SUMMARY OBJECTIVE: The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS: A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS: The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION: Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries. OBJECTIVE involved survivors surgeons reconstruction METHODS databases RESULTS 1 handson hands models labs programs 200 2023 45 4 30 CONCLUSION countries 20 202 3 2

RESUMO Introdução: O uso de mastectomia preservadora de complexo aréolo-papilar (MPCAP) no câncer de mama localmente avançado após quimioterapia neoadjuvante (QTN) é crescente, apesar de ainda haver poucos estudos abordando o assunto. O objetivo desta revisão sistemática foi determinar a segurança da MPCAP após a quimioterapia neoadjuvante. Métodos: para esta revisão sistemática, pesquisamos no MEDLINE; Cochrane; Scientific Electronic Library Online (SciELO); Embase e Scopus. Foi realizada uma busca na literatura de todos os estudos originais, incluindo ensaios clínicos randomizados, estudos de coorte e estudos de caso-controle comparando mulheres submetidas a MPCAP após quimioterapia neoadjuvante para câncer de mama. Os desfechos foram recorrência locorregional, recidiva em papila e recorrência à distância. A análise dos dados foi realizada para avaliar a segurança da mastectomia preservadora de complexo aréolo-papilar após o QTN. A qualidade da evidência foi avaliada com a ferramenta de avaliação de risco de viés da Cochrane - ROBINS-I. Este estudo está registrado no PROSPERO, número CRD42021276778. Resultados: Um total de 437 artigos foram identificados. Quatro artigos foram incluídos na análise, totalizando 1466 pacientes, todos com risco de viés geral moderado a alto. A recorrência local no grupo MPCAP após QTN variou de zero a 9,8%. A recorrência no complexo aréolo-papilar (CAP) variou de zero a 2,1%. A taxa de recorrência à distância variou de 6,5% a 16%. Devido à falta de padrão entre os grupos de controle, não foi possível realizar uma meta-análise. Interpretação: esta revisão fornece informações para a tomada de decisão na realização de NSM após QTN. Apesar das baixas taxas de recorrência local, os pacientes devem ser orientados sobre as informações oncológicas limitadas. Introdução aréolopapilar aréolo papilar (MPCAP (QTN crescente assunto Métodos MEDLINE SciELO (SciELO) Scopus originais randomizados casocontrole caso controle locorregional ROBINSI. ROBINSI ROBINS I. I ROBINS-I PROSPERO CRD42021276778 CRD Resultados 43 identificados 146 alto 98 9 8 9,8% CAP (CAP 21 2 1 2,1% 65 6 5 6,5 16 16% metaanálise. metaanálise meta análise. meta-análise Interpretação limitadas (SciELO CRD4202127677 4 14 9,8 2,1 6, CRD420212767 9, 2, CRD42021276 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

ABSTRACT Background: the use of nipple-sparing mastectomy (NSM) in local advanced breast cancer after neoadjuvant chemotherapy (NQT) is increasing, despite few studies on the subject. The aim of this systematic review was to determine the safety of NSM after neoadjuvant chemotherapy. Methods: for this systematic review we searched MEDLINE; Cochrane; Scientific Electronic Library Online (SciELO); Embase and Scopus. A literature search of all original studies including randomized controlled trials, cohort studies and case-control studies comparing women undergoing NSM after neoadjuvant chemotherapy for breast cancer was undertaken. Outcomes were locoregional recurrence (LRR), nipple recurrence and distant recurrence (DR). Data analysis was undertaken to explore the safety of NSM after NQT. The quality of the evidence was assessed with the Cochrane risk of bias tool. This study is registered on PROSPERO, number CRD42021276778. Findings: a total of 437 articles were identified. Four articles were included with 1466 patients all of which had a high to serious risk of overall bias. Local recurrence in the NSM after the NQT group ranged from zero to 9.8%. Nippleareolar complex (NAC) recurrence ranged from zero to 2.1%. The distant recurrence rate ranged from 6.5% to 16%. Due to the lack of pattern among the control groups, it was not possible to perform a meta-analysis. Interpretation: this review provides information for decision making in performing NSM after NQT. Despite the low rates of local recurrence and patients should be counseled about limited oncological information. Background nipplesparing sparing (NSM (NQT increasing subject Methods MEDLINE SciELO (SciELO) Scopus trials casecontrol case LRR, LRR , (LRR) DR. DR . (DR) tool PROSPERO CRD42021276778 CRD Findings 43 identified 146 98 9 8 9.8% NAC (NAC 21 2 1 2.1% 65 6 5 6.5 16 16% groups metaanalysis. metaanalysis meta analysis. meta-analysis Interpretation (SciELO (LRR (DR CRD4202127677 4 14 9.8 2.1 6. CRD420212767 9. 2. CRD42021276 CRD4202127 CRD420212 CRD42021 CRD4202 CRD420 CRD42 CRD4

Resumo Objectivo Infecção e exposição da prótese são algumas das complicações mais comuns e preocupantes após reconstrução da mama com implantes. Atualmente, ainda não há consenso quanto ao manejo destas complicações. O objetivo deste estudo foi o de revisar os casos da nossa instituição e apresentar um protocolo clínico. Métodos Realizou-se uma revisão retrospectiva de todos os casos consecutivos submetidos a reconstrução mamária imediata com prótese entre 2014 e 2016. Todos os casos foram conduzidos de acordo com um protocolo específico e estruturado. Resultados A exposição do implante ocorreu em 33 de 227 reconstruções (11,9%). Dentre estas, duas pacientes tinham histórico de radioterapia, e foram submetidas a remoção da prótese e posterior reconstrução com retalho miocutâneo. Sinais de infecção local grave foram observados em 12 pacientes, e, em 5, necrose extensa de tecido, e todas foram submetidas a remoção dos implantes; destas, 8 foram recons truídas com expansor, e 2, com retalho miocutâneo. As 14 pacientes remanecentes não haviam sido submetidas previamente à radioterapia, não tinham sinais de infecção, nem necrose extensa; portanto, foram submetidas a sutura primária em uma tentativa de salvar a prótese. Dessas, 8 pacientes (57,1%) conseguiram manter os implantes originais. Conclusão Nosso protocolo clínico é baseado em três pontos principais: histórico de radioterapia, infecção grave, e necrose extensa de tecido. Ele constitui um método prático e potencialmente reprodutível de manejo de uma das complicações mais comuns da reconstrução mamária com implantes.

Abstract Objective Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. Methods We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. Results Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the Conclusion Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.

Abstract Breast cancer (BC) is the leading cause of death by this disease in women worldwide. Among the factors involved in tumorigenesis, long non-coding RNAs (lncRNAs) and their differential expression have been associated. Differences in gene expression may be triggered by variations in DNA sequence, including single nucleotide polymorphisms (SNPs). In the present study, we analyzed the rs527616 (C>G), located in the lncRNA AQP4-AS1, using PCR-SSP in 306 BC patients and 312 controls, from a Brazilian population. In the BC group, the frequency found for CG heterozygotes was above the expected and the overdominant model is the best one to explain our results (OR: 1.70, IC 95%: 1.23-2.34, P<0.001). Furthermore, the SNP were associated with age at BC diagnosis and the risk genotype more frequent in the older age group. According to TCGA data, AQP4-AS1 is down-regulated in BC tissue, and the overexpression is associated with better prognoses, including Luminal A, HER2-, stage 1 of disease and smaller tumor. In conclusion, the CG genotype is associated with increased susceptibility in the southern Brazilian population. This SNP is mapped in the lncRNA AQP4-AS1, showing differential expression in BC samples. Based on these results, we emphasize the potential of the role of AQP4-AS1 in cancer.

Abstract Male breast cancer (MBC) is a rare malignancy that accounts for about 1.8% of all breast cancer cases. In contrast to the high number of the “omics” studies in breast cancer in women, only recently molecular approaches have been performed in MBC research. High-throughput proteomics based methodologies are promisor strategies to characterize the MBC proteomic signatures and their association with clinico-pathological parameters. In this study, the label-free quantification-mass spectrometry and bioinformatics approaches were applied to analyze the proteomic profiling of a MBC case using the primary breast tumor and the corresponding axillary metastatic lymph nodes and adjacent non-tumor breast tissues. The differentially expressed proteins were identified in the signaling pathways of granzyme B, sirtuins, eIF2, actin cytoskeleton, eNOS, acute phase response and calcium and were connected to the upstream regulators MYC, PI3K SMARCA4 and cancer-related chemical drugs. An additional proteomic comparative analysis was performed with a primary breast tumor of a female patient and revealed an interesting set of proteins, which were mainly involved in cancer biology. Together, our data provide a relevant data source for the MBC research that can help the therapeutic strategies for its management.

Abstract Copy number alterations (CNAs) are a frequent feature in human breast cancer, and one of the hallmarks of genomic instability. The FOSL1, GSTP1 and CCND1 genes are located at 11q13, a cytoband commonly affected by CNA in breast cancer, with relevant function in progression and invasion. Our main goal was to analyze CNAs of these genes and determine their association with breast cancer subtypes. Seventy-three cases of invasive breast tumors [52 Luminal, 7 HER2+ and 14 triple negative (TNBC) subtypes] were analyzed by TaqMan assays. CNAs were observed for all genes, with gains more frequently observed. Gains of the FOSL1 gene were observed in 71% of the cases. This gene was the only one with a statistically significant difference (p<0.001) among tumor subtypes, with increased copy number in TNBC compared to luminal and HER2+. No significant association of CNA and clinical and histopathological parameters from the patients was observed. Additional studies in larger breast cancer patient cohorts based on more refined molecular subtypes are necessary to confirm the observed association of FOSL1 gain with aggressive breast tumors phenotypes.

Abstract MicroRNAs (miRNAs) play an essential role in gene expression and affect the development of tumours, including breast cancer (BC). Polymorphisms in miRNA genes can affect the interaction of miRNAs with their target messenger RNA by interfering, creating or disrupting target sites. The single nucleotide polymorphism (SNP) rs2910164, located in the seed region of miR146a, was shown to be associated with BC among different populations. In the present study, we investigated whether rs2910164 is associated with BC in 326 patients and 411 controls from a Brazilian population of predominantly European ancestry. The presence of the allele rs2910164*C was associated with an increased risk of BC (OR=1.4, 95% CI=1.03-1.85, p = 0.03). We also analysed publicly available RNA-seq data to evaluate if miR146a is differentially expressed in different subtypes of BC. Genotyping was performed by polymerase chain reaction with sequence-specific primers (PCR-SSP). By leveraging public data from TCGA database, we analysed 461 patients and found that miR146a is significantly more expressed in BC than in non-tumor tissue (1.47 fold, p = 0.02) and is expressed to a greater degree in aggressive BC subtypes.

Caso clínico atípico de tumor sólido pseudopapilar de pâncreas (TSPPP) acometendo paciente do sexo masculino, 37 anos, com quadro inicial de dor abdominal aguda. Após cirurgia e exame anatomopatológico com imuno-histoquímica, demonstrou padrão condizente com TSPPP e forte positividade para β-catenina. Dois anos após a cirurgia o paciente encontra-se livre de recidiva. O TSPPP é mais comum em mulheres jovens com quadro clínico de massa ou desconforto abdominal, podendo alguns casos ser assintomáticos. Apresenta crescimento lento e baixo potencial de malignidade, sendo a ressecção cirúrgica o tratamento de escolha com altos índices de cura.

Atypical clinical case of solid pseudopapillary tumor (SPPT) of the pancreas in a 37 year-old man with acute abdominal pain. After surgery, anatomopathologic investigation with immunohistochemistry showed pattern in keeping with SPPT and strong positivity for β-catenin. Two years post-surgery the patient does not present recurrence. The SPPT normally occurs in young women with a history of mass or abdominal discomfort, although in some cases it can be asymptomatic. The tumor has slow growth, low potential for malignancy and surgical resection yields high cure rates.

OBJETIVO: Verificar se a mamoplastia de aumento pela via transaxilar apresenta potencial de prejudicar a identificação futura do linfonodo sentinela. MATERIAIS E MÉTODOS: Estudo prospectivo controlado em que foram selecionadas 22 pacientes divididas em grupo pós-mamoplastia e grupo controle, totalizando 43 mamas (22 no grupo pós-mamoplastia e 21 no grupo controle) avaliadas por meio de linfocintilografia imediatamente após injeções periareolares de fitato-99mTc. Os testes estatísticos consideraram como diferenças significativas valores de p < 0,05. RESULTADOS: Todas as mamas do grupo pós-mamoplastia apresentaram drenagem linfática para a cadeia axilar, sem diferença com o grupo controle (p = 0,488). A média de linfonodos captantes foi de 1,27 ± 0,46 no grupo pós-mamoplastia e 1,33 ± 0,58 no grupo controle (p = 0,895). A média de tempo para visualização do primeiro linfonodo foi de 3,14 ± 4,42 minutos no grupo pós-mamoplastia e 5,48 ± 5,06 minutos no grupo controle, novamente sem diferença significativa (p = 0,136). CONCLUSÃO: A mamoplastia de aumento pela via transaxilar não acarretou prejuízo na identificação futura do linfonodo sentinela.

OBJECTIVE: To evaluate the potential influence of transaxillary augmentation mammoplasty on future detection of sentinel lymph node. MATERIALS AND METHODS: Prospective controlled study where 22 patients were selected and divided into two groups (post-mammoplasty and control) corresponding to 43 breasts (22 in the post-mammoplasty group and 21 in the control group) evaluated by lymphoscintigraphy immediately after periareolar 99mTc-phytate injections. In the statistical analysis, p values < 0.05 were considered as significant. RESULTS: All the breasts in the post-mammoplasty group presented lymphatic drainage to the axillary chain, with no difference as compared with the control group (p = 0.488). The average number of hot lymph nodes was 1.27 ± 0.46 in the post-mammoplasty group, and 1.33 ± 0.58 in the control group (p = 0.895). The mean time required to visualize the first lymph node was 3.14 ± 4.42 minutes in the post-mammoplasty group, and 5.48 ± 5.06 minutes in the control group (p = 0.136). CONCLUSION: Transaxillary augmentation mammoplasty did not affect the future detection of sentinel lymph node.

OBJETIVOS: avaliar a quimioterapia neoadjuvante no câncer localmente avançado do colo uterino, por meio da sua aceitabilidade, tolerabilidade, toxicidade, taxa de complicações cirúrgicas, taxa de resposta, taxa de operabilidade e sobrevida em 5 anos. MÉTODOS: foram incluídas 60 mulheres com câncer do colo uterino localmente avançado (IIB e IIIB), submetidas à quimioterapia neoadjuvante com doxorrubicina-bleomicina-cisplatina. Aquelas que se tornaram operáveis após a quimioterapia foram submetidas à cirurgia de Wertheim-Meigs, seguida de radioterapia pélvica complementar. Nas pacientes em que a cirurgia não foi possível após a quimioterapia, realizou-se radioterapia. RESULTADOS: o seguimento médio foi de 108 meses. A taxa de resposta global à quimioterapia foi de 80%, sendo 100% para o estádio IIB e 60% para o estádio IIIB. A porcentagem de pacientes operadas, após a quimioterapia foi de 65%. A sobrevida global em 5 anos para todo o grupo foi 62%. No grupo operado (n=34), a sobrevida global foi de 82,14%, independentemente do estádio inicial. No grupo não operado (n=18), a sobrevida em 5 anos foi 16,67%. CONCLUSÕES: A quimioterapia neoadjuvante com doxorrubicina-bleomicina-cisplatina no câncer do colo uterino localmente avançado é segura, com baixo índice de complicações e permitiu uma alta taxa de operabilidade.

PURPOSE: to evaluate neoadjuvant chemotherapy in locally advanced cervical cancer as to its acceptability, tolerability, toxicity, surgical complications, operability, response rate, and overall survival in 5 years. METHODS: sixty women with locally advanced cervical cancer (stages IIB and IIIB), who were submitted to neoadjuvant chemotherapy, were included. All patients were treated with doxorubicin-bleomycin-cisplatin. Those who had a good response, allowing a surgical approach, underwent the Wertheim-Meigs procedure. After surgery, they were submitted to pelvic radiotherapy. Those that could not be submitted to surgery after chemotherapy underwent total radiotherapy. RESULTS: the average follow-up was 108 months, and 80% of the patients had an overall response to neoadjuvant chemotherapy. In the IIB group, the response rate was 100%, and in the IIIB group it was 60%. The operability rate after neoadjuvant chemotherapy was 65%. The overall survival in 5 years was 62%. Comparing the operated group (n=34) with the nonoperated group (n=18), the overall survival in 5 years was 82.14 and 16.67%, respectively. CONCLUSIONS: neoadjuvant chemotherapy with doxorubicin-bleomycin-cisplatin for locally advanced cervical cancer is safe, with a low rate of side effects, and allowed a high operability rate.

O linfonodo sentinela é o primeiro linfonodo que recebe a drenagem linfática proveniente do câncer de mama. A sua detecção tem a finalidade de predizer o estado da axila e evitar o esvaziamento axilar nos pacientes sem comprometimento metastático. Os autores realizaram uma ampla revisão da literatura, envolvendo os aspectos cirúrgicos, de Medicina Nuclear e de Anatomia Patológica do linfonodo sentinela. Muitos estudos demonstraram a eficácia do linfonodo sentinela em predizer o comprometimento axilar. Entretanto, existem várias técnicas empregadas para a identificação desse linfonodo, sem haver ainda um consenso em relação ao método mais adequado e reproduzível. A associação do corante vital com o probe, até o presente, é a que tem apresentado os melhores resultados. Também não existe uma padronização do exame patológico intra-operatório do linfonodo sentinela e os índices de falso-negativos encontrados são bastante variáveis. A biópsia do linfonodo sentinela pode oferecer uma alternativa segura à dissecção axilar e com menos efeitos colaterais nos pacientes com axila clinicamente negativa. Entretanto alguns pontos conflitantes devem ser resolvidos antes que o método passe a ser utilizado na prática com o câncer de mama. O objetivo desse trabalho foi discutir os principais aspectos envolvidos no desenvolvimento e na aplicação dessa técnica.

The sentinel lymph node is the first in line to receive lymphatic flow from a primary site in breast cancer. The purpose of this study is to review the most recently results in the literature with this technique. This is a comprehensive review in surgical, nuclear medicine, and pathological aspects of sentinel lymph node in breast cancer. Several reports have demonstrated the accurate prediction of axillary nodal status with sentinel lymph node technique. However, a wide range of different methods and materials has been employed for lymphatic mapping. The association of vital blue and the probe seems to be the most reliable. Also, there is no consensus on the pathologic method for sentinel lymph node examination at the time of surgery. Sentinel node biopsy can offer a safe alternative to routine axillary lymph node dissection for staging patients with breast cancer. The remaining controversial issues must be resolved before sentinel lymph node biopsy becomes a widely accepted part of breast cancer care.

A traqueostomia apresenta uma série de vantagens em relação à entubação endotraqueal prolongada: conforto e maior possibilidade de comunicação para o paciente, diminuição da resistência respiratória, melhor controle de via aérea e facilidade de aspiração. No período de setembro de 1996 a dezembro de 1997 foram realizadas setenta traqueostomias à beira de leito na UTI, sob anestesia local, com tempo operatório médio de 30,5 minutos. A principal indicação foi ventilação mecânica prolongada, com uma média de 6,5 dias. Os pacientes foram acompanhados durante a internação por 1.494 dias. No terceiro dia de pós-operatório foi colhida cultura de secreção traqueal em 49 pacientes, predominando Pseudomonas aeruginosa em 40,8% dos casos. Houve 11 casos (15,7%) de complicações maiores: uma fístula traqueoesofágica, uma fasciíte necrotizante, uma úlcera traqueal, duas infecções e seis sangramentos, que necessitaram reintervenção. Um óbito foi relacionado ao procedimento, devido à fasciíte necrotizante cervical. Tendo em vista a gravidade dos pacientes, a traqueostomia à beira de leito demonstrou ser um procedimento seguro e com baixo índice de complicações maiores. Além disso, evita o transporte de doente crítico dentro do hospital, e os custos são menores do que a traqueostomia no centro cirúrgico.

Tracheostomy has several advantages in comparison with prolonged intubation: patients's confort, best possibility of comunication, less respiratory resistance, better airway control and facility of aspiration. During September 1996 and December 1997, 70 bedside tracheostomy were performed on intensive care unit patients, under local anaesthesia, with a mean operatory time of 30.5 minutes. The main indication was prolonged mechanical intubation, with a mean of 6.5 days of orotracheal intubation. Patients were followed during the hospitalization for a total 1.494 days. In the 30 post operative day, samples for culture were collected from 49 patients. Pseudomonas aeruginosa grew in 40.8% of the cultures. There were 11 (15.7%) patients with major complications: one tracheoesophageal fistula, one necrotizing fasciitis, one tracheal ulcer two infection and six bleedings from other interventions. There was one death related to the procedure, due to a necrotizing fasciitis. The bedside tracheostomy showed itself to be a secure procedure with a low index of major complications, avoiding the patients transportation with in the hospital and with low costs in comparison with a surgical roam tracheostomy.

É relatado um caso de esquistossomose na fase aguda com comprometimento cerebral precoce, síndrome piramidal nos membros inferiores, líquido cefalorraquidiano (LCR) normal e lesões com padrão desmielinizante na ressonância magnética (RM) encefálica. O diagnóstico foi comprovado através da imunofluorescência indireta para esquistossomose no LCR. O envolvimento encefálico pelo Schistosoma mansoni é menos frequente do que o medular e a resposta ao tratamento com o praziquantel e a prednisolona foi eficaz neste caso. São poucos os relatos de neuroesquistossomose encefálica. Devido a esse fato sua fisiopatologia e terapêutica necessitam de melhores estudos. Os aspectos imunológicos e apresentação na RM foram enfatizados.

A case of acute shistosomiasis with magnetic resonance images (MRI) of the brain suggestive of demyelinating lesions, pyramidal disorder in the lower limbs and normal cerebrospinal fluid is presented. Diagnosis could be established by detection of antibodies on blood and cerebrospinal fluid. Schistosoma mansoni involves the spinal cord more often than the brain. Praziquantel associated to prednisolone was effective in this case. There are few reports of brain involvement with S. mansoni, but its prevalence is probably greater. Due to the paucity of studies, its pathophysiology and therapeutics remain to be better clarified. The immune and MRI aspects are emphasized.