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Open access

Adam Bilski, Janusz Piekarski and Arkadiusz Jeziorski

Stewart-Treves Syndrome - A Rare Complication of Lymphedema

Stewart-Treves syndrome is the development of angiosarcoma in chronically lymphedematous upper extremities following a mastectomy. This is a very rare entity that occurs in 0.07-0.2% of patients treated for breast cancer. The tumor occurs in a median time ranging from 10 to 17 years after mastectomy and is associated with poor prognosis. An aggressive clinical course and metastatic tendency results in a fatal outcome for most patients within two years of diagnosis. The 5-year survival rate does not exceed 15%. A surgical procedure is the treatment of choice. It is generally recommended to perform limb amputation because of the difficulties in macroscopically defining the tumor margins. Radiotherapy and chemotherapy can be of benefit when excision of the primary or recurrent tumor is impossible or when the patient does not consent to the surgical procedure. We present the only case of Stewart-Treves syndrome among 4908 patients treated for breast cancer in our Department from 1977 to 2005.

Open access

Arkadiusz Jeziorski, Robert Kubiak and Janusz Piekarski

Two Different Primary Carcinomas in One Breast - Diagnostic and Therapeutic Challenge: A Case Report

We present a case of 44-year old women with two primary carcinomas diagnosed in one breast. The carcinomas were invasive mixed ductal-lobular and lobular invasive carcinoma. This specific case was difficult to treat because these carcinomas are differentially susceptible to hormonal treatment. We refrained from making therapeutic decisions based solely on characteristics of the first primary would be improper because important therapeutic option (hormonal treatment) would not be used to treat the other primary. Therefore, the treatment would have been suboptimal. In our opinion, this case supports the close examination of biological characteristics of each carcinoma focus, especially if greater than one cancer focus with different morphology exists in the breast tissue.

Open access

Piotr Sęk, Janusz Piekarski, Robert Kubiak, Wiesław Szymczak, Dariusz Nejc, Piotr Pluta, Adam Bilski and Arkadiusz Jeziorski

Tumor Size and Pathologic Characteristics of Breast Cancer Analysis of 639 Early Breast Cancers

Primary tumor size, an essential clinical parameter, is assessed by oncologist during the physical examination of a patient with breast cancer. The results of such assessment constitutes a basis for classification of breast cancer staging, selection of proper primary treatment, selection of type of surgical treatment and initial evaluation of patient prognosis.

The aim of the study was to describe changes in biological characteristics of breast cancers relative to increases in primary tumor size.

Material and methods. All women treated surgically for breast cancer in the Department of Surgical Oncology, Medical University in Łódź, from 1999 to 2004, were included in our study. We confined our analysis to primary operable, invasive, primary tumors less than 3 cm. 639 cases comprised the study group. We analyzed the associations between primary tumor size and other routinely assessed clinical and pathological parameters.

Results. We found statistical associations between primary tumor size and the presence of metastases in axillary lymph nodes (p<0.0001), presence of extracapsular extension of lymph nodes metastases (p<0.0001), presence of tumor cells emboli (p<0.0001), absence of expression of estrogen receptor (p=0043) and absence of progesterone receptor (p=0.0196) in cancer cells. No association was found between tumor size and histologic tumor type (p=0.205). In a subgroup of ductal carcinomas, tumor size was associated with the grade of cancer (p=0.0002).

Conclusions. Increases in tumor size are accompanied by increasing incidence of unfavorable prognostic factors and decreasing incidence of favorable prognostic factors. Tumor size constitutes the source of direct and indirect prognostic information.

Open access

Angelika Bara, Piotr Pluta and Arkadiusz Jeziorski


Cancer of Unknown Primary Origin (CUPO) is defined by the presence of metastatic lesions, diagnosed by means of cytological or pathological evaluation, for which no primary site can be detected during a thorough examination. The clinical investigation, directed at locating the site of the neoplastic lesion, is determined by the results of laboratory tests, imaging procedures, and pathological examinations. It is also essential to conduct a complete medical history and thorough physical examination. The detection of the primary site allowed to introduce specific therapy, which can offer clinical benefits, considering a favorable prognosis.

The aim of the study was to assess the range of diagnostic procedures performed in patients with CUPO and efficacy in identifying the primary lesion.

Material and methods. Retrospective analysis comprised a group of 29 patients with CUPO, operated between January, 2002 and December, 2011, at the Department of Surgical Oncology, Medical University in Łódź. The study group comprised 16 male and 13 female patients; median age at presentation was 58.3 years (ranging between 30-79 years).

Results. Detailed diagnostic management depending on the location of metastatic lesions and their histological type was performed in 20 of the 29 study patients (69%). Considering the remaining 9 (31%) patients detailed diagnostics was not performed, due to the patients' poor general condition. In 55% (11/20) of patients subject to detailed diagnostics, the primary neoplastic lesion was determined.

Conclusions. Considering the study group, most patients with cancer of unknown primary origin were characterized by a favorable prognosis, which justified thorough diagnostics, in order to establish the primary neoplastic lesion. The introduction of diagnostic examinations enabled to identify the primary site of the tumor in more than 50% of patients. With the development of imaging methods one can expect improvement of unsatisfactory results, considering the detection of primary neoplastic foci.

Open access

Piotr Pluta, Janusz Piekarski, Dariusz Nejc, Grażyna Pasz-Walczak, Andrzej Berner, Piotr Sęk, Adam Bilski, Adam Durczyński and Arkadiusz Jeziorski

A Blue-Dye-Only, Wide-Axillary-Access Technique for Sentinel Node Biopsy in Breast Cancer Patients Undergoing Elective Complete Axillary Dissection

The aim of the study was to assess the value of a sentinel node biopsy with the use of a blue-dye-only technique as a tool for ultrastaging breast cancer in patients undergoing axillary lymphadenectomy. In order to maximize the efficacy of the method, we used a specific technique identifying blue-dyed lymph vessels during surgery. We took advantage of the wide surgical access to axillary lymph nodes.

Material and methods. A blue dye technique for sentinel node biopsy was used during a modified radical mastectomy (Madden type) in 34 patients (85%) or during breast-conserving surgery with complete axillary dissection in six patients (15%).

Results. The sentinel node(s) was identified in 39 of the 40 patients (97.5%). Metastases were detected in sentinel nodes in 14 out of these 39 patients. In one patient (1/39; 2.5%), micrometastasis was identified. The false-negative rate was 0%, sensitivity 100%, and negative-predictive value 100%.

Conclusions. The blue dye method for sentinel node biopsy with wide access to the axilla is an effective and reliable tool for the identification of the sentinel node. The use of this simple technique permits ultrastaging of breast cancer patients undergoing complete axillary dissection.

Open access

Jan Kulig, Grzegorz Wallner, Michał Drews, Mariusz Frączek, Arkadiusz Jeziorski, Wojciech Kielan, Piotr Kołodziejczyk, Anna Nasierowska-Guttmejer, Teresa Starzyńska, Krzysztof Zinkiewicz and Marek Krawczyk

Open access

Piotr Pluta, Piotr Smolewski, Agnieszka Pluta, Barbara Cebula-Obrzut, Agnieszka Wierzbowska, Dariusz Nejc, Tadeusz Robak, Radzisław Kordek, Leszek Gottwald, Janusz Piekarski and Arkadiusz Jeziorski

Significance of Bax Expression in Breast Cancer Patients

Bax protein, the proapoptotic member of Bcl-2 protein family, plays the key role in apoptosis pathway.

The aim of the study was to assess the expression of Bax protein in breast cancer cells.

Material and methods. Sixty-two breast cancer patients were included in the study. The control group encompassed 11 fibroadenoma patients. Single cells were isolated from defrosted samples and prepared for flow cytometry measurement.

Results. Median expression of Bax protein in study group was 7.9% (range: 0-49.4%) and was significantly lower than in control (median expression 15.8%; range 4.9-30.9%; p=0.034). Expression of Bax correlated with expression of p53 and caspase-3 proteins (p<0,01, rank Spearman test). In patients under 70 years old and with positive estrogen receptors status the expression of Bax protein was significantly higher (p=0.03 and p=0.01 respectively).

Conclusions. Lower expression of Bax protein in breast cancer cells may suggest the potential way of apoptosis avoidance of tumor cells. Correlations among Bax protein, p53 and caspase-3 are likely associated with active apoptotic mechanism in breast cancer cells expressing Bax protein. Further investigation with long time follow-up should be performed to establish the prognostic role of Bax protein expression in breast cancer patients.