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Background: Differences in genetics and receptor expression (phenotypes) of invasive ductal breast cancer (IDC) impact on prognosis and treatment response. Immunohistochemistry (IHC), the most used technique for IDC phenotyping, has some limitations including its invasiveness. We explored the possibility of contrast-enhanced positron emission tomography magnetic resonance (CE-FDG PET/MR) to discriminate IDC phenotypes., Methods: 21 IDC patients with IHC assessment of oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor-2 (HER2), and antigen Ki-67 (Ki67) underwent CE-FDG PET/MR. Magnetic resonance-perfusion biomarkers, apparent diffusion coefficient (ADC), and standard uptake value (SUV) were compared with IHC markers and phenotypes, using a Student's t-test and one-way ANOVA., Results: ER/PR- tumours demonstrated higher Kep mean and SUV max than ER or PR+ tumours. HER2- tumours displayed higher ADC mean , Kep mean , and SUV max than HER2+tumours. Only ADC mean discriminated Ki67⩽14% tumours (lower ADC mean ) from Ki67>14% tumours. PET/MR biomarkers correlated with IHC phenotype in 13 out of 21 patients (62%; P=0.001)., Conclusions: Positron emission tomography magnetic resonance might non-invasively help discriminate IDC phenotypes, helping to optimise individual therapy options.

Thyroid microcarcinoma (TMC) it's a rare type of differentiated thyroid cancer, which according to the World Health Organization measures 10 mm or less. Accounting 7-16 % of all thyroid carcinomas, it occurs at any age, more frequently in men, with a female to male ratio of 1:3. More frequently histotype is the papillary subset, PTCM. Aim of this study is to retrospectively evaluate the patients diagnosed with TMC in terms of their clinical and histopathological features. In our institution we collected 23 cases of TMC sampled on 338 plongeant being operated. All the tumors, in our study, were found incidentally during the treatment of benign thyroid diseases. All the sample were analyzed and prepared using the same frozen section technique. Surgical pathology identified 11 papillary microcarcinomas, 10 follicular microcarinomas, 1 oncocytary microcarcinomas and in 1 patient was found only a focal tireocitary transformation. TMC's prognosis and treatment is still a subject of controversy We propose our approch consisting in total thyroidectomy (less than 5 gr residual thyroid tissue), being considered the low rate of post-operative complications, and recurrences: all patients are disease-free at the median follow-up of 78 months (range 96 to 30 months). We have considered either the less malignancy habit of this neoplasia either its well prognosis.

Introduction: A part of the literature supports the undoubtful advantage of neoadjuvant chemotherapy on the overall survival and for the possibility of surgical conservative treatment in locally advanced tumours after downstaging. Other authors report that primitive tumour's surgical removal at first, improves survival in cases with locally advanced /metastatic disease. The advantages were improvement of patient's health status, removal of a reservoir of neoplastic cell neoangiogenic cytokines and growth factors,and cytoreduction., Materials and Methods: Aim of this study is to evaluate the effectiveness on the survival of a primary surgical treatment of the locally advanced tumours comparing two homogeneous groups. In the first group (GROUP 1) 40 patients were enrolled with stage III A, III B,IV tumours and were treated with primary surgery. The second group (GROUP 2) was made up of 40 patients with similar stage treated with neoadjuvant chemotherapy. The surgical treatment had the intention to remove the entire primary tumour., Results: After a median follow up of 48,2 months,22,5 % of GROUP 1 died and 30 % of GROUP 2. The average survival of patients in GROUP 1 was 27,1 months while in GROUP 2 there was an average survival of 16,8 months., Conclusion: In conclusion surgical treatment plays a key role in the treatment of advanced/metastatic disease and is an independent factor associated with survival.

Introduction: Factor VII deficiency is a rare cause of haemorrhagic syndrome. The Authors describe a case of a 46 years old patient with congenital factor VII deficiency that successfully underwent breast surgery after treatment with Novoseven® before the procedure., Materials and Methods: The AA used the schedule reported below to value the levels of PT and aPTT in the patient. Blood Collection: Venous blood from patient and control was collected in glass tubes for routine serum preparation and into plastic tubes (0.129 M sodium citrate, Becton-Dickinson Vacutainer Systems) in a ratio of blood to anticoagulant of 9:1. Platelet Poor Plasma (PPP) was obtained by centrifugation at 4.000 x g for 15 minutes at room temperature. The plasma was recentrifuged for another 10 min at 12000 g to fully eliminate platelet concentration. A normal control plasma pool was prepared by mixing equal volumes of platelet-free plasma obtained from at least 50 normal volunteers. Prothrombin time (PT) was measured with Recombiplastin (IL, Milano Italy). Activated partial thromboplastin times (APTT) was measured with APTT-SP (IL, Milano Italy). They were performed on the coagulation analyzer ACL 1000 (IL, Milano Italy)., Results: The results were interpreted from the ratio of the patient times to the normal control times (Table I)., Conclusion: The infusion of Novoseven solved the clotting problems enabling the surgical procedure, without risks for the patient.

We reported a case of a breast cancer's skin metastases in a patient that had sustained 3 lines of chemotherapy. At first she received surgical treatment with Madden's mastectomy with dissection of axillary limphnodes and positioning of an expander. After that she underwent to chemo- and radiotherapy. The schedules we performed were: FEC, TC,Vinorelbine and Capecitabine. Only after the FEC there was a clinical remission just for 1 year. After that she underwent to surgery for the removal of a lozenge of skin on the right hemithorax, including also the subcutaneous tissue, a strip of muscular tissue, and a residue of the breast implant. The histology showed a multiple-nodules infiltration involving the dermis, the hypodermis, and the muscle. This pattern was valuated as a G3 breast cancer recurrence with ER 70%, PgR<5%, Ki67 50% Her2neu-. During the second line chemotherapy with TC she developed an high grade LCIS with lymphovascular infiltration on the left breast; on the right hemithorax there were cutaneous metastases with dermis' infiltration. Surgery with local excision was performed, and a cutaneous flap was realized.

Benign lymphoreticulosis (cat scratch disease, CSD) may have a clinical course that varies from the most common lymphadenitis localized in the site of inoculation, preceded by the typical "primary lesion," to a context of severe systemic involvement. Among these uncommon clinical aspects, there is mammarian granulomatous lymphadenitis which may appear as a mastitis or a solitary intraparenchymal mass, giving the impression of a breast tumor. In these cases, intensive clinical, instrumental, and laboratory investigations are necessary to exclude malignancy. Because of its rarity, in equivocal cases, it is reasonable to use surgical excision for accurate histological examination. We report a case of CSD of the breast in a 59-year-old woman, analyzing the clinical, histopathological, and instrumental appearance and also performing a literature review.

Sentinel node is defined as the first lymphnode receiving limphatic drain from the breast. Several studies show a very low recurrence rate to axillary and locoregional nodes in sentinel node negative patients who did not undergo axillary dissection. Our study aims to verify if complete axillary dissection could be replaced by sentinel node biopsy (SNB) in the staging and treatment of breast cancer. From January 2005 to December 2008, 377 patients (mean age 57.63) underwent SNB in the General Surgery unit of "San Giuseppe Moscati" Hospital in Avellino (Italy). All the patients underwent SNB with local anesthesia. Histologic studies were performed using GIVOM protocol (Veneto Breast cancer interdisciplinary group). Sixty five patients (17.2%) underwent a radical mastectomy with SNB and 312 (82.6%) patients underwent a quadrantectomy with SNB. Of this last group, 178 (47.2%) underwent a superior quadrant excision with SNB, 77 (20.4%) an inferior quadrant excision with SNB and 57 (15.1%) a central quadrant excision with SNB. Ductal carcinoma represented 57.3% of the tumous detected, lobular carcinoma was diagnosed in 16.4% of the cases, intraductal microinvasive carcinoma in 10.3%, ductal carcinoma in situ in 5.8% while the other histotypes were diagnosed in 10% of the tumours. All SNB+ patients (34.5%) underwent a radical axillary dissection in general anesthesia. Sixty nine (53%) patients were diagnosed with axillary node metastasis, after axillary dissection Micrometastasis resulted in 19.6% of the excised patients. The prevalence of axillary node metastasis was 26.4% (581/2198), while the incidence was 34.5% (130/377). The first axillary lymphnodes level was metastasized in 65.8% patients who had undergone an axillary dissection, level I and II in 268% and all the levels in 7.4%. Only one case (0.4%) of nodal metastatic recurrence has been diagnosed in patients who had undergone SNB alone, after a mean follow-up of 28.5 month. Apart from showing a very high diagnostic and staging accuracy, the high level of SN detection associated with a high predictive rate underline a lower complications rate if compared to complete nodal dissection.