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We present a case involving a 74-year-old woman with cat scratch disease characterized by an enlarged and hard axillary lymph node as well as a palpable breast nodule mimicking a carcinoma. The lymph node and the breast nodule were excised. The pathologic examinations revealed granulomatous lymphadenitis with gram-negative bacilli and an intraductal papilloma. Antibiotic therapy (azithromycin) was prescribed and the patient's clinical evolution was excellent.

In 2020, the COVID-19 pandemic is the major healthcare concern around the world. The infection is especially severe to those with immune system suppression, including patients with cancer. In order to mitigate the negative effects of COVID-19, guidelines have been developed by societies worldwide to review oncology care during this pandemic time. Neoadjuvant endocrine therapy (NET) is a well-stablished option for hormone positive (HR) HER2 negative breast cancer and showed a positive response in breast conservative surgery with substantially less toxicity. Compared to chemotherapy, the NET cost is lower, and its administration is easier, due to less medical visits. Even with remarkable advantages, NET remains taking less place in treatments than it might have. Periods of humanity crisis, such as World Wars and other pandemics, boosted the development of science and established many treatments, which are currently practiced. New data generated during the COVID-19 outbreak can inspire more trials comparing chemotherapy to endocrine therapy within the neoadjuvant setting. The purpose of this letter is to suggest NET as a safe low toxicity treatment strategy for breast cancer, not only to postpone breast cancer surgery during the pandemic, but also to become a standard therapy, a flame kept burning crossing the COVID-19 border.

Introduction: Radiation therapy (RT) plays an important role in the management of patients with ductal carcinoma in situ (DCIS) of the breast, treated by breast-conserving surgery (BCS). RT significantly reduces the risk of local recurrences (LRs) in unselected patients. Efforts are being made, currently, to de-escalate the RT in this scenario with individualized decision-making. Several biomarkers were developed to predict the probability of LR and aid a tailored clinical decision. Objective: The aim of this study was to assess the potential of a modified MSKCC DCIS nomogram to forecast LR after BCS for DCIS patients and assist physicians to recommend RT. Methods: Women with DCIS undergoing BCS, with clear surgical margins and external RT, were enrolled in the study. The MSKCC DCIS Nomogram was modified with the omission of the RT parameter. Patients were considered at high risk for LR when the 10-year probability of LR was >10%. Receiver operating characteristic curves were drawn and the areas under the curves (AUCs) of 10-year follow-up evaluation were calculated. Results: In all, 110 women were studied. Eight patients had LR (7.3%), five being invasives (62.5%) and three in situ (37.5%). LRs occurred in 6.2% and 12.7% of patients who were classified as high risk by the original and by the modified nomogram, respectively. The AUCs were compared. The modified MSKCC DCIS nomogram is warranted for the 10-year risk LR prediction, and it may reinforce RT indication. Conclusion: The modified MSKCC DCIS nomogram may identify patients with DCIS treated by BCS with a high probability of LR and, therefore, may individualize RT recommendation.

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