UNASSIGNED: Breast conserving surgery (BCS) followed by radiotherapy (BCT) and modified radical mastectomy (MRM) are the most common surgical techniques utilized in treatment of early breast cancer (EBC) with similar overall survival and recurrence rates. Western literature suggests that these treatments impact the quality of life (QOL) of patients variably. There are no comparison studies on these treatments as per patient\'s QOL in East Africa. The objectives were to compare the QOL of patients with EBC at least one year after BCT or MRM and assess the factors that affect this QOL.
UNASSIGNED: this was a cross-sectional study conducted at Aga Khan University Hospital-Nairobi (AKUHN). Eligible female patients with EBC who had undergone either BCT or MRM between January 2013 and December 2018 were invited to fill out European Organization for the Treatment and Research of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Data on participant demographics and clinical information was also obtained. Average scores for each aspect of QOL were obtained and overall means for each surgical treatment were compared. Linear regression was done to assess the factors that affected this QOL.
UNASSIGNED: forty-two patients had BCS/BCT and 39 had MRM. Patients who had undergone BCS/BCT had a better overall QOL than those who had undergone MRM (p=0.0149). Multivariate analysis revealed that five years from time of surgery, level of education and diabetes mellitus significantly (p<0.05) affected the QOL of these patients.
UNASSIGNED: after one year from surgery for EBC, patients who had undergone BCS/BCT had a better QOL as compared to MRM.

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BACKGROUND: Secretory breast carcinoma is an uncommon subset of breast cancer that usually has a favorable outcome. Although initially described in children, it also occurs in adults where it may metastasize, possibly resulting in death. To date, only 20 cases of secretory breast carcinoma with distant metastases have been described.
METHODS: A 42-year-old female presented with liver metastasis after modified radical mastectomy of the left breast in 2008 at 34 years of age. The liver metastasis was morphologically similar to the primary tumor. Pan-TRK and Fluorescence in situ hybridization showed a rearrangement in the ETV6 gene. She subsequently underwent adjuvant chemotherapy with a fatal outcome.
CONCLUSIONS: Although secretory breast carcinoma is usually associated with favorable outcomes, our study and reviews provide a novel insight into the genetic spectrum and treatment of secretory breast carcinoma showing reduced expression of hormone receptors, abnormal genomic profiles, and possible poor prognosis. Targeted therapy may curb clinically aggressive cases. Additional molecular investigations are needed to determine the links between specific mutations and poor prognosis.

BACKGROUND: Locoregional recurrence of breast cancer is a challenging issue for clinicians. Treatment options for unresectable recurrent estrogen receptor positive (ER+) breast cancer in previously irradiated area are limited. Some studies showed concomitant fulvestrant with radiation therapy might increase radiosensitivity compared with radiation alone in vitro, no in vivo reports yet.
UNASSIGNED: Here, we present a case report and make a narrative review of concomitant fulvestrant with radiation therapy for unresectable locoregional recurrent ER+ breast cancer. The patient was treated with modified radical mastectomy in 2015, adjuvant chemotherapy, radiotherapy, followed by exemestane until November 2018, relapsed in internal mammary lymph nodes with sternum involved.
METHODS: The final diagnosis was breast cancer internal mammary lymph nodes metastasis with sternum involved.
METHODS: After diagnosis was made, concurrent fulvestrant with reirradiation as a palliative treatment were proposed under multiple disciplinary team.
RESULTS: There was a good clinical response, enabling curative chance with radiation therapy to a total dose of 60 Gy. Computed tomography scan revealed no evidence of residual tumor.
CONCLUSIONS: As far as we know, this is the first report concerning concomitant fulvestrant with reirradiation for unresectable locoregional recurrent ER+ breast cancer. Since no severe adverse events were observed, this strategy could be a suitable \"loco-regional rescue therapy\" to further reduce tumor progression or even reach a curative effect. Studies of this treatment strategy in randomized clinical trials are warranted to further assess its safety and effectiveness.

Male breast cancer (MBC) is uncommon in clinical practice. Using the 21-gene assay to facilitate decision-making on comprehensive treatment of MBC is rarely reported. This study reports the case of a 53-year-old man with left breast cancer. Modified radical mastectomy was performed. Endocrine treatment was chosen for the patient according to the result of the 21-gene assay, a recommended genomic test of breast cancer. The patient remained in good health without evidence of recurrence at 18-month follow-up. This case provides a reference mode for the comprehensive management of early-stage, estrogen receptor-expressing and lymph node-negative MBC patients.

BACKGROUND: Traumatic neuroma is a reparative proliferative response of the nerve after trauma or surgery, which rarely occurs in the breast. However, it must be distinguished from tumor recurrence.
METHODS: A 78-year-old woman underwent left-sided modified radical mastectomy for invasive carcinoma, 7 years before this case. Two painless nodules near the mastectomy scar were discovered in regular follow-up physical examination. A 62-year-old woman had received right-sided modified radical mastectomy for intraductal carcinoma, 4 years before this case. An asymptomatic nodule near the mastectomy scar was detected during follow-up ultrasound (US) examination.
METHODS: The lesions in both patients were diagnosed as traumatic neuroma.
METHODS: The first patient underwent excisional biopsy. The second patient underwent US guided core-needle aspiration, followed by conservative therapy.
RESULTS: Neither patient complained of any discomfort, nor both exhibited normal physical and US findings during follow-up examinations.
CONCLUSIONS: Newly discovered nodules with the benign imaging features near the mastectomy site of a patient, especially with the tail sign, traumatic neuromas should be taken into consideration. Routine US examination is important for follow-up of breast cancer patients who have undergone mastectomy.

BACKGROUND: Harmonic scalpel is considered as a promising surgical tool for breast cancer, while its advantage over conventional approach is still controversial. Therefore, we performed this meta-analysis to compare the outcomes of harmonic scalpel and conventional tools in the surgery for breast cancer.
METHODS: Studies reporting the outcomes of harmonic scalpel and conventional technologies were systematically searched from online databases, PubMed and EMBASE up to April 30, 2018. Data were presented as odds ratio, risk ratio (RR), and mean difference (MD) with 95% confidence interval (CI).
RESULTS: Intraoperative blood loss (I2 = 96%, P < 0.05, MD = -68.78, 95% CI -93.31 to -44.24), seroma (I2 = 3%, P = 0.41, RR = 0.63, 95% CI 0.46-0.86) and hematoma formation (I2 = 0%, P = 0.64, RR = 0.41, 95% CI 0.23-0.73), drainage volume (I2 = 89%, P < 0.05, MD = -105.33, 95% CI -161.33 to -49.33) and time (I2 = 93%, P < 0.05, MD = -2.18, 95% CI -3.75 to -0.61), necrosis (I2 = 35%, P = 0.20, RR = 0.37, 95% CI 0.16-0.86), surgical duration (I2 = 79%, P < 0.05, MD = -8.49, 95% CI -16.56 to -0.43), and hospital stay (I2 = 97%, P < 0.05, MD = -0.94, 95% CI -1.74 to -0.14) are significantly different between the two groups.
CONCLUSIONS: Harmonic scalpel is superior to conventional tools in terms of decreasing intraoperative blood loss, seroma and hematoma formation, drainage volume and time, necrosis prevalence, surgical duration, and hospital stay, which should be strongly recommended in the surgery for breast cancer.

BACKGROUND: Mucoepidermoid carcinoma (MEC) of the breast is a rare entity comprising specific morphological and immunohistochemical features, and has been previously only reported in 33 cases.
METHODS: Four cases of MEC of the breast are reported in this study. All patients were women with ages ranging from 39 to 66 years. The lesions consisted of neoplastic solid nests and cystic spaces sometimes filled with mucoid material.
METHODS: At high power, the tumors were composed of various proportions of basaloid, intermediate, epidermoid, and mucinous cells in different cases. All cases were classified as low-grade MEC of the breast. Tumor cells exhibited low levels of hormonal receptor expression in two cases (cases 1 and 3), and immunonegativity in one case (case 2). On the contrary, estrogen receptors (ER) were positively expressed in 60% of tumor cells in case 4. Tumor cells did not express human epidermal growth factor receptor 2 (HER-2)/neu protein in all the cases.
METHODS: Modified radical mastectomy (Auchincloss) was performed in the first two cases, while the remaining two patients underwent mastectomy plus sentinel lymph node biopsy.
RESULTS: All patients were alive and well without evidence of recurrent disease after a period ranging from 4 months to 156 months.
CONCLUSIONS: MEC of the breast is a rare primary carcinoma that is difficult to diagnose. Multiple tissue blocks are necessary before obtaining all cell types. Special stains for mucin and electron microscopy would be helpful in suspected cases. Hormonal factors might have an impact on the biological behavior of tumors, but further studies are needed to draw conclusions.

Matrix-producing carcinoma (MPC) of the breast is an extremely rare variant of metaplastic breast carcinoma that contains a mixture of epithelial and mesenchymal elements. As overt carcinoma with direct transition to a cartilaginous and/or osseous stromal matrix cells, MPC is of no spindle cells between those two elements. This is the case of a 43 year-old female patient with MPC which coexisted with microglandular adenosis (MGA), atypical MGA (AMGA) and carcinoma in situ arising in MGA (MGACA in situ). MGA is a rare, infiltrative, benign lesion of the breast with an indolent clinical course. Histological evidence of carcinoma arising from MGA has previously been documented. MPC arising in MGA is an extremely rare subtype of breast carcinoma and has been seldom detailed described in the previous studies. This report highlights one such case with cytomorphological and histopathological correlation, along with a review of pertinent literature and differential diagnosis.

BACKGROUND: Nipple-sparing mastectomy (NSM) is an increasingly common procedure; however, concerns exist regarding its oncological safety due to the potential for residual breast tissue to harbor occult malignancy or future cancer.
METHODS: A systematic literature review was performed. Studies with internal comparison arms evaluating therapeutic NSM versus skin-sparing mastectomy (SSM) and/or modified radical mastectomy (MRM) were included in a meta-analysis of overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Studies lacking comparison arms were only included in the systematic review to evaluate mean OS, DFS, LR, and nipple-areolar recurrence (NAR).
RESULTS: The search yielded 851 articles. Twenty studies with 5594 patients met selection criteria. The meta-analysis included eight studies with comparison arms. Seven studies that compared OS found a 3.4% risk difference between NSM and MRM/SSM, five studies that compared DFS found a 9.6% risk difference between NSM and MRM/SSM, and eight studies that compared LR found a 0.4% risk difference between NSM and MRM/SSM. Risk differences for all outcomes were not statistically significant. The systematic review included all 20 studies and evaluated OS, DFS, LR, and NAR. Studies with follow-up intervals of <3 years, 3-5 years, and >5 years had mean OS of 97.2, 97.9, and 86.8%; DFS of 93.1, 92.3, and 76.1%; LR of 5.4, 1.4, and 11.4%; and NAR of 2.1, 1.0, and 3.4%, respectively.
CONCLUSIONS: This study did not detect adverse oncologic outcomes of NSM in carefully selected women with early-stage breast cancer. Use of prospective data registries, notably the Nipple-Sparing Mastectomy Registry, will add clarity to this important clinical question.