Phyllodes tumor in an adolescent female

Phyllodes is a tumor of breast. This fibro-epithelial lesion occurs in less than 1% of all breast tumors in female. They can be benign, borderline or malignant. It commonly occurs in age group of 45-50 years. It is also known as cystosarcoma phyllodes/ serocystic disease of Brodie. Treatment can be either wide local excision or mastectomy to achieve histologically clear margin. Palpable axillary lymphadenopathy can be identified in up-to 10-15% of patients but less than 1% has pathological positive nodes. Mammography and ultrasonography are main imaging modalities. Here, we present a case of a 14-year-old female presenting with a rapidly enlarging breast mass, which was ultimately found to be a Phyllodes tumor.

EP.TH.664Breast lump recurrence - malignancy or iatrogenic disease process?

Backgound Fibromatosis is a rare disease, accounting for 0.2% of breast tumours and 3% of soft tissue tumours. Due to its rarity there is a lack of multi centre trials and therefore evidence and guidance on the best treatment options. Likewise, many clinicians are unfamiliar with how to best manage these patients, even in specialist centres. Methods We present the case of a patient presenting with a suspicious breast lump, diagnosed as fibromatosis. Literature search enabled review of current trends and opinions in the management of such patients. Results We discuss the case of a 70 year old patient with a right breast lump, presenting 3 years following wide local excision and radiotherapy for DCIS. Imaging and examination were suspicious for malignancy. Biopsy demonstrated fibromatosis, for which the patient is currently being managed with active observation. Discussion and Conclusion Desmoid tumours of the breast are a rare but important differential in patients presenting with a breast lump. The aetiology remains poorly understood but they have been linked to genetic conditions, and trauma. As with this case, trauma may be iatrogenic in the form of surgery or radiotherapy. Due to the destructive nature of fibromatosis, the current trend in the management of these patients advocates wide local excision where possible. However, there is a high recurrence rate. There has been some success with medical therapies such as NSAIDs and tyrosine kinase inhibitors. These may be viable options in patients in whom surgery is not suitable.

A Comparative Study between Round Block Technique and Standard Wide Local Excision in Breast Cancer Patients

Background The goal of optimizing the cosmetic and oncologic outcomes of BCS has been addressed in recent years by the emergence of the field of oncoplastic surgery, that originally defined as an assortment of volume replacement techniques performed by plastic surgeons to replace all or part of the resected breast volume with myocutaneous tissue flaps. The definition of oncoplastic surgery has more recently been expanded to include a wide range of volume displacement or volume redistribution procedures performed by breast surgeons and general surgeons to optimize breast shape and breast volume following breast cancer surgery. Aim of the Work To assess the round block technique as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. Patients and Methods This is a prospective randomized study to assess the round block technique as an oncological procedure for management of early breast cancer near to nipple-areola complex as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. Twenty breast cancer patients are subdivided into group (A) 10 females which underwent round block technique and group (B) 10 femaleswhich underwent standard wide local excision. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be non-significant between 2 groups so the only difference is the surgical technique. Results The round block technique and SWLE have the same results regarding operative time, intra-operative blood loss and post operative complications with the advantage to RBT because of its better cosmetic outcomes and lower re-excision rates. So, the round block technique is superior to SWLE in selected cases. Conclusion The round block technique has comparable operative parameters to SWLE with no evidence of increased surgical complications. With a lower re-excision rates and better cosmoses were observed in the round block patients as it is scarless operation without nipple and areola shift suggesting that the round block technique is superior to SWLE in selected cases.

Evaluation of Round Block Oncoplastic breast surgery in early Juxta-areolar breast cancer in comparison to conventional breast conservation surgery

Background Breast cancer is the most common cancer in women all over the world representing 18% of all women reported cases of cancer. It represents the leading cause of women mortality as representing 23% of all women cancer deaths. The decision in any breast cancer patient is taken by MDT that includes breast surgery consultant, pathology consultant, plastic surgery consultant, radiology consultant and medical oncology consultant. Breast conserving surgeries are now the standard technique for management of breast cancer patient. Oncoplastic techniques are replacing SWLE for their better cosmetic outcomes and better exposure of the tumor. Objective The aim of this work was to assess the round block technique as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. Methods This is a retrospective study to assess the round block technique as an oncological procedure for management of early breast cancer near to nipple-areola complex as regard oncological safety, surgical outcomes and patients' satisfaction comparing results with standard wide local excision. It was conducted at general surgery department, Ain Shams university hospitals. Approval of the Ethical Committee and written informed consent from all participants were obtained. In our study 40 breast cancer patients are subdivided into group (A) 20 females which underwent round block technique and group (B) 20 femaleswhich underwent standard wide local excision. Patient and tumor criteria including age, co morbidities, tumor size and distance between tumor and nipple-areola complex were considered to be nonsignificant between 2 groups so the only difference is the surgical technique. Results The study shows that the round block technique and SWLE have the same results regarding hospital stay, post operative complications and oncological recurrence with the advantage to RBT because of its better cosmetic outcomes. So, the round block technique is superior to SWLE in selected cases. Conclusion The round block technique has comparable post operative parameters with better cosmoses as it is scarless operation without nipple and areola shift suggesting that the round block technique is superior to SWLE in selected cases.

Primary Malignant Melanoma Limited to the External Auditory Canal: A Rare Presentation

Malignant melanoma limited to the external auditory canal is very rare. These patients present relatively late as compared with melanoma involving other subsites of external ear. However, the tumor is slow-growing but shows aggressive behavior with a poor prognosis when presented late. We have a 44-year-old female who presented with a blackish lesion, which was bleeding on and off from her left ear. She was managed with wide local excision, preserving maximum part of external auditory canal cartilage. The histopathology of the lesion was suggestive of malignant melanoma. After a thorough evaluation, she was kept under close follow-up. Malignant melanoma of external auditory canal shows poor prognosis usually, mainly because of late presentation. Thus, early diagnosis is crucial, as in our case, where wide local excision was sufficing, and the patient is disease-free after 4 years of follow-up.

Synchronous Fibromatosis Indistinguishable from Suspected Synchronous Gastrointestinal Stromal Tumor: A Case Report

Desmoid tumors most commonly occur in the anterior abdominal wall in approximately 50% of cases and are locally aggressive. We describe a case of a 38-year-old lady who was investigated as a case of gastrointestinal tumor. Post-operative immunohistochemistry staining showed the presence of a synchronous desmoid in the abdominal wall and proximal ileum. Wide local excision remains the gold-standard of treatment with pharmacotherapeutics and radiotherapy serving as adjuvant or palliative treatment options.

392 Magseed-Guided Wide Local Excision During the COVID-19 Pandemic: A Tenable Solution to Barriers in Accessing Elective Breast Cancer Surgery

Introduction Magseed-guided localisation has emerged as a suitable alternative to wire-guided localisation (WGL) for impalpable breast cancers, with advantages including advanced insertion and simpler logistical planning. Given the severe disruption to elective surgeries during the Covid-19 pandemic, a local Magseed pathway was developed enabling safe patient flow. Magseed was inserted well in advance of the operation, enabling time to self-isolate and obtain a negative COVID swab prior to admission to a dedicated COVID -free suite. We present the patient-reported outcomes of the new pathway. Method A prospective service evaluation was conducted in a University hospital. Patients undergoing Magseed-guided wide local excision (WLE) from 01/07/2020 to present were surveyed to detail their experiences on the Magseed pathway. Qualitative data investigating anxiety and comfort post-insertion were reported using 10-fold Likert scales. Quantitative data was collected on patient demographics and tumour specification. Results 41/46 women who underwent Magseed localisation WLE completed the survey, with median age 65 years (IQR 53-72) and median BMI 26.5 kg/m2 (IQR 22.4-30.8). 71% had invasive ductal carcinoma with or without ductal carcinoma in-situ. 10% women found the procedure uncomfortable (<5) and 98% women reported low anxiety (<5) over seed displacement. If given the choice, 98% patients would prefer Magseed over WGL. Conclusions The new Magseed pathway is regarded positively among patients, despite ongoing disruption in elective breast cancer services. Given the progression of the second wave and likelihood of future outbreaks, Magseed localisation could be adopted widely to ensure continuous provision of safe elective surgeries.