Younger age and not having nodal evaluation at the time of surgery are associated with decreased OS in AYA male patients with invasive cancer. This highlights the need to perform axillary node sampling through sentinel node biopsy at the time of mastectomy in these young male patients.

Cite this article as: Bawa R, Matemavi P, Maizlin I, Sung KJ. Ductal carcinoma in-situ in Turner syndrome patient undergoing hormone replacement therapy: A case report. Int J Cancer Ther Oncol. 2016; 4(1):4113. Abstract Turner's syndrome is a rare congenital disease which affects about 1 in every 2500-3000 live-born females. This happens due to chromosomal abnormalities in a phenotypic female, causing increased gonadotropin concentrations and low concentrations of estrogens from infancy. As a result, hormone replacement therapy is started in most adolescent Turner syndrome patients to initiate and sustain sexual maturation. Accordingly, most Turner's syndrome patients undergo several decades of estrogen replacement therapy, from puberty to post-menopausal age. The highly publicized findings of the Women's Health Initiative have called into question the appropriateness of hormone replacement therapy in adolescents with Turner's syndrome. Those concerns were mostly theoretical extrapolations, as few prospective studies of cancer occurrence in women with Turner syndrome have been reported. Consequently, several recent publications have challenged those extrapolations, based on the assertion that the levels of hormone replacement in Turner syndrome patients are well below the physiologic levels observed in normal menstruating women, as well as the fact that these women are significantly younger than those studied by the Women's Health Initiative. In discord to those reports, we present a case of ductal carcinoma in-situ in a 40-year-old Turner patient, who had undergone over two decades of combined hormone replacement therapy. The patient underwent an elective excisional biopsy for a palpable mass, with histopathology revealing a complex fibroadenoma with a nidus of ductal carcinoma in-situ. The lesion was noted to be estrogen receptor positive and progesterone receptor negative, with heavy staining for HER-2/Neu receptor. The patient was treated with tamoxifen. While a rare case, it is imperative for the astute clinician to keep in mind the consequences of long-term hormone replacement therapy in Turner's syndrome patients in order to avoid missed diagnosis of breast cancer for optimum management of these patients.

Background: The purpose of this study was to evaluate the perceived efficacy of a daily surgical morning report meeting on improved physician communication, and as a means of evaluating resident performance of the ACGME core competencies. Methods: Anonymous web-based surveys of involved house staff were given before and after the implementation of the surgical morning report meeting. This study was conducted at New York Hospital Queens in Flushing, New York. This institution is a university-affiliated community teaching hospital. Surgical house staffs present at the morning report meeting were surveyed. Results: The majority of surgical house staff surveyed believed that this meeting improved the quality of hand-offs and communication between shifts. The presence of a faculty member, review of radiological studies, and case discussions were perceived as important elements. This meeting allowed an ongoing assessment of resident performance in several important core competencies. Conclusion: Morning report is a valuable addition to surgical training programs, in that it improves Communication and hand-offs between resident shifts. The meeting provides an additional point of measurement of resident performance of the ACGME core competencies.

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