Introduction: Breast cancer is the most frequently encountered malignant tumour in women around the world with high incidence and mortality rates worldwide. The concept of being able to prognosticate breast cancer based on routine peripheral blood examinations is attractive given the ease of access, replicability, and lower cost. Aim: To estimate the Systemic Immune-inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI) in invasive ductal carcinoma of breast and to study association between SII and SIRI with prognostic parameters such as molecular subtypes, Grade and Stage of the disease. Materials and Methods: This retrospective cross-sectional analytical study was conducted at Departments of Pathology and Surgical Oncology, Sri Devaraj Urs Medical college, Tamaka, Karnataka, India, from February 2024 to August 2024 it included 90 histopathologically confirmed cases of invasive ductal carcinoma of the breast diagnosed between January 2018 and December 2020. Clinicopathological data such as age, tumour grade, stage, and molecular subtype were obtained from medical records. Neutrophil, lymphocyte, monocyte, and platelet counts were obtained from case files. The SII and SIRI were calculated using standard formulas. Optimal cut-off values were derived using Receiver Operating Characteristic (ROC) curve analysis, and patients were categorised into high and low index groups. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 22.0. Associations between inflammatory indices and prognostic parameters were assessed using the Chi-square test, with p<0.05 considered statistically significant. Results: A total of 90 patients with invasive ductal carcinoma of the breast were included in the study. Based on ROC analysis, the cut-off values for SII and SIRI were 568.83 and 0.831, respectively. High SII levels showed a statistically significant association with histological grade (p=0.002). However, no significant association was observed between SII and tumour stage (p=0.235) or molecular subtype (p=0.770). Similarly, elevated SIRI levels were significantly associated with histological grade (p=0.013) and tumour stage (p=0.022). No significant association was observed between SIRI and molecular subtypes (p=0.734). Conclusion: Systemic inflammatory indices such as the SII and SIRI represent accessible, inexpensive, and non invasive tools that may aid in prognostic assessment and risk stratification in patients with invasive ductal carcinoma of the breast. Their evaluation using routine peripheral blood parameters highlights the potential clinical utility of inflammation-based biomarkers in the overall management and prognostication of breast cancer.

Background With the widespread availability of whole-slide imaging, many studies have utilized digital images of hematoxylin and eosin (H&E)-stained breast cancer tissues and applied convolutional neural networks (CNNs) for pathological diagnosis. However, CNN-based diagnosis is largely a black box and may be limited in quantitative morphological research. In this study, we developed a simple algorithm for morphometric analysis of three nuclear atypia features on H&E-stained whole-slide images to predict nuclear grade, hormone receptor status, and Ki-67 levels in breast cancer.Materials and Methods Using 43,183H&E-stained nuclear images larger than 20 µm2 from 131 invasive ductal breast carcinomas, we calculated the following features of nuclear atypia using a computer vision algorithm: anisonucleosis (variation in nuclear size), inhomogeneous chromatin density, and the average size of prominent nucleoli. Anisonucleosis was quantified as the percentage of nuclei larger than 47μm². Inhomogeneous chromatin was defined as the percentage of blue-saturated structures with 0.92-fold luminance or less than the average nuclear luminance. Prominent nucleoli were identified based on blue-saturated structures with 0.87-fold luminance or less, circularity greater than 0.65, and size greater than 1.15μm². Using these values of nuclear atypia features, the thresholds that were the most associated with grade and biomarkers were calculated using receiver operating characteristic curves by Youden index.Results The morphometric algorithm using these thresholds predicted nuclear grade (grade 1 and 3), Ki-67 index ≧ 20%, and hormone receptor negative status with sensitivities of 52.1 to 100% and specificities from 34.3 to 85.3%. Two multivariable logistic regression models combining these three thresholds predicted nuclear grade, Ki-67, and hormone receptor negative with much better accuracy, sensitivities ranging from 57.1 to 91.3%, specificities from 50.9 to 82.2%, and area under curve of 0.70-0.82. The algorithm was applied to an independent set of 42 tumors.Conclusion The present morphological algorithm of nuclear atypia might provide new insights into the computational grading of invasive breast cancer.

Adjuvant radiotherapy (RT) is standard for breast cancer, but its impact on skin cancer risk, especially in Asian populations, remains unclear despite advanced techniques. This study aimed to assess skin cancer incidence following RT in a large South Korean cohort. This retrospective cohort study, using South Korean Health Insurance Review and Assessment Service data (2009-2012), included 37,957 patients aged ≥20 with invasive breast cancer or ductal carcinoma in situ who underwent curative surgery. Prior malignancies or oncological treatment were excluded. Incidence of malignant melanoma and non-melanoma skin cancers were assessed. 1:1 propensity score matching was performed to balance confounders, resulting in 19,856 matched patients (9928 per group). Multivariable Cox proportional hazards models identified risk factors. Post-matching, skin cancer incidence was comparable between RT and non-RT (NRT) groups (0.97% vs. 1.02%; p = 0.720). RT showed no significant association with overall skin cancer (p = 0.604), malignant melanoma (p = 0.094) or non-melanoma skin cancer (p = 0.196). Increased risk was associated with older age, mole presence (HR 5.254), pre-malignant skin lesions (HR 12.905), and lymphedema (HR 1.978). Adjuvant RT did not increase skin cancer risk after breast cancer surgery. Dermatologic factors and lymphedema were principal predictors, emphasising vigilant follow-up in at-risk patients.

To present a case of tumor-to-tumor metastasis involving vestibular schwannoma and review previously reported cases, with focus on histopathologic and immunohistochemical characteristics. Case report of a 55-year-old female with a history of invasive ductal breast carcinoma who presented with unilateral hearing loss and gait disturbance. MRI demonstrated a right-sided extra-axial cerebellopontine angle lesion. Patient underwent surgical resection with histopathologic and immunohistochemical profiling of the tumor. A near-total resection was achieved. Microscopic analysis demonstrated vestibular schwannoma with nests of glandular elements. Immunohistochemical staining confirmed metastasis of her known invasive ductal carcinoma to vestibular schwannoma. Subsequent staging imaging showed advanced oncologic spread. Including the present case, there have been 11 reports of tumor-to-tumor metastasis involving vestibular schwannoma. The risk of tumor-to-tumor metastasis should be considered in patients with concomitant systemic malignancy and vestibular schwannoma. Cell-cell adhesion mechanisms may facilitate the spread of breast cancer to vestibular schwannoma. Further reports may help to better understand vestibular schwannoma by analyzing its interaction with other oncologic entities.

Invasive ductal carcinoma of the breast is known to typically metastasise to the lungs, liver, bone and brain, with subcutaneous soft tissue involvement being rare, with only eight cases reported internationally. We report the case of a woman with a history of left-sided invasive ductal carcinoma treated with a mastectomy and adjuvant therapy, who presented 7 years later with a 2.8 cm subcutaneous lesion over the contralateral shoulder. Histopathological examination and immunohistochemistry confirmed metastatic invasive ductal carcinoma, displaying a morphological and receptor profile congruent with her primary tumour. This case highlights the potential for late and atypical metastatic presentations of breast cancer and underlines the importance of maintaining diagnostic vigilance in long-term survivors.

68 Ga-NY104 is a novel tracer targeting carbonic anhydrase IX (CAIX) with promising diagnostic efficacy for clear cell renal cell cancer. We present a 55-year-old woman with a suspected left renal mass who underwent 68 Ga-NY104, showing no significant uptake in the renal mass but incidentally revealing an intense uptake nodule in the left breast. Subsequent 18 F-FDG PET/CT revealed mild renal mass and intense breast nodule uptake. Postoperative pathology confirmed the renal mass as benign angiomyolipoma and the breast nodule as invasive ductal carcinoma. This case highlights the inclusion of primary breast cancer in the differential diagnosis of extra-renal CAIX-avid lesions.

Performance of contrast-enhanced spectral mammography for sizing breast invasive ductal carcinoma with an in situ component.

Synchronizing activity of Biobran/MGN-3 with exosomes: Therapeutic targeting of hypoxia pathway to inhibit angiogenesis and proliferation of breast invasive ductal carcinoma

We present a woman in her 60s who underwent bilateral mastectomy with left axillary targeted lymph node biopsy in the setting of high grade invasive ductal carcinoma of the left breast with metastasis to a left axillary lymph node. Her postoperative course was complicated by high output milky drainage from her left axillary surgical drain, consistent with a chyle leak, after confirmatory testing demonstrated drain fluid with high triglyceride content. The patient failed non-operative management consisting of low-fat diet and compressive measures. Ultimately, the patient returned to the operating room where indocyanine green near-infrared fluorescence lymphography was used to localized damaged lymphatic channels, which were then ligated to resolve the leak. This report outlines a unique identification method of an unusual complication and serves to inform breast surgeons who may encounter this complication.

Invasive lobular and ductal breast cancers: a systematic review and metanalysis in association with BRCA1/2 mutation status.

Radiation-induced brachial plexopathy in a patient with ATM mutation following radiochemotherapy for grade 2 invasive ductal breast carcinoma

In this case report, we present a rare occurrence of wire migration to the pectoralis muscle in the axillary region. A 49-year-old woman with a biopsy-proven left breast invasive ductal carcinoma underwent wire localization prior to surgery; however, the procedure was delayed due to cardiac evaluation, during which the wire migrated. The wire was eventually found embedded in the pectoralis muscle and successfully removed under ultrasound guidance by an interventional radiologist. This case highlights the need for vigilance and preparedness for unexpected wire migrations during breast localization procedures. It underscores the importance of interdisciplinary collaboration between radiologists, surgeons, and interventional specialists to address such complications effectively. The successful wire removal procedure performed by the interventional radiologist demonstrates the value of utilizing advanced imaging techniques for precise localization and retrieval of migrated wires. By presenting this unique case, we contribute to the existing literature on wire localization and its potential complications.

Introduction: Poorly Differentiated Clusters (PDC) and Tumour Budding Count (TBC) have emerged as potential histological markers of tumour aggressiveness. While their prognostic significance is well-documented in colorectal carcinoma, their role in invasive breast carcinoma remains underexplored. Aim: To assess the frequency of PDCs in invasive breast carcinoma and to analyse their association with various clinicopathological factors, tumour budding and molecular profile. Materials and Methods: This cross-sectional study was done from January 2022 to December 2025 at the Department of Pathology, Adichunchanagiri Institute of Medical Sciences, Karnataka, India. Clinicopathological details were noted down and PDC and TBC were assessed and graded on routine Haematoxylin and Eosin (H&E) slides. Further Immunohistochemistry (IHC) was done for Oestrogen Receptor (ER), Progesterone Receptor (PR), Human Epidermal Growth Factor Receptor 2 (HER2), and Ki-67 for molecular classification of tumour. Statistical Package for the Social Sciences (SPSS) software version 25.0 was used to assess association between PDCs and TBC, clinicopathological features and molecular profile of tumour. Chi-square and multivariable logistic regression tests were done and p-value of <0.05 was considered significant. Results: The study included 44 cases of invasive ductal carcinoma breast, no special type. Age of the patients ranged between 34 and 75 years. Majority of cases were of grade 2 (27 cases; 61.36%) and T2 stage (28 cases; 63.64%). PDC showed an association with tumour grade and tumour budding with a p-value of <0.05 and 0.02, respectively. There was no association with lymph node metastasis, lymphovascular invasion and tumour size. Similarly, hormone receptor, HER2 and Ki-67 expression did not show any association (p-value>0.05). On multivariate analysis, only TBC grade 1 showed a statistically significant association with PDC (OR=0.052, 95% CI: 0.003- 0.864, p-value=0.039). Conclusion: PDC evaluation is a simple and cost-effective morphological indicator of tumour aggressiveness on routine H&E section. It may compliment the conventional prognostic factors and aids in improved risk stratification.

Introduction Malignant hypertension (MHT) is a severe form of untreated hypertension, characterised by systolic blood pressure over 200 mmHg and diastolic pressure over 120 mmHg. The MHT is associated with a poorer prognosis and more severe consequences than common arterial hypertension. It is harmful for the endothelium, causing microcirculation damage, which leads to multi-organ ischemic dysfunction, affecting many organs, i.e., the kidneys, the heart, the brain, and the retina. This condition may trigger or accompany atypical hemolytic uremic syndrome (aHUS). We present diagnostic difficulties and therapeutic approach in a patient with MHT unmasking aHUS due to a complement factor I variant. Case description A 44-year-old woman with no previous medical history was admitted to a local emergency room with general malaise, dyspnea and one-week lasting hematuria. Physical examination revealed blood pressure 280/150 mmHg, pale skin, and oedema affecting the lower limbs. Laboratory tests showed severe normocytic anaemia, thrombocytopenia, schistocytosis, reticulocytosis, and elevated lactate dehydrogenase activity. Kidney function was poor – serum creatinine concentration (sCr) was 5.9 mg/dl, urinalysis was abnormal, active sediment with massive erythrocyturia and subnephrotic range of proteinuria were present. The Coombs’ test was negative. Daily urine output was up to 3.5 l. Ultrasound ruled out urine obstruction, edematous renal parenchyma and renal artery stenosis. Brain computed tomography scan excluded intracranial bleeding. Echocardiography showed left ventricular hypertrophy. Hypertensive crisis was diagnosed, and antihypertensive treatment was administered with improvement. Due to suspicion of aHUS patient was referred to our hospital for consideration of anti-complement therapy (anti-C5). Kidney biopsy revealed acute ischemic glomerulopathy without thrombotic microangiopathy (TMA) but with fibroelastosis. In the meantime, sCr decreased, so anti-C5 therapy was omitted and the patient was discharged home. Within a few months, kidney function improved. Genetic testing confirmed a pathogenic variant in CFI, indicating aHUS as the cause of kidney injury. Three years later, the patient was diagnosed with left breast invasive ductal carcinoma of no specific type, which did not trigger aHUS recurrence. Conclusions The MHT is a well-known trigger of aHUS. This case highlights the importance of early hypertension diagnosis and management to prevent complications such as MHT that might lead to aHUS in genetically predisposed patients.

BACKGROUND: Accurate prognostic stratification of invasive ductal carcinoma (IDC) of breast is essential for personalized breast cancer treatment, but single-index DWI fails to capture the complex non-Gaussian diffusion of intratumoral water molecules. This study aims to evaluate the diagnostic efficacy of combining dynamic enhanced magnetic resonance imaging (DCE-MRI) features and quantitative parameters from six diffusion models in predicting prognostic factors of mass-type breast invasive ductal carcinoma (IDC). METHODS: 100 patients with mass-type IDC who underwent routine breast MRI and multi-b-value DWI examinations in our hospital were enrolled. All patients were confirmed pathologically and had immunohistochemical results for Ki-67 and tumor-infiltrating lymphocytes (TILs). Among them, 15 cases exhibited low Ki-67 expression, while 85 cases showed high Ki-67 expression; 54 cases were categorized in the low TILs group, and 46 cases were classified in the medium-high TILs group. Clinical features, routine MRI features, and parameters from six diffusion models, including continuous-time random walk (CTRW), fractional order calculus (FROC), stretched exponential model (SEM), intravoxel incoherent motion magnetic resonance imaging (IVIM), and diffusion kurtosis imaging (DKI), were recorded. Independent predictive factors were identified through multivariate regression analysis. Receiver operating characteristic (ROC) curves were constructed to evaluate and compare the diagnostic efficacy of both independent and combined parameters. The Delong test was used to compare the diagnostic efficacy of each model. RESULTS: Multivariate logistic regression analysis identified αCTRW as an independent predictor of Ki-67 and TILs levels, with AUCs of 0.732 and 0.649, respectively. Additionally, the combination of time signal curve (TIC) and αCTRW for predicting TILs levels yielded an AUC of 0.700. There was no statistically significant difference between the AUCs of αCTRW and the combined diagnostic model (αCTRW + TIC). CONCLUSION: CTRW-α is a promising non-invasive imaging biomarker for predicting Ki-67 and TILs levels in mass-type IDC. By capturing intratumoral water molecule diffusion heterogeneity, it supports accurate preoperative prognostic stratification and personalized treatment decision-making, highlighting the value of multi-exponential DWI models in breast cancer imaging. TRIAL REGISTRATION: Not applicable.

Does oncoplastic breast-conserving surgery provide superior esthetic and functional outcomes compared with conventional breast-conserving surgery? A retrospective matched-pair study from a high-volume tertiary center in Türkiye.

BackgroundLymphovascular invasion (LVI) is an adverse prognostic factor; preoperative prediction by imaging is difficult, but radiomics extracts quantitative tumor biology features. Investigating the value of combining magnetic resonance imaging (MRI)-based radiomics features with multiple machine learning (ML) models in predicting LVI status in invasive ductal carcinoma (IDC) of the breast.MethodsA retrospective cohort of 678 female patients with pathologically confirmed IDC of the breast was collected from June 2021 to June 2025. All patients underwent preoperative MRI. Based on postoperative pathology, patients were categorized into LVI-positive (n=258) and LVI-negative (n=420) groups. Using ITK-SNAP software, regions of interest (ROIs) were delineated in phase-3 dynamic contrast-enhanced MRI images to extract radiomics features. Feature selection and dimensionality reduction were performed using redundancy analysis and the least absolute shrinkage and selection operator (LASSO) regression. Data were randomly split into an 8:2 ratio for training (n=542) and testing (n=136) sets. Eight ML models were then constructed: logistic regression (LR), support vector machine (SVM), K-nearest neighbors (KNN), random forest, extreme random trees (ExtraTrees), extreme gradient boosting (XGBoost), light gradient boosting machine (LightGBM), and multi-layer perceptron (MLP). Univariate and multivariate LR analyses were performed to screen clinical and radiological features for establishing clinical models. Concurrently, a combined model integrating radiomics features with clinical characteristics was developed. The discriminatory power of each model was evaluated using the area under the curve (AUC). AUC values for the radiological model, clinical model, and combined model underwent statistical comparison via Delong’s test. Decision curve analysis (DCA) was employed to assess their clinical utility.ResultsA total of 1,197 radiomics features were extracted, and after dimensionality reduction, 23 features with the highest predictive value were selected. The clinical prediction model constructed based on multifactorial analysis results indicated that LVI positivity was more likely to occur in postmenopausal patients [odds ratio (OR) =1.690; 95% confidence interval (CI): 1.174–2.433], those with higher histological grade (OR =1.527; 95% CI: 1.107–2.107), sentinel lymph node metastasis (OR =0.198; 95% CI: 0.137–0.285), distinct molecular subtypes (OR =0.740; 95% CI: 0.567–0.965), and MRI maximum diameter ≥2 cm (OR =2.059; 95% CI: 1.362–3.113). Among radiomics models, the XGBoost model demonstrated optimal performance with a training set AUC of 0.912 and a validation set AUC of 0.706. The combined model exhibited the highest discriminatory ability in the training set (AUC =0.956) and a validation set AUC of 0.778. DCA indicated the combined model provided higher clinical net benefit.ConclusionsA combined model incorporating MRI radiomics features and clinical factors demonstrates predictive value for the presence or absence of LVI in IDC of the breast, serving as a reference for individualized treatment decisions.

Breast amyloidosis is a rare disorder that can mimic malignancy, particularly in patients with a history of breast cancer. We describe a 61-year-old woman with a history of left breast invasive ductal carcinoma who developed an enlarging mass at the mastectomy site eight years post-treatment. Imaging suggested recurrence; however, biopsies revealed Congo red-positive amyloid deposits with admixed necrosis, fibrosis, and inflammation, with no evidence of recurrent carcinoma or lymphoproliferative disease. Mass spectrometry identified only amyloid signature proteins, with no specific amyloid fibril protein or subtype detected, and in the absence of systemic involvement, supporting a diagnosis of localized degenerative amyloidosis possibly related to prior treatment. This not only represents a novel etiopathological category of post-treatment degenerative amyloidosis but also highlights the importance of Congo red staining and mass spectrometry in the evaluation of ambiguous post-treated lesions to prevent misdiagnosis and overtreatment.

The tumour microenvironment and systemic inflammatory environment are related to the diagnosis, treatment and prognosis of various tumours. This study aimed to evaluate the clinicopathological significance and prognostic value of the tumour microenvironment and systemic environment in patients with breast invasive ductal carcinoma (IDC). A total of 222 patients with breast IDC who underwent radical mastectomy were included. Stromal maturity and tumour-infiltrating lymphocytes (TILs), along with a series of systemic inflammatory cell indicators from venous blood, were evaluated. Chi-square tests were performed to explore the relationships between the parameters. Kaplan‒Meier analysis and Cox proportional hazards regression models were used for survival analysis. Stromal maturity was significantly correlated with tumour necrosis, lymphovascular invasion, axillary lymph node metastasis, and clinical stage (all P < 0.001). TILs were significantly associated with nuclear grade, histopathological grade, tumour necrosis, lymphovascular invasion, and clinical stage (all P < 0.001). High TIL numbers were often accompanied by more mature stroma. No significant correlations were detected between stromal maturity/TILs and systemic inflammatory markers. Multivariate Cox proportional hazards model analysis revealed that TILs, pathological grade, clinical stage, and molecular subtype were independent prognostic factors for patients with IDC. ROC curve analysis revealed that the accuracy of stromal maturity detection was greater than that of TILs alone, and the combined assessment of both parameters achieved the best predictive performance. Stromal maturity and TILs in patients with breast IDC have important clinicopathological and prognostic significance, providing clinical guidance and a theoretical basis for the precise diagnosis and prognostic evaluation of this disease.

Association of genetic variation in TLR4 and TLR9 genes with susceptibility to invasive ductal breast carcinoma.