Breast Cancer Recurrence Survival Among Iranian Patients; A 17-Year Retrospective Cohort Study

Background: Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome. Methods: This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated. Results: The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis. Conclusion: Our study showed that Her2 enriched positive BCs had the worst survival and triple negative receptor BC showed the best survival. This may be due to the discovery of Herceptin drugs for Her 2 enriched receptor breast cancers which ameliorates their prognosis and survival. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. Since our patients have not consumed Herceptin drugs over the last 17 years, the difference between our findings and those of other studies could be related to the release of this category of drugs.

Spindle Cell Carcinoma of the Breast: A Case Report Representing Diagnostics, Therapeutics, Intervention, and Outcome

Background: Spindle cell carcinoma (SpCC) is an unusual form of squamous cell carcinoma (SCC) and can sometimes present in the breast. Owing to the rarity of breast SpCC, few case studies are available nowadays and proper evidence is scarce. Case presentation: We herein report a 60-year-old female patient, who was referred to the surgery services after presenting with a right breast ulcerated mass. On physical examination, a 7x7 cm mass was found along with a 3 cm ulcer on the top of it. Both mammography and ultrasound showed a dense mass, and tru-cut and skin punch biopsies confirmed neoplastic spindle cells within the lesion. The patient underwent a right total mastectomy with sentinel lymph node biopsies with no further chemotherapy or radiotherapy. Conclusion: Owing to the heterogeneity of SpCC, there is no exact treatment protocol for this type of cancer, and mastectomy or conservative surgery can be performed in certain groups of patients depending on tumor size, stage, and lymph node involvement. Fortunately, promising medical and biological therapies might be of use in the near future.

Neuroanatomic Map for Nerve Block Design in Breast Surgery

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Outcome of Breast Cancer Patients with COVID-19 Infection: A Report from a Tertiary Cancer Center in India

Background: Nowadays breast cancer (BC) is the most common cancer in women. More than 1.5 million cases are detected yearly. Survival of patients is dependent on several factors. Metastasis and cancer recurrence of different types and in different locations have various outcome. Methods: This is a retrospective cohort study to describe survival of patients after diagnosis of breast cancer based on receptor subtypes and sites of metastasis among Iranian population. A total number of 2051 females with breast cancer were evaluated and among these, 138 patients with recurrent BC were investigated. Results: The 1-year survival of local, bone, visceral and brain metastasis were 64.99%, 63%, 32.83%, and 21.57%, respectively. Based on sites of metastasis, bone and local metastasis showed the best survival while brain and visceral metastasis had the worst survival and prognosis. Conclusion: Our study showed that Her2 enriched positive BCs had the worst survival, this may be due to Trastuzumab uncovered insurance till 10 years ago in our country. Also, drugs related to luminal A and B which are used to improve their survival and hormonal therapy could be associated with their better prognosis in comparison to triple negative receptor subtype. But this study showed that triple negative BC had better survival.

Management of Early Breast Cancer at an Australian Cancer Centre During the Early Phase of COVID-19 Pandemic

Background: This study aimed to prospectively record changes to treatment for early breast cancer patients during the first wave of the COVID-19 pandemic in Australia. The purpose was to assess the impact on breast cancer outcomes and to determine the need for any mitigative actions. Methods: The study was conducted in the breast cancer unit of a tertiary referral hospital. Patients with early (non-metastatic) breast malignancy discussed in multidisciplinary team meetings between March and June 2020 were included. Patients were newly diagnosed, post-operative or post-neoadjuvant chemotherapy. Standard treatment was defined by Westmead Breast Cancer Institute protocols and any variations related to the pandemic were recorded. Results: In the study, 145 patients were included (median age 59 years). Pandemic-related changes to management were noted in 13 of 145 (9.0%) patients. Four patients experienced a delay to cancer treatments, four were not offered reconstructive/ symmetrisation surgical procedures, three had altered radiotherapy protocols and two patients were not offered enrolment to a clinical trial. These impacts affected the groups presenting with new cancers (n=7/86, 8.1%), post-operative cases (n=4/25, 16.0%) and post-neoadjuvant chemotherapy cases presenting for surgical planning (n=2/34, 5.9%). Conclusion: Most patients (91.0%) received standard treatment during the first wave of the pandemic. The minor variations from institutional protocols observed in this study are unlikely to affect local control or survival in this patient cohort, but close follow-up is required. Quality of life may have been affected for four patients who had downgraded or delayed reconstructive procedures.

Impact of Molecular Subtypes of Breast Cancer on Axillary Lymph Node Metastasis: A Tertiary Center Experience

Background: Axillary lymph node metastasis (ALNM) is one of the important prognostic factors of breast cancer. The objective of this study was to assess the risk of ALNM in different molecular subtypes determined by estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (her2neu) of breast cancer. Methods: This retrospective study was conducted on patients who had undergone upfront breast conserving surgery (BCS) or modified radical mastectomy (MRM). Patients were classified as HR (hormone receptor) +/ her2neu- (ER or PR positive and her2neu negative), HR+/her2neu+ (ER or PR positive and her2neu positive), HR-/her2neu- (ER, PR and her2neu negative or triple negative or basal type), and HR-/her2neu+ (ER or PR negative and her2neu positive). The association between clinicopathological variables and ALNM was evaluated in logistic regression analyses. Results: In this study, 476 patients met the inclusion criteria, and had 67.2% ALNM at diagnosis. ALNM was statistically significantly correlated with age ≤ 40 years (p=0.026), tumor grade (p=0.007), pathological tumor size (P<0.001), estrogen receptor (P=0.045), molecular subtypes (P=0.021), LVI (P<0.001), and PNI (P<0.001). Post Hoc test revealed that HR-/her2neu+ subtypes of breast cancer had the highest and HR+/her2neu- had the lowest risk of ALNM. Conclusion: ALNM may be predicted by molecular subtypes of breast cancer. The risk of ALNM is less in TNBC although it is clinically more aggressive. These findings may play an important role in gauging the individualized axillary management in breast cancer.

Pure Mucinous Breast Carcinoma with Micropapillary Pattern in a 32-Year-Old Female

Background: Mucinous carcinoma (MC) is a rare breast malignancy with a large extracellular mucin secretion. It has a good prognosis in comparison to other breast malignancies. Case presentation: We report a 32 years old female with multiple hard palpable masses in the left breast with rapid growth in 6 months. She was mentally retarded with lower limb varicose veins associated with mucocutaneous lesions on the face. She underwent ultrasound examination of the breast, thyroid and lower extremity veins. Core needle biopsy and fine needle aspiration from left breast lesions and right thyroid nodules showed MC and follicular lesion with hurtle cell change, respectively. Suspected metastasis in the left rib and calvarium in the subsequent bone scan survey and brain magnetic resonance imaging was reported. She underwent radical mastectomy and right hemi-thyroidectomy. Conclusion: Pure mucinous carcinoma with micropapillary pattern (MUMPC) is a new histology variant of Pure Mucinous Carcinoma (PMC) that shows favorable prognosis with less aggression and occurs in older patients. However, PMC in our patient occurred at a young age with greater aggression.

Dermatofibrosarcoma Protuberans and Adjuvant Radiotherapy: A Case Report with Uncertain Surgical Margins in The Breast

Background: Dermatofibrosarcoma Protuberans (DFSP) is a rare, locally aggressive superficial soft tissue tumor that can occur in many parts of the body. Surgical resection with a wide margin of safety is the main treatment modality of this rare tumor of the breast. According to the postoperative pathology report, the patient can be followed up or adjuvant radiotherapy (RT) can be added. Case presentation: A 22-year-old woman presented with a mass filling the lower inner quadrant of her right breast. Tru-cut biopsy revealed a mesenchymal tumor, but excision was recommended for definitive diagnosis. A right breast quadrantectomy was performed. The result came as DFSP. Tumor diameter was 10x9x6.5 cm and the tumor was positive in most of the surgical margins. The patient underwent re-resection and a residual tumor with a diameter of 0.2 cm was detected at a distance of 3.3 cm from the surgical margin. Although the surgical margins were negative, the distance of the posterior surgical margin, in particular, could not be assured. Because of the uncertainty of surgical margins, 60 Gy RT was planned. Conclusion: The localization of DFSP in the breast is extremely rare and surgery is the primary treatment. RT should be added as an adjuvant when safe surgical margins cannot be obtained.

Surgical Oncology Myth or Reality

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Serum Inflammation Biomarkers and Micronutrient Levels in Nigerian Breast Cancer Patients with Different Hormonal Immunohistochemistry Status

Background: The importance and relevance of serum inflammation biomarkers and DNA methylation-dependent micronutrients in breast tumorigenesis is gaining wider acceptance. However, the association of serum inflammation biomarkers and micronutrient status with expression of estrogen receptors (ER), progesterone receptors (PR) and human epidermal growth factor receptor-2 (HER-2) by the tumor has not been investigated in Nigerian breast cancer patients. The objective of this study was to determine the levels of serum biomarkers of inflammation (Homocysteine, Nitric Oxide (NO), Hydrogen peroxide (H2O2), Myeloperoxidase (MPO), Tumor necrosis factor alpha (TNF-α), Interleukins 6 and 8 (IL-6 and IL-8) and DNA methylation-dependent micronutrients [Zinc (Zn), Folic acid, Vitamin B6 and B12] in breast cancer patients with different hormone receptor levels (ER, PR and HER-2). Methods: One hundred and fifteen women (80 with breast cancer and 35 controls) were randomly recruited for this study. Serum levels of homocysteine, folic acid, vitamins B6, vitamin B12, TNF-α, IL-6 and IL-8) were analyzed using ELISA. The levels of NO, MPO, H2O2 and Zn were analyzed using spectrophotometer. The levels of serum inflammation biomarkers and DNA methylation-dependent micronutrients in patients with breast cancer and control subjects without breast cancer as well as breast cancer patients with ER, PR and HER-2 expression were determined. Results: The results showed that mean serum levels of IL-6 (p=0.002), IL-8 (p=0.018) and H2O2 (p=0.000) were significantly increased while TNF-α (p=0.014) and NO levels (p=0.044) were significantly decreased in breast cancer compared to healthy controls (p<0.05). However, there were no statistically significant differences in the levels of Zn, homocysteine, Vitamin B6, Vitamin B12 and MPO in breast cancer patients and controls (p>0.05). Furthermore, the levels of serum inflammatory biomarkers and methylation-dependent micronutrients were similar in HER-2, ER and PR breast cancer hormone subtypes. Conclusion: Systemic inflammation exists in breast cancer patients but the inflammation biomarkers and methylation-dependent micronutrients did not differ among patients with PR, ER and HER-2 antigen expression.