1
|
Hassan N, Saad Abdalla Al-Zawi A, Idaewor P, Rasheed N, Chicken DW. Uremic Bilateral Breast Calciphylaxis: A Case Report and Literature Review. Cureus 2023; 15:e46024. [PMID: 37900509 PMCID: PMC10602656 DOI: 10.7759/cureus.46024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/31/2023] Open
Abstract
Calciphylaxis, also called calcific uremic arteriolopathy, is a rare benign cutaneous manifestation. Although little is known about its pathogenesis, it is thought to be a result of vascular wall calcification leading to soft tissue necrosis, and it is usually encountered in patients with end-stage kidney disease (ESKD) on long-term renal dialysis. Breast calciphylaxis is a rare entity that may present as a breast mass or necrotic ulcers, and it is common for it to be initially mistaken for a malignant breast pathology. In this article, we present a case of bilateral breast calciphylaxis in a 66-year-old female with ESKD receiving long-term dialysis.
Collapse
Affiliation(s)
- Natalie Hassan
- Critical Care, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Abdalla Saad Abdalla Al-Zawi
- General and Breast Surgery, Mid and South Essex NHS Foundation Trust, Chelmsford, GBR
- General and Breast Surgery, Anglia Ruskin University, Chelmsford, GBR
- Breast Surgery, Broomfield University Hospital, Chelmsford, GBR
| | - Philip Idaewor
- Histopathology/Cellular Pathology, Mid and South Essex NHS Foundation Trust, Basildon, GBR
| | - Noreen Rasheed
- Radiology, Basildon and Thurrock University Hospital, Basildon, GBR
| | | |
Collapse
|
2
|
Elremeli M, Idaewor P, Rasheed N, Saad Abdalla Al-Zawi A. Li-Fraumeni Syndrome, A Rarity Among Rarities: A Case Report and Review of Literature. Cureus 2023; 15:e45462. [PMID: 37859908 PMCID: PMC10583736 DOI: 10.7759/cureus.45462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/21/2023] Open
Abstract
Li-Fraumeni syndrome (LFS) is a rare inherited cancer susceptibility disorder with a wide tumour spectrum, particularly in children and young adults. Patients with LFS have life-long cancer risk, and the most commonly encountered tumours include soft tissue sarcoma, breast cancer, brain tumours, osteosarcoma, leukaemia and adrenocortical carcinoma. LFS is associated with mutations in the tumour suppressor gene TP53, andnearly two-thirds of families with LFS have this germline mutation. However, the diagnosis of LFS is currently based on recognised strict clinical criteria regardless of the genetic mutation status, as a few families with the clinical characteristics and cancer predisposition of LFS do not have TP53 mutations. Breast cancer is particularly significant among the common malignancies associated with LFS as it is the most common cancer in women worldwide. We present a case of a 27-year-old woman with unilateral breast cancer, in whom further history revealed a brain tumour at the age of 14 years. Due to the early onset of breast cancer and history of childhood malignancy, we suspected LFS. Genetic testing revealed a TP53 mutation, further suggesting the diagnosis of LFS. This has important implications in managing this patient's breast cancer, as the need for risk-reducing mastectomy and arranging a special surveillance programme. It also has great implications for the patient's family members, especially in terms of psychological impact, particularly when the mutation has been detected in children. Also, there is a need for periodic surveillance, which can help in early diagnosis and timely treatment with a more favourable outcome.
Collapse
Affiliation(s)
- Mariam Elremeli
- Paediatrics-Allergy/Immunology, Imperial College London, London, GBR
| | - Philip Idaewor
- Histopathology/Cellular Pathology, Mid and South Essex National Health Service (NHS) Foundation Trust, Basildon, GBR
- Histopathology/Cellular Pathology, Basildon and Thurrock University Hospital National Health Service (NHS) Foundation Trust, Basildon, GBR
| | - Noreen Rasheed
- Radiology, Basildon and Thurrock University Hospital National Health Service (NHS) Foundation Trust, Basildon, GBR
| | - Abdalla Saad Abdalla Al-Zawi
- General and Breast Surgery, Mid and South Essex National Health Service (NHS) Foundation Trust, Basildon, GBR
- General and Breast Surgery, Basildon and Thurrock University Hospital National Health Service (NHS) Foundation Trust, Basildon, GBR
- General and Breast Surgery, Anglia Ruskin University, Chelmsford, GBR
| |
Collapse
|
3
|
Fatayer H, O'Connell RL, Bannon F, Coles CE, Copson E, Cutress RI, Dave RV, Gardiner MD, Grayson M, Holcombe C, Irshad S, Irwin GW, O'Brien C, Palmieri C, Shaaban AM, Sharma N, Singh JK, Whitehead I, Potter S, McIntosh SA. Current practice and surgical outcomes of neoadjuvant chemotherapy for early breast cancer: UK NeST study. Br J Surg 2022; 109:800-803. [PMID: 35543289 PMCID: PMC10364769 DOI: 10.1093/bjs/znac131] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/17/2022] [Accepted: 04/03/2022] [Indexed: 11/13/2022]
Affiliation(s)
- Hiba Fatayer
- Liverpool Breast Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Rachel L O'Connell
- Department of Breast Surgery, Royal Marsden NHS Foundation Trust, Sutton, UK
| | - Finian Bannon
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Belfast, UK
| | | | - Ellen Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK
| | - Ramsey I Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton and University Hospital Southampton, Southampton, UK
| | - Rajiv V Dave
- Nightingale Breast Cancer Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Matthew D Gardiner
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, UK
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Margaret Grayson
- Northern Ireland Cancer Research Consumer Forum, Northern Ireland Cancer Trials Network, Belfast City Hospital, Belfast, UK
| | - Christopher Holcombe
- Liverpool Breast Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Sheeba Irshad
- Guy's Cancer Centre, Guy's and St Thomas' NHS Trust, London, UK
- School of Cancer and Pharmaceutical Sciences, King's College London, London, UK
| | - Gareth W Irwin
- Breast Surgery Department, Belfast City Hospital, Belfast Health and Social Care Trust, Belfast, UK
| | - Ciara O'Brien
- Department of Medical Oncology, Christie Hospital NHS Foundation Trust, Manchester, UK
- School of Medical Sciences Faculty of Biology, Medicine and Health University of Manchester, Manchester, UK
| | - Carlo Palmieri
- University of Liverpool, Institute of Systems, Molecular and Integrative Biology, Department of Molecular and Clinical Cancer Medicine, Liverpool, UK
- Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - Abeer M Shaaban
- Department of Pathology, Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | | | - Jagdeep K Singh
- Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, UK
| | - Ian Whitehead
- Liverpool Breast Unit, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Shelley Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Bristol, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - Stuart A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | | |
Collapse
|
4
|
Murphy J, Gandhi A. Does Mastectomy Reduce Overall Survival in Early Stage Breast Cancer? Clin Oncol (R Coll Radiol) 2021; 33:440-447. [DOI: 10.1016/j.clon.2021.03.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/22/2020] [Accepted: 03/05/2021] [Indexed: 01/12/2023]
|
5
|
Murphy JA, Myers D, Trueman P, Searle R. Cost-effectiveness of single-use negative-pressure therapy compared with standard care for prevention of reconstruction failure in prepectoral breast reconstruction. BJS Open 2021; 5:6220255. [PMID: 33839751 PMCID: PMC8038262 DOI: 10.1093/bjsopen/zraa042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 10/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Single-use negative-pressure wound therapy (sNPWT) has been reported to reduce the incidence of reconstruction failure in prepectoral breast reconstruction compared with standard surgical dressings. The aim of this economic evaluation was to investigate the cost-effectiveness of sNPWT compared with standard care for the prevention of reconstruction failure in prepectoral breast reconstruction in the UK. Method A decision tree model was used to estimate the expected cost and effectiveness per patient. Effectiveness was measured both by the number of reconstruction failures avoided and the gain in quality-adjusted life-years (QALYs). The baseline incidence of reconstruction failure (8.6 per cent) was taken from a recently published study of 2655 mastectomies in the UK. The effectiveness of sNPWT used results from a clinical study comparing sNPWT with standard dressings. Previously published utility weights were applied. The cost of reconstruction failure was estimated from detailed resource data from patients with reconstruction failure, applying National Health Service reference costs. One-way, probabilistic, scenario and threshold analyses were conducted. Results The undiscounted cost per patient associated with reconstruction failure was estimated to be £23 628 (£22 431 discounted). The use of sNPWT was associated with an expected cost saving of £1706 per patient, an expected increase in QALYs of 0.0187 and an expected 0.0834 reconstruction failures avoided. Cost-effectiveness acceptability analysis demonstrated that, at a threshold of £20 000 per QALY, 99.94 per cent of the simulations showed sNPWT to be more cost-effective than standard care. Conclusion Among patients undergoing immediate prepectoral breast reconstruction, the use of sNPWT is more cost-effective than standard dressings.
Collapse
Affiliation(s)
- J A Murphy
- Nightingale Breast Unit, Manchester University NHS Foundation Trusts, Manchester, UK
| | | | | | | |
Collapse
|
6
|
Whitehead I, Irwin GW, Bannon F, Coles CE, Copson E, Cutress RI, Dave RV, Gardiner MD, Grayson M, Holcombe C, Irshad S, O'Brien C, O'Connell RL, Palmieri C, Shaaban AM, Sharma N, Singh JK, Potter S, McIntosh SA. The NeST (Neoadjuvant systemic therapy in breast cancer) study: National Practice Questionnaire of United Kingdom multi-disciplinary decision making. BMC Cancer 2021; 21:90. [PMID: 33482770 PMCID: PMC7825231 DOI: 10.1186/s12885-020-07757-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 12/21/2020] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Neoadjuvant systemic therapy (NST) is increasingly used in the treatment of breast cancer, yet it is clear that there is significant geographical variation in its use in the UK. This study aimed to examine stated practice across UK breast units, in terms of indications for use, radiological monitoring, pathological reporting of treatment response, and post-treatment surgical management. METHODS Multidisciplinary teams (MDTs) from all UK breast units were invited to participate in the NeST study. A detailed questionnaire assessing current stated practice was distributed to all participating units in December 2017 and data collated securely usingREDCap. Descriptive statistics were calculated for each questionnaire item. RESULTS Thirty-nine MDTs from a diverse range of hospitals responded. All MDTs routinely offered neoadjuvant chemotherapy (NACT) to a median of 10% (range 5-60%) of patients. Neoadjuvant endocrine therapy (NET) was offered to a median of 4% (range 0-25%) of patients by 66% of MDTs. The principal indication given for use of neoadjuvant therapy was for surgical downstaging. There was no consensus on methods of radiological monitoring of response, and a wide variety of pathological reporting systems were used to assess tumour response. Twenty-five percent of centres reported resecting the original tumour footprint, irrespective of clinical/radiological response. Radiologically negative axillae at diagnosis routinely had post-NACT or post-NET sentinel lymph node biopsy (SLNB) in 73.0 and 84% of centres respectively, whereas 16% performed SLNB pre-NACT. Positive axillae at diagnosis would receive axillary node clearance at 60% of centres, regardless of response to NACT. DISCUSSION There is wide variation in the stated use of neoadjuvant systemic therapy across the UK, with general low usage of NET. Surgical downstaging remains the most common indication of the use of NAC, although not all centres leverage the benefits of NAC for de-escalating surgery to the breast and/or axilla. There is a need for agreed multidisciplinary guidance for optimising selection and management of patients for NST. These findings will be corroborated in phase II of the NeST study which is a national collaborative prospective audit of NST utilisation and clinical outcomes.
Collapse
Affiliation(s)
- I Whitehead
- Royal Liverpool University Hospital, Liverpool University Hospitals NHS Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK
| | - G W Irwin
- Belfast Health and Social Care Trust, Belfast City Hospital, Lisburn Road, Belfast, BT9 7AB, UK
| | - F Bannon
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - C E Coles
- University of Cambridge, Cambridge, UK
| | - E Copson
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - R I Cutress
- Cancer Sciences Academic Unit, Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
| | - R V Dave
- The Nightingale Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, M23 9LT, UK
| | - M D Gardiner
- Department of Plastic Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough, SL2 4HL, UK
| | - M Grayson
- NI Cancer Research Consumer Forum, c/o NI Cancer Trials Network, East Podium, C-Floor, Belfast City Hospital, Belfast, BT9 7AB, UK
| | - C Holcombe
- Liverpool University Hospitals Foundation Trust, Prescot Street, Liverpool, L7 8XP, UK
| | - S Irshad
- Guy's Cancer Centre, Guy's & St Thomas' NHS Trust, Great Maze Pond, London, SE1 9RT, UK
- School of Cancer & Pharmaceutical Sciences, King's College London, London, SE1 9RT, UK
| | - C O'Brien
- The Christie Hospital NHS Foundation Trust, Wilmslow Road, Manchester, M20 2BX, UK
- School of Medical Sciences Faculty of Biology, Medicine and Health University of Manchester, Manchester, M13 9PL, UK
| | - R L O'Connell
- Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey, SM2 5PT, UK
| | - C Palmieri
- University of Liverpool, Institute of Systems, Molecular and Integrative Biology, Department of Molecular and Clinical Cancer Medicine, Liverpool, UK
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - A M Shaaban
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - N Sharma
- Breast Unit, Level 1 Chancellor wing, St James Hospital, Beckett Street, Leeds, LS97TF, UK
| | - J K Singh
- Queen Elizabeth Hospital Birmingham and University of Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B15 2GW, UK
| | - S Potter
- Bristol Centre for Surgical Research, Population Health Sciences, Bristol Medical School, Canynge Hall, 39 Whatley Road, Clifton, Bristol, BS8 2PS, UK
- Bristol Breast Care Centre, North Bristol NHS Trust, Southmead Hospital, Southmead Road, Bristol, BS10 5NB, UK
| | - S A McIntosh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, 97 Lisburn Road, Belfast, BT9 7AE, UK.
| |
Collapse
|
7
|
This month on Twitter. Br J Surg 2020; 107:619. [DOI: 10.1002/bjs.11605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|