Objective To observe an early result after the repair of the large upper thoracic wall defect by a combined use of the titaniumnet, reconstruction nickelclad, and latissimus dorsi myocutaneous flap in a patient who underwent a breast sarcomatoid caricinoma resection on the upper thoracic wall. Methods A breast sarcomatoid carcinoma in the upper thoracic wall was removed in 1 56yearold female patient in February 2006. After the tumorectomy, a large thoracic wall defect was left, which was 20cm×15cm in size. The defect was covered by the titanium net, the bilateral stumps of the clavicles were connected by the reconstruction nickelclad, and the soft tissue defect was repaired with the right latissimus dorsi myocutaneous flap(20cm×15cm). Results The patient depended on the breathing machine for 3 days after operation. When the breathing machine was discontinued, the patient developed a severe paradoxical breathing. Two weeks after operation when theblood circulation of the flap was stabilized, the paradoxical breathing disappeared with the help of the chest bandage for fixation of the chest cavity, and the blood supply of the flap was improved. The chest X-ray film showed that the titanium net and the reconstruction nickelclad were well positioned. The patient received chemotherapy 1 month after operation, The follow-up for 3 months revealed that the patient’s local condition and physical condition were good, and ROMof both the shoulders was improved, with AF 90° and ABD 90°. No recurrence ofthe tumor was found. Conclusion A large thoracic wall defect should be repaired with solid materials. The normal anatomic locations of the clavicles should be maintained with fixation by the reconstruction nickelclad for a good function of the shoulders. The latissimus dorsi myocutaneous flap can be properly enlarged.
Objective To study the relationship between metalloproteinases (MMPs) and breast cancer. Methods The literature in recent years on the relationship between the expression of MMPs and breast cancer was reviewed. Results The balance between MMPs and tissue inhibitors of metalloproteinases (TIMPs) is keeping normally kept in human body. Many of the studies showed that the expression of MMPs is increased in breast cancer. Conclusion The growth, invasion and metastasis of breast cancer is closely related with the increased expression of MMPs. This suggests that MMPs is a valuable prognostic marker and TIMPs would be a novel drug against cancer.
ObjectiveTo investigate the expression and distribution of CD15s antigen in breast cancer and its relationship with carcinogenesis, progression and metastatic proclivity. MethodsCatalyzed signal amplification(CSA) immunohistochemical technique was used to detect the expression of CD15s antigen in breast cancer and in adjacent normal mucosa. Immunoelectromicroscopic ultrastructural localization of CD15s antigen labelled by colloidal gold was also bserved.ResultsThe positive rate of CD15s antigen expression in primary breast cancer was 79.8%(75/94). In adjacent normal mucosa (n=10) CD15s antigen showed weaker staining. The positive rate of CD15s antigen expression in grade Ⅱ-Ⅲ (87.3%) was notably higher than that in grade Ⅰ (69.2%, P＜0.05). In patients with lymph node metastasis, the positive rate of CD15s antigen expression was 90.2%, which was significantly higher than 67.4% in nodes with no metastasis (P＜0.05). CD15s antigen immunoreactivity was mainly localized in the border membrane of cytoplasm, endoplasmic reticulum, golgi complex and surrounding nuclear membrane in tumor tissue, and in the border membrane of cytoplasm in adjacent normal tissue. Conclusion CD15s antigen is a practical parameter for evaluating the degree of malignancy and lymphatic metastatic proclivity of breast cancer. It can provide a new pathway to investigate the carcinogenesis and progression of breast cancer.
ObjectiveTo investigate the relationship between the polymorphisms of estrogen receptor α (ERα) gene PvuⅡ, XbaⅠ and breast hyperplasia. MethodsPolymerase chain reaction-restriction fragment length polymorphism was used to detect the polymorphisms of ERα gene PvuⅡ, XbaⅠ in breast hyperplasia patients (study group, n=89) and healthy controls (control group, n=35). ResultsThe differences of the genotypic frequency and allele frequency of the ERα gene Xba Ⅰ were significant between the study group and the control group (Plt;0.05). According to analysis of the odds ratio (OR), the risk of developing breast hyperplasia for X allele carriers was 0.551 as compared with x allele carriers. But there was no significant difference for the gene polymorphism of PvuⅡ between the study group and the control group (Pgt;0.05). ConclusionThe polymorphisms of XbaⅠof ERα gene is associated with breast hyperplasia and the mutant gene increases breast hyperplasia risk.
ObjectiveTo review the recent studies about sentinel lymph node biopsy in breast cancer.MethodsThe literatures in recent years on the history, concept, technique and clinical application of sentinel lymph node biopsy were reviewed and summarized.ResultsThere was no unified method for sentinel lymph node biopsy. There was a wide range of detection rate and falsenegative rate.ConclusionProspective multicenter random clinical trials will help to evaluate the clinical application of sentinel lymph node biopsy.
One thousand four hundred and twenty four patients with breast cancer were treated in our hospital from 1980 to 1993. The authors analysed the clinical date of this patients. The results showed that 1193 patients (84.4%) had menopause after 45 years old, 840 patients (59.4%) had menorrhea more than 30 years, 980 patients (80.5 %) had their first pregnancy after 25 years old, and 912 cases (74.9 %) had no history of breast feed. Breast cancer is related to genetic factors, other breast disease, mental factors and trace elements in human hair. The study of breast cancer and its relative factors can be expected to open a new road for the treatment and prevention of this disease.
ObjectiveTo explore the feasibility and the practical value of conserving upper limb lymph nodes in axillary lymph node dissection (ALND) for early breast cancer. MethodsFrom August 2007 to January 2010, 124 patients with early breast cancer were studied and divided into two phases: phase one, from August 2007 to July 2008; phase two, from August 2008 to January 2010. Five milliliter of methylene blue was injected subcutaneously in ipsilateral forearm in all the patients before operation to locate the upper limb lymph nodes. Routine ALND was performed in 22 patients of phase one. The level Ⅱ lymph nodes and the upper limb lymph nodes were separated from the axillary lymph nodes, respectively. The lymph nodes of level Ⅱ were investigated by combining touch cytology with frozen section during operation. The lymph nodes of level Ⅰ, Ⅱ, Ⅲ, and the upper limb lymph nodes were investigated postoperatively by routine pathological examination to evaluate the feasibility of conserving the upper limb lymph nodes. One hundred and two patients in phase two were divided randomly by lottery into control group (30 cases), and conserving group (72 cases) in which upper limb lymph nodes were selectively conserved. The surgical procedure for control group was same as the phase one blue stained upper limb lymph nodes, in the conserving group were conserved selectively when the lymph nodes metastasis of level Ⅱ were not detected by combining touch cytology with frozen section during operation. The data were collected and analysed on pathological results of all patients and arm circumference was compared between control group and conserving group. Results Total 119 of 124 patients (96.0%) were found with blue stained upper limb lymph nodes. The concordance rate was 99.2% (123/124) between the intraoperative combining pathological method and the postoperative routine pathological examination. No upper limb lymph node metastasis was found in the phase one and the control group of phase two with level Ⅱ group negative. The incidence of arm lymphedema in the control group and the conserving group with level Ⅰ and Ⅱ lymph nodes dissection was 18.2% （4/22） and 20% （1/51）, respectively on 6 months after operation. The difference was statistically significant （χ 2=6,34， Plt;0.05）. ConclusionsMethylene blue being injected subcutaneously in ipsilateral upper limb can be used to show validly lymph nodes of upper limb in the axillary region. ALND with selectively conserving upper limb lymph nodes when level Ⅱ lymph nodes negative in metastasis, can prevent postoperative arm lymphedema.
bjective To investigate the correlation between expression of vascular endothelial growth factor(VEGF) of serum and tumor tissues and the clinical prognosis in patients with breast cancer. Methods The expressions of VEGF level of serum and tumor tissues in 44 patients with invasive duct breast cancer, 13 with benign breast diseases and 40 healthy controls. Serum VEGF level was measured by ELISA method. The protein expression of tissue VEGF, ER and C-erbB-2 were evaluated by immunohistochemistry LSAB method. Results Serum VEGF level and tissue VEGF expression in breast cancer were higher than those in benign breast diseases （P＜0.001）, and there was no significance in benign breast diseases and healthy controls （Pgt;0.05）. VEGF expression was correlated with lymph node metastasis (P＜0.01), ER and C-erbB-2 expression (P＜0.05, P＜0.01) and clinical stage （P＜0.01）. There were no statistical correlation between VEGF expression and age, tumor size (Pgt;0.05). Conclusion There is positively correlation between serum VEGF level and tissue VEGF expression, and between VEGF expression and clinic prognosis. Serum VEGF level may be one of important index of prognosis estimation in patients with breast cancer.
During the coronavirus disease 2019 epidemic, West China Hospital, Sichuan University explored a new management model to ensure timely diagnosis and treatment and regular follow-up for breast cancer patients. On the basis of previous internet Breast Cancer Information Management System, patient management WeChat groups were integrated to develop an online and offline interconnect management platform. Regular follow-up of patients was mainly conducted by telephone, with WeChat management group as auxiliary. Coronavirus infections were screened during telephone follow-up. In the meanwhile, patients who needed to be further treated would be identified and recommended to the outpatient follow-up. The new management model can improve the efficiency of follow-up management, on the premise of reducing the risk of coronavirus disease 2019 transmission for both health care providers and patients.
Objective To detect the expressions of CK5/6 and Ki-67 in breast cancer， and explore the clinical significance. Methods The expressions of CK5/6 and Ki-67 were detected by immunohistochemistry in 162 cases of breast cancer . The correlation between CK5/6 expression and Ki-67 expression and the relationship of the expressions of two factors to the clinicopathologic factors were analyzed. Results There were 12 cases of the triple negative breast cancer 〔negative estrogen receptor （ER）， negative progesterone receptor （PR）， and negative Her-2〕 in 162 patients with breast cancer. The positive rates of CK5/6 and Ki-67 in the breast cancer tissues were 30.9% （50/162） and 65.4% （106/162），respectively. The positive rates of CK5/6 and Ki-67 in the patients with triple negative breast cancer were significantly higher than those of non-triple negative breast cancer 〔CK5/6：75.0% （9/12） versus 27.3% （41/150）， χ2=11.837， P=0.001；Ki-67：100% （12/12） versus 62.7% （94/150）， χ2=6.847， P=0.009〕. The expressions of CK5/6 and Ki-67 in the breast cancer tissues were not associated with age （P＞0.05）， but they were associated with histology grade （P＜0.05）. The expression of CK5/6 wasn’t associated with tumor size and lymph node status （P＞0.05）， but the expression of Ki-67 was associated with them （P＜0.05）. The expression of CK5/6 in the breast cancer tissue had a positive correlation with the expression of Ki-67 in the breast cancer tissue （rs=0.271， P=0.000）. There were 64 cases when the expression of Ki-67 was （＋＋） and （＋＋＋）， the positive rate of CK5/6 was 43.8% （28/64） and it was significantly higher than that when the expression of Ki-67 was （-） and （＋） 〔22.4% （22/98）， χ2=8.233， P=0.004〕. The positive expressions of CK5/6 and Ki-67 in the breast cancer tissues were negatively correlated with the expressions of ER and PR （CK5/6 and ER：rs=-0.446， P=0.000；CK5/6 and PR：rs=-0.370， P=0.000；Ki-67 and ER：rs=-0.518， P=0.000；Ki-67 and PR：rs=-0.515， P=0.000）. The positive expressions of CK5/6 and Ki-67 in the breast cancer tissue were not correlated with the Her-2 expression （CK5/6 and Her-2：rs=0.105， P=0.183；Ki-67 and Her-2：rs=0.068， P=0.393）. Conclusion The expressions of CK5/6 and Ki67 not only can evaluate the basic rules of breast cancer from origin and development， but also they are beneficial to choose the chemotherapy of different patients.