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Idiopathic granulomatous mastitis (IMD) is a chronic benign inflammatory disease of the breast which can mimic breast cancer. It is more common in young women of childbearing age and poses a challenge in diagnosis of inflammatory breast tumor. We report the case of a 26-year-old female patient who presented with inflammatory breast. Clinical examination showed apyretic patient with edematized and painless irregular smooth mass in the left breast measuring 4 cm surmounted by crusts and multiples fistulizing scars discharging pus by applying pressure, with mobile ipsilateral axillary adenopathy. The remainder of the physical examination showed inflammatory erythematous patches on both legs. A mammogram plus breast ultrasound was performed followed by biopsy that objectified fibrous mastopathy. Lumpectomy was performed due to the persistence of symptoms. Anatomopathological examination objectified granulomatous mastitis. Etiological research didn't identify a clear cause. Corticotherapy associated with antibiotic therapy was started with complete regression of symptoms after two months. [ABSTRACT FROM AUTHOR]

Objectives: Breast surgery is the cornerstone of breast cancer treatment. Its indications and procedures are constantly evolving. To update best practices, four questions were submitted to the Senology Commission (SC) of the Collège national des gynécologues et obstétriciens français (CNGOF), covering the indications and modalities of tumor surgery: (1) initially, (2) following neoadjuvant systemic treatment, (3) in case of local recurrence, and (4) the quality and safety of care indicators applicable to this surgery., Methods: The CNGOF SC essentially based its responses on the clinical practice recommendations and guidelines of the French Cancer Institute concerning invasive carcinomas of the breast. Exclusion criteria were carcinoma in situ, sarcoma and axillary surgery., Results: To define the type of breast surgery, knowledge of four parameters is essential: the patient's level of risk, the presence of metastases, the size of the breast tumor and its focality (assessed by the clinical/mammography/ultrasound tripod). (1) In the case of initial management, the 6 indications for mastectomy are patient choice (particularly in case of high risk), contraindication to radiotherapy, inflammatory cancer (T4d), surgery with positive margins (after several surgical intervention), surgery that cannot be performed as a monobloc in the case of tumors with multiple foci, and poor expected aesthetic results. All other situations should be treated conservatively. (2) The same criteria apply after neoadjuvant systemic treatment, with conservative treatment still possible whatever the size (excluding carcinomatous mastitis) and focality of the initial tumor. (3) In case of local recurrence, total mastectomy is the reference treatment, with a second conservative treatment reserved for patients with no risk factors for a second recurrence, and no poor prognostic factors, after validation in a multidisciplinary meeting. (4) Four quality and safety indicators apply to breast surgery: it must be performed after obtaining a histological diagnosis, within less than 6 weeks of mammography, in a single surgery in over 80% of cases, and followed by local radiotherapy in the case of conservative treatment., Conclusion: The indications and modalities of breast surgery are evolving rapidly. To improve aesthetic results, oncoplastic techniques, immediate breast reconstruction, and preservation of the skin or nipple-areolar complex need to be further developed and evaluated in the long-term. These developments must necessarily be accompanied in France by a training policy for breast surgeons., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé Le vert d’indocyanine est un colorant soluble dans l’eau, à élimination hépatique et excrétion biliaire. Illuminé par une source laser infrarouge, le vert d’indocyanine émet une lumière fluorescente dans le spectre du proche-infrarouge qui est invisible à l’œil nu mais qui peut être visualisée à l’aide d’une caméra proche-infrarouge. Lorsqu’il est injecté en intraveineux, il peut être utilisé comme marqueur de la perfusion cutanée. Injecté en sous-cutané, il permet de cartographier le réseau lymphatique. En chirurgie sénologique et en reconstruction mammaire, il est utilisé pour repérer le ganglion sentinelle chez les patientes atteintes d’un cancer du sein, pour évaluer la perfusion des lambeaux cutanés de mastectomie, pour évaluer la perfusion des lambeaux libres utilisés en reconstruction mammaire autologue et dans la prise en charge du lymphœdème secondaires des membres. Le vert d’indocyanine pourrait être enfin utilisé pour guider l’excision des tumeurs non palpables du sein. Summary The Indocyanine green (ICG) is a soluble dye that is eliminated by the liver and excreted in bile. When illuminated by an near-infrared light, the ICG emits fluorescence in the near-infrared spectrum, which can be captured by a near-infrared camera-handled device. In case of intravenous injection, ICG may be used as a marker of skin perfusion. In case of interstitial injection, it may be useful for lymphatic network mapping. In oncological and reconstructive breast surgery, ICG is used for sentinel lymph node identification, to predict mastectomy skin flap necrosis, to assess the perfusion of free flaps in autologous reconstruction and for diagnosis and treatment of upper limb secondary lymphedema. Intraoperative indocyanine green fluorescence might also be used to guide the excision of nonpalpable breast cancer. [ABSTRACT FROM AUTHOR]

Le lymphangiome orbitaire est une tumeur bénigne à développement progressif, qui se présente sous forme de vaisseaux à parois fines et à lumières dilatées complètement isolées de la circulation artérioveineuse. Le lymphangiome peut se localiser au niveau de la conjonctive, des paupières ou de l'orbite. A ce propos, nous rapportons un cas de lymphangiome orbitaire envahissant le globe oculaire et dont la présentation initiale mimait celle d'un rétinoblastome. Patiente âgée de 19 ans, se plaignant d'une exophtalmie droite et d'une baisse de la vision de l'éil droit évoluant depuis 4 ans. L'examen des annexes objectivait une exophtalmie majeure compliquée d'une ankylose du globe oculaire droit. La photographie du fond d'éil droit montrait la présence d'une masse rétinienne blanchâtre, associée à un essaimage vitréen fait de formations floconneuses. L'échographie oculaire en mode brillance montrait un épaississement hyperéchogène de la rétine. L'IRM orbito-cérébrale montrait une lésion kystique intra orbitaire en rapport avec un lymphangiome. Devant l'évolution longue de la maladie et l'aspect de la masse à l'imagerie, le diagnostic de rétinoblastome a été écarté. La patiente a subit une énucléation et une tumorectomie. L'étude histopathologique de la pièce opératoire a révélé un lymphangiome.

Les tumeurs para testiculaires sont des tumeurs rares et complexes qui ont une symptomatologie insidieuse et pauvre. Les formes bénignes représente 70%. Le lipome para testiculaire étant le type le plus fréquent. L'examen clinique est peu spécifique. L'examen échographique est la pierre angulaire pour assoir le diagnostic. Le traitement chirurgical s'impose en cas de tumeur symptomatique, l'histologie étant habituellement typique permet la confirmation diagnostique. Le pronostic est bon malgré d'éventuelles récidives.

Les tumeurs para testiculaires sont des tumeurs rares et complexes qui ont une symptomatologie insidieuse et pauvre. Les formes bénignes représentent 70%. Le lipome para testiculaire étant le type le plus fréquent. L'examen clinique est peu spécifique. L'examen échographique est la pierre angulaire pour assoir le diagnostic. Le traitement chirurgical s'impose en cas de tumeur symptomatique, l'histologie étant habituellement typique permet la confirmation diagnostique. Le pronostic est bon malgré d'éventuelles récidives. [ABSTRACT FROM AUTHOR]

Abstract: The quality of surgical margins in lumpectomy are strong criteria to define risk of locoregional recurrence when conservative treatment is undertaken. Intraoperatively, the limits of adequate resection are sometimes difficult to define. This is why some teams propose the realization of systematic cavity margins during the excision of lumpectomy during the same operation. We expose the potential benefits of this type of practice using data from the literature. [Copyright &y& Elsevier]

Abstract: Purpose of the study: The objective of this study was to compare prospectively the delineations of tumour bed after breast conserving surgery from two techniques for defining the target volume. Patients and methods: Sixteen patients treated by lumpectomy with development of surgical clips were included. For each patient, four radiation oncologists delineated the clinical target volume (CTV boost) following its own method (technique 1) or using a predefined methodology (technique 2), the diameter to be applied around each clip relative to the risk of local recurrence. Factors taken into account to adjust the volume were tumour size, age, surgical margins and the presence of extensive ductal carcinoma. We then analyzed the factors varying the volume and variation of delineation for each method by calculating the concordance index: Kappa index and overlap. Results: For all 16 patients, the volume delineated was nearly identical: 29.65cm3 with technique 1 and 33.54cm3 with technique 2 (P =0.6). The correlation was higher with technique 2 over technique 1, with KI from 0.146 to 0.285 (P =0.0001) and an OV of 0.302 to 0.458 (P =0.0002). Conclusion: Our study shows that within the same institute, there is a great variability in CTV delineation boost, even in the presence of surgical clips. A standardized approach to adjusting the volume of relapse risk factors has improved the consistency. [Copyright &y& Elsevier]

La chirurgie oncoplastique fait partie intégrante du traitement des cancers opérables du sein. Le maître mot est « anticipation », car comme en oncologie médicale, la prédiction du résultat chirurgical est indispensable lorsque l’on envisage une intervention. La première technique, historiquement, est la plastie mammaire de réduction, intervention de base de la chirurgie plastique mammaire, qui a été utilisée dans les tumeurs des quadrants inférieurs. Puis, progressivement au cours des dix dernières années, les techniques d’oncoplastie sont devenues plus spécifiques pour arriver au concept de « un quadrant, une technique ». Les quadrants externes sont le siège le plus fréquent des cancers, et la technique de « plastie externe » est devenue, dans les centres experts, une technique de routine. Une formation spécifique est nécessaire, mais elle n’est pas encore sanctionnée par des diplômes en raison d’une demande importante et d’un nombre d’enseignants chirurgicaux limité. Enfin, il est fondamental que les chirurgiens aient des connaissances des principaux traitements médicaux et d’irradiation afin de fournir aux patientes une prise en charge multidisciplinaire de qualité. Il est tout aussi nécessaire que les oncologues médicaux et les radiothérapeutes aient une bonne connaissance des techniques chirurgicales pour cette multidisciplinarité indispensable au contrôle adéquat de la maladie et de la préservation de la silhouette. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: The main objective was to assess contributions and limits of surgical clips combined with computed tomography to define the tumor bed after conservative treatment of breast cancer. This retrospective observational study enrolled 16 patients treated by lumpectomy with surgical clips placed in the tumor bed. Patients and methods: We assessed the difficulties in localizing the tumour bed based on collected data (i.e. clinical description, mammography, ultrasound examination, surgical procedure and pathology data). The clip''s number and localization, and the volumes of the boost were also analyzed. Results: There was no preoperative occurrence of localization in 57 % of cases for palpable tumours, and in 13 % of cases where the lesion was subclinical. The collected data did not allow establishing a precise localization. The mean number of surgical clips per patient was 4 (range 1–9), and the delineation of the target volumes by radiation oncologists was not standardized. Oncoplastic techniques may produce difficulties in the localization of tumour bed. Conclusion: The placement of surgical clips by the surgeon is helpful, primarily when oncoplastic techniques are used. In many situations, these clips may cause problems of interpretation. In order to optimize the delineation of the boost, we propose a multidisciplinary approach and methodology to be used at the Henri Becquerel Cancer Centre. [Copyright &y& Elsevier]

La poitrine est un symbole de la féminité. Une tumorectomie ou une mastectomie retentit inéluctablement sur la qualité de vie de la patiente. À l'officine, la délivrance d'une prothèse mammaire externe repose sur un savoir-faire et un savoir-être. The breast is a symbol of femininity. A lumpectomy or mastectomy inevitably affects the patient's quality of life. At the pharmacy, the delivery of an external breast prosthesis is based on know-how and interpersonal skills. [ABSTRACT FROM AUTHOR]

Objectives. – Phyllodes tumors of the breast (PTB) are rare fibro epithelial tumors. Their terminology, histological classification and their treatment are exposed to controversy. The aim of our work is to underline the epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours through a retrospective study and a review of the literature.Patients and methods. – We reviewed at the National Institute of Oncology of Rabat, Morocco, between 1985 and 1998, all the files of patients with histological certainty of PTB, doubtful PTB were excluded. We collected epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours. Statistics: quantitative parameters were represented by mean ± S.D. and qualitative parameters by percentage or effective.Results. – We studied nine cases of PTB, which represented 0.09% of all primitive tumors of the breast treated at our institution during the study period. All our patients were female. Mean age was 37.3 ± 10.07 years. Two of our patients (22.2%) had a history of fibroadenoma and 44.4% were nulliparous. Mean delay before consulting was 60.7 ± 17.56 months and the median tumour size was 13 ± 7.47 cm. Pathological findings were six benign or borderline phyllodes tumours (66.7%) and three cystosarcomas phyllodes (33.3%). The treatment consisted in simple mastectomy in seven cases (77.8%) and tumorectomy in two cases (22.2%). All the surgical margins were clear. Two of the three cystosarcomas phyllodes received adjuvant external bean radiation therapy 50 Gy on the thoracic chest wall. After a median outcome of 3 ± 2 years ranging from 3 to 74 months, we did not note any relapse or metastasis.Discussion and conclusion. – In our series, PTB happened exclusively in females. History of fibroadenoma within 22.2% of the patients suggests the hypothesis of a filiation between these two entities. Their distinctive features were young age in diagnosis, long delay before consulting, important tumor size, predominant benign and borderline histological types, treatment mainly surgical and good local and distant control. [Copyright &y& Elsevier]

The surgical management of breast cancer has been marked by a therapeutic de-escalation from radical surgery to breast conservation and from axillary curage to sentinel lymph node sampling. With regard to breast surgery, the de-escalation of treatment has been largely due to organized screening, which has made it possible to diagnose tumors of smaller volume or at an earlier stage. The indications for conservative surgery have been broadened by the addition of radiotherapy on one hand, and the introduction of adjuvant and neo-adjuvant treatments on the other hand. In an effort to de-escalate surgery, totally non-invasive techniques such as radiofrequency, HIFU (High Intensity Focused Ultrasound) or cryotherapy have been tested. Currently, three trials are underway to evaluate active surveillance, without surgery, in the management of certain low-risk ductal carcinomas in situ (DCIS). Regarding axillary procedures, the sentinel node technique has allowed axillary staging in patients with early breast cancer without clinical or radiological lymph node involvement. Currently, international recommendations (ASCO, NCCN) and the consensus of experts in St Gallen do not recommend additional curage in cases of macro or micrometastatic invasion of the sentinel lymph nodes if the criteria of ACOSOG Z0011 are met. The question now arises as to the relevance of a biopsy of suspected axillary nodes during the initial workup and the usefulness of the sentinel node technique in the case of a negative initial workup., (Copyright © 2021 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Introducere. Endometriomul de perete abdominal este o patologie rară care apare la nivelul cicatricelor abdominale după o intervenţie în timpul căreia se deschide uterul, cel mai frecvent după operaţie cezariană. Incidenţa endometrioamelor parietale este de 0,03-0,4%. Materiale şi metodă. Prezentăm cazul unei paciente secundipare, la termen, în vârstă de 31 de ani, care a născut prima oară în urmă cu 5 ani, prin operaţie cezariană. Din anamneză am reţinut că, de aproximativ doi ani (deci cu un an şi trei luni înainte de sarcina actuală), pacienta prezintă o formaţiune tumorală la nivelul cicatricei post-operaţie cezariană - care, în afara sarcinii, prezenta toate semnele unui endometriom parieto-abdominal şi care în timpul sarcinii actuale s-a redus în dimensiuni, chiar devenind nedureros. Pacienta a născut la termen prin operaţie cezariană pentru iminenţă de ruptură uterină şi în acelaşi timp operator s-a practicat şi tumorectomie parieto- abdominală, excizându-se o formaţiune de 4/3 cm care a fost trimisă la examenul histopatologic. Rezultate şi concluzii. Evoluţia postoperatorie a fost favorabilă, iar pacienta s-a externat a doua zi postoperatoriu. Rezultatul histopatologic a confirmat endometrioza în muşchiul drept abdominal. Evoluţia plăgii a fost spre vindecare şi, la 5 luni postoperatoriu, era suplă, fără a se decela clinic sau imagistic nicio recidivă. [ABSTRACT FROM AUTHOR]

Abstract: Conservative renal surgery for cancer has now achieved consensus for imperative, relative, and elective indications (tumor < 4 cm with healthy contralateral kidney). The results show 90%–100% 10-year survival rates and 0%–3% recurrence rates. Surgical techniques are improving and complication rates are decreasing with experience. It is now recognized that margin thickness has no real significance provided that it is negative, even if excision is flush with the tumor capsule. Finally, the frequently cited multifocal lesions are no longer an argument against conservative surgery. The usual limitations of conservative surgery are the size and location of the tumor. Nevertheless, there is no statistically significant difference in the survival and recurrence rates between T1 a (<4 cm) and T1 b (4-7 cm) tumors, even if the risk of renal sinus fat tissue involvement increases proportionally with tumor size. Finally, resectiog tumors of the renal sinus is possible without adding to the risk of metastasis but increases the risk of surgical complications. The risk of deteriorated renal function with radical nephrectomy is now well documented. Laparoscopy, which has become the reference treatment mode for radical nephrectomy, remains reserved for conservative surgery for exophytic tumors less than 3–4 cm because of the technical difficulties involved in resection and hemostasis. Although conservative surgery is now recognized, extending its indications to tumors greater than 4 cm or in cases of parenchymatous location is supported by real arguments that need to be confirmed. The limit remains the surgical feasibility. [Copyright &y& Elsevier]