TP8.1.6 Why do people remain in hospital after mastectomy?

Aims Mastectomy is established as a safe day-case procedure. Amidst the ongoing COVID-19 pandemic it is essential to find ways to continue elective surgery with greater efficiency. The aim of this study is to establish factors associated with overnight admission after simple mastectomy, enabling more effective pre-operative planning. Methods All patients undergoing simple mastectomy in our unit between January and October 2020 were included. Those undergoing immediate reconstruction were excluded. The electronic case notes were reviewed to include procedure performed and patient characteristics. Basic statistical analysis was performed. Results 95 patients underwent simple mastectomy (28 with axillary clearance and 58 with sentinel node biopsy). 56% of procedures were day-case. Axillary clearance was more common in the inpatient compared to the day-case surgery group (24% vs 45%). Both average age and ASA were significantly lower in the day-case compared to the inpatient group (p < 0.05). There was no significant difference in BMI or specimen weight between groups. 16 patients underwent simple mastectomy without drain insertion, none required admission. Of the patients admitted overnight following surgery, 50% were pre-planned admissions. 57% of these were for patients identified as high surgical or anaesthetic risk at pre-operative assessment. Overall 5 patients stayed in hospital due to patient preference. Conclusions In addition to axillary surgery performed, age, ASA and perceived pre-operative risk are associated with overnight admission following simple mastectomy. Knowledge of these factors can better inform pre-operative planning. Providing enhanced post-operative support at home may enable more patients to be discharged on day of surgery.

Paget’s Disease of the Breast and Our Clinical Experience at Ain Shams University Hospitals

Background Worldwide, breast cancer comprises 10.4% of all cancer incidences among women, making it the second most common type of non-skin cancer (after lung cancer) and the fifth most common cause of cancer death. In 2004, breast cancer caused 519,000 deaths worldwide (7% of cancer deaths; almost 1% of all deaths). Breast cancer is about 100 times more common in women than in men, although males tend to have poorer outcomes due to delays in diagnosis. Aim of the Work To clarify clinical, pathological features and outcomes of the treatment modalities for Paget’s disease of the breast at Ain Shams University Hospitals. Materials and Methods Our study was held as a retrospective cohort study to clarify clinical, pathological features and outcomes of the treatment modalities for Paget’s disease of the breast at Ain Shams University Hospitals. Results At Ain Shams university hospitals patients having pagetoid cells by biopsy and no mass radiologically underwent simple mastectomy and if pathology proved any malignancy in breast tissue axillary clearance was done and might be followed by radiotherapy. Conclusion Patients having pagetoid cells by biopsy and a mass radiologically which is invasive or insitu with microinvasion will undergo modified radical mastectomy and may be followed by radiotherapy. But if pagetoid cells and mass radiologically which is in situ simple mastectomy will be done.

METAPLASTIC CARCINOMA OF BREAST : A CASE REPORT

Metaplastic breast cancer constitute nearly 1 % of all breast carcinoma cases. There is metaplasia of normal epithelial components of the breast into other types. They are highly aggressive with very poor prognosis. Here we present a case of 30 year old female who presented with a breast lump in her left breast associated with dull aching pain. It was 10 x 10 cm in size involving upper inner, upper outer, lower outer quadrants and retroareolar area of left breast. USG was suugestive of BIRADS VI lesion. Axillary lymph nodes were not found enlarged clinically or radiologically. Core biopsy report showed Phylloides tumor of breast. The patient underwent simple mastectomy of left breast and histopathology revealed spindle cell variant of metaplastic breast cancer. The cell blocks sent for immunohistochemistry were negative for estrogen, progesterone receptors and Her2neu receptor. The post surgical treatment of this type of breast cancer is still under study.

The application of completion mastectomy and immediate reconstruction in a patient unable to undergo radiotherapy following breast conserving surgery: a case report

Breast conserving surgery (BCS) with adjuvant radiotherapy (RT) confers an equivalent 20 year survival rate to mastectomy. Concerningly, 15% of BCS patients do not receive RT. Several barriers to completing RT have been described. However, non-compliance with post-BCS radiotherapy due to severe claustrophobia is not well documented in the literature. We report the case of a patient who declined radiotherapy following BCS due to severe claustrophobia. With advances in oncoplastic breast surgery, completion nipple-sparing mastectomy (NSM) may be an alternative to simple mastectomy in BCS patients unable to undergo RT. NSM is an oncoplastic procedure that involves attaining complete oncologic resection whilst sparing the nipple-areolar complex. Recent literature highlights that NSM has more favourable aesthetic outcomes and improves quality of life compared to simple mastectomy. This report further describes the novel use of NSM and reconstruction for the case patient and highlights its potential use in patients who are unable to undergo neoadjuvant RT.

: Bilateral complex lactating adenosis: clinical presentation and management in Sudan

lactating adenosis are benign breasts neoplasm usually seen during pregnancy and lactation. We present a rare case of bilateral complex benign lactating adenosis in 19 year old female patient presented with lactating adenosis mimic cancer growth after giving birth. Histopathology confirm diagnosis and Simple mastectomy was the treatment of choice.

A retrospective review of phyllodes tumors of the breast from a single institution

BACKGROUND: Phyllodes tumors (PTs) are rare fibroepithelial breast tumors with diverse biological behavior. OBJECTIVE: This study aimed to analyze the characteristics, management, and outcome of phyllodes tumors. METHODS: Patients diagnosed with PTs in our institution from January 2013 to December 2017 were identified retrospectively by the ICD-10 code. Data were collected from medical records. The diagnosis of this tumor was based on histopathological results. Variables analyzed included age, tumor site, surgical option, axillary lymph nodes, chemotherapy and radiotherapy, metastases, disease-free survival (DFS), and overall survival (OS) rate. RESULTS: Sixty-nine cases of PTs were diagnosed during the period, of which 31 were benign, 38 were malignant, and 1 was a case of bilateral metachronous tumors. We did not find any borderline pathologic cases. The patient’s ages ranged from 20 to 71 years, with the highest number of cases (28) from the 40-49-year-old age group. The majority of patients (42) had PT on the right side. Simple mastectomy was the most performed treatment, with 53 such cases, including both benign and malignant. The axillary staging was carried out in 16 cases, of which none had nodal metastasis. Ten cases received chemotherapy, and 16 cases of malignant phyllodes received postoperative radiotherapy. We found 4 cases with distant metastases and 5 cases that developed local recurrence. The DFS rate reached 92.75%, and the overall 5-year survival rate was 84.21%. CONCLUSIONS: The incidence of PTs is highest in women in the 3rd and fourth decades of age. Simple mastectomy and wide excision are the treatments of choice, with a low recurrence rate in both benign and malignant PTs cases.

Adenoid cystic carcinoma, report of a case

Introduction: Adenoid cystic carcinoma (CAQ) is a typical tumor of the salivary glands and infrequent in the breast (less than 0.1%). It stands out for being triple negative with a favorable prognosis. Its infrequency and slow progression mean that today there is no consensus regarding its therapeutic management and follow-up. Objective: To provide a new case to learn more about the nature, management and evolution of this type of neoplasm. Material and methods: We analyzed the data collected in our case and compared it with what was published in the literature. Results: a typical triple negative case is presented, with a large size with respect to the breast (T2), so it was decided to perform a simple mastectomy as initial treatment with immediate reconstruction due to the absence of axillary involvement. Subsequently, it was decided not to apply adjuvant treatment since the tumor was not aggressive, the hormone receptors were negative, and the final lesion was less than 5cm with wide margins and no evidence of lymphovascular invasion. Conclusion: To date, breast CAQ continues to present uncertain management and follow-up given that we do not have enough data in the literature to know its evolution correctly, therefore more studies are needed with the intention of being able to standardize treatment and surveillance of this tumor.

Appendiceal adenocarcinoma with breast metastases

Malignant lesions of the vermiform appendix make up a rare subset of colorectal cancer. While colorectal cancer frequently metastasises to the liver, lung, regional lymph nodes and peritoneum, metastasis to the breast is extremely rare. Here, we describe the case of an 84-year-old woman who had the incidental finding of appendiceal adenocarcinoma following emergency laparoscopic appendectomy. She declined further operative or adjuvant treatment for her disease. She represented 1 year later with metastatic appendiceal adenocarcinoma disease to her left breast. A simple mastectomy for symptomatic treatment was performed. In this report, we describe the first case of appendiceal adenocarcinoma metastases to the breast. Due to its rarity, there is a paucity of evidence related to the management of this condition. The limited evidence is reviewed and discussed.