Mammary microcalcifications (MCs) are calcium deposits that are considered as robust markers of breast cancer when identified on mammography. MCs are frequently associated with premalignant and malignant lesions. The aim of the present review was to describe the MC types and associated radiological and pathological aspects in detail, provide insights and approaches to the topic, and describe specific clinical scenarios. The primary MC types are composed of calcium oxalate, hydroxyapatite and hydroxyapatite associated with magnesium. The first type is usually associated with benign conditions, while the others remain primarily associated with malignancy. Radiologically, MCs are classified as benign or suspicious. MCs may represent an active pathological mineralization process rather than a passive process, such as degeneration or necrosis. Practical management of breast specimens requires finely calibrated radiological pathological procedures. Understanding the molecular and structural development of MCs may contribute to breast lesion detection and treatment. Contents1. Introduction 2. Microscopic localization of MCs 3. Etiology of MCs 4. Radiological classification of MCs 5. MC management and biopsy with radiological guidance 6. Sending MC specimens to the pathology laboratory 7. MCs in breast cancer 8. MCs in specific clinical scenarios 9. Conclusions

Rates of alanine incorporation into glucose by isolated liver cells of fed rats are 5-fold higher than those observed when lactate was used as substrate. The rates of g~~eoneogenesis from alanine and lactate in isolated liver cells of fed pregnant rats increase 50 and ~~%, respectively, over virgins during the last 3 days of gestation. The results support the existence of an increase in the aianine-glucose cycle in the iate pregnancy as an important homeostatic pathway in the supply of glucose to the growing fetus. GluconeogemsisGestatr'on

Introduction: Breast cancer is a heterogeneous disease with well-defined molecular subtypes and variable clinical behavior. The overexpressed HER2 subtype represents approximately 20% of all breast carcinomas. It is associated with a poor prognosis, increased risk of systemic and brain metastases, and poor overall survival until the advent of anti-HER2 therapies, such as trastuzumab. Its introduction into clinical practice has improved the prognosis in cases of breast cancer with overexpressing of pure HER2. However, some cases develop resistance to this drug. Objectives: To evaluate immunoexpression of possible markers involved in the HER2 pathway in breast carcinoma with overexpressing of pure HER2 treated with trastuzumab. Methods: We included 90 patients diagnosed with pure positive HER2 breast carcinoma treated with trastuzumab at the IBCC and HSP/Unifesp public hospitals between 2009 and 2018. Through immunohistochemistry, markers involved in the HER2 pathway (MUC4, IGF-1, IGF-1R, EGFR, p21, p27, p53, p16, cyclin D1, PTEN, CDK4, Bcl-2, VEGF, AR, MDM2, and TNFα) were analyzed samples paraffin-embedded of tumor and compromised lymph nodes and then, correlated with clinicopathological variables. The statistics were performed using the SPSS® software, version 25, from the company IBM, values equal to or less than 0.05 were considered significant (p ≤0.05). To verify possible associations between the clinical-pathological variables and the analyzed markers, Pearson’s X2 test, and Fisher’s exact test were used; for survival analysis, the Kaplan-Meier method was used. Results: Treatment resistance of pure HER2-positive breast cancer cases after trastuzumab treatment was 40%; the OS of this series was 4.13 years (95% CI 5.1 - 12.5) and the DFS was 3.6 years (95% CI 5.1 - 13.1). In the tumor samples it was possible to determine potential markers of good prognosis: cyclin D1 with nuclear grade (p=0.049) and recurrence (p=0.038); IGF-1 with tumor size (p= 0.015) and death (p= 0.046); p16 with response to treatment (p= 0.016); PTEN with response to treatment (p= 0.050) and death (p= 0.030). The results also showed possible markers of poor prognosis such as p53 with SBR GH (p= 0.003) and GN (p= 0.048); and IGF-1R with compromised lymph node (p=0.016). In compromised lymph nodes samples, the correlations showed TNFα with tumor size (p=0.043); and CDK4 with the response to treatment (p=0.011) as possible markers of good prognosis; only p53 with GH SBR grade (p= 0.045) maintained its potential for poor prognosis. Conclusions: In tumor samples, it was possible to demonstrate that the markers: cyclin D1, IGF-1, p16, and PTEN had the potential for a good prognosis panel and p53 and IGF-1R for worse. In samples of compromised lymph nodes, p53 remained as a marker of poor prognosis, while TNFα and CDK4 of good prognosis. Citation Format: Andreia Fabiana V. Franco, Angela Flavia L. Waitzberg, Joaquim T. Araujo Neto, Fatima S. Pasini. Immunoexpression of markers related to the HER2 pathway in cases of pure positive her2 breast carcinoma treated with trastuzumab [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P2-04-01.

Background: 74% of women have urogenital symptoms classified as Genito-urinary Syndrome of menopause (GSM) during breast cancer treatment. Promestriene is effective and safe in the treatment of GSM. However, some women and oncologists are not comfortable with long-term use. Therefore, new options for and alleviating GSM have been considered, such as microablative fractional CO2 laser (CO2L) and microablative fractional radiofrequency (RF). Objective: To compare the effect of promestriene, CO2L, and RF treatments of GSM in women with breast cancer in the use of antiestrogens therapy, concerning clinical and histological findings of vulvar vestibule. Methods: This is a secondary analysis of a Multi-arm randomized controlled trial (NCT04081805). Were eligible for the study 100 women with breast cancer using adjuvant endocrine therapy referring moderate to severe symptoms of GSM (itching, dyspareunia, fissures, thinning of vaginal rugae, and tropism reduction). After providing written informed consent, they were evaluated according to pre and post-treatmentpost-treatment protocol by filling the VAS of GSM and by clinical evaluation including a standardized gynecological exam with vestibular biopsy. Women were then randomized to either CO2L, RF or promestriene groups. The CO2L and RF groups received 3 consecutive monthly outpatient vulvovaginal energy applications. The CT was oriented for domiciliary use of promestriene, 1g/d for 21 days and, subsequently, twi4 month seek for 4 months. The follow-up visit was performed 120 days after interventions and also included an evaluation of global patient impression of improvement (5 points Likert scale). Results: 94 women were randomized as follows: 32 in the CO2L group, 32 in the RF and 30 in the promestriene. 70 patients concluded the treatment and had adequate pre and post-treatment material to analyze, 23 CO2L, 21 RF and 26 promestriene. Pre-treatment demographic and clinical data are presented on table 1. The evolution of GSM according to each treatment is demonstrated on table 2. Was also reported a high satisfaction after the treatment protocol in all groups evaluated by Likert Scale:CO2L 4,783 (0,518), RF 4,150 (0,813), CT 4,280 (1.13), p=0,055. The histological parameters were presented on table 3. Histological atrophy was surprisingly identified in only 4 women (5.7%), pre-treatment. No injuries to the histological structure of the vulvar vestibule or relevant clinical adverse events were identified post-treatments. Conclusion: CO2L, RF, and promestriene provided significant and similar improvement of GSM in women with breast cancer using anti-estrogens. The use of energies did not cause structural tissue damage or relevant clinical complications. Table 1. Clinical and demographic parameters before treatment Mean (standard deviation); BMI body mass index, Tukey test: Similar letters (a, b) mean similar results. Chi-Square Table 2. Evolution of GSM (VAS) after treatment with CO2L, RF, and promestriene Mixed ANOVA. VAS - Visual Analog Scale of GSM Symptoms, values expressed in mean (SD) Table 3. Histological parameters according groups and pre and post-treatment Citation Format: Angela Flavia L. Waitzberg, Andreia Fabiana V. Franco, Ana Maria Bianchi-Ferraro, Roberto Marcela, Gabriela Cantarelli, Chayane Dedonatto, Marisa Patriarca, Rita Dardes, Neila Speck, Zsuzsanna Jarmy-di Bella, Marair Sartotti, Joaquim Almeida. CO2 laser, radiofrequency, and promestriene in treatment of genitourinary syndrome of menopause in breast cancer survivors. Clinical and histological aspects of a randomized control trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-34.

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