BACKGROUND Gastrointestinal stromal tumors (GISTs) are the most frequent mesenchymal tumors of gastrointestinal tract. The most common sites of metastases are the liver and the peritoneum, whereas breast metastases from GIST are extremely rare. We present a second case of GIST breast metastasis. CASE SUMMARY We found a case of breast metastasis from rectum GIST. A 55-year-old female patient presented with rectum tumor with multiply liver lesions and metastasis in the right breast. Abdominal-perineal extirpation of rectum was performed, histology and immunohistochemistry study showed GIST, mixed type with CD117 and DOG-1 positive staining. The patient was taking imatinib 400 mg for 22 mo with stable disease. Because of growth of the breast metastasis the treatment was changed twice: The dose of imatinib was doubled with further progression in the breast lesion and then the patient was receiving sunitinib for 26 mo with partial response in the right breast and stable disease in the liver lesions. The breast lesion increased and right breast resection was done – surgery on local progression, the liver metastases were stable. Histology and immunohistochemistry studies revealed GIST metastasis, CD 117 and DOG 1 positive with KIT exon 11 mutation. After surgery the patient resumed imatinib. Until now the patient has been taking imatinib 400 mg for 19 mo without progression, last follow up was in November 2022. CONCLUSION GISTs breast metastases are extremely rare, we described the second case. At the same time second primary tumors have been reported frequently in patients diagnosed with GISTs and breast cancer is one of the most common second primary tumors in patients with GISTs. That is why it is very important to distinguish primary from metastatic breast lesions. Surgery on local progression made it possible to resume less toxic treatment.

Over the past two decades, the surgical treatment of breast cancer (BC) has changed from standard radical mastectomies to organ-preserving and reconstructive plastic surgeries using endovideosurgical and robotic technologies.  Robot-assisted radical subcutaneous mastectomy, as a minimally invasive method of surgical treatment  of BC in the early stages, is recognized as safe and effective.The results of robot-assisted radical subcutaneous mastectomy and radical subcutaneous mastectomy with endoprosthesis in 27 patients with histologically verified BC are presented. A comparative assessment of postoperative complications of robot-assisted radical subcutaneous mastectomy with endoprosthesis and radical subcutaneous mastectomy with endoprosthesis was performed. It was found that the postoperative period in robotic interventions is more favorable, which confirms the low need for analgesics, the absence of signs of the formation of hematomas of the surgical wound, as well as a decrease in the frequency of inflammatory infiltrates and gray soft tissues in the area of the postoperative suture. Performing a robot-assisted radical subcutaneous mastectomy with endoprosthesis can significantly improve the surgical and aesthetic results of BC treatment in the early stages of this disease.

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The volume of surgical treatment of breast cancer depends largely on the size of the primary hearth. Malignant neoplasms diagnosed at the initial stage of the disease make it possible to carry out organpreserving operational interventions, which is particularly important in the treatment of elderly patients with concomitant somatic diseases. Clinical observation is presented, which demonstrates the importance of the timely identified and consequences of the late diagnosis of breast cancer in the patient of the elderly, in the form of a crumpled radical operation that affects the quality of life of the patient.

e12613 Background: Breast cancer is in first place among malignant diseases in women in Russia. We can provide, in most cases, breast-conserving surgery (BCS), due to progress in early diagnosis. Evaluation of positive margins is still one of the most important objectives in breast-conserving surgery. Objectives: To assess the benefits of IDSR in BCS of patients with “carcinoma in situ”. Methods: The results of treatment of 55 patients with breast cancer “carcinoma in situ” in our clinic were evaluated in two comparable groups. Group A included 28 patients, who were operated on from January 2019 to June 2019 and had breast-conserving surgery without IDSR. Group B included 27 patients, who were operated on from June 2019 to January 2020 and had breast-conserving surgery with the evaluation of margins by IDSR. Results: In a planned histological examination positive margins were detected in group A in 4 cases (14%) and required reoperation. In group B all margins were clear. After IDSR, 6 (22%) patients out of 27 in this group showed microcalcifications in the resection margins or at a distance of less than 1 mm and required intraoperative additional excision to obtain clean margins. Conclusions: IDSR reduces the frequency of reoperation due to increased detection of positive margins, allows to correct scope and duration of surgery because of impact on the time of the surgical decision-making process.