Any palpable abnormality in a pregnant or postpartum woman persisting for more than a few weeks needs a careful investigative workup to rule out PABC.

Although up to 90% of PABC presents as a palpable mass, there can be atypical presentations, including milk rejection from the affected breast or bloody nipple discharge.

Bloody nipple discharge can be especially difficult to differentiate from a benign or malignant origin as it may happen due to pregnancy-induced changes leading to delicate intraductal epithelial spurs that are easily traumatized and shed and thus not considered pathologic in all cases.

In the absence of clinically detectable masses or abnormality on cytology, these patients may be followed closely.

However, if bloody nipple discharge persists after several months postpartum, diagnostic studies should be performed to rule out pathology.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncology #PregnancyAssociatedBreastCancer #BreastCancer #CASO #CenterforAdvancedSurgicalOncology

Patients with PABC are often found to have advanced disease at diagnosis, with the median size of tumor ranging from 3.4 to 4 cm and the reported incidence of axillary lymph node metastasis between 56% and 73%.

Delay in diagnosis is often due to the physiologic changes that occur in breasts during pregnancy that can pose challenges for differentiating a new mass from engorged and nodular breast tissue on a physical examination.

In the first and second trimesters, there is active proliferation and differentiation of the lobules, alveoli, and lactiferous ducts, leading to enlargement and increased overall density of breast tissue.

The prolactin level rises during the third trimester, which stimulates milk-producing cells to differentiate, and alveoli and milk ducts are filled with colostrum.

Around parturition, the breasts undergo lactogenesis, which leads to the secretion of colostrum and then milk.

#Arrangoiz #BreastSurgeon #PregnancyAssociatedBreastCancer #CancerSurgeon #SurgicalOncology #CASO #PABC #CenterforAdvancedSurgicalOncology

PABC shares histology and some prognostic features with breast cancer occurring in other young women.

Invasive ductal carcinoma is the most common histologic subtype, followed by invasive lobular carcinoma.

The majority of tumors are grade II or III, and lymphovascular invasion is common.

However, the molecular subtypes of PABC seem to differ from those of non-PABC.

Several case-control studies have demonstrated that the hormone receptor status in PABC is more likely to be negative when compared with that in breast cancer in age-matched cohorts.

In contrast, there are conflicting reports of the HER-2 receptor status for PABC.

In a case-control study published in 1993 by Elledge and colleagues, 58% of the tumors from pregnant patients were positive for HER-2 on immunohistochemistry, whereas only 16% of age-matched non-pregnant patients had HER-2-positive tumors.

However, in a more contemporary report from the MD Anderson Cancer Center series of pregnant women by Middleton and colleagues, 28% of PABC cases had positive membrane staining for HER-2, and there was no significant difference when compared with breast carcinoma in young nonpregnant women.

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncology #PregnancyAssociatedBreastCancer #BreastCancer #PABC #CASO #CenterforAdvancedSurgicalOncology

Pregnancy-associated breast cancer (PABC) is defined as breast cancer diagnosed during pregnancy or in the first postpartum year.

Breast cancer is the second most common malignancy affecting pregnant women.

It is estimated that one in 3,000 pregnant women is diagnosed with breast cancer and that up to 3% of all breast cancers are associated with pregnancy.

In general, breast cancer in young women is rare; the estimated incidence of breast cancer in women younger than 40 years of age was less than 4% in 2015 in the United States.

However, by definition, PABC occurs in women of reproductive age, and the average age of women with PABC is between 32 and 38 years of age.

The birth rate for women age 30 to 44 years has been steadily increasing in the past few decades, and as more women are delaying childbearing for various reasons, the incidence of PABC has risen and is expected to continue to rise.

As in non-PABC, the risk of PABC seems to be age related.

A large Canadian population cohort study using birth data from a national registry reported that PABC appeared to be more common among women with a first-term pregnancy occurring after the age of 35.

#Arrangoiz #BreastSurgeon #CancerSurgeon #PABC #PregnancyAssociatedBreastCancer #SurgicalOncology #Miami #SurgicalOncologist #CASO #CenterforAdvancedSurgicalOncology

Peritoneal washing cytology (CY)+ in Pancreatic ductal adenocarcinoma (PDAC) is classified as M1 disease by the American Joint Committee on Cancer staging system and NCCN guidelines, whereas the Japanese General Rules for Pancreatic Cancer have not yet included the CY status for staging.

Hiroyoshi Tsuchida et al analysed well-maintained, nationwide database of 1970 patients with PDAC to evaluate the relationship among CY status, clinical factors, and overall survival and to clarify the clinical implications for operative resection in patients who are CY+ status.

It demonstrated that OS in patients who underwent resection was markedly worse in patients who were CY+ than in patients who were CY– who underwent resection and that peritoneal recurrence appeared earlier in patients who were CY+.

Read full text article at
https://www.surgjournal.com/article/S0039-6060(19)30411-8/fulltext

#Arrangoiz #CancerSurgeon #surgjournal #surgery #surgeryjournal #pancreas #peritonealWashingCytology

👉The most recent publication of our CovidSurg collaboration showed head and neck surgery during the pandemic, represents a significant risk of contagion of # COVID19, which is significantly higher (an order of magnitude) than the risk of community transmission. 

👉The study can be seen in the Cancer journal of the American Cancer Society 

👉bit.ly/3pcnZw2

#Arrangoiz #CancerSurgeon #HeadandNeckSurgery 
#CovidSurg

An extreme form of parathyroid bone disease termed osteitis fibrosa cystica is characterized by significant loss of bone density, development of bone cysts and brown tumors (shown below), skeletal deformity, bone pain, and a propensity for pathologic fractures. Fortunately, it is quite rarely seen these days.

Read more about the signs and symptoms of parathyroid disease at https://collectedmed.com/index.php/article/article/demo_article_display/7544/83/1/1

#Arrangoiz #ParathyroidSurgeon #ParathyroidExpert #Surgeon #CASO #CenterforAdvancedSurgicalOncology #HeadandNeckSurgeon

• Demographics :
  • Advanced age
  • Overweight or obesity (particularly in postmenopausal women)
  • White race or Ashkenazi Jewish descent
• Medical history:
  • BRCA1 or BRCA2 mutation
  • First-degree relative with breast or ovarian cancer
  • History of atypical hyperplasia or lobular carcinoma in situ
  • One prior breast biopsy (regardless of results)
  • Personal history of breast or ovarian cancer
• Medications and diet:
  • Alcohol consumption (more than one drink per day)
  • Current or prior use of hormone therapy or oral contraceptives
• Reproductive history:
  • Menarche before 12 years of age Menopause after 55 years of age Nulliparity or age older than 35 years at first delivery Other High breast density on mammography Prior thoracic radiation exposure

• #Arrangoiz #CancerSurgeon #BreastSurgeon @SurgicalOncologist #CASO #CenterforA

The ACS updated its guidelines for breast cancer screening in average-risk women in October 2015. At this time, the ACS is in the process of updating the breast cancer screening guidelines for women at high risk, which were last updated in 2007.

Beginning in their early 20s, women should be told about the benefits and limitations of breast self exam (BSE).

The ACS does not recommend clinical breast examination for breast cancer screening in average-risk women at any age.

ACS recommendations are as follows:

• Women should begin regular screening mammography at age 45 years (strong recommendation)
• Women aged 45 to 54 years should be screened annually (qualified recommendation)
• Women 55 years and older should transition to biennial screening or have the opportunity to continue screening annually (qualified recommendation):
  • Women should have the opportunity to begin annual screening at 40 to 44 years  of age (qualified recommendation)
• Women should continue screening mammography as long as their overall health is good and they have a life expectancy of 10 years or longer (qualified recommendation)

The ACS recommends annual MRI screening along with mammography, based on evidence from non-randomized screening trials and observational studies, in women with the following risk factors:

• BRCA mutation
• First-degree relative of BRCA carrier, but untested
• Lifetime risk ∼20–25% or greater, as defined by BRCAPRO or other models that are largely dependent on family history

The ACS recommends annual MRI screening, based on expert consensus opinion that considers evidence of lifetime risk for breast cancer, in women with the following risk factors:

• Radiation to chest between age 10 and 30 years
• Li-Fraumeni syndrome or first-degree relatives with the syndrome
• Cowden and Bannayan-Riley-Ruvalcaba syndromes or first-degree relatives with those syndromes

#Arrangoiz #BreastSurgeon #CancerSurgeon #SurgicalOncologist # CASO #CenterforAdvancedSurgicalOncology