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Breast cancer related lymphedema (BCRL) is a chronic debilitating condition seen after treatment of breast cancer. The overall incidence varies from 20% to 56% in all patients treated for breast cancer. Every patient is at a lifelong risk for BCRL and the risk goes on increasing as the followup period increases. Locoregional treatment including surgery or radiotherapy is the most common risk factor for development of arm lymphedema. There are two phases of arm lymphedema. There is increased fluid accumulation in the fluid phase of lymphedema which later on goes into the solid phase where fat and fibrotic tissue is deposited in the subcutaneous tissue. The treatment of BCRL is a challenge both for the patient and the treating surgeon and it needs multidisciplinary team work to be successful. Non-surgical treatment modalities include complete decongestive therapy (CDT) and pneumatic compression therapy. Surgery for BCRL is usually undertaken as a salvage modality after failure of conservative approaches. The surgical spectrum for BCRL varies from extensive excisional operations which were commonly done in the past to newer methods like suction assisted protein lipectomy, lymphatic reconstruction and vascular lymph node transfer (VLNT) using super-microsurgical techniques. There is no consensus regarding the preference of one procedure over other due to lack of randomised control trials. It is however suggested to do lymphovenous anastomosis and complete decongestive therapy for early cases in fluid phase; while patients in the solid phase may be treated with a combination of liposuction with CDT or VLNT alone.

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Molecular Oncology has paved its way in the comprehensive cancer care, and its burgeoning role especially in the discovery of novel cellular targets is responsible for emergence of the new Paradigm called "Genomic Paradigm", a shift from the old age "Clinico-Pathological Paradigm". In breast cancer, till recently clinical decisions, prognostications, and predictions were based solely upon histopathologic analysis, or one or a small numbers of genes or their expressions (proteins) in the tumor tissue. With the advent of newer technologies like microarray, which allows us to read the "Molecular Signature" of an individual patient's tumor, the molecular information is exploited for novel targeted treatments and new biomarkers identification. This has led to better classification of cancers for prognostication and treatment selection. In this review we have summarized various Genomic Expression Profiling (GEP) which are available commercially or in different developmental phases.

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Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is a more aggressive subtype of breast cancer and targeting the HER2 receptor has proven effective in improving the prognosis of these patients. Pertuzumab, a recombinant humanized monoclonal antibody and the first in a class of HER2 dimerization inhibitors approved for treating HER2+ breast cancer. It blocks ligand-dependent heterodimerization and ligand-independent homodimerization of HER2 with other HER members. When used in combination with trastuzumab and taxane, pertuzumab complements the action of trastuzumab and results in a comprehensive blockade of HER2 signaling pathway. This review article traces the development of pertuzumab from concept to its current use in HER2+ breast cancer treatment. A search of Medical Literature Published since 2007 was performed in PubMed using the keywords "pertuzumab," "HER2+ breast cancer," "HER2 targeted therapy," "metastatic breast cancer," and in search engines for ongoing trials with pertuzumab and incidence of cancer and breast cancer in India. A total of 35 publications and abstracts from the American Society of Clinical Oncology were selected for this review. Pertuzumab is approved in combination with trastuzumab and docetaxel for the treatment of patients with HER2+ metastatic BC, who have not received prior anti-HER2 therapy or chemotherapy for metastatic disease. The dual HER2 blockade of pertuzumab and trastuzumab is now accepted worldwide as a standard of care by various guidelines.

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Introduction: Bilateral breast cancer BCC is relatively uncommon with an overall incidence of 5-20% in women with early breast cancer. They are divided into synchronous if cancers are detected simultaneously or within 6 months of each other and metachronous if they are detected more than 6 months apart from each other. Family history and hereditary cancers multicentricity and lobular histology are some of the factors associated with BCC. In this background, we sought to evaluate the incidence, clinicopathological profile, and management of women with bilateral primary breast cancer at our institute. Materials and Methods: We retrospectively reviewed the medical records of women who underwent surgery for BCC at the breast services unit at our institute from October 2010 to April 2015. The clinicopathological profile and outcomes were analyzed using SPSS 22 software and appropriate statistical tests. Results: Out of 1330 women who underwent surgery for early breast cancer between October 2010 and April 2015, 44 were bilateral. Twenty-eight were synchronous and 16 were metachronous. Mean age of the presentation of patients was 53 years (range 30-79 years). The histological type were same in 82.14% of synchronous tumors and 87.5% of metachronous tumors (P = 0.496). The grades were similar in 42.85% of synchronous tumors and 56.25% of metachronous lesions (P = 0.294). The stage concordance among synchronous tumors was 39.28%, whereas it was 60% among metachronous lesions (P = 0.164). Conclusions: The management of BCC is complex and has to be tailored to the individual based on characteristics of index and second tumor, prior therapy, adjuvant treatment, and risk stratification. Moreover, the concordance of receptor expression is higher in synchronous cancers than metachronous cancers.

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Wire Guided Localisation has been the traditional technique for occult breast lesions. However, ROLL has emerged as a safer alternative to WGL approach. ROLL provides an improvement on margin positive rates and offers better pain and cosmetic advantages to the patient combined with a shorter learning curves for both radiologists and surgeons. SNOLL adds to the advantages of the procedure by combining SLNB with ROLL hence offering an economic advantage. The use of ROLL as primary modality for occult lesion localisation is bound to increase with potential to replace WGL as the primary modality for such lesions.

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Myoepithelial carcinomas of soft tissue origin are rare tumors in the pediatric population. Due to the rarity of this malignancy, very few cases have been reported in the literature, and a consensus on treatment has not been established. Most myoepithelial carcinomas of soft tissue present in the extremities and are treated with surgical excision followed by adjuvant radiotherapy. We report 2 cases of pediatric myoepithelial carcinoma presenting with vertebral involvement making complete surgical removal impossible. These patients underwent chemotherapy and adjuvant radiotherapy as the main treatment for their primary tumors.

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Serrated adenoma is a newly described entity in the group of gastric adenomas. Until date only 20 cases of gastric serrated adenoma have been reported. It is an important entity to be diagnosed accurately as it has a very high-risk of malignant transformation, especially those located in the cardia of stomach. Serrated adenoma associated with adenocarcinoma is more frequent in the elderly, but pure serrated adenoma is common in the young, in whom follow-up is mandatory. Gastric serrated adenoma has distinct location, definite histomorphology and characteristic Ki-67 immunohistochemical staining. Ki-67 staining helps to differentiated pure serrated adenoma from those associated with adenocarcinoma. We present a young adult male, incidentally detected to have gastric serrated adenoma.

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Introduction: Squamous cell carcinoma is the most common malignancy of the conjunctiva worldwide. Ocular surface squamous neoplasia (OSSN) describes the spectrum of ocular surface intraepithelial neoplasia, pre-invasive and invasive squamous cell carcinoma. Method: This nonrandomized study aims to describe the epidemiology, clinical features and evaluate the outcome of treatment in patients with histological diagnosis of OSSN managed at a single tertiary center in Ibadan, Nigeria. Result: Twenty-five patients were managed within the study period with a mean age of 42 ± 15.3 years and male: female ratio of 1:1.5. All patients presented with growth and redness, and, visual impairment was observed in seven (28%) patients. Fifteen (60%) patients were seropositive for HIV infection and one patient (4%) had xeroderma pigmentosum. The right side was involved in 11 (44%) patients and there were no bilateral lesions. Morphologically, 18 (72%) lesions were gelatinous, six (24%) were leucoplakic while one (4%) was nodular. Twenty-two (88%) patients underwent surgical excision with alcohol kerato-epitheliectomy and cryotherapy, while three (12%) patients had lid sparing orbital exenteration. The three (12%) patients with intraepithelial neoplasm, and six (24%) who had SCC but with tumor-free margins received no adjuvant treatment post-operatively, while 13 (52%) with SCC and microscopic margin involvement were treated with four courses of 0.04% topical mitomycin C (MMC) and the three (12%) patients who had orbital exenteration were referred for radiotherapy. The average follow-up period was 12 months, no patient was lost to follow-up and none has had recurrence. Conclusion: OSSN occurs in younger individuals, and is strongly associated with HIV infection in our environment. Early diagnosis and intervention can prevent severe ocular morbidity. Wide surgical excision with intra-operative cryotherapy and adjuvant treatment with topical MMC post-operatively seem to give good outcome in our patients.

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GIST and EGIST are known to be distinct clinico-pathological entities. The occurrence of both in the same patient as a pattern of recurrence is extremely rare. We report one such case which was managed successfully due to high index of suspicion and interdisciplinary co-ordination.

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Objective: The objective of this study was to establish the diagnostic significance of breast incidentalomas detected on whole-body fluorine-18 ( ¹⁸ F) fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). Materials and Methods: We retrospectively analyzed the data of 3868 patients who underwent ¹⁸ F FDG PET/CT at our institution, for the presence of hypermetabolic focus in the breasts. Patients with known breast cancer or with the previous history of breast cancer were excluded from the study. Ten out of remaining 3868 patients had abnormal focal uptake in the breast. We, therefore, enrolled these 10 patients with histopathology confirmation in this study. Results: Among all 3868 patients, 10 (0.25%) patients demonstrated incidental focal uptake in breast parenchyma. All of these 10 patients were females. Histopathology examination confirmed malignancy in 8 out of 10 patients (80%), these included invasive ductal cancer in 4 patients, non-Hodgkin's lymphoma in 2 patients, and metastasis from rectal cancer and endometrial cancer, respectively, in 2 patients. Of the 10 patients, 2 (20%) had lesions that were confirmed to be benign. Both of these were proven to be fibroadenomas. The mean maximum standardized uptake value (SUV _max ) on FDG-PET/CT scans was 1.35 ± 1.2 in the benign cases versus 3.8 ± 1.83 in the malignant cases. This difference was statistically insignificant (P = 0.056). All malignant lesions had SUV _max 2.0 or greater. The mean size differed significantly between the benign and malignant groups (2.55 ± 0.63 vs. 1.31 ± 0.44 cm) (P = 0.005) with benign lesions being bigger in size. Conclusion: Unexpected focal areas of hypermetabolic activity discovered in the breast at the time of PET/CT are associated with a high likelihood of malignancy in as many as 80% of cases. Therefore, any suspicious activity discovered in the breast on PET/CT should be evaluated until a diagnosis is found.

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