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Necrotizing fasciitis is a rare but potentially lethal infection of the skin and soft tissue, commonly seen in the perianal and gluteal regions. Concomitant diabetes is a predisposing factor. Primary necrotizing fasciitis of the breast is rare in healthy women. In this article, we present a very rare case of breast necrotizing fasciitis in the context of the literature. We report the case of a 35-year-old female patient who had given birth two months prior to admission and developed necrotizing fasciitis of the breast during lactation. The patient presented to the emergency department with sepsis. Examination revealed widespread erythema, dark discoloration, edema, and necrotic areas indicative of wet gangrene and crepitation in the left breast. Necrotizing fasciitis is a rapid and aggressive disease that can be fatal, and delayed diagnosis may unfortunately result in death. Therefore, careful evaluation of all suspected cases, especially for patients with risk factors, is crucial for early diagnosis and timely treatment. This case highlights the importance of recognizing necrotizing fasciitis of the breast in lactating women to ensure prompt and appropriate management, potentially saving lives.

Objective: Among women, breast cancer (BC) is the most prevalent form of cancer. Many molecular targets have been discovered for BC prognosis and treatment. However, new markers still need to be identified, as cancer pathogenesis is triggered by different mechanisms. The aim of this study was to examine the changes in the paraoxonase genes (PON1, PON2, and PON 3) involved in the pathogenesis of BC. Materials and Methods: The characteristics of the mutations were evaluated with the Cbioportal database. Kaplan-Meier Plot evaluated recurrence-free survival (RFS). The UALCAN database determined the promoter methylation. Gene expression was evaluated by GEPIA2.0 database. Results: PON1 harbored the most mutations. There was a significant decrease in PON3 expression levels in BC samples compared with healthy samples. PON1 and PON2 expression levels did not differ between BC tissue and normal adjacent tissue. Elevated expression levels of PON1 and PON2 genes were correlated with longer RFS, whereas reduced expression of the PON2 gene showed an association with longer RFS. Moreover, the promoter regions of PON1 and PON 3 were found to be hypermethylated, while the promoter region of PON 2 was found to be hypomethylated. The PON3 promoter region was significantly hypermethylated in luminal and human epidermal growth factor receptor 2 (HER2) + BC subtypes. However, the PON3 promoter region was significantly hypomethylated in the triple negative breast cancer (TNBC) subtype. Conclusion: These results suggest that methylation and expression status of PON3 in BC and BC subtypes (TNBC, luminal and HER2) may indicate a poor prognosis. The PON3 gene could be a negative prognostic marker in BC. However, the results should be supported by prospective studies.

Abstract Background Functional status of T cells determines the responsiveness of cancer patients to immunotherapeutic interventions. Even though T cell‐mediated immunity is inaugurated in the tumor‐adjacent lymph nodes, peripheral blood has been routinely sampled for testing the immunological assays. The purpose of this study is to determine the immune checkpoint molecule expression and the exhaustion‐related phenotype of cytotoxic T cells in the regional lymph nodes from breast cancer patients. Patients and methods Multicolor immunophenotyping was used to determine the expression of PD‐1, TIM‐3, LAG3, CTLA‐4, CCR7, CD45RO, CD127, CD25, CXCR5, and ICOS molecules on CD3+CD4−CD56−CD8+ cytotoxic T cells freshly obtained from the lymph nodes and the peripheral blood samples of the breast cancer patients. The results were assessed together with the clinical data. Results A population of cytotoxic T cells was noted with high PD‐1 and CXCR5 expression in the lymph nodes of the breast cancer patients. Co‐expression of PD‐1, CXCR5, TIM‐3, and ICOS indicated a follicular helper T cell (Tfh)‐like, exhaustion‐related immunophenotype in these cytotoxic T cells. Only a minor population with CTLA‐4 and LAG3 expression was noted. The PD‐1+CXCR5+ cytotoxic T cells largely displayed CD45RO+CCR7+ central memory markers. The amount of CXCR5‐expressing PD‐1− cytotoxic T cells was elevated in the lymph nodes of the patients. Conclusion The regional lymph nodes of breast cancer patients harbor Tfh‐like exhausted cytotoxic T lymphocytes with high PD‐1 and TIM‐3 checkpoint molecule expression. The immunological conditions in the regional lymph nodes should be implicated for immune checkpoint immunotherapy (ICI) of cancer.

Objective:Breast cancers in women with low serum adiponectin levels have been reported to show phenotypes that are more aggressive. In 2008, we investigated the relationship between serum adiponectin levels and breast cancer in our case-controlled study involving 83 patients, in which serum adiponectin levels were measured preoperatively. In this study, we aimed to investigate the relationship between serum adiponectin levels and breast cancer-specific survival among these 83 patients.Materials and Methods:All 83 patients with stage I-III breast cancer, whose adiponectin levels were measured preoperatively in 2008 were enrolled in this study. The patients had no history of medications influencing insulin resistance prior to collecting the blood samples. Serum adiponectin concentrations were measured after overnight fasting (≥12 hours) by drawing a venous blood sample of 30 mL from the arm. ELISA (B-Bridge Human Adiponectin ELISA kit) was used for testing.Results:The mean adiponectin level was found to be 15,300 ng/mL. When the adiponectin levels of the patients were analyzed according to the stage of the disease, adiponectin levels tended to be significantly lower as the stage increased. The stage of the disease was an important determinant for both Diseas Free Survival (DFS) (p=0.003) and Overall Survival (OS) (p=0.005). A significant relationship between adiponectin levels and OS was also observed (p=0.025), and levels of adiponectin above the mean value of 15,300 ng/mL were associated with improved DFS (p=0.001).Conclusion:Preoperative adiponectin levels may be useful to predict survival rates in breast cancer or may be used as a marker/predictor for defining patients who require more aggressive treatment. In order for adiponectin to be used as a practical clinical marker for breast cancer, large database studies are should be conducted.

Objective:Breast cancer subtypes are used as prognostic and predictive factors considering the genomic profile of the disease. This study is designed to investigate the Sentinel Lymph Node (SLN) detection rate in breast cancer for different biological characteristics.Material and Methods:Patients on whom we performed the methylene blue method alone were named as Group I, radiocolloid substance method alone as Group II and both methylene blue and radiocolloid method as Group III. The results of biological tumor characteristics and characteristics of the patients on different SLN biopsy techniques were investigated.Results:The overall SLN detecting success rate was 83.3%. When considered for each group, success rate was 80% for group I, 84.9% for group II and 90.6% for group III. While a success rate of 94.6% was achieved with radiocolloid only in the patients in Luminal A and B subgroup, 90% success rate was achieved in Her2 (+) and triple negative (TN) patients with combined method.Conclusion:While successful results could be achieved by using radiocolloid substances alone in patients with Luminal A and B subtypes, combined methods should be used in HER2 (+) and TN patients.

Objective:Invasive lobular carcinoma (ILC) of the breast makes up 5 to 15 percent of all invasive breast cancers. It has distinctive clinical and histopathological features when compared to invasive ductal carcinoma (IDC). This study intends to describe factors influencing sentinel lymph node (SLN) positivity in patients with “pure” ILC.Materials and Methods:Data of 105 patients, who were treated at a tertiary oncology center, with lobular carcinoma of the breast that were subjected to SLN biopsy was probed retrospectively. Patients were categorized as ≤60 and >60 years of age, positive or negative for estrogen receptor and progesterone, tumor grade I, II and III, Ki67≤15% and >30%, lymphovascular invasion presence and the presence of multicentricity and multifocality.Results:Mean age at the time of diagnosis was 52 (38-81). Mean tumor size was 2.7 cm (0.7-13cm). Univariate analyses revealed a significant relationship between tumor size (≤2 cm vs >2cm) and metastasis in the SLN. This relation kept its significance in multivariate analyses. (p=0.013).Conclusion:With so many different characteristics from IDC, ILC is mostly a uniform tumor. In this study, tumor size was the only independent clinical parameter that was found related to SLN metastases.

Objective: Omitting axillary lymph node dissection (ALND) in a subgroup of patients with sentinel lymph node (SLN) metastasis is becoming a widely accepted practice. Avoiding the well-known complications of ALND is the sole aim without compromising the curative intention of surgery.Materials and methods: The data were probed for breast cancer patients that were operated on between February 2014 and June 2016. SLN biopsies were performed in 507 patients and out of 157 patients who underwent ALND for a metastatic SLN, 151 were found eligible for the analyses as having macrometastatic (>2mm) SLN. MD Anderson, Memorial Sloan Kettering Cancer Center and Helsinki nomograms were also tested in our patient population.Results: Pathologic tumor size greater than 2 cm, the ratio of metastatic SLN to dissected SLN, metastatic tumor greater than 1 cm and tumors that extended outside the SLN’s capsule were found to be associated with non-sentinel node metastasis in both univariate and multivariate tests. MD Anderson nomogram performed well with an area under the curve (AUC) value of 0.72.Conclusion: Our results suggest that ALND should be considered in patients with macrometastatic SLN greater than 10 mm in size, have extracapsular extension, have metastatic SLNs at a rate of more than 50% and whose primary tumor is greater than 2 cm.

The Oncoplastic and Reconstructive Breast Surgery course was held in Izmir by the Izmir Breast Diseases Federation in collaboration with the Breast Diseases Federation of Turkey. The techniques of oncoplasty, the application details and experience in this subject were shared. In this text, the main topics and outcomes are briefly summarised. These evaluations can be considered highly valuable on both local and regional scales.

Objective:General surgeons’ approaches to breast masses in their daily practices and their perspectives for issues on breast diseases and breast surgery are investigated through a survey.Materials and Methods:Answers of 524 general surgeons for the survey “Approach to breast diseases and breast surgery” between November 2012 and February 2013 were assessed. Demographic features, approaches to the breast masses, and answers for the clinical scenerios of surgeons were questioned. Surgeons were asked about management of breast cancer and the future role of surgeons for oncoplastic breast surgery and breast diseases.Results:Participants were representing 14.6% of all general surgeons in Turkey. The survey revealed that breast diseases are the most common cause for admission in general surgery outpatient clinics. Needle biopsies were employed by 241 (60%) respondents. Three hundred and seventy-one (71%) participants indicated that breast cancer management could be accurately conducted by the general surgeons. Two hundred and seventy-three (52%) respondents think that oncoplastic breast surgery should be performed by a general surgeon and 241 (41%) respondents predict that the role of general surgeons for breast diseases and breast surgery will decrease in the future.Conclusion:Basic approaches towards breast masses need to be improved in our country despite the highest frequency of breast diseases in outpatient admissions. The views and opinions of surgeons on breast diseases and the course of breast surgery in different regions and different communities need to be defined and clarified.

Phyllodes tumors are fibroepithelial lesions and malign forms are rare neoplasms with lower than 1% of all primary breast tumors. Malign forms are usually behaves like sarcomas because they occur in the stroma of the breast. Also proliferation of epithelium occurs and even it is less often, the epithelial component of phyllodes tumors can transform into malignancy too. This epithelial malignancies are usually in the form of infiltrative carcinomas and non-invasive tumors arising in benign phyllodes tumors are much rarer but can be seen. Literature include very few cases about this situation and cases are usually old woman. We report a 19-year old patient who was diagnosed with ductal carcinoma in situ arising in benign phyllodes tumor of the breast.

Complications of modified radical mastectomy operation are bleeding, infection, necrosis and seroma. Most common complication is seroma. Evidence of seroma causes infection and increases the risk of necrosis, also increases the time of flep adjusting to chest wall and length of hospitality. We started this randomised prospective study at January 1999. Candidates of modified radical mastectomy in our clinic has been divided into two groups (decided by the usage of silicon and PVC drainage systems) (Group 1: PVC, Group 2: Silicon). For homogenisation of each group; patients who has body-mass index higher then 30 %, systemic diseases like diabetes, Neoadjuvan chemotherapy, and patients who has chestwall anomalies were excluded from the study. Overall drainage volume, evidence of infection and necrosis, and removal time of drainage system was noted. Indications of removing the drainage system for both group were; daily drainage volume under 50 ml, evidence of infection and daily drainage over 50 ml for 9 days. Mean drainage volumes of Group 1 and Group 2 were 985.4 ml and 639.1 ml, respectively. Infection was observed in 13 patients in Group 1, and 4 patients in Group 2. Evidence of necrosis was observed in 3 patients in Group 1, and none in Group 2. Group 1 and Group 2 median removal time of drainage was 6.25 and 5.18 days, respectively. Statistical significant differences was present. After examining these results, we decided the usage of closed silicon drainage systems after modified radical mastectomy operation decreases the complications of operation.