SEl Boghdadly, J Pitkanen, M Hassonah, M Al Saghier, Emergency Mastectomy in Gigantomastia of Pregnancy: A Case Report and Literature Review. 1997; 17(2): 220-222

We present an extreme case of gigantomastia in pregnancy during the second gemelar pregnancy of a 30-year-old woman. Her first pregnancy was 8 years ago, was also gemelar and she delivered with caesarean section. From the beginning of her current pregnancy, the patient noted steady growth of both of her breasts that reached enormous dimensions at the end of the pregnancy. This kind of breast changes did not occur during her first pregnancy. The patient also suffered from myasthenia gravis that was in remission during this pregnancy, without any therapy. The patient was in the 38 weeks of gestation, and a delivery with caesarean section was performed in line with the reduction of her breasts. The main reasons that led me to perform these two interventions as one act were the fact that puerperal mastitis could develop on these enormous breasts, further the small regression of these huge breasts during the bromocriptine treatment, as well as the intention to avoid other operative traumas, considering possibility of exacerbation of myasthenia gravis. I had already performed bilateral reduction mammaplasty with free areola-nipple graft, when a tissue with total weight of 20 kg (2 × 10 kg) was removed. The patient had an excellent post-operation recovery course.

BACKGROUND:The main prognostic factor in early staged breast cancer is the axillary lymph node metastatic affection. Sentinel lymph node biopsy, as a staging modality, significantly decreases surgical morbidity. The status of internal mammary lymph nodes gains an increased predictive role in grading breast carcinomas and modulation of postoperative therapeutic protocols. If positive, almost always are associated with worse disease outcome. Nevertheless, the clinical significance of internal mammary lymph node micrometastases has not been up to date precisely defined.AIM:To present a case of female patient clinically diagnosed as T1, N0, M0 (clinical TNM) ductal breast carcinoma with scintigraphic detection of internal mammary and axillary sentinel lymph nodes.METHODS:Dual method of scintigraphic sentinel lymph node detection using 99mTc-SENTI-SCINT and blue dye injection, intraoperative gamma probe detection, radioguided surgery and intraoperative ex tempore biopsy were used.CASE REPORT:We present a case of clinically T1, N0, M0 ductal breast cancer with scintigraphic detection of internal mammary and axillary sentinel lymph nodes. Intraoperative ex tempore biopsy revealed micrometastases in the internal mammary node and no metastatic involvement of the axillary sentinel lymph node.CONCLUSION:Detection of internal mammary lymph node metastases improves N (nodal) grading of breast cancer by selecting a high risk subgroup of patients that require adjuvant hormone therapy, chemotherapy and/or radiotherapy.

Introduction: Breast cancer accouns for 22.9% of all cancers in women and 13.7% of cancer deaths. Positive axillary lymphnodes (ALN) predict the development of distant metastases. The status of the sentinel lymphnode (SLN) is crutial for the treatment selection. Aim: To determine the benefits of SLN detection in patients with breast cancer. Material and methodology: 38 female patients (pts), age 44 ± 12 years, with T1-2 N0 M0 breast cancer, without enlarged ALN on ultrasound (US), were included. SLN detection was performed using gamma camera and gamma detection probe after periareolar subcutaneous and/or peritumoral injection of (99m-Technetium-SENTISCINT). Blue dye was administered 20 min before the operation. SLN was extirpated and ex tempore histopathology was performed. Results: Ex tempore SLN evaluation was negative and the lymphatic pathways preserved in 28/38 (74%) pts. In 10/38 (26%) pts SLN was positive, followed by radical surgery. In 3/28 ex tempore negative patients, histopathological analysis showed metastatic involvement (false negative). In 3/10 ex tempore positive patients micro metastases 0,2-2 mm were detected. 12 pts had 2 SLN, 8/12 (66%) had negative and 4/12 (34%) had positive SLN. 3 pts had a rare double drainage to axilla and a. mammaria int. Conclusion: Our results confirm that SLN detection technique is non-invasive, safe and reliable and should be incorporated into the guidelines for breast cancer pts (T1-2 N0 M0). The most reliable option for colloid application is the combined technique of periareolar and peritumoral injection. Patients with drainage to a. mammaria interna should be selected for adjuvant protocols.