Purpose Our previous work has shown low serum 25-hydroxyvitamin D concentrations in association with aggressive breast cancer subtypes. Vitamin D receptor (VDR) is central for vitamin D-mediated transcription regulation. Few studies have examined breast VDR expression with tumor characteristics or patient survival. Experimental Design VDR expression in breast tumor tissue microarrays was determined by immunohistochemistry in 1,114 female patients as low, moderate and strong expression based on an immunoreactive score, and examined with histopathological tumor characteristics and survival outcomes including progression free survival, breast cancer specific survival, and overall survival. Results A majority (58%) of breast tumors showed moderate or strong VDR expression. VDR expression was inversely related to aggressive tumor characteristics, including large tumor size, hormonal receptor (HR) negativity, and triple-negative subtype (p<0.05). In addition, VDR expression was also inversely related to Ki-67 expression among patients older than 50 years. Nevertheless, VDR expression was not associated with any patient survival outcomes examined. Conclusions In a large patient population, VDR expression is inversely associated with more aggressive breast cancer, but not with breast cancer survival outcomes. The present findings of VDR expression are consistent with our previous results of circulating vitamin D biomarkers, which provide two converging lines of evidence supporting the putative benefits of vitamin D against aggressive breast cancer. Because of the observational nature of our analyses, future studies are warranted to establish the causality of the reported associations.

Patient: Male, 59 Final Diagnosis: Invasive ductal carcinoma Symptoms: Foul-smelling discharge • painful breast mass Medication: — Clinical Procedure: Modified radical mastectomy Specialty: Surgery Objective: Rare disease Background: Male breast cancer is rare, accounting for approximately 1% of all malignancies in men. The lack of awareness of this rare cancer results in delayed diagnosis and its aggressive behavior can result in poor prognosis. This report is of a case of locally advanced, high-grade breast cancer in a 59-year-old man who was reluctant to undergo diagnostic procedures, and describes the approach to clinical management. Case Report: A 59-year-old man presented with a large left breast mass with enlarged axillary lymph nodes. The patient had ignored the mass and declined all diagnostic procedures. After modifying the diagnostic workup and involving a psychiatrist, the patient agreed to undergo a modified radical mastectomy. Histopathology showed a high-grade invasive ductal carcinoma with lymph node metastasis. The breast cancer was triple-positive for human epidermal growth factor receptor 2 (HER2), estrogen receptor (ER), and progesterone receptor (PR). Adjuvant treatment included herceptin, tamoxifen, and radiation therapy. Conclusions: This case demonstrates the importance of raising public awareness of breast cancer in men, and to assess and overcome the factors leading to delay in accessing medical attention. In challenging cases, modifying the diagnostic workup and the treatment approach with the least deviation from the standard of care, including counseling may be required.

PURPOSEDespite the established guidelines for breast cancer treatment, there is still variability in surgical treatment after neoadjuvant therapy (NT) for women with large breast tumors. Our objective was to identify predictors of the type of surgical treatment: mastectomy versus breast-conserving surgery (BCS) in women with T3/T4 breast cancer who received NT.METHODSPopulation-based Florida Cancer Data System Registry, Florida’s Agency for Health Care Administration, and US census from 1996 to 2009 were linked for women diagnosed with T3/T4 breast cancer and received NT followed by either BCS or mastectomy. Analysis of multiple variables, such as sociodemographic characteristics (race, ethnicity, socioeconomic status, age, marital status, and urban/rural residency), tumor’s characteristics (estrogen/progesterone receptor status, histology, grade, SEER stage, and regional nodes positivity), treatment facilities (hospital volume and teaching status), patients’ comorbidities, and type of NT, was performed.RESULTSOf 1,056 patients treated with NT for T3/T4 breast cancer, 107 (10%) had BCS and 949 (90%) had mastectomy. After adjusting with extensive covariables, Hispanic patients (adjusted odds ratio (aOR) = [3.50], 95% confidence interval (CI): 1.38–8.84, P = 0.008) were more likely to have mastectomy than BCS. Compared to localized SEER stage, regional stage with direct extension (aOR = [3.24], 95% CI: 1.60–6.54, P = 0.001), regional stage with direct extension and nodes (aOR = [4.35], 95% CI: 1.72–11.03, P = 0.002), and distant stage (aOR = [4.44], 95% CI: 1.81–10.88, P = 0.001) were significantly more likely to have mastectomy than BCS. Compared to patients who received both chemotherapy and hormonal therapy, patients who received hormonal NT only (aOR = [0.29], 95% CI: 0.12–0.68, P = 0.004) were less likely to receive mastectomy.CONCLUSIONOur study suggests that Hispanic ethnicity, advanced SEER stage, and type of NT are significant predictors of receiving mastectomy after NT.

Coronary artery disease (CAD) is one of the most common public health problems worldwide. The overall prevalence of coronary artery disease in Saudi Arabia is 5.5%. 1 Coronary artery bypass graft surgery has gained momentum over the last years effectively treating CAD. Either arteries or veins can be used as conduits for coronary artery bypass graft (CABG) surgery. There are many sites that the conduit can be harvested from, including saphenous vein, left or right internal thoracic artery, radial artery, inferior epigastric artery, right gastroepiploic artery, and splenic artery. 2 The internal thoracic artery, also called internal mammary artery (IMA) graft, is currently the gold standard for myocardial revascularization. It offers long-term patency and provides a long conduit which resists atherosclerosis postimplantation. 3 Internal mammary artery grafts are not detached fully from their original site. IMA graft remains connected to its natural site of origin, and only one end is detached from the chest wall. This end is reattached to the coronary artery intended for the bypass Figure 1(A). 4 IMA gives out multiple vessels at the chest wall that supply the breast, sternum, mediastinum, and thymus. Although the breast is also supplied by the lateral mammary artery and the posterior intercostal branches of the Aorta, Figure 1(B), the IMA compromises the major source of breast vascularization (almost 60%) through the anterior intercostal perforators. 5,6 The harvesting of IMA in CABG procedure is associated with many complications. They are mostly wound related, ranging from skin dehiscence to complete avascular necrosis of the sternum. 7 Ipsilateral breast necrosis following CABG surgery is a rare incident due to the abundant vascularity of the breast and has been sporadically reported in the literature. However, contralateral breast necrosis after CABG procedure had not been reported in the literature up to date.Breast fat necrosis can result from different surgical, pathological, and traumatic causes. It usually presents as a breast lump which can imitate breast cancer. This is especially concerning in elderly patients where a higher probability of both breast cancer and CAD co-exist. The main clinical features of fat necrosis are hard palpable masses with irregular borders. In some cases, they can be tender and associated with skin tethering, bruising,

The increase in survival after childhood radiation therapy for some blood malignancies has led to an increase in the diagnosis of radiation-induced secondary solid malignancies (SSM). We report a young man presenting with invasive breast cancer 19 years after receiving radiation therapy and bone marrow transplant for acute lymphocytic leukaemia in childhood. This latency period is longer than previously reported. Therefore, survivors of radiation-treated primary cancer should be closely monitored for SSM, including breast cancer, for the rest of their lives.

<div>Abstract<p><b>Purpose:</b> Our previous work has shown low serum 25-hydroxyvitamin D concentrations in association with aggressive breast cancer subtypes. Vitamin D receptor (VDR) is central for vitamin D–mediated transcription regulation. Few studies have examined breast VDR expression with tumor characteristics or patient survival.</p><p><b>Experimental Design:</b> VDR expression in breast tumor tissue microarrays was determined by immunohistochemistry in 1,114 female patients as low, moderate, and strong expression based on an immunoreactive score, and examined with histopathologic tumor characteristics and survival outcomes including progression-free survival, breast cancer–specific survival, and overall survival.</p><p><b>Results:</b> A majority (58%) of breast tumors showed moderate or strong VDR expression. VDR expression was inversely related to aggressive tumor characteristics, including large tumor size, hormonal receptor (HR) negativity, and triple-negative subtype (<i>P</i> < 0.05). In addition, VDR expression was also inversely related to Ki-67 expression among patients older than 50 years. Nevertheless, VDR expression was not associated with any patient survival outcomes examined.</p><p><b>Conclusions:</b> In a large patient population, VDR expression is inversely associated with more aggressive breast cancer, but not with breast cancer survival outcomes. The present findings of VDR expression are consistent with our previous results of circulating vitamin D biomarkers, which provide two converging lines of evidence supporting the putative benefits of vitamin D against aggressive breast cancer. Because of the observational nature of our analyses, future studies are warranted to establish the causality of the reported associations. <i>Clin Cancer Res; 23(1); 97–103. ©2016 AACR</i>.</p></div>

<p>Supplementary Table 1. Associations of vitamin D receptor (VDR) expression with tumor histopathological characteristics</p>

<div>Abstract<p><b>Purpose:</b> Our previous work has shown low serum 25-hydroxyvitamin D concentrations in association with aggressive breast cancer subtypes. Vitamin D receptor (VDR) is central for vitamin D–mediated transcription regulation. Few studies have examined breast VDR expression with tumor characteristics or patient survival.</p><p><b>Experimental Design:</b> VDR expression in breast tumor tissue microarrays was determined by immunohistochemistry in 1,114 female patients as low, moderate, and strong expression based on an immunoreactive score, and examined with histopathologic tumor characteristics and survival outcomes including progression-free survival, breast cancer–specific survival, and overall survival.</p><p><b>Results:</b> A majority (58%) of breast tumors showed moderate or strong VDR expression. VDR expression was inversely related to aggressive tumor characteristics, including large tumor size, hormonal receptor (HR) negativity, and triple-negative subtype (<i>P</i> < 0.05). In addition, VDR expression was also inversely related to Ki-67 expression among patients older than 50 years. Nevertheless, VDR expression was not associated with any patient survival outcomes examined.</p><p><b>Conclusions:</b> In a large patient population, VDR expression is inversely associated with more aggressive breast cancer, but not with breast cancer survival outcomes. The present findings of VDR expression are consistent with our previous results of circulating vitamin D biomarkers, which provide two converging lines of evidence supporting the putative benefits of vitamin D against aggressive breast cancer. Because of the observational nature of our analyses, future studies are warranted to establish the causality of the reported associations. <i>Clin Cancer Res; 23(1); 97–103. ©2016 AACR</i>.</p></div>