Use of the ipsilateral breast in anterolateral chest wall reconstruction.

Chest wall ablative surgery often requires autologous tissue transfer to reconstruct the resulting defect. The female breast is commonly of a suitable size to provide anteromedial chest wall coverage as a pedicled dermoglandular flap. In anterolateral defects the latissimus dorsi or serratus anterior flaps are often the preferred choice, in the absence of which free tissue transfer is an alternative technique.

Jejunal lymphangioma presenting as an ovarian mass.

Intra-abdominal lymphangiomas are rare benign tumours that usually arise in the mesentery of the small bowel. We present the case of an intra-abdominal lymphangioma that involved both the jejunum and its adjacent mesentery that ultrasound and CT scanning suggested was an ovarian tumour. Laparoscopy confirmed normal ovaries and a jejunal mass which was resected at laparotomy.

The use of fulvestrant, a parenteral endocrine agent, in intestinal obstruction due to metastatic lobular breast carcinoma.

Background: The role of fulvestrant in the management of intestinal obstruction associated with lobular carcinoma has not been specifically described.

Case Presentation: Herein we present two cases where fulvestrant, as the only available parenteral endocrine agent for postmenopausal advanced breast cancer has the opportunity to provide a means to initiate treatment in those patients who present with varying degrees of intestinal obstruction.

Conclusion: Fulvestrant may obviate the use of chemotherapy while achieving sustained clinical benefit with less toxicity, in appropriately selected patients.

Incidence of intramammary nodes in completion mastectomy specimens after axillary node sampling: implications for breast conserving surgery.

Background: Axillary node sampling (ANS) is widely used in conjunction with breast conserving surgery in the treatment of primary breast cancers in the UK. Some evidence suggests that axillary staging techniques can miss intramammary nodes contained within the axillary tail of the breast. This study aims to assess the incidence of such nodes in completion mastectomy specimens in women who have had previous breast conserving surgery and ANS.

Male breast cancer: a review of clinical management.

Aims: Male breast cancer incidence is 1% of all breast cancers and is increasing. We aim to present an overview of male breast cancer with particular emphasis on clinical management.

Methods: Studies were identified by an online search of literature in the MEDLINE database till June 2006 followed by an extensive review of bibliographies.

Clinical value of epidermal growth factor receptor expression in primary breast cancer.

EGFR expression in primary breast cancer has been extensively investigated for its prognostic and predictive value. However overall there is no consensus on its potential to guide such prognostication. This is largely because of the great heterogeneity in study designs and methods used to assay the EGFR protein.

Randomized clinical trial comparing radioisotope occult lesion localization and wire-guided excision for biopsy of occult breast lesions.

Background: Accurate localization of impalpable breast lesions that require biopsy is important. This randomized trial compared radioisotope occult lesion localization (ROLL) with the standard hooked-wire technique.

Methods: Ninety-five patients were randomized to receive either ROLL or wire localization of an occult breast lesion.

Expression and co-expression of the members of the epidermal growth factor receptor (EGFR) family in invasive breast carcinoma.

The epidermal growth factor receptor (EGFR) family plays an important role in breast carcinogenesis. Much interest has been focused recently on its members because of their potential role as prognostic indicators in breast cancer and their involvement in cancer therapy. We have evaluated more than 1500 cases of invasive breast carcinoma immunohistochemically using tissue microarray technology to examine the expression of EGFR family receptor proteins.

Woman feels breast lump--surgeon cannot: the role of ultrasound in arbitration.

The role of ultrasound scanning (USS) in patients complaining of a breast lump where the clinical examination (CE) is normal is not clearly defined. To determine this in greater detail, all patients complaining of a breast lump underwent CE. Where no lump could be found, but was still reported by the patient, an USS was performed.

Co-expression of neuregulins 1, 2, 3 and 4 in human breast cancer.

We have produced antibodies to the NRG2-alpha, NRG2-beta, NRG3 and NRG4 proteins and used these, and previously described antibodies to NRG1-alpha and NRG1-beta, to detect expression of each ligand by immunocytochemical staining in a series of 45 breast cancers. Each protein was expressed in a proportion of cases. Statistical analysis suggested that expression of one factor was associated with a high probability that other members of the family were co-expressed.

Local anaesthetic and steroid combined injection therapy in the management of non-cyclical mastalgia.

Aims: We aimed to assess the effectiveness of a local anaesthetic and steroid combination injection therapy in the management of non-cyclical mastalgia.

Methods: Patients with non-cyclical mastalgia were assessed for rib tenderness (lateral chest wall tenderness-LCWT). The tenderest spot was injected with a combined preparation of 1 ml 2% lignocaine and 1 ml 40 mg depomedrone.

Management of physiological gynaecomastia with tamoxifen.

Aims: We aimed to confirm suggestions that tamoxifen therapy alone may resolve physiological gynaecomastia.

Methods: A prospective audit of the outcome of tamoxifen routinely given to men with physiological gynaecomastia was carried out at Nottingham. Men referred with gynaecomastia had clinical signs recorded, e.

Radioisotope for occult lesion localisation (ROLL) of the breast does not require extra radiation protection procedures.

Aim Of Study: Dosimetry data from patients and hospital personnel involved in the use of radioisotope for occult lesion localisation (ROLL) of the breast were collected to determine the need for extra radiation protection procedures.

Methods: Sixty-three patients have been enrolled to date into a randomised trial evaluating ROLL. Two megabecquerels of (99m)Tc- MAA in a syringe was mixed with X-ray contrast medium; this was injected directly into the lesion under image guidance.

Incidence of clinically significant lymphoedema as a complication following surgery for primary operable breast cancer.

There has recently been considerable interest for the need for specialist lymphoedema nurses to be appointed in the NHS. However, we had noticed in our cancer follow-up clinics that the incidence of lymphoedema appeared to be very low. Treatment for primary breast cancer (>5 cm) has been surgery and low axillary sampling (ANS).

Lymphoscintigraphic evaluation of chronic lower limb oedema.

Ultrasound, computed tomography (CT), magnetic resonance imaging (MRI), venography, lymphoscinti-graphy (LS) and contrast lymphography are frequently utilized in the evaluation of lower limb oedema but no clinical data from the Caribbean have been published on the role of LS despite its well-recognized clinical application. The successful clinical application of CT, colour doppler sonography and MRI in differentiating the various causes of lower limb oedema is well understood. Lymphoscintigraphy has found less acceptability especially in the Caribbean where nuclear imaging techniques are only now currently being developed.

Intraductal injection of the breast: a potential pitfall of radioisotope occult lesion localization.

The use of radioisotope for the localization of occult breast lesions (ROLL) has been advocated in preference to wire guided excision as it allows reduced excision volume and better lesion centering. However, as this technique is new, potential complications are unknown. In 2 out of 38 ROLL procedures performed at our institution, intraductal injection of isotope has occurred.

HER-2 in breast cancer--methods of detection, clinical significance and future prospects for treatment.

The Human Epidermal Growth Factor (HER-2) oncogene encodes a transmembrane tyrosine kinase receptor with extensive homology to the Epidermal Growth Factor Receptor (EGFR) which is the prototypal member of this family of receptor tyrosine kinases. HER-2 gene amplification is found in 20-30% of breast cancers. Various methods such as immunohistochemistry, southern and slot blotting, enzyme immunoassays and fluorescence in situ hybridization have all been employed to evaluate HER-2 gene and protein abnormalities.