Sanjay Warrier

Programmed death ligand 1 expression in triple-negative breast cancer is associated with tumour-infiltrating lymphocytes and improved outcome.

Triple‐negative breast cancer (TNBC) patients generally have a poor outcome; there is a pressing need to identify more effective therapeutic strategies. Clinical trials targeting programmed death 1/programmed death ligand 1 (PD1/PDL1) in melanoma and non‐small‐cell lung cancer have reported high response rates, and tumoral PDL1 expression has been suggested as a potential biomarker to enrich for patient response to these treatments. There are only very limited data to date reporting the expression of PDL1 in TNBC.

Preservation or division of the intercostobrachial nerve in axillary dissection for breast cancer: Meta-analysis of Randomised Controlled Trials

PURPOSE Management of the ICBN during axillary dissection is controversial and the division of ICBN is often trivialised. The effect of dividing the ICBN, and its association with sensory disturbance, is unclear. A systematic review and meta-analysis was performed to evaluate the effect of preserving the ICBN during axillary dissection. METHODS A systematic literature review and meta-analysis is performed according to the PRISMA and Cochrane Collaboration guidelines. RESULTS Three RCTs and four non-RCTs were reviewed. A meta-analysis demonstrated that the incidence of sensory disturbance was significantly lower with preservation of ICBN compared to division of the ICBN with Mantel-Haenzel combined odds ratio 0.31 (0.17-0.57, 95% CI). There was relatively low level of heterogeneity (I(2) = 19%, χ(2) = 2.48, df = 2). The sensory disturbance was more likely to be hyposensitivity when compared to hypersensitivity (p < 0.0001). No difference on number of lymph nodes dissected or operating time was noted. CONCLUSION This meta-analysis demonstrates that division of the ICBN is associated with higher risk of sensory disturbance, and that the nature of this sensory disturbance is more likely to be hyposensitivity, attributable to reduced nerve function.

Adenomyoepithelioma with Ductal Carcinoma In Situ: A Case Report and Review of the Literature

Adenomyoepithelioma (AME) with microglandular adenosis-like growth pattern and superimposed ductal carcinoma in situ (DCIS) was identified in a 55-year-old female after biopsy of an atypical lesion identified through routine breast screening. A literature review reveals that this association has rarely been described.

Phyllodes tumour with heterologous sarcomatous differentiation: Case series with literature review

Highlights • Phyllodes tumours with heterologous sarcomatous differentiation are extremely rare.• We report 2 such cases in females in their fifties and describe the clinical presentation, diagnostic investigations and management with 2 year follow-up.• There is limited literature to guide adjuvant therapy and prognosis of phyllodes tumours with heterologous sarcomatous differentiation.

MicroRNA-related DNA repair/cell-cycle genes independently associated with relapse after radiation therapy for early breast cancer

PURPOSE Local recurrence and distant failure after adjuvant radiation therapy for breast cancer remain significant clinical problems, incompletely predicted by conventional clinicopathologic markers. We had previously identified microRNA-139-5p and microRNA-1274a as key regulators of breast cancer radiation response in vitro. The purpose of this study was to investigate standard clinicopathologic markers of local recurrence in a contemporary series and to establish whether putative target genes of microRNAs involved in DNA repair and cell cycle control could better predict radiation therapy response in vivo. METHODS AND MATERIALS With institutional ethics board approval, local recurrence was measured in a contemporary, prospectively collected series of 458 patients treated with radiation therapy after breast-conserving surgery. Additionally, independent publicly available mRNA/microRNA microarray expression datasets totaling >1000 early-stage breast cancer patients, treated with adjuvant radiation therapy, with >10 years of follow-up, were analyzed. The expression of putative microRNA target biomarkers--TOP2A, POLQ, RAD54L, SKP2, PLK2, and RAG1--were correlated with standard clinicopathologic variables using 2-sided nonparametric tests, and to local/distant relapse and survival using Kaplan-Meier and Cox regression analysis. RESULTS We found a low rate of isolated local recurrence (1.95%) in our modern series, and that few clinicopathologic variables (such as lymphovascular invasion) were significantly predictive. In multiple independent datasets (n>1000), however, high expression of RAD54L, TOP2A, POLQ, and SKP2 significantly correlated with local recurrence, survival, or both in univariate and multivariate analyses (P<.001). Low RAG1 expression significantly correlated with local recurrence (multivariate, P=.008). Additionally, RAD54L, SKP2, and PLK2 may be predictive, being prognostic in radiation therapy-treated patients but not in untreated matched control individuals (n=107; P<.05). CONCLUSIONS Biomarkers of DNA repair and cell cycle control can identify patients at high risk of treatment failure in those receiving radiation therapy for early breast cancer in independent cohorts. These should be further investigated prospectively, especially TOP2A and SKP2, for which targeted therapies are available.

Traumatic unilateral deep cerebral venous infarction.

A case of unilateral deep cerebral venous infarction in a young man associated with mild head injury is presented. The diagnosis is made on the basis of the clinical, radiological, operative and histopathological findings. We propose that a thrombosis or obstruction of the anterior segment of the basal vein of Rosenthal (BVR) was the primary pathology. This is discussed in respect to current knowledge of deep cerebral venous anatomy and embryology.

An update in breast cancer screening and management

This article provides an overview of the main controversies in a number of key areas of breast cancer management. Relevant studies that have contributed to guide the treatment of this heterogeneous disease in the field of breast screening, surgery, chemotherapy and radiotherapy are highlighted. Mammography and ultrasound are the main methods of breast screening. MRI and tomosynthesis are emerging as new screening tools for a selected group of breast cancer patients. From a surgical perspective, oncoplastic techniques and neoadjuvant chemotherapy are improving cosmetic results in breast-conserving surgery. For high-risk patients, controversies still remain regarding prophylactic mastectomies. Finally, the appropriate management of the axilla continues evolving with the increasing role of radiotherapy as an alternative treatment to axillary dissection.

PARAGANGLIOMA AND PARAGANGLIOMATOSIS OF THE CAUDA EQUINA

Extra-adrenal paragangliomas, as distinct from pheochromocytomas of the adrenal medulla, may occur throughout the body. They are rare neoplasms arising from neural crest cells, which are distributed along the autonomic nervous system. The most common site for extra-adrenal paragangliomas is the carotid body. These tumours may also occur in the spinal canal – usually in association with the cauda equina or filum terminale. We present the case of a paraganglioma of the cauda equina, managed for 10 years, that is unusual in the sense of its multifocal nature at presentation and extent of local progression.

A New Method of Salvaging Breast Reconstruction After Breast Implant Using Negative Pressure Wound Therapy and Instillation.

Breast implant infections and their associated inflammatory response can have severe consequences, such as the loss of the prosthesis and cavity, or extensive scarring. Negative pressure wound therapy has been indicated for the management of implant infections. This report describes situations where negative pressure wound therapy was used in conjunction with instillation therapy to treat breast implant infections. The findings showed that the application of these techniques accelerated the treatment of the infections and, most importantly, maintained the breast cavity for future reconstruction.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266

A case report of invasive ductal carcinoma of the breast with prominent sebaceous differentiation.

Background Sebaceous carcinoma of the breast is a rare entity, with only nine examples reported previously (WHO, 2012). Sebaceous carcinoma is defined as a breast carcinoma with prominent sebaceous differentiation in no less than 50% of cells (WHO, 2012). Limited data is available regarding the significance of sebaceous differentiation. Aim To present a case of diagnostic interest. Method and results We present a case of a 77-year-old woman with a self-detected left breast mass. After an initial core biopsy she underwent a mastectomy with sentinel lymph node biopsy. His-topathology confirmed an ER-positive/PR-positive/Her2-equiv-ocal invasive ductal carcinoma, with prominent sebaceous differentiation, and negative sentinel nodes. Discussion The amount of sebaceous differentiation falls just short of the greater than 50% required for diagnosis of sebaceous carcinoma. The differential diagnosis includes carcinoma with apocrine differentiation, lipid-rich carcinoma, and liposarcoma. A review of the available literature highlights the scarcity of knowledge of this rare entity. Very little is understood about the clinical course and prognosis of sebaceous carcinoma, and follow up data is limited. There is an association in the cases reported, with high grade tumours and high mitotic counts, and the predominant type of breast cancer associated is ductal. The two cases that have reported metastasis have been late in onset, and have occurred in sites which are not common for breast malignancies (scalp and skin). The significance of sebaceous differentiation is difficult to establish, and further research is warranted.