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Rationale: The risk of women developing a breast cancer (BC) after receiving chest radiotherapy for paediatric cancers and Hodgkin lymphomas is well established. The aim of this study was to assess these patients' clinical characteristics and clinical outcomes., Methods: The study concerns women with a history of primary neoplasms treated with chest irradiation ± chemotherapy and subsequently diagnosed with BC., Results: We identified 78 women who developed BC (invasive in 68 cases, 87%). They were a median 18 and 38 years of age when their first neoplasm and BC were diagnosed, respectively. Breast-conserving surgery was performed in 39 patients, and 32 underwent breast irradiation. Twenty of the 41 patients (49%) treated with chemotherapy received an anthracycline-containing regimen. The 5- and 11-year event free survival (EFS) and overall survival (OS) rates were 69% and 42%, respectively. Nine patients (12%) developed a third cancer and 18 (23%) a cardiovascular event. Of the 68 women with invasive BC, the first event involved contralateral BC in 55% of cases: time to progression (TTP) rates were 70% and 47% at 5 and 11 years. The 5- and 11-year BC-specific survival rates (BCSS) were 84% and 68%, respectively., Conclusions: Judging from our experience, survival rates after BC developing in women previously given chest radiotherapy are not dissimilar to those observed in other women with primary BC. Given the far from negligible risk of subsequent cancers and cardiovascular events, it is mandatory to discuss the best choice of treatment for such patients in terms of their chances of cure and quality of life, and also the risks of late sequelae., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Purpose: To assess the occurrence of breast cancer (BC) after exposure to ionizing radiation for pediatric cancer, by means of a multimodal screening program., Patients and Methods: We identified 86 patients who had received chest wall radiation therapy for pediatric cancer. Clinical breast examination (CBE), ultrasound (US), and mammography (MX) were performed yearly. Magnetic resonance imaging (MRI) was added as of October 2007. We calculated the risk of developing BC by radiation therapy dose, patient age, and menarche before or after primary treatment., Results: Eleven women developed a BC from July 2002-February 2010. The sensitivity of the screening methods was 36% for CBE, 73% for MX, 55% for US, and 100% for MRI; the specificity was 91%, 99%, 95%, and 80% for CBE, MX, US, and MRI, respectively. The annual BC detection rate was 2.9%. The median age at BC diagnosis was 33 years. Although age had no influence, menarche before as opposed to after radiation therapy correlated significantly with BC (P=.027): the annual BC detection rate in the former subgroup was 5.3%., Conclusions: Mammography proved more sensitive and specific in our cohort of young women than CBE or US. Magnetic resonance imaging proved 100% sensitive (but this preliminary finding needs to be confirmed). Our cohort of patients carries a 10-fold BC risk at an age more than 20 years younger than in the general population., (Copyright © 2013 Elsevier Inc. All rights reserved.)

The authors present a clinical contribution on Paget's disease of the breast, concerning 194 cases of mammary carcinoma observed in the period 1988-1995. Treatment strategy is discussed, particularly regarding the cases without a palpable node or positive mammography that can be cured by conservative operations or, more recently, radiotherapy alone.

For centrally located small tumours we have sought, with the aid of a plastic surgeon, to achieve the same radicality as in the other quadrants, while achieving a good cosmetic result. We considered 37 patients with small centrally located breast carcinoma, in whom we performed a new surgical technique. From analysis of this series it emerged that a high percentage (54.1%) had nipple and areolar involvement, suggesting their removal; it is no problem to sacrifice these when a good cosmetic result can be achieved by plastic remodelling.

The in vitro activity of elsamicin A (ELS) was investigated compared with that of doxorubicin (DX) on two sensitive breast cancer cell lines: one estrogen receptor-positive (ER+, MCF7) and one estrogen receptor-negative (ER-, MDA-MB-231) line, and on a DX-resistant subline (MCF7DX). The activity of the two drugs was also investigated on 19 clinical breast cancer specimens from untreated patients. The drugs were tested at pharamcologically relevant concentrations, as calculated from the area under the curve for a 3 h exposure to the lethal dose producing 10% mortality (LD10) in mice, and at 10- and 100-fold concentrations. In DX-sensitive lines, a greater inhibition of RNA and DNA precursor incorporation, as well as of cell proliferation, was caused by ELS than by DX. Moreover, the antiproliferative effect was 10-fold higher in the ER+ MCF7 than in the ER- MDA-MB-231 cell line (IC50: 0.25 versus 0.21 micrograms/ml). ELS was cross-resistant to DX in the MCF7DX subline. In clinical specimens, effects on DNA precursor incorporation were more often observed for ELS than for DX at the same drug concentrations. The in vitro sensitivity to ELS was more pronounced for ER+ than for ER- tumors: minimal inhibiting concentrations of the drug were 0.1 and 3.5 micrograms/ml, respectively, in the two groups. If confirmed in a larger series of human breast tumors, these in vitro results would indicate a promising role for ELS in clinical treatment, mainly of ER+ breast cancer patients.

Mondor's disease or thrombophlebitis of the subcutaneous veins of the chest region is an uncommon condition and is rarely associated with breast cancer. From January 1980 to June 1990, 63 cases of Mondor's disease were diagnosed (57 women and 6 men). In 31 patients, no apparent cause was determined (primary disease), whereas in 32 cases, the disease was secondary because the etiopathogenesis could be discerned. The identified potential causes were three cases of myentasis (all in men), eight cases of accidental local trauma (seven in women), seven cases of iatrogenic origin (three surgical breast biopsies, one skin biopsy, one needle biopsy, one mastectomy, and one reconstruction operation), six cases of inflammatory process, and eight cases associated with breast cancer (all females). Three of the tumors were less than 1 cm in diameter. The authors performed conservative surgery in four patients and demolitive in the other four. In this series, the incidence of breast cancer in association with Mondor's disease was the highest yet reported (12.7%). It was concluded that Mondor's disease may at times be caused by breast carcinoma. This association is by no means exceptional and implies that mammography should always be performed for Mondor's disease, even when the results of a physical examination are negative.

A case of rare, malignant schwannoma of the breast has been analysed with regard to its history and diagnostic problems, such as the mammographic pattern and the role of cytology in the preoperative mesenchymal suggestion.

We report on 534 breast masses examined by fine-needle aspiration cytology. Two samples were obtained from each mass, one with aspiration and the other without. Aspiration, equivalent to that obtained by a 20-ml syringe on full aspiration, was obtained by an automatic aspirator. The two sampling modalities did not differ apart from aspiration and were compared in terms of inadequate sampling rates. The inadequacy rate was the same in 166 cancers (6.6%), whereas a significant difference was recorded in favor of aspiration (13.6 versus 24.4%) in 368 benign masses. When inadequate results were excluded, the accuracy of the two modalities was almost the same. Sensitivity was 97.4% and 96.7% and specificity was 99.4% and 99.3% for sampling with and without aspiration, respectively. Reducing the rate of inadequate sampling from benign masses seems to be the major advantage of aspiration. Double sampling, independent of the specific techniques, reduced inadequacy rates to very low levels (1.2% for cancers; 5.9% for benign masses) and may be useful as a routine policy.

Serum levels of total sialic acid, carcinoembryonic antigen (CEA), ferritin, lactate dehydrogenase, and creatine phosphokinase were measured both in tumor drainage blood (axillary vein) and in peripheral blood obtained from 121 breast cancer patients during surgery. No significant differences between mean values in peripheral and tumor draining blood, between cancer patients and healthy controls, or between patients with or without axillary lymph node metastases were found for any of the markers. Both ferritin and CEA levels were higher in axillary and peripheral blood from patients with central breast cancer versus other sites but the difference was significant only for CEA (p less than 0.05). CEA levels were significantly higher (p less than 0.01) in patients with greater than 2 cm diameter carcinomas versus T1 stage patients in axillary but not in peripheral blood. When the cephalic vein was clamped before the axillary sample was taken, ferritin showed a significant increase (p less than 0.05). We conclude that measurement of sialic acid, CEA, and ferritin in axillary venous blood in breast cancer patients is not of clinical benefit, although further data are needed to clarify whether other advantages can be derived.

To investigate the psychologic adjustment of women undergoing radical mastectomy for cancer, we compared drug consumption (analgesics and sedatives) in the postoperative period and the time lag between operation and the first spontaneous observation of surgical wound in two groups operated according to different procedures. Group 1 (52 patients; mean age, 47 years) underwent a two-stage surgical treatment consisting of biopsy (local anesthesia) followed after 2-4 h by mastectomy (general anesthesia); in the interval patients were informed about ongoing procedures by the surgeon, who also pronounced some key words such as tumor, malignant disease, cancer. Group 2 (66 patients; mean age, 47 years) underwent biopsy and mastectomy in a single stage under general anesthesia. The relative risk (RR) of Group 1 vs Group 2 patients was calculated as regards both drug consumption and time of the first self-observation of the surgical wound. Our results seem to suggest that the two-stage procedure through special care given by the surgeon may result in a positive coping pattern and thus better acceptance of the mutilation.

Concentrations of total serum N-acetyl-neuraminic acid, carcinoembryonic antigen, ferritin, lactate dehydrogenase, creatine phosphokinase and total proteins were measured in both tumor drainage blood (axillary vein) and in peripheral blood taken during surgery from 44 breast cancer patients. There were no significant differences in any of the markers between mean values in peripheral and tumor drainage blood, between cancer patients and healthy controls, between patients with or without axillary lymph node metastases, or according to the site of breast mass.

In an attempt to reach a definite preoperative diagnosis of solitary, solid, breast lesions, data collected in our Institute during the last year was analyzed and confirmed the possibility of obtaining adequate cytologic and histologic specimens with fine-needle aspiration. When this is used in association with conventional cytologic examination the sensitivity of the procedure is increased from 73% to 78%. In 14% of cases, these combined aspiration techniques provided extra information concerning the histotype and infiltration of the tumor which was not obtainable with cytology alone.