parenchyma including pectoralis fascia, nipple areolar complex and overlying skin. The terminology of “mastectomy” can refer to radical mastectomy, Patey’s mastectomy, modified radical mastectomy, skin sparing mastectomy, areolar sparing mastectomy, nipple sparing mastectomy, or subcutaneous mastectomy.

Part IV Lipofilling

Lipofilling is also known as fat grafting or fat transfer or fat injection or lipotransfer. It is becoming popular among breast reconstructive and oncoplastic surgeon due to technically ease and simplicity. Two major steps are liposuction and lipoinjection. The fat specimen from liposuction can be prepared with various methods depending on surgeons’ preference. The indication of lipofilling technique for breast reconstruction is extending and evolving. Most authors favor this procedure in delayed breast reconstruction to correct secondary defects after breast cancer reconstruction or to treat tissue damages and deformities after radiotherapy. There is limited literature report and experience of immediate breast reconstruction and lipofilling.

Part III Reconstruction and Correction Technique for Nipple–Areolar Complex

In general, the nipple–areolar complex reconstruction is a final procedure to complete the breast reconstruction after the breast mould and the volume is settled. The principle of NAC reconstruction is to create the most natural look of NAC which can maintain nipple projection, volume and natural color of the entire NAC.

Part V Surgical Corrections of Complications

Despite being an unpleasant situation, the complications after breast total or partial reconstruction constitute part of breast surgeon routine. The main obstacles the surgeon has to face are related to management of the emotional patient’s burden, the injured tissue manipulation, few surgical options after complications, and the natural difficulties to improve the results.

Part II Reconstruction Techniques for Partial Mastectomy and Other Partial Breast Deformities

Breast conservative therapy or breast conserving surgery refers to partial removal of breast tissue followed by radiotherapy. The radiotherapy can be delivered during the surgery as intraoperative or postoperative external radiotherapy. Therefore, various terminologies such as wide local excision, wide excision, lumpectomy, segmentectomy, quadrantectomy, or partial mastectomy can cause breast deformity in different degree. The main objective of reconstruction for these defects is to restore the natural breast appearance in terms of shape and volume without leaving a cavity or deformity in the breast.