Challenges in the Management of Malignant Adenomioepithelioma of the Breast: a Case Report and Review of the Literatures

Abstract

Background: Malignant adenomyeloblastoma is a rare tumor, with no guidelines available for its treatment. Case presentation: We discuss a case of malignant adenomyeloblastoma of the right breast in a 59-year-old woman. The patient underwent a lumpectomy, and pathological diagnosis of malignant adenomyeloblastoma was distinct from the preoperative needle-biopsy diagnosis of intraductal papilloma. The patient underwent mastectomy and chemotherapy immediately. However, local recurrence was occurred 11 months after the initial operation. We summarize the characteristics of patients with malignant adenomyeloblastoma in PubMed and Web of Science databases, and share our experience and discoveries. Statistics included the univariate and multivariable Cox proportional hazards models. Overall, 34 patients were analyzed. Conclusions: At diagnosis, the median age was 59.3 years and the median tumor size was 30.0 mm. The most common initial surgery was breast-conserving surgery (50%), and a proportion of patients underwent axillary lymph node dissection (32%). Age, max diameter, and axillary status were associated with overall survival. Complete surgical excision with adequate margins is the most important treatment. Patients may not benefit from remedial adjuvant therapy, but may benefit from prompt postoperative adjuvant therapy. Multidisciplinary cooperation and follow-up are essential for the management of these patients. Our data would provide novel insights into a rare tumor that might avoid over- or under-treatment of the patients.

Respiratory and other systemic complications of coronavirus disease 2019 in adults: A narrative review

“…-LMWH and Unfractionated Heparin preferred over direct oral anti-coagulants (DOAC) [6,90,92] Neurological Complications-Central Nervous System (CNS), Peripheral Nervous System (PNS)…”

“…There has also been a statistically significant difference found between PT prolongation and D-dimer elevation in ICU patients as compared to non-ICU patients. [90] Pathophysiology DIC is based on many pathogenic factors including damage to the microvascular system resulting into the hyperactivation of the coagulation cascade, systemic microvascular thrombosis, massive consumption of coagulation factors and secondary hyper-fibrinolysis. [91] This causes clinical syndromes characterized by hemorrhage and microcirculation failure.…”

“…These patients along with those who developed inflammatory factor storms are at higher risk for DIC. [90] Many critically ill patients have vasculitis-like manifestations including small vessel hyperplasia, vessel wall thickening, lumen stenosis, occlusion and focal hemorrhage. In some cases, gangrene of the extremities has also been noted.…”

“…In COVID 19 patients, the anti-inflammatory characteristics of LMWH could be an added advantage and the potential need to integrate other anti-thrombotic therapies such as anti-thrombin as well as recombinant thrombomodulin could also be valuable in this dynamic phase of 'immunothrombosis'. [90,95] (Table 1)…”