Breast Disease - Volume 33, issue 1

Authors: Raghavendra, G.K.G. | Sreenivasa, R.H. | Ashok, K. | Chitsabesan, P. | McLean, N.R. | Youssef, M. | Piper, M. | Carr, M.

Article Type: Review Article

Abstract: Background: The effectiveness of surgically placed wound catheters (SPWC) and local anaesthetic infusion in the management of post-operative pain following breast surgery is controversial. This meta-analysis was performed to assess efficacy SPWC compared to other techniques of pain management. Material and methods: The meta-analysis included randomised control trials that compared SPWC with other forms of pain control. Post-operative opioid requirements and pain measured in visual analogue scale (VAS) were analysed using Comprehensive Meta-analysis Software version 2. Literature was reviewed for the safety of the SPWC and local anaesthetic infusion. Results: Four randomised controlled trials evaluating 147 …women were included in the final analysis. The overall standard difference in means was 0.094 and 0.033 for post-operative opioid requirement and pain respectively favouring the SPWC and local anaesthetic infusion group. It is a safe technique with no major adverse events as a result. Conclusion: Surgically placed wound catheters and local anaesthetic infusion is clinically safe in a wide range of surgical procedures on the breast and there appears to be a trend towards improved post operative pain relief. The studies analyzed in this review have several important drawbacks such as inadequate power to detect significant differences (none of them included more than 50 patients). A well designed RCT of patients undergoing breast surgery with an adequate number is of patients required to emphatically demonstrate if the operative site infusion with local anaesthetic solution postoperatively is safe and efficacious compared to opioid based regimens alone for post operative pain relief. Show more

DOI: 10.3233/BD-2010-0316

Citation: Breast Disease, vol. 33, no. 1, pp. 1-8, 2012

Authors: Obajimi, M.O. | Adeniji-Sofoluwe, A.T.S. | Oluwasola, A.O. | Adedokun, B.O. | Soyemi, T.O. | Olopade, Funmi | Newstead, Gilean

Article Type: Research Article

Abstract: Introduction: Mammographic breast density is dependent on the relative proportion of radiolucent fat and radio-dense connective and glandular tissue. This breast density is said to be a marker of risk for breast cancer and has received widespread interest in many countries in recent years. Aims and Objectives: The main objective of this study is to estimate the prevalence of the various mammographic breast density patterns and seeks to find any association between the reported breast patterns and various demographic variables in women in Ibadan, South West Nigeria. Methods: A prospective descriptive study of mammographic breast pattern …in 498 women at the Department of Radiology, University College Hospital Ibadan. Two screening views and additional views when necessary were done on each breast with the Senographe DMR+ Mammographic Unit. Participants also completed an assisted administered questionnaire which was used to obtain data on their socio-demographic characteristics. Results: The study confirmed significant association with age and parity as in previous reports in the diaspora. Conclusion: The study confirmed denser mammographic breast pattern in younger and nulliparous women. Future work on mammographic density and other variables is contemplated for complete cancer related data in our peculiar setting. Show more

Keywords: Mammographic, breast, Pattern, women Ibadan

DOI: 10.3233/BD-2010-0313

Citation: Breast Disease, vol. 33, no. 1, pp. 9-15, 2012

Authors: Gilbert, Samuel F. | Soliman, Amr S. | Karkouri, Mehdi | Quinlan-Davidson, Meaghen | Strahley, Ashley | Eissa, Mohab | Dey, Subhojit | Hablas, Ahmed | Seifeldin, Ibrahim A. | Ramadan, Mohamed | Benjaafar, Noureddine | Toy, Kathy | Merajver, Sofia D.

Article Type: Research Article

Abstract: Introduction: Male breast cancer (MBC) is a rare disease. Rates of MBC in Northern Africa vary by region. The age-standardized incidence for MBC is higher in Morocco than in Egypt, and the Egyptian rate is similar to the U.S of approximately 1/105 . This study aimed at investigating the clinical and molecular characteristics of MBC in Egypt and Morocco. Methods: This case-case study included 211 cases from Egypt and 132 from Morocco. Tumor tissues were available for 47 Egyptian and 18 Moroccan patients. Medical record information was abstracted for patients’ demographics, medical history, and treatment. BRCA2 protein expression …status was examined in Egyptian and Moroccan tumors. Androgen receptor CAG repeat length was analyzed using the tissue samples in Egyptian MBC tumors and controls. Limited amount of tissues from Morocco did not allow for the analysis of CAG repeats. Results: Egyptian MBC patients had a significantly lower age at diagnosis (Egypt: 57.5 ± 15.1 , Morocco: 63.9 ± 14.4 , P = 0.0002 ) and a higher prevalence of liver cirrhosis (Egypt: 28.0%, Morocco: 0.8%, P = < 0.0001 ). MBC patients also had higher tumor grades [I (0.9%), II (81.0%), III (18.1%)] in Egypt vs. [I (10.7%), II (81.0%), III (8.3%)] in Morocco (P = 0.0017 ). The clinical and molecular characteristics of the groups from the 2 countries did not significantly differ. There was no significant difference with respect to BRCA2 expression amongst countries (Egypt: 28.9% non-wild type, Morocco: 27.8% non-wild type, P = 0.9297 ) or CAG lengths amongst BRCA2 expression types in Egyptians (Wild type: 54.6% with CAG repeat lengths of 20+, Non-wild type: 50% with CAG repeat lengths of 20+, P = 0.7947 ). Conclusions: Differences in MBC between Egypt and Morocco are more likely due to differences in other risk factors such as consanguinity and use of xenoestrogenic pesticides. Show more

Keywords: Male breast cancer, breast cancer, Egypt, Morocco, developing countries

DOI: 10.3233/BD-2010-0323

Citation: Breast Disease, vol. 33, no. 1, pp. 17-26, 2012

Authors: Shetty, Preetha J. | Pasupuleti, Nagarjuna | Chava, Srinivas | Nasaruddin, Khaja | Hasan, Qurratulain

Article Type: Research Article

Abstract: Breast cancer (BC) is the commonest cancer in women worldwide with a widely variable incidence between countries and regions. BC is either familial or sporadic. Mutations in tumor suppressor gene, PTEN has been associated with syndromic BC and in a subset of sporadic BCs. The present study was carried out in archival formalin fixed paraffin embedded samples. Immunohistochemistry and quantitative RTPCR indicated a reduced expression/ transcription of PTEN in tumor as compared to adjacent non-tumorous tissue. However, the promoter methylation evaluated by Methylation Specific Restriction Assay indicated that only 20% of the tumors showed PTEN methylation and could not account …for the rest of the samples with reduced expression. Overall evidence from literature and our present findings indicate that: (i) Loss of Heterozygosity at PTEN gene locus (ii) germline and somatic gene mutations of PTEN (iii) epigenetic silencing by methylation in PTEN promoter CpG cluster (iv)protein interactions which reduce PTEN transcription and (v) PTEN protein degradation together play an important role in the etiology of BC. Show more

Keywords: Altered expression, breast cancer, CpG cluster, MSRA, promoter hypermethylation, PTEN

DOI: 10.3233/BD-2010-0312

Citation: Breast Disease, vol. 33, no. 1, pp. 27-33, 2012

Authors: Mouawad, Nicolas J. | Cleary, Robert K.

Article Type: Case Report

Abstract: Breast carcinoma continues to be the most common neoplasm in women, with a lifetime risk affecting approximately 1 in 8. Factors affecting prognosis include the size and grade of the primary lesion, regional axillary lymphadenopathy, the presence of hormonal receptors, and distant metastatic disease. Although metastatic breast disease usually affects the lungs, bones, and brain, abdominal association is not as common. Interestingly, lobular carcinoma, a subtype that only accounts for a minor portion of breast cancers, usually has luminal gastro-intestinal involvement. We describe a 57-year old Caucasian female with recurrent episodes of abdominal pain and concurrent …intermittent obstructive symptomatology with overflow diarrhea over a one-year period. Conventional endoscopic and imaging workup was unrevealing. Capsule endoscopy was used, but this caused a complete bowel obstruction necessitating surgery, and subsequent resection of a strictured segment. Pathological examination yielded metastatic adenocarcinoma, consistent with origin in breast, lobular type. Immunohistochemistry confirmed the origin. Luminal gastro-intestinal involvement is a rare, yet recognized, site of breast adenocarcinoma metastasis; it is even more uncommon with an undiagnosed primary. It may mimic other gastro-intestinal disease, and as such, it would be prudent to maintain a modest index of suspicion given the high prevalence of breast neoplasia. Show more

DOI: 10.3233/BD-2010-0317

Citation: Breast Disease, vol. 33, no. 1, pp. 35-40, 2012

Authors: Tantrige, Priyan Maleuwe | Hassanally, Delilah

Article Type: Case Report

Abstract: Giant juvenile fibroadenomas in patients with hemihypertrophy are exceptionally rare. We present a very interesting case of a 13 year old girl with hemihypertrophy of the left side presenting with recurrent giant juvenile fibroadenomas of the left breast. The giant fibroadenomas occurred twice in the left breast over two years. The first had a diameter of 12 cm and was excised through an inframammary incision. The second occurred a year later, had a diameter of 11 cm, and was associated with three smaller fibroadenomas. These lesions were removed through a single periareolar incision. The procedures were complicated by keloid scarring …but the results were improved with steroid impregnated tape dressing and local methylprednisolone injection. This report adds to our experience in managing patients with recurrent giant juvenile fibroadenomas complicated by hemihypertrophy and raises awareness to anticipate keloid scarring. Show more

Keywords: Recurrent giant juvenile fibroadenoma, keloid, hemihypertrophy

DOI: 10.3233/BD-2010-0305

Citation: Breast Disease, vol. 33, no. 1, pp. 41-44, 2012

Authors: Gupta, Pramod | Foshee, Soume | Garcia-Morales, Francisco | Gray, Toby

Article Type: Research Article

Abstract: We report a rare case of mammary fibroadenoma in a 75 year old male patient with emphasis on imaging findings and review of the previously reported cases.

DOI: 10.3233/BD-2010-0320

Citation: Breast Disease, vol. 33, no. 1, pp. 45-48, 2012

Authors: Klar, Amar J. S.

Article Type: Research Article

Abstract: The majority of breast cancer cases seen in women remain unexplained by simple Mendelian genetics. It is generally hypothesized that such non-familial, so-called sporadic cases, result from exposure of the affected individuals to a cancer-causing environment and/or from stochastic cell biological errors. Clearly, adverse environment exposure can cause disease, but is that necessarily the cause of most sporadic cases? Curiously, female breast cancer patients who were selected to prefer right-hand-use reportedly exhibited a higher incidence of reversed-brain hemispheric laterality when compared to that of the public at large. Notably, such a higher level of hemispheric reversal is also found in …healthy, left-handed or ambidextrous persons. Based on the association between these disparate traits, a new hypothesis for the etiology of sporadic breast cancer cases is advanced here; breast cancer predisposition and brain laterality development likely share a common genetic cause. Show more

DOI: 10.3233/BD-2010-0318

Citation: Breast Disease, vol. 33, no. 1, pp. 49-52, 2012

Article Type: Book Review

DOI: 10.3233/BD-2010-0315

Citation: Breast Disease, vol. 33, no. 1, pp. 53-53, 2012