Introduction: Breast cancer occurring bilaterally in men is extremely rare. Breast cancer represents 1% of all cancers, while bilateral cancer represents 5% of a total number of patients with breast cancer, which may be synchronic or metachronic. Many cases of breast cancer in men are detected between 60 and 70 years, with an average of 67 years of age. In men there is a tendency for late diagnosis at a more advanced stage than in women. Case report: A male patient, JSS, 68 years old, from Afogados da Ingazeira, state of Pernambuco, was seen with breast tumoration in June 2016. He arrived at the service with an existing diagnosis of breast cancer through core-biopsy examination. The physical exam presented bulging in the left retroareolar region and a hardened tumoration in palpation. Radical mastectomy was performed. The histopathological results confirmed an invasive mucinous carcinoma with histological grade I, nuclear grade II and mitotic grade I. Free margins. The most frequent histological type in men is ductal (85%–90%), followed by papillary in 4.5% and mucinous in 2.8% of the cases. Nineteen free axillary lymph nodes were dissected, with Estrogen and Progesterone + receptors, Her-2, negative and with Ki-67 of 5%. Breast cancers in men present with more positivity for hormone receptors and low expression for Her-2. The pathological staging was classified as II a. The patient was being followed by the clinical oncology department, where he was chosen not to do chemotherapy and only hormone therapy, with Tamoxifen 20 mg. However, over a period of six months he noticed the presence of a tumoration in the right breast. An image examination was performed with MG/USG, which confirmed the presence of a tumor in the right retro-areolar region (Birads IV). A core-biopsy of the lesion was requested, which confirmed an invasive breast cancer. The patient underwent right radical mastectomy, whose result confirmed an invasive ductal carcinoma with pathological staging II a. Conclusion: This pathology is extremely rare in men and the evaluation of the contralateral breast is of fundamental importance. Early diagnosis and compliance with treatment will reduce tumor recurrence and provide a better prognosis for these patients.
Introduction: Breast angiosarcoma is very rare and highly aggressive. It has an incidence of 0.5% to 1% of cases and its presentation is typically in women between 14 and 82 years of age with an average age that revolves around 35 years. Breast angiosarcoma presents clinically as a unilateral, softened tumor with ill-defined borders and skin thickening, with a variable growth rate. However, if compared to epithelial breast cancer, angiosarcoma has a faster growth rate. The second is known as stromal sarcoma, fibrosarcoma, leiomyosarcoma, histiocytoma, and giant cell sarcoma. Regarding adjuvant therapy, chemotherapy and radiotherapy, they present an ineffective response. The effective treatment to offer a chance of healing is a broad surgical approach. Case report: Female patient U..S., 35, from Paulo Afonso, state of Pernambuco, complaining of a left breast nodule. She had a tumorectomy in her city, due to fibroadenoma and phyloid tumors with atypia and mitosis. In our service, she underwent a series of tests, where mammogram/ultrasonography confirmed the presence of a 1.5 cm nodule in the left breast.She underwent a new segmental resection surgery, whose histopathology confirmed a low-grade malignant cystosarcoma phyllodes and exiguous margins.A new surgical proposal was discussed with the patient – a simple mastectomy with immediate reconstruction with silicone breast implant and latissimus dorsi flap. The surgery was performed and the histopathological result was the absence of residual neoplastic tissue, with an area of scar fibrosis and usual ductal hyperplasia. After her recovery, the patient was referred to clinical oncology and radiotherapy, but both had no indication for adjuvant therapy. After one year, the patient returned to undergo symmetrization of the opposite breast and reconstruction of the nipple-areolar complex. After two years, the patient returned with a breast US, which demonstrated a nodular image of 1.5 cm adjacent to the breast prosthesis and an MRI suggested the same image. A core biopsy was performed, which confirmed a malignant variant recurrent tumor. The tumor evolved very quickly and the surgery was performed with an enlarged resection of the entire pectoralis large and small and skin inclusion. To correct the deformity, we used the rotation of the great epiploon with the lower abdominal dermocutaneous flap.
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