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Frontiers in Medicine 2024Retroperitoneal fibrosis, a condition of uncertain origin, is rarely linked to 8% of malignant cases, including breast, lung, gastrointestinal, genitourinary, thyroid,...
BACKGROUND
Retroperitoneal fibrosis, a condition of uncertain origin, is rarely linked to 8% of malignant cases, including breast, lung, gastrointestinal, genitourinary, thyroid, and carcinoid. The mechanism leading to peritoneal fibrosis induced by tumors is not well understood, possibly encompassing direct infiltration of neoplastic cells or the initiation of inflammatory responses prompted by cytokines released by tumor cells. We report a case of breast cancer with renal metastasis and retroperitoneal fibrosis detected using F-FDG PET/CT, providing help for clinical diagnosis and treatment.
CASE REPORT
A 49-year-old woman was referred to the hospital with elevated creatinine and oliguria for over a month. Abdominal computer tomography (CT) and magnetic resonance imaging (MRI) showed a retroperitoneal fibrosis-induced acute kidney injury (AKI) was suspected. However, a percutaneous biopsy of the kidney lesion confirmed metastasis from breast cancer. The physical examination revealed inverted nipples and an orange peel appearance on the skin of both breasts. Ultrasonography revealed bilateral hyperplasia (BIRADS 4a) of the mammary glands and bilateral neck and axillary lymphadenopathy. Subsequently, F-deoxyglucose positron emission tomography/computer tomography (F-FDG PET/CT) detected abnormally high uptake (SUVmax) in the bilateral mammary glands and axillary lymph nodes, suggesting bilateral breast cancer. Furthermore, abnormal F-FDG uptake was detected in the kidney, suggesting renal metastasis. In addition, abnormal F-FDG uptake was observed in the vertebrae, accompanied by an elevation in inhomogeneous bone mineral density, raising suspicion of bone metastases. However, the possibility of myelodysplasia cannot be dismissed, and further investigations will be conducted during close follow-ups. There was significant F-FDG uptake in the retroperitoneal position indicating a potential association between retroperitoneal fibrosis and breast cancer. The final pathological diagnosis of the breast tissue confirmed bilateral invasive ductal carcinoma. The patient had been treated with 11 cycles of albumin-bound (nab)-paclitaxel (0.3 mg) and had no significant adverse reaction.
CONCLUSION
In this case, neither the bilateral breast cancer nor the kidney metastatic lesion showed typical nodules or masses, so breast ultrasound, abdominal CT, and MRI did not suggest malignant lesions. PET/CT played an important role in detecting occult metastases and primary lesions, thereby contributing to more accurate staging, monitoring treatment responses, and prediction of prognosis in breast cancer.
PubMed: 38741768
DOI: 10.3389/fmed.2024.1353822 -
Archives of Plastic Surgery May 2024Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy...
Several strategies for the management of venous congestion of the nipple-areola complex (NAC) after reduction mammaplasty have been proposed. Among these, hirudotherapy represents an ancient but still effective method, even though the risk of infections related to leeches should be considered. We report a peculiar case of breast infection and sepsis after leech therapy in a patient who underwent a reduction mammaplasty. A prompt surgical debridement of the wounds and necrotic tissues associated with targeted antibiotic therapy led to a fast improvement of clinical conditions, and partial preservation of the NAC was obtained. Accurate knowledge of the clinical presentation of soft tissue infections related to leeching allows for an early diagnosis and would serve as a warning for surgeons who approach such breast cosmetic procedures.
PubMed: 38737840
DOI: 10.1055/s-0043-1776696 -
Plastic and Reconstructive Surgery.... May 2024We present a novel percutaneous areola reduction technique that, to our knowledge, has never been used or published in the past. This technique is a useful solution to...
We present a novel percutaneous areola reduction technique that, to our knowledge, has never been used or published in the past. This technique is a useful solution to the downsides of the current most commonly used technique for areola reductions that uses a circumareolar incision. Our current technique utilizes a percutaneous approach, which is a minimally invasive procedure, and produces a virtually scarless result.
PubMed: 38706471
DOI: 10.1097/GOX.0000000000005783 -
Alternative Therapies in Health and... Apr 2024The study aims to assess and compare the outcomes of modified radical surgery, preserving the nipple-areola complex, against radical mastectomy in patients with...
OBJECTIVE
The study aims to assess and compare the outcomes of modified radical surgery, preserving the nipple-areola complex, against radical mastectomy in patients with triple-negative breast cancer. Emphasis is placed on the clinical significance of this comparison, including its potential impact on patient outcomes, quality of life, and healthcare resources.
METHODS
Relevant literature from January 2017 to January 2022 was searched in the following databases: PubMed, Embase, MEDLINE, Science Citation Index, Web of Science, China National Knowledge Internet, CCD, and CSPD with keywords. The electric search yielded 613 relevant articles, including 351 from Pubmed, 187 from Embase, 5 from MEDLINE, 21 from CNKI, 4 from CCD, and 45 from CSPD. After duplicate screening, 185 items were eliminated, leaving 428 articles. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated with RevMan 5.3, and sensitivity analysis, cumulative meta-analysis, and publication bias analysis were also performed. A total of 613 relevant articles were collected from the above databases, among which 428 articles remained after the initial screening and were further screened based on the established inclusion and exclusion criteria. The efficacy of modified radical surgery and breast-conserving surgery in the treatment of early breast cancer was assessed by analyzing outcome indicators, including recurrence rate, distant metastatic rate, and three-year survival rate. The methods section details a systematic approach to data collection and analysis, specifying the databases and time frame for the literature search and the statistical tools used for the meta-analysis. The selection process, from the initial number of articles to the final inclusion based on defined criteria, is transparent, ensuring the study's methodological robustness in evaluating the efficacy of surgeries for early breast cancer.
RESULTS
Finally, ten articles were found to match the criteria and included in this study. According to the meta-analysis, there was no statistically significant difference between the breast-conserving therapy (BCT) and modified radical mastectomy (MRM) groups in terms of the recurrence rate (OR = 0.76, 95%CI = 0.39, 1.55, P > .05) and distant metastatic rate (OR = 0.81, 95%CI = 0.46, 1.31, P > .05). Nevertheless, the three-year survival rate was 85.2% in the BCT group and 91.7% in the MRM group; a statistically significant difference was observed in the three-year survival rate (OR = 1.47, 95%CI = 1.01, 2.37, P = .03) between the BCT and MRM groups. Accordingly, breast-conserving surgery and modified radical surgery produced comparable clinical outcomes for the treatment of early breast cancer.
CONCLUSION
In the treatment of early breast cancer, breast-conserving surgery has the advantages of less bleeding, fewer clinical complications, and favorable cosmetic outcomes compared with modified radical surgery. Furthermore, patients with breast-conserving surgery showed comparable recurrence and distant metastatic rates to those with modified radical surgery in postoperative follow-up, which, therefore is a suitable treatment option for the widespread recommendation. The study's findings hold significant clinical relevance, implying that while BCT remains a viable option, MRM may offer a survival advantage. This insight empowers both patients and clinicians in making informed, personalized treatment decisions tailored to individual circumstances.
PubMed: 38687862
DOI: No ID Found -
Eplasty 2024Breast conservation therapy typically consists of lumpectomy, which often leads to poor cosmetic outcomes. Concurrent oncoplastic reductions are performed to maximize...
BACKGROUND
Breast conservation therapy typically consists of lumpectomy, which often leads to poor cosmetic outcomes. Concurrent oncoplastic reductions are performed to maximize aesthetics and patient outcome. We present an oncoplastic breast reconstruction in a breast re-reduction case in this study.
METHODS
A 62-year-old female was diagnosed with invasive ductal carcinoma of the left upper outer breast by core needle biopsy. The patient had a prior bilateral breast reduction using a superior-central pedicle approach 15 years ago and desired breast conservation therapy.
RESULTS
The oncoplastic reconstruction technique used was a superomedial pedicle Wise-pattern bilateral breast reduction. The lump was excised lateral to the pedicle after initial de-epithelialization and incision of the superomedial pedicle's lateral aspect. The remainder of the pedicle was developed, and the same procedure was performed on the right breast at the same time. Excess tissue was excised bilaterally from the medial, superior, and inferior, and the optimal new nipple position was obtained. Both nipples were viable and well perfused following closure of the incisions.
CONCLUSIONS
Breast cancer is uncommon in patients who have had bilateral breast reductions. Oncoplastic reduction is an uncommon procedure used in patients who want to preserve their breasts while maintaining their aesthetic appearance. There is currently no agreement on the most effective and safest surgical technique for breast re- reduction surgery, and no reports on oncoplastic reconstruction in patients requiring breast re-reductions. In an oncoplastic reconstruction case, we achieved an acceptable outcome with our superomedial pedicled Wise-pattern bilateral breast reduction technique.
PubMed: 38685994
DOI: No ID Found -
JPRAS Open Jun 2024Inverted nipples are commonly observed and can lead to challenges in breastfeeding, sexual experiences, and dissatisfaction with one's physical appearance. Currently,...
Inverted nipples are commonly observed and can lead to challenges in breastfeeding, sexual experiences, and dissatisfaction with one's physical appearance. Currently, there is a lack of consensus on the optimal treatment approach. The use of a smooth silicone implant to reconstruct the nipple-areola complex in post-mastectomy breast reconstruction has recently been proposed. This study presents the first case using this approach in a patient with a grade II inverted nipple who previously failed conventional reconstructive surgical treatment.
PubMed: 38681532
DOI: 10.1016/j.jpra.2024.03.017