Objective: To study the clinicopathological characteristics，diagnosis，multiple modality therapy and prognosis of accessory breast cancer. Methods: Clinical data of 38 patients with accessory breast cancer seen in our hospital between October 1985 and November 2007. Results: The 38 cases of accessory breast cancer accounted for 0.15% of all 26,078 breast cancer cases during the same period.Six patients of stage Ⅰ and 3 patients of stage Ⅱ underwent breast-conserving local wide excision of the tumor plus axillary lymph node dissection,with the resection margins pathologically negative.The other 9 cases of stage Ⅱ patients were treated with Auchincloss mastectomy.Stage Ⅲ and stage Ⅳ patients were treated with Auchincloss or Halsted mastectomy.The most common histological type of accessory breast cancer was infiltrating ductal Carcinoma for 18 patients(47.4%)，of which 3 cases were associated with adenoma of the nipple tube.There were 6 cases of carcinoma simplex，6 cases of intraductal Carcinoma，3 cases of adenocarcinoma with focal squamous cancer cells differentiation，3 cases of medullary carcinoma，and 2 cases of mucinous adenocarcinoma.The most common pathological stages(according to AJCC staging of breast cancer,2002.6th edition)were stage Ⅱ and Ⅲ in 12 cases(31.6%)，stage Ⅰ in 6 cases，and stage Ⅳ in 8 cases.All patients were followed-up for 1 to 23 years.The median follow-up time was 6 years and 7 months，and the follow-up rate was 100%.Until November 2008，12 patients died of metastasis and the other 26 patients were still alive.The 5-year overall survival rate was 35.3%.significantly lower than that of breast cancer patients(66.8%).The 3-year survival rate was 77.8%.The 5-year disease free survivaI rate was 28.6%and the 3-year disease free survival rate was 63.6%. Conclusion: Accessory breast cancer is rarely seen but is aggressive.The diagnosis mainly depends on clinical characteristics，postoperative pathology and imaging examinations.Early diagnosis is essential.Surgery combined with other adjuvant therapies can improve patient survival.

Objective:To investigate the expression of indoleamine 2,3-dioxygenase and the distribution of Treg cells in breast cancer and tumor draining lymph nodes (TDLNs) and to explore the relationship between them.Methods:26 cases of breast cancer and 10 cases of breast benign diseases were collected from Tianjin medical university cancer hospital.RT-PCR was used to detect the mRNA of IDO in breast cancer,TDLNs,benign diseases and normal breast tissues.Immunohistochemistry was used to detect the expression of IDO and Foxp3 proteins in the same tissues. Results:The mRNA and the percentage of IDO~+ cells [(19.59±7.65)%] in TDLNs were higher than in breast cancer [(13.16±7.82)%] (P<0.05),while in the breast cancer were higher than in benign diseases [(3.24±1.30)%] and normal breast tissue [(2.70±1.53)%] (P<0.05).Expression of IDO protein in breast cancer was associated with tumor clinical stage and lymph nodes metastasis while had no relationship with tumor diameter,ER,PR and Her2 status.The percentage of Foxp3~+ cells in breast cancer [(3.50±1.04)%] was higher than in benign diseases [(0.71±0.42)%] (P<0.05) and normal breast tissue [(0.55±0.34)%],and that of the TDLNs [(6.13±2.31)%] was higher than in breast cancer [(3.50±1.04)%] (P<0.05).The percentage of IDO~+ cells was positive correlated with the distribution of Treg cells in breast cancer(r~2=0.449,P<0.05)and TDLNs (r~2=0.454,P<0.05).Conclusion:Expression of IDO in breast cancer is upregulated.The high level expression of IDO is accompanied by increasing Treg cells in breast cancer and TDLNs,which suggests that breast cancer can recruit Treg cells by expressing IDO to participate the immune tolerance.

Purpose: Seroma formation is a common complication in breast cancer patients undergoing mastectomy, and it negatively affects patient recovery after surgery. The present study aimed to evaluate a simple method using fascia suture technique to fix the flap and reduce the incidence of seroma. Methods: A single-center, prospective, randomized controlled trial was carried out among 160 patients who had undergone mastectomy from May 2018 to September 2019. All patients were randomly divided into the fascia suture group (n = 80) or control group (n = 80) and were followed up for at least 3 months for the assessment of immediate and late complications after surgery. Results: No significant differences were observed between the 2 groups with regard to the basic characteristics. Duration of surgery in the fascia suture group was longer by about 6 minutes compared with that in the control group (114.93 ± 13.67 minutes vs. 108.81 ± 15.20 minutes, p = 0.008). The fascia suture group had a shorter duration of drain placement (10.99 ± 3.26 days vs. 13.85 ± 5.37 days, p < 0.001), a smaller volume of the total drainage (460.95 ± 242.92 mL vs. 574.83 ± 285.23 mL, p = 0.007), and the first 3-day drainage (224.96 ± 101.01 mL vs. 272.3 ± 115.47 mL, p = 0.006), compared with the control group. The incidence of seroma formation (G2 or G3) was significantly lower in the fascia suture group compared with the control group (28.8% vs. 12.5%, p = 0.033). Besides, there was no statistical difference between the 2 groups in the assessment of other complications, including postoperative pain, hematoma, surgical site infections, flap necrosis, and skin dimpling (all p > 0.050). Conclusion The fascia suture technique is a simple and effective method for reducing seroma formation and should be used to prevent seroma formation after mastectomy.