Recurrence of primary extramedullary plasmacytoma in breast both simulating primary breast carcinoma

BACKGROUND: Extramedullary myelomas (plasmacytoma) are malignant proliferations of plasma cells in the absence of bone involvement. When they occur in the soft tissue they usually involve the upper respiratory tract and oral cavity. Extramedullary plasmacytomas of breast are uncommon. CASE PRESENTATION: A 70 year-old woman with bilateral breast masses underwent excisional biopsy for suspected primary carcinoma that subsequently proved to be a recurrence from extramedullary plasmacytoma of the mediastinum. This was diagnosed and treated 5-years prior to appearance of breast lumps. CONCLUSION: Though uncommon, considering the possibility of metastatic carcinoma and primary, secondary or recurrent lymphoproliferative disease presenting as a breast mass may avoid unnecessary surgeries

How Does Voxel Size of Cone-beam Computed Tomography Effect Accurate Detection of Root Strip Perforations

Introduction: Our study aimed to assess the diagnostic accuracy of different voxel sizes for cone-beam computed tomography (CBCT) when detecting strip perforations of variable sizes. We used 0.2 and 0.3 mm3 voxel for detecting root strip perforations. Methods and Materials: This was an in vitro study conducted on 155 extracted humans' mandibular first molars. The teeth were randomly divided into five groups (n=31). Perforation were not induced in the control group. In the remaining four groups, strip perforations of 0.5, 1, 1.5, and 2 mm diameters were created in the mesiolingual canal using #3 Gates Glidden drills. The CBCT scans were taken first with a 12×9 cm field of view (FOV), 90 kVp, 4 mA, and 0.2 mm3 voxel size for 24 sec and then with a 12×9 cm FOV, 90 kVp, 2 mA, and 0.3 mm3 voxel size for another 24 sec. Two observers evaluated the images and reported the largest diameter of perforations. The results were compared with the gold standard values (determined by an electronic digital caliper) using statistical methods, including the kappa coefficient and generalized estimating equation (P<0.05). Results: Based on the findings of our study, the inter-observer agreement ranged from 58-100%, while the intra-observer agreement was reported to be around 100%. The difference in accuracy between 0.2 and 0.3 mm3 voxel sizes was not statistically significant (P>0.05). In addition, the accuracy of detecting different perforation sizes in the CBCT did not follow a specific pattern.  Conclusion: This in vitro study showed that CBCT is a reliable diagnostic tool, and even in lower dosages of 0.3 mm3 voxel size, image resolution and diagnostic accuracy was not affected. Moreover, smaller root perforations could be detected as accurately as larger ones with CBCT

Seroma formation after surgery for breast cancer

BACKGROUND: Seroma formation is the most frequent postoperative complication after breast cancer surgery. We carried out a study to investigate the effect of various demographic, clinical and therapeutic variables on seroma formation. PATIENTS AND METHODS: A retrospective cross sectional study of patients who underwent surgical therapy for breast cancer with either modified radical mastectomy (MRM) or breast preservation (BP) was carried out. The demographic data and clinical information were extracted from case records. Seroma formation was studied in relation to age, type of surgery, tumor size, nodal involvement, preoperative chemotherapy, surgical instrument (electrocautery or scalpel), use of pressure garment, and duration of drainage. The multiple logistic regression analysis was performed to estimate odds ratios. RESULTS: A total of 158 patients with breast cancer were studied. The mean age of the patients was 46.3 years (SD ± 11.9). Seventy-three percent underwent modified radical mastectomy and the remaining 27% received breast preservation surgery. Seroma occurred in 35% of patients. In multivariate logistic regression analysis an association of postoperative seroma formation was noted with modified radical mastectomy (OR = 2.83, 95% CI 1.01–7.90, P = 0.04). No other factor studied was found to significantly effect the seroma formation after breast cancer surgery. CONCLUSION: The findings suggest that the type of surgery is a predicting factor for seroma formation in breast cancer patients

Variation of ATM Gene Expression in Peripheral Blood Cells of Sporadic Breast Carcinomas in Iranian Patients

Abstract The ataxia telangiectasia mutated gene (ATM), candidate for breast cancer susceptibility gene, encode a 350-kDa protein belongs to the core components of DNA-damage response machinery. Female AT carriers have at least 5-fold increase risk for breast cancer. Reduction in ATM expression is shown in multiple studies in breast tissues. We aimed to perform a research to measure the ATM mRNA expression in peripheral blood cells in breast cancer patients. Peripheral blood sample from 40 newly diagnosed, histologically confirmed female breast cancer patients was collected before surgery. Total RNA was isolated from blood cells using the RNX-Plus solution and reverse transcribed into cDNA. Real-time PCR was performed using the 2 -∆∆CT method to calculate relative changes in gene expression by REST software. The Relative Quantitation (RQ) mean was 1.27 with the min. and max. equal to 0.20 and 3.34, respectively. Calculation of patient frequencies in different groups revealed that 17.5% had reduced expression lower than two fold decreases and 15% high expression more than two fold increases, but according to REST software there was no up-regulation or down-regulation compared to normal females. The findings of multiple studies consistent with this study indicate that the ATM gene may play an important role in breast cancer development and progression, and ATM expression is down-regulated in breast cancer tissues. Although, some of the results do not support a suppressor role for ATM in the development of sporadic breast cancer, 17.5% of our patients had under expression of ATM mRNA less than two fold relative to control

Neutrophil-Lymphocyte Ratio in Different Stages of Breast Cancer

Despite many advances in the treatment of breast cancer, it is still the second most common cause of death in women in the United States. It has been shown that inflammation plays a major role in the treatment of these cancers and inflammatory factors enhance tumor growth, invasion, metastasis, and vascularization. In this study, we would like to analyze peripheral blood neutrophil-lymphocyte ratio (NLR) in breast cancer patients and its correlation with disease staging. This cross-sectional analytic study was conducted in Imam Hospital, affiliated with Tehran University of Medical Sciences; a total of 195 female patients with breast cancer met the inclusion criteria. All of the patients had a complete blood count with leukocyte differential performed before chemotherapy. Medical records including pathology reports were also available. Data for all patients were collected prior to any surgical intervention. Exclusion criteria included clinical evidence of active infection, presence of hematological disorders, acute as well as chronic inflammatory or autoimmune diseases, or prior steroid therapy. Higher platelet count was significantly associated with the higher stage. The stage was not associated with the hemoglobin level. There was no association between the tumor size and age of patients with NLR. There was a significant relationship between NLR and IDC. There was a significant relationship between IDC and NLRs of less than 8.1 and greater than 3.3. There was a significant relationship between NLR and vascular invasion. There was no association between NLR and estrogen receptor and HER2. There was no significant relationship between the PLR and the cancer stage. In this study, NLR showed a significant relation with the disease staging. As the NLR increases the stage increases as well. Therefore, this ratio may be helpful in the preoperative evaluation of patients with breast cancer

Breast conserving surgery versus mastectomy: cancer practice by general surgeons in Iran

BACKGROUND: There appear to be geographical differences in decisions to perform mastectomy or breast conserving surgery for early-stage breast cancer. This study was carried out to evaluate general surgeons' preferences in breast cancer surgery and to assess the factors predicting cancer practice in Iran. METHODS: A structured questionnaire was mailed to 235 general surgeons chosen from the address list of the Iranian Medical Council. The questionnaire elicited information about the general surgeons' characteristics and about their work experience, posts they have held, number of breast cancer operations performed per year, preferences for mastectomy or breast conserving surgery, and the reasons for these preferences. RESULTS: In all, 83 surgeons returned the completed questionnaire. The results indicated that only 19% of the surgeons routinely performed breast conserving surgery (BCS) and this was significantly associated with their breast cancer case load (P < 0.01). There were no associations between BCS practice and the other variables studied. The most frequent reasons for not performing BCS were uncertainty about conservative therapy results (46%), uncertainty about the quality of available radiotherapy services (32%), and the probability of patients' non-compliance in radiotherapy (32%). CONCLUSION: The findings indicate that Iranian surgeons do not routinely perform BCS as the first and the best treatment modality. Further research is recommended to evaluate patients' outcomes after BCS treatment in Iran, with regard to available radiotherapy facilities and cultural factors (patients' compliance)

Archives of Breast Cancer: An Academic Multidisciplinary Breast Cancer Forum

Welcome to Archives of Breast Cancer (ABC), a new journal with sole focus on breast diseases and especially breast cancer. Breast cancer is a devastating disease that impacts many women and threatens their health and wellbeing. A large number of health professionals from a wide spectrum of clinical disciplines, such as surgery, medical oncology, public health, pathology, radiation oncology, diagnostic radiology, and nuclear medicine, are involved in dealing with such a challenging and common disease. The concept of applying a multidisciplinary approach to clinical and non-clinical aspects of breast cancer has been found to be of vital importance to the understanding of this prevalent type of cancer. Such collaboration can also improve the quantity and quality of the research in this field. To this end, journals which choose to publish multidisciplinary articles as their primary focus can serve as the academic forum to share ideas from a variety of expertise. Archives of Breast Cancer can certainly add to the depth and quality of the research in the field. Articles on a single topic would be readily available to the readers from multiple disciplines and all in one journal. This would eventually lead to fruitful interaction among specialists seeking to investigate this disease, yet,from different perspectives. The benefits of this interaction in the process of devising appropriate strategies and approaches in dealing with the problem are crystal clear. The world of medical sciences has witnessed an abundant increase in the quality and quantity of breast-cancer-related research. In the past 20 years, the number of published articles indexed in PubMed from 1994 to 2014 is more than 5 times than the number published before 1993 (about 170,000 compared to 30,000). Meanwhile, the number of PubMed indexed medical journals dedicated to breast cancer research has also risen from 5 in 1993 to 17 in 2014. This increasing trend highlights an essential need for development of a journal that will specifically publish breast-cancer-related articles and papers. It will pave the way for those who are interested in the subject and who seek to find the results of the most recent research in this field. Thus, this journal, as its main goal, provides an opportunity for better communication and interaction among medical practitioners, basic science researchers, and health care professionals interested in breast diseases. To achieve this goal, ABC benefits from one of the most qualified editorial boards selected from related specialties with various academic affiliations. The vision of ABC is to become a source of reliable and wellresearched articles focusing on breast cancer. Second, it intends to be an outstanding media, introducing to the world of medicine, cutting edge technologies, recent clinical approaches, diagnostic and practical methods, and even surgical details crucial in dealing with breast cancer. We hope that we can make a considerable contribution to the prevention, early detection, management, and rehabilitation of patients suffering from breast cancer. All the members of ABC editorial staff believe that collaboration and interaction amongthe related scientists, physicians and surgeons, social experts, and policy makers from the four corners of the world would be the ultimate means to achieve the goals of the journal

Oncological Outcome of Oncoplastic Breast Surgery: A Review of the Literature

Oncoplastic breast surgery (OBS) has gained widespread acceptance during the last two decades as an integral component of breast cancer surgery. OBS combines oncological principles of breast cancer surgery with plastic surgery techniques to provide the best cosmetic results without compromising oncological outcome of breast cancer treatment and it has opened up the possibility to perform breast conservation in large tumors. The purpose of this review is assessment of the oncological outcome of OBS in the treatment of breast cancer. We performed an extensive search of PubMed for articles published on oncological results and safety of OBS. There are few randomized clinical trials (RCTs) comparing the results of OBS with standard breast conservation techniques; however, based on the results of several prospective studies, it can be concluded that in terms of oncological outcome, OBS is at least as safe as standard techniques for breast conservation

Predictors of Sentinel Node Involvement in Breast Cancer

Background: Sentinel  lymph  node  biopsy  has  shown  to  be  a  good  alternative procedure  for  axillary  lymph  node  dissection  and  to lead  to  lower  frequency  of morbidity, though this technique has its own side effects. It needs especial equipment and may not be available in some medical centers, especially in developing countries. This study aimed to identify a subgroup of patients with higher probability of metastasis to sentinel lymph node that can be excluded from indications of this procedure. Methods: In this cross-sectional study, the clinical data of 195 patients with breast cancer who underwent sentinel lymph node biopsy in Tehran, Iran, between 2009 and 2011 were reviewed. Whenever tumor features showed significant association with sentinel node metastasis in univariate analyses, logistic regression was used to identify independent predictors. Results: Univariate analyses revealed that tumor size and lymphovascular invasion have significant association  with  sentinel  lymph  node metastasis (P  =  0.009  and P < 0.001, respectively). Moreover, age had an significant association with positive sentinel lymph node biopsy (SLNB) (P = 0.004). Other factors, including tumor grade, estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2, were not associated with positive sentinel lymph node biopsy in univariate analysis. All factors  that  showed  significant  association  in  univariate  analysis  remained statistically significant predictors of positive SLB in multivariate analysis. Conclusions: It seems that young breast cancer patients, those who have tumors larger than 5 cm and those with lymphovascular invasion, are at an increased risk of sentinel lymph node metastasis

Axillary Reverse Mapping: A Potentially Safe Procedure in Oncology

Background: In an attempt to reduce the risk of developing lymphedema following breast cancer surgery, some researchers suggested that by identifying and preserving the lymphatic plexus which drains ipsilateral arm we can minimize the risk of lymphedema. The procedure is known as axillary reverse mapping (ARM). In the current study, we investigated the oncological safety of this technique. Methods: A total of 60 patients who were undergoing axillary lymph node dissection were involved. The indications for axillary dissection were whether clinically node-positive axilla or positive sentinel lymph node biopsy. ARM was performed by injecting 2 ml of methylene blue subcutaneously in the upper and medial part of ipsilateral patients’ arm along the intermuscular groove. Results: ARM nodes were identified by means of methylene blue injection in 51(85%) patients (identification rate = 85%). For the subgroup of clinically positive axillary lymph nodes, identification rate was 93.1%, and the corresponding figure was 77.4% for positive SLNB group (P = 0.148). Pathological evaluation of harvested ARM nodes demonstrated metastatic involvement in 8(27.5%) and 1(3.2%) patients in clinically positive and SLNB positive groups respectively (P = 0.026). Conclusions: Based on the findings of this study it seems that ARM could be considered as a safe procedure in patients who are a candidate for ALND when SLNB is positive. In contrast, in patients with clinically positive axillary nodes, there is a considerable risk of tumoral metastasis in ARM nodes