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To analyze the litterature data concerning the results of the main international randomized trials of adjuvant Aromarase Inhibitors (AI) in adjuvant setting for early breast cancer and the impact on daily practice in the management of breast cancer.We selected through a litterature review 30 publications concerned the topic of AI RESULTS: They concerned the large ATAC, BIG, MA17 and IES concerning anastrozole, letrozole and exemestane . AI have been compared to tamoxifen in upfront of swich intents and showed a superiority to reduce, mortality rate, controlateral breast cancer risk, a better tolerance profile compared to tamoxifen and a sigificant benefit in term of disease-free survival. These results made a revolution in the adjuvant BC treatment, leading to the systematic use of upfront AI in menopaused patients.Adjuvant hormonotherapy in menopaused patients is now based on AI and proved its superiority to tamoxifen in term of distant, controlateral risks reduction and disease-free survival, less for overall survival.

Sternal arch is a nonspecific clinical signs wich may arise during following of breast cancer, this sign reveals an involvement of internal mammary nodes secondary to breast cancer.To report a rare event such as a loco-regional sternal or parasternal invasion secondary to locally advanced cases of breast cancer (BC) about a Tunisian series.We collected retrospectively from 1988 to 2012, 11 cases of BC treated at the Institut Salah Azaiez (ISA) of Tunis, with presence during the disease evolution (initial or at relapse) of a sternal or parasternal swelling. We analyzed their clinical history, clinical and imaging data (CT-scan and/or MRI), stage, time of occurrence, treatment and evolutionAll patients were females and their mean age was 46 years varying from 24 to 75 years. The sternal or parasternal swelling was found at diagnosis in 5 cases and on recurrence in 6 patients after a mean free interval of 24 months,12 months in 5 cases. The mean clinical tumor size of the primitive BC was 38 mm (24-75 mm) and lesions located in external quadrants in 3 cases and internal or central in 6 cases. Sternal involvement related to large Intrammmary Chain (IMC) adenopathies was diagnosed by CT-scan. 7 patients had synchronous metastases. 9 out of the 11 patients received a locoregional RT and two received chemotherapy (CT).Sternal or parasternal swelling is a clinical apparent symptom of advanced internal mammary lymph nodes in breast cancer. The first etiologic diagnosis in this context is an advanced internal mammary chain (IMC) node involvement from breast cancer.

Trastuzumab is humanized monoclonal antibody targeting her 2 neu receptor, overexpressed in 20% of breast cancers and part of the complex of Epidermal Growth Factor Receptor.To review new advances in the knowledge of the practical use of "trastuzumab (Herceptin ®)" in breast cancer.Review of literature using medical data bases (Medline, Science direct) with the following key words: breast cancer, targeted therapy, HER2 neu, transtuzumab/herceptineTrastuzumab represent an important advance in breast cancer treatment with an improvement of median survival in metastatic setting and overall and disease-free survival in adjuvant setting in association with chemotherapy. Herceptin remain well tolerated with a low and rare risk of cardiac failure.Trastuzumab is a new therapeutic tool very interesting to ameliorate prognosis of breast cancer.

The association of superior vena cava syndrome with involvement of the internal mammary lymph nodes in breast cancer has not been reported in the literature.To report two cases of association of superior vena cava with involvement of the internal mammary lymph nodes in breast cancer.We report two observations in two patients 45 and 52 years with breast cancer classified T4N2M0 and T3N2M0 treated. Both patients had clinical features compatible with the diagnosis of superior vena cava confirmed by the initial clinical appearance (observation 1) and after treatment (observation 2) to the CT scan.The combination of superior vena cava with the achievement of the internal mammary chain in breast cancer worse prognosis.