Multimodal cancer therapy for breast cancer in the first trimester of pregnancy. A case report.
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Abnormalities, Multiple↗
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[Current aspects of cystic lymphangioma in the neck].
Cystic hygroma of the neck (CHN) is the result of a defect in the embryonary development of the lymphatic system. In many cases foetal ultrasound allows an early diagnosis before birth, the prognosis being very different according to the gestational age at the time of detection. When discovered before 30 weeks of gestation it is almost always associated with chromosomal abnormality and/or polymalformation leading to spontaneous or therapeutic abortion. On the contrary when appearing after the 30th week of gestation, CHN is usually an isolated malformation as when discovered during infancy or childhood. Approximately 2/3 of these "late" CHN are present at birth; 90% are discovered before 2 years of age. A spontaneous regression occurs in about 15% of the cases. In 70% of cases the CHN is simple without extension to the oropharynx or mediastinum and its complete surgical resection is usually easy. Extension to the oropharynx is present in about 20% of the cases; there is a risk of neonatal respiratory distress and the treatment is difficult. Extension to the mediastinum is found in about 10% of the cases; respiratory distress is rare and a large surgical resection is necessary. Surgery is the primary treatment of CHN after a careful evaluation of the extension of the tumor by ultrasound, scanography or nuclear magnetic resonance, and oropharyngeal endoscopy. It allows a "macroscopically complete" resection in about 80% of the cases, but a recurrence is observed in approximately one every five cases. Following partial resection or important recurrence, treatment includes according to the cases; new attempt of surgical resection, sclerosing therapy, and laser therapy for the oropharyngeal forms.
Child↗
Lymph node negative invasive breast carcinoma 1 centimeter or less in size (T1a,bNOMO): clinicopathologic features and outcome.
BACKGROUND: Patients with lymph node negative invasive breast carcinomas < or = 1 cm in size have a low recurrence rate and may be spared adjuvant therapy. Reliable prognostic features will help physicians design appropriate treatment for these patients. METHODS: The clinicopathologic features, prognostic marker profiles, and clinical outcomes of 88 T1a,bN0M0 carcinomas in 87 patients who presented between 1975 and 1990 were studied. The size of each tumor was determined by direct measurement of histologic sections. The median follow-up was 7.8 years (range, 4-15 years). The characteristics of tumors diagnosed between 1975 and 1983 and between 1984 and 1990 were also compared. RESULTS: Before 1984, the majority of patients presented with palpable mass lesions, whereas from 1984 on, more patients presented with mammographic abnormalities. However, no significant differences in the pathologic features of tumors were observed between the two periods. There were only 3 locoregional recurrences (3%) and 4 distant recurrences (5%). Palpable tumors had worse prognoses than mammographically detected lesions (P = 0.02). Histologic grade, lymphatic invasion, hormone receptors, Ki-67 antigen, and bcl-2 expression were significant univariate prognostic indicators. The small number of patients in the series precluded multivariate analysis. None of the 43 patients (49%) with tumors < or = 0.5 cm, or of histologic and nuclear Grade 1, or of favorable histologic types developed recurrences; and their outcomes were significantly better than those of other patients (P = 0.013). Tumors originally classified as T1b, but which exceeded 1 cm on review and were excluded from the study, had a significantly higher distant recurrence rate (23%) than bona fide T1a,b carcinomas (P = 0.03). CONCLUSIONS: T1a,bN0M0 carcinomas have a low recurrence rate, especially those tumors < or = 0.5 cm, or of low histologic or nuclear grade, or of favorable histologic type. The high recurrence among patients with tumors initially understaged as T1a,b carcinoma underscores the importance of accurately determining tumor size.
Adult↗
p107 Expression in colorectal tumours rises during carcinogenesis and falls during invasion.
p107 Links to cyclin A/CDK2 (cyclin-dependent kinase 2) and cyclin E/CDK2 that are important cell cycle regulators. However, p107 expression remains unclear in almost all kinds of human solid tumours. To clarify the expression of p107 in colorectal tumours, 22 normal mucosae, 9 hyperplastic polyps, 60 adenomas, 198 primary carcinomas, 21 lymph-nodal metastases, and 10 hepatic metastases were immunohistochemically stained for p107, cyclin A, cyclin E, CDK2 and Ki67. Results were measured using labelling indices (LIs). p107 LIs surpassed the highest value in normal tissues in six of nine hyperplastic polyps, 54 of 60 adenomas, 144 of 198 primary cancers, 13 of 21 nodal foci and three of 10 hepatic foci. p107 LIs also apparently rose from normal through hyperplasia and adenoma to early carcinoma. However, they declined in liver-metastatic foci, and in primary cancers showing large size, mucinous type, venous invasion, lymphatic invasion, poorly differentiated type, deep invasion, lymph-nodal metastasis, hepatic metastasis or advanced stage. Low p107 LIs were also linked to a poor survival, particularly in stage-III patients. As the p107 LI gradually rose, the CDK2 (in primary cancers only), cyclin A, cyclin E and Ki67 LIs were elevated concurrently-in both adenomas and primary cancers. Thus, in colorectal tumours, p107 expression rises abnormally and gradually during carcinogenesis and then falls during invasion, and thereby probably perturbs the cell-cycle control and promotes carcinogenesis and invasion. Clinically, reduced p107 may indicate a poorer prognosis.
Adult↗
Metastatic and invasive tumours involving the heart in a geriatric population: a necropsy study.
In a series of 744 necropsied subjects with a diffuse malignant process, 57 cases of cardiac involvement were observed (50 metastatic carcinomas and 7 lymphomas or myeloproliferative disorders). The most frequent site of involvement was the pericardium and epicardium in lung or breast carcinoma, suggesting regional lymphatic invasion. Myocardial involvement was rarer and usually associated with cutaneous melanoma and lymphoma, suggesting haematogenic invasion. Endocardial involvement was exceptional. The multiple causes of heart disturbance in the elderly cloud the clinical diagnosis of such cardiac involvement; however, isolated pericardial and/or epicardial abnormalities should heighten suspicion of a neoplastic process.
Aged↗
Unusual findings during abdominal placement of a ventriculoperitoneal shunt: report of three cases.
The authors present three cases of infants born with myelodysplasia. Each infant underwent closure of a myelomeningocele and within 2 to 4 days placement of a ventriculoperitoneal (VP) shunt. In each case, on opening the peritoneal cavity, the authors observed egress of a dark or creamy dark fluid. None of the patients had a history of abdominal birth trauma. The decision was made to continue the procedures and send samples of the unusual fluids to the laboratory for culture and analysis. The cultures proved to be nondiagnostic and the characteristics of the fluid samples were most consistent with those of blood-tinged chyle. The authors hypothesize that, occasionally, the mechanical tautness that is created with repair of myelomeningoceles is sufficient to rupture small lymphatic vessels and accompanying blood vessels of the abdomen. An alternative hypothesis is that abdominal compression due to closure of the myelomeningocele may temporarily compress the liver, leading to raised intraportal pressures and resulting in weeping of chyle from the gastrointestinal tract. This abnormal fluid accumulation did not lead to chronic ascites, VP shunt infection, or dysfunction at long-term follow-up examination and abdominal visceral function has not been an issue.
Ascitic Fluid↗
Stage I primary malignant mixed müllerian tumor of the fallopian tube. Report of a case with five-year survival after minimal surgery without adjuvant treatment.
BACKGROUND: Sarcomas of the fallopian tube are rarities in gynecologic oncology, consisting of < 1% of all genital sarcomas. CASE: A 70-year-old woman with a stage I malignant mixed müllerian tumor (MMMT) (International Federation of Gynecology and Obstetrics classification of fallopian tube carcinomas) did not undergo radical surgery or adjuvant treatment because of the patient's refusal of them. The patient underwent only abdominal hysterectomy with bilateral salpingo-oophorectomy. She was discharged feeling well and without abnormal clinical findings. Sixty months after primary surgery there were no signs of recurrence. CONCLUSION: This case suggests the possibility of a good prognosis in early-stage MMMT, especially if there is no deep infiltration of the fallopian tube muscle layer or lymphatic permeation and if the peritoneal cytology is negative. The important feature of this report is the five year disease-free survival after nonradical surgery for prognostically favorable MMMT.
Aged↗
Ultrastructure of abnormal cells in Sezary syndrome, mycosis fungoides, and parapsoriasis en plaque.
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Blood Cells↗
Imaging findings in patients with myelofibrosis.
The purpose of this review is to illustrate the wide range of radiological abnormalities in myelofibrosis. Myelofibrosis, also called myeloid metaplasia, is a myeloproliferative disorder of unknown etiology. The common imaging findings in patients with myelofibrosis are osteosclerosis, hepatosplenomegaly, and lymphadenopathies. In addition, extramedullary hematopoiesis may develop in multiple sites such as chest, abdomen, pelvis, and central nervous system, simulating malignant disease. Selected plain-film, CT, and MR images in patients with myelofibrosis are shown as pictorial essay to allow ready recognition of the most common imaging abnormalities of the disease.
Bone and Bones↗
Prostatic occurrence of transitional cell carcinoma after intravesical chemotherapy.
Thirteen patients with Stage Tis, Ta, or T1 transitional cell carcinoma (TCC) of the bladder treated by transurethral resections and intravesical chemotherapy developed TCC of the prostate. Among the 13 cases, cytology specimens were obtained from 10 at the time prostatic disease was diagnosed; 9 demonstrated TCC. One was treated successfully by transurethral resection of a Ta lesion involving the prostatic urethra only. One of 2 patients declining radical surgery is alive with residual disease at twenty-four months, and the other died of progressive disease at nineteen months. Of the 10 patients who underwent radical cystoprostatectomy, 7 are alive with no evidence of disease eight to forty-two months postoperatively, with 2 of these 7 having received 4 courses of systemic methotrexate, vincristine, Adriamycin, and cisplatinum (MVAC) for metastatic disease. Two of the 10 died of metastatic disease six and thirteen months postoperatively, and one frail patient died of surgical complications. When treating patients with intravesical chemotherapy for superficial TCC, biopsy of the prostate should be done during follow-up examinations, especially in the presence of cytologic or palpable prostatic abnormalities.
Administration, Intravesical↗
E cadherin expression in normal and neoplastic canine mammary gland.
The epithelial intercellular adhesion molecule, E cadherin, was evaluated immunohistochemically in a series of normal and malignant neoplastic canine mammary glands. The normal glands showed strong immunolabelling at the intercellular borders of all the ductal cells. Tubular and papillary mammary adenocarcinomas had reduced intercellular E cadherin positivity with "heterogeneous" or "cytoplasmic" distribution. Solid and squamous cell carcinomas were negative. These results suggest that reduced expression and abnormal distribution of E cadherin may be related to the differentiation grade of these neoplasms.
Animals↗
Generalized lymphadenopathy and T cell abnormalities in hemophilia A.
Two patients with hemophilia A had generalized lymphadenopathy, lymphopenia, elevated IgG values, depressed T4 (helper) lymphocytes, elevated T8 (suppressor) lymphocytes, and abnormally low T4/T8 ratios. One of the patients, who also had hepatosplenomegaly, underwent cervical lymph node biopsy; the node contained 43% T8-lymphocytes, a marked elevation over the small fraction of T8 cells usually found in lymph nodes. These patients may have a form of the acquired immune deficiency syndrome described in male homosexuals, Haitians, intravenous drug abusers, and recently, in patients with hemophilia. We studied T cell phenotypes in 43 patients with hemophilia. Fourteen of 28 patients given commercial factor VIII concentrates had abnormal T4/T8 ratios; none of nine patients who used cryoprecipitate had abnormal values. T4 helper cells were significantly lower, T8 suppressor cells significantly elevated, and T4/T8 ratios significantly lower in the lyophilized concentrate users and in patients with hemophilia as a total group. The type of therapeutic factor VIII replacement may alter the risk of developing T4/T8 abnormalities or AIDS.
Acquired Immunodeficiency Syndrome↗
Fertility in patients treated with radiotherapy following orchidectomy for testicular seminoma.
This study evaluated the effect of paraaortic and ipsilateral pelvic node irradiation on the fertility of a group of 50 patients with Stage I and II testicular seminoma. Eleven patients were infertile before the start of treatment, and another 23 were unable or unwilling to father a child after radiotherapy. From the remaining 16 patients, 11 pregnancies resulted. It has been shown that fertility can be preserved if the dose to the remaining testis can be reduced to less than 2 Gy. No genetic abnormalities were seen in the offspring of any patient.
Adult↗
Changes in lymph microcirculation during pathological stress.
Stress caused by immobilization and acoustic stimulation produces considerable changes in lymph microcirculation. These changes manifested in dilation of microvessels, enhanced phasic contractile activity and its abnormal pattern, accelerated lymph flow, and recruitment of new lymphangions in drainage functions.
Animals↗
[The radiological evaluation of the abnormal thymus and its frequency in myasthenia gravis (author's transl)].
The radiological evaluation of the thymus is discussed and the results of 159 pneumomediastinums are described. Amongst these patients, 28.5% had a persistent thymus, 41.1% showed partial involution of the thymus, 22.5% showed total involution and in 7.9% a thymoma was found. Comparison of patients with myasthenia gravis with a group suffering from autoimmune diseases showed a similar incidence of abnormal thymuses. The value of radiology in assessing the need for thymectomy as a treatment is stressed.
Adult↗
[Antecedents of cytological screening among patients treated for invasive cervical neoplasm].
OBJECTIVE: The aim of this study is to evaluate if the seriousness of invasive neoplasms of the uterin cervix actually observed is related to the apparition of rapid onset cases. POPULATION: 219 invasive cancers of the cervix treated from 1988 to 1999 in a gynecological oncologic department. METHODS: prognostic factors of cancers have been studied and compared to those of cases treated between 1975 and 1980 in the same department. The existence of cytological screenings has been searched and results have been analysed. RESULTS: Cervical cancers treated during the last 12 years have more serious prognostic factors than those treated during the former period. This evolution is shown by a progression of advanced stages of + 10.2%, an increase of lymph node invasion in proximal stages of + 13,4% and the doubling of number of adenocarcinomas. Though no change of the natural history of cancers has been proved. Only 42% of patients had profited of a cervical screening and cancers diagnosed at "stage I" are statistically more numerous in this group. Improvement should be brought up in the quality of samplings and of the care of abnormal results of cytological screening.
Adenocarcinoma↗
The association of the expression of MTA1, nm23H1 with the invasion, metastasis of ovarian carcinoma.
OBJECTIVE: To understanding the molecular mechanisms in invasion and metastasis of the ovarian carcinoma, we investigate a novel candidate metastasis-associated gene (MTA1) and nm23H1 mRNA expression and mutation in ovarian carcinoma. METHODS: Twenty primary ovarian carcinoma specimens, 20 corresponding lymph nodes and 8 normal ovarian was examined for mRNA expression and mutation of MTA1 and nm23H1 genes by reverse-transcription polymerase chain reaction (RT-PCR) and RT-PCR-SSCP analysis. The level of the expression was determined by the relative optic density (ROD) of the PCR products. RESULTS: The frequency of MAT1 overexpression was 100% (7/7) in primary ovarian carcinoma with metastasis but only 38.5% (5/13) in those without metastasis (P=0.0103). Overexpression of MAT1 was observed in 87.5% (6/7) of lymph nodes with metastasis but only 23% (3/13) of lymph nodes without metastasis (P=0.0118). In contrast with MAT1, low expression of nm23H1 mRNA was seen in 7 of 7 ovarian carcinoma with metastasis but only in 4 of 13 (30%) of those without metastasis (P=0.0043). Low nm23H1 expression was also seen in 7 of 7 lymph nodes with metastasis but only in 5 of 13 (38.5%) nonmetastatic lymph nodes (P=0.0102). The ROD ratio of MAT1 to nm23H1 increased with the development of metastasis. No mutation of MAT1 and nm23H1 genes was found by SSCP analysis. CONCLUSION: The mRNA expression of MTA1 and nm23H1 is positively and negatively correlated with lymph node metastasis, respectively. Expression abnormalities but not mutation of the two genes are frequent events related to lymph node metastasis of ovarian cancer.
Female↗
Congenital malformations, mortality and styrene exposure.
The prevalence of congenital malformations among children born to styrene-exposed male and female workers, as well as the mortality of the exposed workers, was studied. A cohort of 2,209 workers (1,698 men, 511 women) was selected from the personnel files of 160 workplaces using styrene in the manufacture of reinforced plastic products. The earliest exposure histories began in 1960, but the majority of workers had been exposed after 1967. The data on children born to the exposed workers were linked with those of the Register of Congenital Malformations. The number of malformations of children born to the workers was, both before and during the styrene exposure, below the expected values. In the cohort there were 37 observed deaths (expected 74.0), six of which were due to cancer (expected 13.0). The cancer sites were the stomach (2 cases), bronchus (1), breast (1), ovary (1), and kidney (1 case). There were no cases of lymphatic or haematopoietic cancer. Most of the cancers appeared after short exposure times and soon after the commencement of exposure.
Abnormalities, Drug-Induced↗