Upper Outer Quadrant Of Breast Research Articles

Two-Stage Surgical Management of Accessory Breast Tissue With Pedicled Breast Tissue: A Case Report of Asymmetry Correction.

Accessory breast tissue is a relatively common variant of ectopic breast tissue. It defines a tissue that can be seen in conjunction with a nipple, areola, and underlying glandular tissues and can develop in addition to the normal breast tissue. While swelling may be accompanied by symptoms such as pain that worsens with the menstrual period, lactation, and limitation of shoulder joint movements, aesthetic concerns also constitute an important part of the surgical needs of patients. An 18-year-old patient without any known comorbidities attended because of a developmental disorder in her left breast that has existed since birth and an accessory breast tissue containing the nipple and areola in the upper-outer quadrant of the left breast. The surgical aim was to excise the patient's accessory breast tissue and ensure symmetry, and a two-stage surgical intervention was planned. In the first stage, the accessory breast tissue in the upper-outer quadrant of the breast was transposed preserving the 2nd and 3rd Internal Mammary Artery-based perforators by passing it through a subcutaneous tunnel and folding it in its ideal place. At second stage, the reduction mammoplasty surgery was performed on the right breast to ensure symmetry with the left breast, and resection was performed on the nipple in the middle lower quadrant of the left breast. At the end, acceptable symmetry and patient satisfaction were achieved.

Evaluation of Resection Margin by Intraoperative Frozen Section Biopsy in Breast Conservative Surgery for Early Breast Carcinoma

Background: Breast cancer is currently the second leading cause of cancer deaths in women. Early detection and accurate classification of suspicious masses as benign or malignant is important for arriving at an appropriate treatment plan. Aims: To evaluate the resection margin by intra-operative frozen section in breast conserving surgery for early breast carcinoma. Methods: This cross sectional study was carried out in the department of general surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. A total of 20 patients with early stage breast carcinoma underwent surgery were included in this study. Admitted patients with diagnosis of invasive ductal carcinoma of the breast, patient who gave consent for research purpose, patients diagnosed with stage I & II breast cancer, small (up to 4 cm) unifocal tumor and clinically negative axillary nodes were enrolled in this study. Statistical analyses of the results were obtained by using window based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: It was observed that more than one third (40.0%) patients belonged to age 41-50 years. The mean age was 45.55±10.94 years with ranged from 28 to 75 years. Half (50.0%) patient’s educational level was primary. Majority (85.0%) patient’s occupational statuses were housewife. Majority (90.0%) patients had lump size >2-≤5 cm. The mean lump size was 2.89±0.66 cm with ranged from 1.5 to 4 cm. Three fourth (75.0%) patients had lump in the right breast. Almost two third (60.0%) patients had lump in the upper outer quadrant of breast. Two (10.0%) patients had Grade I and 18(90.0%) had Grade II tumor. Three fourth (75.0%) patients had resected tumor of T2 >2-≤5 cm size. The mean size of resected toumour was 2.65±0.62 cm with ranged from 1.4 to 3.8 cm. The frequency of positive resection margin on frozen section was 3 (15%). Among them 1 (33.3%) patient had positive superior margin and 2 (66.7%) had positive lateral ....

Radiation-induced fibrosarcoma after breast-conserving therapy for breast cancer: a case report and literature review

BackgroundRadiation-induced sarcoma (RIS) has a 10-year incidence of 0.2–0.27% and a poor prognosis, although the radiation should need for breast-conserving surgery. In particular, radiation-induced fibrosarcoma has been rarer, and its incidence is 2.6–3.7% of RIS.Case presentationA 43-year-old woman with pT1N1M0 breast cancer underwent breast-conserving surgery, chemotherapy, radiation therapy 8 years ago, and continued hormonal therapy. She complained of a hard unprotruded mass palpated in her right upper outer quadrant of breast. Although we suspected local recurrence, core needle biopsy revealed atypical spindled tumor cells without mammary or epithelial markers. A diagnosis of fibrosarcoma was made via tumorectomy. She underwent additional enlarged surgery.ConclusionsWe report a rare case of fibrosarcoma in breast after breast-conserving surgery and radiation therapy. Fibrosarcoma after radiation therapy for breast cancer has been reported in 30 cases, including the present case. The dead and alive cases were not significantly different in terms of age, primary breast cancer, radiation dose, and following months. Patients with breast masses after radiation therapy should be suspected local recurrence and RIS.

Clinical Presentation and Management of Breast Lump in Sylhet M.A.G Osmani Medical College and Hospital- A Study of 100 Cases

A breast lump is a growth of tissue that develops within breast. A breast lump is often interchangeably described as a mass, swelling, thickness or fullness. The present cross sectional study was to find the clinical presentation and management of breast lump patient. The study was conducted in the Department of Sylhet MAG Osmani Medical College Hospital between July 2017 to December 2019. The patients who presenting with breast lump were study population and patient with male breast lump and breast abscess were excluded from the study. The mean ages at diagnosis, menarche and menopause were 39.1±15.6, 12.4±1.1, 41.9±10.5 years respectively. The average time lapsed between marriage and 1st child birth was 4.6±2.2 years. Out of 100 patient majorities (84%) patients were married, 8% had family history of breast cancer, 9% had history of taking oral contraceptives. All of the patients complained of swelling in the breast, thirty-four patients complained pain in the breast, twenty-four discharge from the nipple and seven patients complained fever. Half of the patients’ had location of swelling in upper outer quadrant of breast. The mean size of swelling was 4.0±1.5 cm and the lowest and highest size of swelling was 1 cm and 10 cm respectively. Fifty-four percent of patient had firm swelling, forty-one percent had hard and five percent had soft swelling. Two percent had fluctuation in the swelling. Four percent ulceration of breast, two percent peau-d-orange, six percent with fixity of skin and two percent fixity to the underlying structures. Regarding lymph node status twenty-two percent had axillary and four percent had supraclavicular lymphadenopathy. Regarding characteristics of nipple thirteen percent patient had tender nipple followed by eight percent had retracted, four percent had ulcerated and only two percent had protruded nipple. Nearly forty percent patients had blood stained discharge. Out of hundred patients four percent had a history of jaundice, ........

English

BACKGROUND Breast cancer is now the most common cancer in cities in India and 2 nd most common cancer in the rural areas. Fine needle aspiration cytology (FNAC) is a less invasive pre-operative diagnostic method and is preferred over core / excision biopsy to decide the benign or malignant nature of the breast lump. Prognostic factor assessment by FNAC would allow the identification of patients who would benefit from neo adjuvant treatment (patients with grade 3 tumours) and in whom conservation surgery is inadvisable.1 The purpose of this study is to compare the grades of breast cancer in FNAC with histopathology as gold standard and compare the oestrogen (ER) and progesterone (PR) hormonal expression pattern on immunocytochemistry (ICC) with immunohistochemistry (IHC). From this study we intend to assess the usefulness of cytological grading and ER, PR hormone receptor status pre-operatively so that hormonal therapy can be included with neoadjuvant chemotherapy. METHODS This is a cross sectional study with a sample size of 50, conducted in the Department of Pathology. RESULTS Out of 50 cases, maximum number of patients were in the age group of 51 - 60 years. 68 % had attained menopause; 69 % of patients had tumour size between 2 - 5 cm and 90 % of tumours were in the upper outer quadrant of breast. Considering hormonal expression, in case of ER there was a moderate agreement between ICC and IHC (κ = .428, P = 0.005) and no agreement was seen in case of PR (κ = .073, P = 0.625). Regarding the cytological grading, this study showed highest degree of concordance with grade II tumours with a sensitivity of 75.9 %. For Grade I it was 2.5 % and for grade III, it was 33.3 %. CONCLUSIONS Evaluation of hormonal status and nuclear grading is fairly reliable on cytology when performed on qualitatively superior FNAC material from the primary breast lesions. KEYWORDS Carcinoma Breast, FNAC, ER / PR, Immunocytochemistry, Immunohistochemistry, Cytological Nuclear Grading

A Prospective Study of the Inferio-Medial pedicle technique As an Oncoplastic Procedure for Upper and lateral Quadrants Breast Masses; Oncological Safety and Clinical Outcomes

Abstract Background the goal of modern breast surgery is to cure patients with preservation of breast tissue as much as possible with satisfactory physical and psychological outcome. This goal has led to introduction of a new scope of surgery into our clinical practice called oncoplastic breast surgery, with the advantage of combining oncological safety and satisfactory cosmetic outcome. Objective it was to focus on the infero-medial pedicle technique as an oncoplastic procedure for management of breast cancer and to assess the technique clinically regarding oncological safety, surgical outcomes and patient satisfaction. Patients and Methods a prospective analytical study included 15 patients, which was conducted at Ain-Shams University Hospitals. An approval of the Ethical Committee and written informed consent from all participants were obtained. Septum based infero-medial pedicle technique was proposed for patients in whom oncoplastic surgery were possible on oncologic grounds for upper outer quadrant of breast. Results the mean age of our study was 39 years, 50% of the cases fall between 38 to 57 years. In our study only 3 cases (33%) have had complications, 2 cases got wound infection; they were diabetics reflecting the immune compromisation with diabetes mellitus. We reported lower results of surgical site infection (15%). The operative duration of our study was long at first (240 minutes) but with progression of our study and as we build up more experience the operating time was reduced to (120 minutes). Conclusion the choice of the oncoplastic technique is mainly based upon the location of the tumor, size of the breast and distance of the tumor from the nipple areola complex.

Clinicopathological Characteristics of Breast Carcinoma in Premenopausal Women

Background: Breast cancer is one of the leading causes of mortality world-wide. The objective of this study was to see the pattern and characteristics of carcinoma breast in premenopausal women reporting at a tertiary care hospital.Material and Methods: This cross-sectional study was conducted at surgical unit of Pakistan Institute of Medical Sciences (PIMS), Islamabad from May 2012 to April 2015. A total of 144 female patients were admitted during this period as diagnosed cases of carcinoma breast. Of these patients, all cases of breast carcinoma diagnosed in premenopausal women were selected and assessed for tumor type, TNM classification and involved breast quadrants.Results: Out of 144 patients 70 (48.6%) cases of carcinoma breast were reported in premenopausal women. The ages ranged from 14 to 48 years with a mean age of 33 ± 7.95 years. According to TNM classification, 2.9% patients were in T1, 25.7% were in T2, 32.9% were in T3 and 38.6% were in T4. Similarly, 37.1% patients presented with a nodal status of N0, 38.1% with N1, 21.4% with N2 and 2.9% with N3. Out of 70 patients, 11 (15.7%) presented with distant metastasis (M1) at the time of diagnosis. The upper outer quadrant of breast (32.9%) was most commonly involved site, followed by upper inner, lower outer and lower inner quadrants, respectively. Most common tumor type was invasive ductal carcinoma (85.7%), followed by invasive lobular carcinoma (7.1%), papillary carcinoma (4.3%), medullary carcinoma (1.4%) and malignant phylloides (1.4%). Regarding exposure to risk factors of breast cancer in these patients, 35.7% women did not breast feed and 27.1% were nulliparous. There was no history of use of oral contraceptive pills in 82.8% and positive family history was reported in 27.1% patients.Conclusions: Late presentation with advanced disease in premenopausal women is more common in our part of the world as compared to international literature. More studies on larger sample sizes should be carried out to validate these findings.

PCN180 EPIDEMIOLOGY OF BREAST CANCER IN KAZAKHSTAN IN 2014-2018.

Breast cancer (BC) is the most prevalent oncological disease in Kazakhstan. This study aims to determine epidemiological statistics of breast cancer(BC) and analyse trends and variations of incidence rates by age and region. National BC Registry data for 2014-2018 was analysed using STATA(version 15.1; StataCorp, USA). Differences in the age profile of regions have been adjusted through age-standardising the incidence rates by direct method weighted based on WHO world standard population estimates, therefore, any differences in incidence rates between areas do not reflect differences in the age of the female population. The most common topographical types of BC diagnosed in 2014-2018 were C50.4 Upper-outer quadrant of breast(35.6%) and C50.1 Central portion of breast(14.5%). Whereas the most common morphological types of BC were infiltrating duct carcinoma NOS(39.6%) and malignant neoplasm(10.54%). Age-standardised incidence rate remained stable in 2016-2017 at around 43.12 per 100 000 female population. Rates vary from 29.8 (Atyrau region) to 79.74 (Astana city) per 100 000 female population. According to the 2017 data, the age-specific incidence rates grow steadily with age, peaking among women in the age group of 70-74. The number of cases were highest among women in their 40s(19%), 50s(33%), and 60s(25%), accounting for 77% of total BC diagnoses in 2017. Whereas in 2016, the age-specific incidence rates peaked twice: in the 50-54 and 65-69 age groups. The highest number of cases were among women in their 40s(18%), 50s(36,5%), and 60s(24,5%), accounting for 79% of all newly diagnosed BC cases in 2016. This BC registry analysis provides comprehensive estimates of age-standardised incidence rates and other epidemiological statistics for Kazakhstani population that lay a foundation for future research in Central Asia.

Abstract 1215: Epidemiology of breast malignancies in sub-Saharan Africa: A ten-year retrospective evaluation of 2,419 patients at a major tertiary institution in Southwestern Nigeria

Abstract Background: There is limited information on the epidemiology and clinical presentation of breast cancer in Sub-Saharan Africa. This analysis evaluated the prevalence, characteristics of the disease over a ten-year period, as well as the impact of sociodemographic factors on late breast cancer presentation in Lagos State University Teaching Hospital (LASUTH) Lagos, a major tertiary institution in Nigeria, the most populous country in Africa. Objectives: The aim of this study is to determine the epidemiological variants of all breast cancer cases at LASUTH, 2007- 2017. Materials and Methods: There was no restriction on gender or age groups. Late presentation was defined by symptomatic presentation. Tumors were characterized by histological subtypes. Mean, frequencies and percentages were performed using STATA/IC 12.1 for Windows. Results: A total of 2419 breast cancer patients were seen during the ten-year period. There were more female malignancies (n=2380, 98.4%) compared to male malignancies (n=39, 1.6%). The prevalence of breast cancer was found to be 37.5%. The overall mean age (years) was 47.27, the age range was 19 to 91 years. Increased risk of late presentation (n=1910, 79%). Overall higher presentation were made from christians (n= 1849, 76.4%), married individuals (n=2089, 86.4%), people in unskilled professions such as traders (n=808, 33.4%) and people with a tertiary level of education (n= 239, 12.8%). As the primary level of treatment, most of the patients had mastectomy (n=1533, 63.4%), chemotherapy (n=600, 24.8%) and radiotherapy (n=51, 2.1%). The topography of all reported cases include upper-outer quadrant of breast (n=433, 17.9%), axillary tail of breast (n=381, 15.8%), overlying lesion of breast (n=144, 11.5%), lower-inner quadrant of breast (n=133, 5.5%), upper-inner quadrant of breast (n=92, 3.8%), nipple (n=77, 3.2%), lower-outer quadrant of breast (n= 75, 3.1%) and the central portion of breast (n= 42, 1.7%). The three most common morphologies were Pleomorphic carcinoma (n=717, 29.6%), Infiltrating duct carcinoma (n=630, 26%) and giant cell type of the malignant tumor (322, 13.3%). Conclusion: Our study shows that breast cancers usually present mostly in young women in Nigeria, and shows the influence of culture on late presentation. Therefore we should institute deliberate public health education and counseling in our social institutions such as religious circles that are designed particularly to favour the peculiar demographics of the population to prevent late presentation. In addition, cross-sectional studies of breast cancer tumors in younger women (before the age of 40) should be explored to better understand the disease and further understanding too of breast cancers in African American women. Citation Format: Funlayo O. Buraimoh, Abiodun O. Popoola. Epidemiology of breast malignancies in sub-Saharan Africa: A ten-year retrospective evaluation of 2,419 patients at a major tertiary institution in Southwestern Nigeria [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 1215.

36 cases adenoid cystic carcinoma of the breast in China: Comparison with matched grade one invasive ductal carcinoma-not otherwise specified

ObjectiveThe aim of this study was to investigate the clinicopathological characteristic of adenoid cystic carcinoma (ACC). Materials and methodsThe clininopathological features, along with relapse free survival(RFS) and overall survival(OS) of 36 patients with ACC were retrospectively investigated and compared with those of 108 grade 1 invasive ductal carcinoma not-otherwise-specified (G1-IDC-NOS) patients. ResultsMost cases of ACC were ER, PR and HER-2 negative which was classified as triple-negative subtype. Five cases were concomitant with other pathological types of cancer. Axillary lymph node dissection(ALND) was performed in 31 patients and 2 of them with lymph nodes metastasis. Two patients died of lung metastases at 46 and 116 months after the surgery respectively. Compared with G1-IDC-NOS, ACC showed lower Ki-67 index, less lymph nodes metastasis, lower P53 expression, and higher proportion in location of upper outer quadrant of breast. There was no difference of OS and RFS between ACC and G1-IDC-NOS. ConclusionsACC of the breast was a rare disease with a good prognosis although most of them were classified as triple-negative subtype. And the value of axillary node dissection and adjuvant therapy needs to be further investigated.

Evaluation of Clinico-Pathological Study of Breast Cancer in Rural Population

Background and Objectives : Breast cancer is the second most common cancer in the Indian female population . As per our hospital data, breast cancer is also to be the second leading malignancy in women. Hence, we undertook this study to evaluate the clinical profile and histological types of breast cancer in our patients. Majority of our patients are from rural areas. Materials and Methods: The study was undertaken for a period of four years from January 2012 to December 2015 comprising of one hundred female patients who were treated in the department of Surgery at Agartala Government Medical College & G B P Hospital, Agartala . Diagnosis were made by a combination of clinical assessment , radiological imaging and tissue biopsy the so- called triple assessment . Results: The commonest presentation of cancer of breast was breast lump . The commonest age group of breast cancer ranged from 41 years to 60 years . The most common site of tumor was the upper outer quadrant of breast and infiltrating ductal carcinoma (IDC) was the most common histologic type of breast cancer in our society . Conclusion: The incidence of breast cancer in India is increasing and basic education and awareness of the women's health , self breast examination, and clinical breast examination may help increasing awareness and help to identify breast cancer at early stage in developing countries.

Clinical presentation, imaging, pathological profile and management of benign breast conditions based on aberrations of normal development and involution classification: A prospective cohort study

Aim: To map the spectrum of benign breast disorders in patients with reference to ANDI, attempt a clinicopathological and imaging correlation, and evaluate the impact of this concept on the choice of treatments and their outcome. Material and Methods: This prospective study was carried out in the Department of Surgery at tertiary care hospital in central India. A total of 176 consecutive female patients who have attended menarche and presenting with benign breast conditions classified under ANDI classificationattending the surgery department From November 2012 to November 2014 for benign breast conditions were enrolled in the study. Patient parameters were recorded on a predesigned case record form. After clinical assessment, imaging and pathologic evaluation was done as indicated. Results: The mean age of presentation was 26.708.86 years. Most of patients presented with a commonest complaint of lump in the breast (89.2%). History of painless lump & lumpiness/nodularity was found in 99 cases. The maximum number of patients i.e. 114 (64.8%) presented within first 12 months of appearance of lump. Right breast was commonly involved i.e. in 72cases (40.90%).Mastalgia was not a predominant symptom in patients with benign breast conditions. Consistency in majority of cases was firm i.e. in 162 (92%) cases. Maximum number of breast lumps was located in the upper outer quadrant of breast i.e. 60(34.1%). Nodularity was not seen in 78% cases. Maximum no. of cases had discrete lump on presentation i.e.72%. There was no tenderness in 74% cases. 68% of patient had fibroadenoma. Most common age group was 21-30 yrs. Right upper quadrant was most commonly involved. Out of 121 cases, 84 underwent surgery, 29 conservative treatment & 8 both conservative with surgery. 57(32.38%) patients were diagnosed with mastalgia with or without nodularity. Diagnostic accuracy of Sono mammography in detection of fibroadenoma is 98.68. Diagnostic accuracy of FNAC and Histopathology in detection of fibrocystic changes is 98.8. Out of total 176 cases, 94 underwent surgery, 73 conservative treatment and 9 underwent conservative with surgery. Conclusion: The ANDI classification, a comprehensive system, can resolve most of the issues that face a clinician when dealing with benign breast diseases.