227. Spontaneous splenic rupture secondary to lobular breast carcinoma metastases

227. Spontaneous splenic rupture secondary to lobular breast carcinoma metastases

S94 about the prognostic importance in Japanese patients with breast cancer. The aim of this study was to examine the relationship between initial BMI...

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S94 about the prognostic importance in Japanese patients with breast cancer. The aim of this study was to examine the relationship between initial BMI and clinical outcome in patients with estrogen receptor (ER) positive and human epidermal growth factor receptor type 2 (HER2) negative invasive breast cancer. Materials and methods: Six hundred twelve patients with ER positive and HER2 negative stage I-III breast cancer treated from 2005 to 2012 at Fujita Health University were analyzed. ER, progesterone receptor (PgR), HER2, and Ki-67 were assessed by immunohistochemistry (IHC). The threshold for ER positivity was 1%. Tumors were consider HER2 positive if IHC staining was 3+ or FISH positive. BMI was divided into 4 categories as follows: underweight (BMI < 18.5 Kg/m2), normal weigh (BMI 18.5e24.9 Kg/m2), overweight (BMI 25e29.9 Kg/m2), obese (BMI  30 Kg/m2). Relapse-free survival (RFS) curves and overall survival (OS) curves were generated using the Kaplan-Meier method and survival comparisons were made with the log-rank test. The chi- square test was used to examine differences with categorical variables. The level of significance was taken to be 0.05. IBM SPSS Statistics19 software package was used for statistical analysis. Results: Of these 612 patients, 10% (n¼61) were underweight, 69.9% (n¼428) were normal weigh, 16.7% (n¼102) were overweight, and 3.4% (n¼21) were obese. Menopausal status was significantly different between the four BMI categories. No correlation was found between BMI and stage, pathological lymph node status, Ki67 labeling index, PgR status, and histological grade. BMI at diagnosis did not affect the risk of recurrence and death. Conclusions: In our series the incidence of obesity is lower than that in western countries and prognostic significance for BMI was not observed in terms of relapse-free and overall survival. Our study was a retrospective analysis of a limited patient group. A larger cohort study in Japanese women might provide additional data in terms of outcome. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.220

227. Spontaneous splenic rupture secondary to lobular breast carcinoma metastases S. Seewoonarain1, V. Kumar1, S.C. Jenkins1 1 Princess Alexandra Hospital, Harlow, United Kingdom Background: We present the rare case of a female patient with treated breast cancer presenting with spontaneous splenic rupture of the spleen and histology showing lobular breast cancer metastasis. Materials and Methods: The patient presented with anaemia and left sided abdominal pain with no history of trauma. She was known to have breast cancer and treated with radiotherapy and chemotherapy 3 years ago. Abdominal CT scan reported a splenic rupture and the patient underwent laparotomy and splenectomy. Histology of the spleen confirmed metastatic lobular carcinoma. Results : Breast metastasis to the spleen is a relatively rare event. Splenic rupture as attributed to metastases is rarer still. The incidence of splenic metastases in cancer patients ranges from 2.3-12.9% in post-mortem studies. Based on autopsy studies the prevalence of splenic metastasis from breast carcinoma ranges from 6.9%-16%. Although splenic secondaries are not an uncommon event, splenic rupture secondary to malignancy is an unusual phenomenon. There have been several studies debating the low frequency of splenic metastasis as despite the rich vasculature of the spleen, haematogenous spread is rare. Several theories have been proposed including the mechanical hypothesis whereby the constant blood flow and splenic contractions prevent metastatic emboli implanting in the spleen. Additionally the angle of the splenic artery from the coeliac trunk may prevent metastatic emboli entering the blood stream as well as a lack of afferent lymphatics to the spleen reduces the number of metastatic cells reaching the spleen.

ABSTRACTS The second hypothesis is the micro-environment of the spleen itself which contain immune-competent cells preventing implantation of metastatic cells and its ability to produce angiostatin, an antiagiogenesis agent, which combats the angiogenesis of malignancy. Conclusion: This case is unusual in that firstly, we report the rare phenomenon of metastatic breast carcinoma to the spleen and secondly, that the presentation of splenic rupture secondary to lobular breast carcinoma is rarely reported event. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.221

228. The behavior of HER2 positive DCIS of the breast M. Sundquist1, E. Scherman1, T. Tot2 1 County Hospital Kalmar, Surgery, Kalmar, Sweden 2 Hospital Falun, Pathology, Falun, Sweden Background: Ductal cancer in situ of the breast (DCIS) is increasing. In the past patients with pure DCIS has not received any adjuvant therapy. Today adjuvant radiotherapy is given to many breast conserved DCIS patients and trials have shown adjuvant endocrine therapy to decrease to risk of recurrence. Trials using adjuvant trastuzumab are ongoing. The purpose is to describe the behavior of HER2 positive DCIS of grade 3 or 2 with necrosis. Material and methods: Forty-one consecutive patients with grade 3 or 2 with necrosis without invasive component, with micro invasive component (DCIS-MI) or accompanying macro invasive cancer respectively were identified from the patient’s database 2005-2012 of Kalmar County Hospital. Formalin fixed paraffin embedded tumour specimens were analyzed for HER2 expression with immunohistochemistry according to standard protocol. Results: Nineteen patients with pure DCIS had 5 invasive local recurrences. Four of these had HER2+++ in their original DCIS specimen. Three developed distant metastases. Of 13 patients with DCIS-MI 5 developed distant metastases. All of these were HER2+++ in the DCIS component. Of 8 patients with invasive ductal cancer (IDC) accompanied by extensive DCIS 7 had distant recurrences, all of which were HER2+++ in the DCIS component. Conclusions: HER2 positive DCIS Grade 3 or 2 with necrosis is an aggressive phenotype even without presence of macro invasive breast cancer. Optimal local and systemic treatment need to be developed. No conflict of interest. http://dx.doi.org/10.1016/j.ejso.2014.08.222

229. What type of volume displacement of oncoplastic surgery do Korean prefer, small scar or natural contour? T. Kim1, K.H. Kim1, H.J. Baik1, K.D. Byun1 1 Pusan Paik Hospital Inje University, General Surgery, Busan, South Korea Background/Objective: Nowadays oncoplastic surgery (OPS) has been popular for breast cancer operation in Korea. Modern goal of surgery in breast cancer has become to make good looking breast as normal as possible. Some types of volume displacement of OPS such as parenchymal rotation have long scar. Many Korean women did not like long scar. This study was described about the cosmetic outcomes and preference of patient for scar of volume displacement of OPS undertaken in Korean woman with small or medium sized breast. Methods: We tried to undergo volume displacement of OPS in 102 breast cancer patients with small or medium sized breast between 2011 and 2012. We performed 3 kinds of parenchymal displacement after breast conserving surgery. First, we undertook parenchymal rotation (dermoglandular rotation,DGR) with long scar in 18 women with breast cancer.