Abstract Introduction: Cystic breast cancer is a rare entity. Breast cysts are most often benign. The clinical characteristics of malignancy are not specific. Objective: To report a series of malignant cystic tumors of the breast and to describe their different characteristics. Materials and Methods: This was an observational study carried out between January 2018 and October 2021 at the Dakar university surgical oncology unit. We studied the clinical appearance, imaging, histopathology, extent of disease and treatment. We did not include cases of pure, single, or multiple chronically progressive cysts. Results: There were 8 patients, 6 women and 2 men. The average age was 44. All patients presented with a palpable unilateral deforming skin mass without inflammatory character. One patient presented with a bloody discharge. The cyst was multilocular with out intracystic growth in 2 cases and presented a growth signal in 6 cases. Imaging was ACR 3 in 5 cases and ACR 4 in 3 cases. Histopathology found 6 invasive carcinomas including 2 papillary, 3 Invasive Carcinoma of No Special Type (ICNST), 1 lobular carcinoma as well as one case of lobular carcinoma in situ of the come do carcinoma type in women and 2 ICNST in men. The extension workup was found in only 1 male patient in the presence of metastases. Treatment included chemotherapy, mastectomy and radiotherapy for 6 of the patients. There wasn’t any complete response for invasive cases. Survival is 100% to date. Conclusion: Cystic breast tumors sometimes hide the cancer that is difficult to diagnose. The prognosis seems favorable, however.

Abstract The intercostobrachial nerve (ICBN) is responsible for the sensory innervation of a part of the inner side of the arm. Injury of the intercostobrachial nerve is a complication of axillary dissection during lymph node dissection. Objective: This study aimed to determine the effect of preservation of the intercostobrachial nerve on postoperative sensory disturbances. Methods: This is a prospective, single-center study which was carried out in 90 patients followed in the oncology department of the Aristide Le Dantec hospital in Dakar, suffering from breast cancer and having undergone breast surgery associated with axillary dissection, for a period of 6 months. The patients were divided into two groups depending on whether the intercostobrachial nerve (ICBN) was preserved or not. The two groups were compared in terms of the incidence of sensory disturbances. Results: Sixty patients without nerve preservation and 30 patients with nerve preservation were included in the study, i.e., 90 patients in total. ICBN was injured in 60 patients of which 41 patients (83.7%) developed numb ness in the inner arm. While in the preserved group, only 8 patients suffered from numbness (16.3%) with a significant P value of 0.002; however, for other variables such as the incidence of neuropathic pain and hypoesthesia-like sensory deficit, there was no significant difference. Conclusion: Preservation of the inter costobrachial nerve during axillary dissection for breast cancer reduces the incidence of sensory disturbances on the upper limb.

Abstract Introduction: Breast cancer remains a public health problem due to its severity and because it is the leading cause of death from cancers in women world wide as well as in Cameroon. Our objective was to study the diagnostic and therapeutic options that patients followed for breast cancer choose in Yaounde. Method: This was an analytical cross-sectional study with prospective data collection among patients followed for breast cancer at two referral hospitals in Yaounde from February 1, 2019 to August 31, 2019. Data collected were recorded and analyzed using R application version 3.5.0., p values < 0.05 were considered to be statistically significant. Results: A total of 105 patients were recruited, including 104 women and 1 man. The median age was 46 years with extremes of 25 and 77 years. Most patients (71%) had a monthly income of less than 175 USD. Patients in this study had opted for: contemporary medicine (49.5%), therapeutic abstention (38.1%), naturopathy (1.9%), self-medication (9.5%) and traditional medicine (1%). The factors significantly associated with the choice of contemporary medicine as a first diagnostic option were monthly income above 175 USD (OR = 0.37, 95% CI: 0.15 - 0.89, p = 0.028), good level of education (OR = 0.37, 95% CI: 0.16 - 0.82, p = 0.034) and good knowledge about breast cancer (OR = 0.28, 95% CI: 0.08 - 0.89, p = 0.005). The majority of patients (65.7%) sought contemporary medicine as the first therapeutic option after a diagnosis of breast cancer was confirmed, while about a third of them had chosen alternative treatment options including naturopathy (15.2%), traditional medicine (9.5%), religious practices (4.8%), therapeutic abstention (2.9%) and self-medication (1.9%). Conclusion: The first diagnostic and therapeutic choices of breast cancer patients in our setting are numerous and intricate, including contemporary medicine, therapeutic abstention, self-medication, traditional medicine, naturopathy and religious practices. There is a need to promote breast cancer awareness in our population.

Abstract Cystic lesions are very commonly encountered entities in the breast. Among these, Complex Cystic Breast Masses (CCBMs), which contain both anechoic and echogenic components, can result in a variety of imaging appearances. These include cystic lesions with thick walls and/or internal septa, intra cystic nodular lesions, and solid-cystic masses of varying compositions. Ultrasound is the mainstay for evaluating cystic lesions, and thus recognizing the imaging features appropriately and suggesting suitable interventional procedures are included in their management. In this pictorial essay, we describe the wide range of ultrasound appearances of CCBMs with a number of clinically encountered examples from our institution. This article would enhance the understanding of readers in possible differentials to be included in their clinical practice and to suggest appropriate further intervention, when deemed necessary.

Abstract Background: Triple negative breast cancer (TNBC) tends to present aggressively with rapid progression and poor survival. Methods: We retrospectively reviewed patients’ files to define TNBC patients’ characteristics, predictive and prognostic factors, pattern of recurrence and survival. Results: 965 cases were identified. 147 patients (15.2%) were TNBC. 71.1% patients were premenopausal. T2, T3, T4 tumors represented 46.1%, 32% and 14.1%, respectively. N0, N1, N2, N3 disease represented 18.5%, 50.9%, 27.8% and 2.8%, respectively. Stages II, III & IV constituted 34.1%, 44.2% and 15.5%, respectively. 31.5% patients received neoadjuvant chemotherapy with 17.7% complete pathological response. 19.5%, 35.9%, 44.6% patients had unknown, ≤20 and >20 Ki67, respectively. Among non-metastatic patients (n = 108), 21.3% patients developed relapse with median time to relapse of 11 months. 78.3% of them had visceral (88.3% lung) metastasis, 13% bone metastasis, 21.7% brain metastasis and 13% LRR. There is significantly high risk of relapse in patients with large tumor size [T4: 66.75%, T3: 22.9%, T2: 16.7%, T1: 0% (p = 0.002)], positive LNs [N3: 100%, N2: 37.9%, N1: 15.1%, N0: 4.3% (p < 0.001)] and Ki67 [>20: 31.6% versus 10.8% for Ki67 ≤ 20 (P = 0.007)]. Multivariate analysis revealed only T4 and N2-3 were significantly associated with high probability for relapse (P = 0.022 & 0.038). The 3-year DFS and OS were 73.2% and 75% respectively. For metastatic patients (n = 20), the m PFS was 7 months and m OS 1.5 years. Conclusion: Our data confirms the aggressive nature of TNBC with significant risk of relapse for patients with large tumor and positive lymph nodes. Maintenance metronomic capecitabine, neoadjuvant/adjuvant immunotherapy could be beneficial for non-metastatic patients. Lungs and brain were the most common sites of distant failure with poor survival that necessitates administration of molecular biomarkers (BRCA mutations, PD-L1 expression and microsatellite instability) for patients’ selection for novel targeted therapy.

Abstract The coexistence of tuberculosis with axillary lymph node metastases in breast carcinoma is rare. Axillary lymph node metastasis is the most important factor in the staging of breast carcinoma, and the number of axillary lymph nodes metastasizing changes the stage. Since tuberculosis also produces lymph node enlargement, this can mimic or complicate the staging of a malignant disease. Dual organ pathology can lead to interpretation difficulties and inappropriate treatment of tuberculosis as well as breast carcinoma. Additionally, fine needle aspiration cytology (FNAC) of such cases can be misleading if only one of the diseases is detected. We report two cases of infiltrating carcinoma of the nonspecific type of the breast in two women aged 35 and 55 where tuberculosis was found in the axillary lymph nodes in addition to metastases. As the present case led to the fortuitous discovery of tuberculosis with tumor metastasis, it reinforces the possibility of a coexisting lesion in the minds of pathologists, especially in areas endemic to tuberculosis.

Abstract The high incidence of breast cancer poses one of the greatest risks to female health worldwide. Sentinel lymph node biopsy (SLNB) is the standard of treatment for patients with axillary lymph node-negative early-stage breast cancer. Herein, the precise use of tracers is the key to ensuring the success of SLNB. However, owing to select-few limitations of traditional tracers, their clinical application is limited. New tracer techniques, such as the near-infrared fluorescent dye method (using indocyanine green), contrast-enhanced ultrasound, and superparamagnetic iron oxide nanoparticles are being applied in clinical practice. In this paper, we review the recent progress in SLNB tracer technology.

Abstract Purpose: The effect of manual lymphatic drainage in patients with breast cancer is controversial. The purpose of this study is to evaluate the role of manual lymphatic drainage (MLD) in breast cancer-related lymphedema treatment. Methods: The electronic databases of EMBASE, PubMed, Web of Science, and The Cochrane Library were searched to find English articles on MLD which were published before January 2020. After two evaluators selected the studies and independently evaluated literature quality, meta-analysis was carried out with RevMan 5.3 software. The outcome index of lymphedema treatment changed in edema volume. Results: The study included six RCTs of 364 patients and the meta-analysis showed no significant difference in the effect of MLD for BCRL compared with other treatments (mean difference, 3.76; 95% confidence interval, −35.09 to 42.62; Z, 0.19; p = 0.850). Conclusion: MLD can relieve the body tissue, rapidly improve local condition, and enhance complete decongestive therapy (CDT) efficacy. MLD can prevent BCRL and improve the symptoms of stage I lymphedema. It should be widely applied to prevent BCRL from entering an irreversible state.

Abstract Purpose: To explore the effect of comprehensive intervention based on transition theory in enhancing the readiness for discharge of post-operative breast cancer patients. Method: In a non-simultaneous controlled study test, 99 post-operative breast cancer patients hospitalized between August 2019 and February 2020 were selected as the control group and 93 post-operative breast cancer patients hospitalized between March and August 2020 were selected as the test group at a Grade A tertiary tumor hospital. While the control group used the conventional care model, the test group added a comprehensive intervention based on transition theory to the routine nursing, which focused on stimulating patients’ awareness of health transitions, assisting patients to identify health critical events, strengthening social support and promoting self-management. The differences between the two groups were compared in terms of patient readiness for discharge and patient evaluation of the quality of discharge teaching. Result: The total score of readiness for discharge was higher in the test group than in the control group (171.7 ± 24.5 vs. 155.9 ±28.9) and the scores for “Self-condition” (55.6 ± 8.2 vs. 50.8 ± 9.7), “Disease Knowledge” (64.7 ± 13.1 vs. 57.7 ± 13.8), “Coping Ability after Discharge”(24.6 ± 4.8 vs. 22.2 ± 5.6), “Expected Social Support after Discharge” (26.8 ±4.5 vs. 25.2 ± 4.8) were higher than those of the control group, and all differences were statistically significant (p < 0.05). The total score of the test group on the quality of discharge teaching scale was higher than that of the control group (162.1 ± 19.9 vs. 152.6 ± 28.7), and the scores for “Content that Patients Self-perceived they required before discharge” (53.2 ± 9.5 vs. 49.4 ± 12.1),“Content that Patients Actually Acquired before Discharge” (51.2 ± 9.2 vs. 48.3 ± 11.3) and “Guiding Skills and Effects of Discharge for Nurses” (110.9 ± 12.6 vs. 104.3 ± 19.00) were also higher than those of the control group (p < 0.05). Conclusion: Comprehensive intervention based on transition theory for post-operative breast cancer patients is beneficial to improve the quality of discharge nursing guidance, thereby improving the readiness for discharge of patients and enhancing the sense of control and identity of patients after discharge.

Abstract Breast cancer stem cells (BCSCs) are a small subpopulation of cancer cells having the ability of self-renewing and multi-lineage differentiation, which have also been termed as “tumor-initiating cells”. And in recent years, the role of epithelial mesenchymal transition (EMT) in malignant tumors has been valued. This paper will briefly review and discuss the relationship between BCSCs and EMT.