Co-existent breast malignancy and contralateral primary axillary tuberculosis

Breast tuberculosis is an extremely rare entity representing less than 0.1% of all breast disease in developed countries1. Tuberculous infections within the United Kingdom have seen a steady decline with the highest rates present within North West London where infection rates reach 24.8 per 1000002. The presentation can mimic malignancy and lymphatic involvement of the breast both clinically and mammographically, with nodules within the upper outer quadrant, making accurate diagnosis challenging.3 Approximately 30% of breast TB cases present with axillary lymphadenopathy and a recent case series review of approximately 44 cases in London found that the most common presenting feature was a solitary breast lump in 87% of cases.4 We present a case of a patient presenting with primary malignancy and contralateral nodal disease highly suspicious for breast malignancy. Subsequent investigation led to the identification of synchronous localized cancer and tuberculous lymphadenitis. Synchronous presentation is uncommon and recognition and differentiation is vital as axillary lymph node metastasis is the most important factor in the staging of breast carcinoma and determining the subsequent oncological and surgical management.

Overhaul of Radiological Mammography Check-ups for Early Malignancy Diagnosis during COVID-19 Pandemic

Background. The article reports the number of examinations with stationary mammography systems, in outpatient screenings, as well as in a mobile mammography survey across the Sverdlovsk Region.Aim. A study of expedience and design of radiological breast check-ups (exemplified by mammography) for early cancer diagnosis under the COVID-19 pandemic situation.Materials and methods. A survey based at the Sverdlovsk Regional Oncology Dispensary’s Department of Diagnostic Radiology analysed the expedience and design of non-invasive diagnostic procedures in a case study of breast X-ray checkups (mammography) in the Sverdlovsk Region during 2019—2020. Th e survey used the Sverdlovsk Region population statistics on breast malignancy incidence for 2019—2020.Results. According to reports, the number of outpatient screening surveys significantly decreased in 2020 vs. 2019 due to the coronavirus pandemic and effective ban on screenings and medical check-ups. Th e mobile mammography screening numbers increased more than twice in 2020 vs. 2019.Discussion. Screening measures continued during the COVID-19 pandemic. Clinicians adhered to local guidelines, while fully complying with the recommendations to contain SARS-CoV-2 infection. Th e growth of mobile mammography screenings enabled completion of the annual check-up plan, however, the breast malignancy detection rate slightly dropped in 2020 compared to 2019.Conclusion. Mammography screenings at the Sverdlovsk Regional Oncology Dispensary in 2019--2020 demonstrate the expedience and good organisation of breast radiological check-ups (mammography) in Sverdlovsk Region. Accounting for the epidemiological state of coronavirus infection, a positive trend is evident towards growing examinations and improved breast malignancy detection, which lowers mortality accordingly among the female population of Sverdlovsk Region.

Malignancy risk of indeterminate mammographic calcification in symptomatic breast clinics

BackgroundTo explore the potential risk factors predicting malignancy in patients with indeterminate incidental mammographic microcalcification and to evaluate the short-term risk of developing malignancy.MethodsBetween January 2011 and December 2015, one hundred and fifty (150) consecutive patients with indeterminate mammographic microcalcifications who had undergone stereotactic biopsy were evaluated. Clinical and mammographic features were recorded and compared with histopathological biopsy results. In patients with malignancy, postsurgical findings and surgical upgrade, if any, were recorded. Linear regression analysis (SPSS V.25) was used to evaluate significant variables predicting malignancy. OR with 95% CIs was calculated for all variables. All patients were followed up for a maximum of 10 years. The mean age of the patients was 52 years (range 33–79 years).ResultsThere were a total of 55 (37%) malignant results in this study cohort. Age was an independent predictor of breast malignancy with an OR (95% CI) of 1.10 (1.03 to 1.16). Mammographic microcalcification size, pleomorphic morphology, multiple clusters and linear/segmental distribution were significantly associated with malignancy with OR (CI) of 1.03 (1.002 to 1.06), 6.06 (2.24 to 16.66), 6.35 (1.44 to 27.90) and 4.66 (1.07 to 20.19). The regional distribution of microcalcification had an OR of 3.09 (0.92 to 10.3), but this was not statistically significant. Patients with previous breast biopsies had a lower risk of breast malignancy than patients with no prior biopsy (p=0.034).ConclusionMultiple clusters, linear/segmental distribution, pleomorphic morphology, size of mammographic microcalcifications and increasing age were independent predictors of malignancy. Having a previous breast biopsy did not increase malignancy risk.

COMPARISON OF POST-OPERATIVE VALUES WITH PRE OPERATIVE VALUES OF CA 15-3 AND ITS PROGNOSTIC VALUE

Objective: This study was designed and conducted to establish the relationship of biomarker CA 15-3 levels with tumor load in cases of carcinoma breast. Methods: Fifty female patients with confirmed diagnosis of breast malignancy were included in the study. CA 15-3 levels were measured before surgery and after surgery. Results: It was found that levels of the biomarker were increased in all the cases; the rise was higher in advance cases of carcinoma. Levels decreased after the surgery and this decrease was statistically significant. Conclusions: It was concluded that levels of CA 15-3 increase in cases of carcinoma breast; higher levels indicate advanced stage and that decrease in levels indicate effective treatment.

Clinicopathological Characteristics and Treatment Outcomes of Occult Breast Cancer: A Population-Based Study

Background Occult breast cancer (OBC) is a special type of breast cancer. It is defined as an axillary lymph node metastasis without ipsilateral breast malignancy according to mammogram and ultrasonography. Because of its rarity and no primary lesion, clinicopathological information is still insufficient, causing a controversial condition about its treatment recommendation. In this study, we aimed to clarify major clinicopathological information, treatment strategies and prognosis of OBC based on a large population. Methods We retrospectively collected adult female OBC population from Surveillance, Epidemiology, and End Results (SEER) database. We divided the whole OBC cohort into two groups based on surgical treatment. Descriptive analysis of 18 clinicopathological variables was conducted by Wilcoxin rank sum test, Chi-square and Fisher’s exact test. Survival analysis was performed in the whole cohort as well as based on different clinicopathological factors. Univariate and multivariate Cox regression analysis was performed to identify potential independent predictor for prognosis of OBC. Results 1189 OBC patients was included in final analysis. Elderly patients predominated with a mean age of nearly 60. Most of the OBC patients were diagnosed as an early-stage carcinoma and ductal carcinoma took up nearly 40% of all the histological types of OBC. Luminal A is the commonest subtypes of OBC. For in-breast treatment, number of patients received mastectomy was 4 times more than that of patients received breast-conserving surgery (BCS). More than 70% patients receiving BCS took radiotherapy, significantly more than the portion of patients receiving radiation in mastectomy group (50.9%, P < 0.001). Median follow-up period of all subjects was about 62 months. 5-year and 10-year overall survival (OS) of the complete OBC cohort was 81.6% and 68.8%, respectively. No significant difference in OS and breast-cancer specific survival (BCSS) was found between mastectomy and BCS. Older age and larger number of positive lymph nodes causes a worse prognosis whereas radiotherapy brought a better clinical outcome for OBC patients. Conclusion OBC is a rare breast malignancy with a generally good prognosis. Less-intensive surgical intervention does not negatively impact clinical outcomes of OBC while additional radiotherapy is totally beneficial to prolong OS and BCSS.

Endogenous estrogens—breast cancer and chemoprevention

Breast cancer is the most common female malignancy and the second leading cause of cancer related deaths. It is estimated that about 40% of all cancer in women is hormonally mediated. Both estrogens and androgens play critical roles in the initiation and development of breast cancer. Estrogens influence normal physiological growth, proliferation, and differentiation of breast tissues, as well as the development and progression of breast malignancy. Breast cancer is caused by numerous endo- and exogenous risk factors. The paper presents estrogen metabolism, in particular 17β-estradiol and related hormones. The mechanisms of estrogen carcinogenesis include the participation of estrogen receptors, the genotoxic effect of the estrogen metabolites, and epigenetic processes that are also presented. The role of reactive oxygen species in breast cancer has been described. It called attention to a role of numerous signaling pathways in neoplastic transformation. Chemoprotective agents, besides other phytoestrogens, classical antioxidants, synthetic compounds, and their mechanisms of action have been shown.