Savelina L. Popovska, Ivan N. Ivanov and Dorian Y. Dikov
1. Bear HD. Indication for neoadjuvant chemotherapy for breast cancer. Semin Oncol. 1998; 25(2 Suppl3):3-12.
2. Botti C,Vici P, Lopez M, Scinto AF, Cognetti F, Cavaliere R. Prognotic value of lymph node metastasis after neoadjuvant chemotherapy for large-sized operable carcinoma of the breast. J Am CollSurg. 1995; 181 (3):202-208.
3. Kuerer HM, Newman LA, Buzdar AU, Hunt KK, Dhingra K, Buchholz TA, et al. Residual metastatic axillarylymphnodes following neoadjuvant chemotherapy predict disease
Borislav Kondov, Goran Kondov, Zoran Spirovski, Zvonko Milenkovikj, Risto Colanceski, Gordana Petrusevska and Meri Pesevska
involvement dramatically decreasing as a result of mammographic screening. Archives of Surgery 131 301-308.
7. Barth A, Craig PH, Silverstein MJ. Predictors of axillarylymphnode metastases in patients with T1 breast carcinoma. Cancer. 1997;79:1918-22.
8. Tan YY, Wu CT, Fan YG, et al. Primary tumor characteristics predict sentinel lymph node macrometastasis in breast cancer. Breast J. 2005;11:338-43.
9. Ravdin PM, De Laurentiis M, Vendely T, Clark GM. Prediction of axillarylymphnode status in breast cancer patients by use
that the group of breast cancer patients with more than 3 positive axillarylymphnodes (PALN) benefit from PMRT, but it is questionable if the benefit is the same all over the described group. 2 Currently, inadequate data exist to provide answer to this question.
According to our clinical experience, we assumed that patients with many PALN might have a greater chance of already present micrometastatic disease and therefore a greater chance for distant spread than for LR relapse. However, existing TNM classification with 10 lymph nodes as the lower limit of the
Baiba Līcīte, Arvīds Irmejs, Jeļena Maksimenko, Pēteris Loža, Genādijs Trofimovičs, Edvīns Miklaševičs, Jurijs Nazarovs, Māra Romanovska, Justīne Deičmane, Gunta Purkalne and Jānis Gardovskis
Ciatto, S., Brancato, B., Risso, G., Ambrogetti, D., Bulgaresi, P., Maddau, C., … Houssami, N. (2007). Accuracy of fine needle aspiration cytology (FNAC) of axillarylymphnodes as a triage test in breast cancer staging. Breast Cancer Res. Treat., 103 (1), 85–91.
Cools-Lartigue, J., Meterissian, S. (2012). Accuracy of axillary ultrasound in the diagnosis of nodal metastasis in invasive breast cancer: A review. World J. Surg. , 36 (1), 46–54.
Diego, E. J., McAuliffe, P. F., Soran, A., McGuire, K. P., Johnson, R. R., Bonaventura, M., Ahrendt, G. M
Yu-Li Su, Shan-Hsuan Li, Yen-Yang Chen, Hui-Chun Chen, Yen Tang, Cheng-Hua Huang, Fong-Fu Chou, Shih-Chung Wu and Kun-Ming Rau
. Int J Radiat Oncol Biol Phys 2005; 62: 175-82.
19 . Truong PT, Berthelet E, Lee J, Kader HA, Olivotto IA. The prognostic significance of the percentage of positive/dissected axillarylymphnodes in breast cancer recurrence and survival in patients with one to three positive axillarylymphnodes. Cancer 2005; 103: 2006-14.
20 . Lauria R, Perrone F, Carlomagno C, De Laurentiis M, Morabito A, Gallo C, et al. The prognostic value of lymphatic and blood vessel invasion in operable breast cancer. Cancer 1995; 76: 1772
Kampol Ratchaworapong, Sarawut Thanawut, Sirisanpang Yodavudh and Suthat Chottanapund
1. Supraporn S. First annual meeting Thai Breast Disease Society. Bangkok: Thai Breast Breast Society; 2007.
2. Attasara P BR. Hospital-based cancer registry. Bangkok: National Cancer Institute; 2007.
3. Nakamura S. Axillarylymphnode dissection in sentinel node positive breast cancer: is it necessary? Curr Opin Obstet Gynecol. 2013 Feb 19. [Epub ahead of print].
4. Moncayo VM, Aarsvold JN, Grant SF, Bartley SC, Alazraki NP. Status of sentinel lymph node for breast cancer. Semin Nucl
Bushra Siddiqui, Kafeel Akhter, Shahbaz Habib Faridi and Veena Maheshwari
1. Tulasi NR, Raju PC, Damodaran V, Radhika TS. A spectrum of coexistent tuberculosis and carcinoma in the breast and axillarylymphnodes: Report of five cases. Breast 2006;15:437-9.
2. Kaplan MH, Armstrong D, Rosen P. Tuberculosis complicating neoplastic disease. A review of 201 cases. Cancer 1974;33:850-8.
3. Alzaraa A, Dalal N. Coexistence of carcinoma and tuberculosis in one breast. World J Surg Oncol 2008;6:29.
4. Baslaim MM, Al-Ghamdi MA, Al-Numani TS, Ashour AS, Al-Amoudi SA
Eun-Ha Moon, Seok Tae Lim, Yeon-Hee Han, Young Jin Jeong, Yun-Hee Kang, Hwan-Jeong Jeong and Myung-Hee Sohn
Background. The objective of the study was to compare the diagnostic efficacy of an integrated Fluorine-18 fluorodeoxyglucose (F-18 FDG) PET/CT-mammography (mammo-PET/CT) with conventional torso PET/CT (supine-PET/CT) and MR-mammography for initial assessment of breast cancer patients.
Patients and methods. Forty women (52.0 ± 12.0 years) with breast cancer who underwent supine-PET/CT, mammo- PET/CT, and MR-mammography from April 2009 to August 2009 were enrolled in the study. We compared the size of the tumour, tumour to chest wall distance, tumour to skin distance, volume of axillary fossa, and number of metastatic axillary lymph nodes between supine-PET/CT and mammo-PET/CT. Next, we assessed the difference of focality of primary breast tumour and tumour size in mammo-PET/CT and MR-mammography. Histopathologic findings served as the standard of reference.
Results. In the comparison between supine-PET/CT and mammo-PET/CT, significant differences were found in the tumour size (supine-PET/CT: 1.3 ± 0.6 cm, mammo-PET/CT: 1.5 ± 0.6 cm, p < 0.001), tumour to thoracic wall distance (1.8 ± 0.9 cm, 2.2 ± 2.1 cm, p < 0.001), and tumour to skin distance (1.5 ± 0.8 cm, 2.1 ± 1.4 cm, p < 0.001). The volume of axillary fossa was significantly wider in mammo-PET/CT than supine-PET/CT (21.7 ± 8.7 cm3 vs. 23.4 ± 10.4 cm3, p = 0.03). Mammo-PET/CT provided more correct definition of the T-stage of the primary tumour than did supine-PET/ CT (72.5% vs. 67.5%). No significant difference was found in the number of metastatic axillary lymph nodes. Compared with MR-mammography, mammo-PET/CT provided more correct classification of the focality of lesion than did MR-mammography (95% vs. 90%). In the T-stage, 72.5% of cases with mammo-PET/CT and 70% of cases with MRmammography showed correspondence with pathologic results.
Conclusions. Mammo-PET/CT provided more correct definition of the T-stage and evaluation of axillary fossa may also be delineated more clearly than with supine-PET/CT. The initial assessment of mammo-PET/CT would be more useful than MR-mammography because the mammo-PET/CT indicates similar accuracy with MR-mammography for decision of T-stage of primary breast tumour and more correct than MR-mammography for defining focality of lesion.
Mariana Mihăilă, V. Herlea, Camelia Dobrea, Ioana Lupescu, Gina Rusu Munteanu, Grethi Chiriac, L. Micu, R. Serescu and I. Copaci
We present the case of a 76 year old female patient admitted in the Department of Cardiology for physical asthenia, profuse sweating and dyspnea with orthopnea for about one month. Clinical and paraclinical assessments performed at admission confirmed the diagnosis of cardiac tamponade. Surgical intervention was performed and 400 mL of clear effusion were drained. Post-operative evolution was marked by recurrence of symptoms, requiring after 3 weeks a new drainage of 600 mL of clear effusion, and biopsy of the pericardium was performed. Pathological exam described serous pericarditis with chronic inflammatory infiltrate, xanthogranulomatous reaction intricated in the pericardium and mesothelial hyperplasia. The patient was subsequently transferred to the Department of Internal Medicine for further investigations. Physical examination showed a patient with altered general status, pallor, vesicular murmur absent in both bases, presenting cutaneous hyperpigmentation at the level of the right hemi-abdomen and hip with posterior extension, and a peripheral indurated erythematous plaque. The patient presented nodular masses of 3 cm in the right latero-cervical and bilateral axillary regions, non-adherent to the superficial structures, as well as adenopathic blocks in both inguinal regions. CT scan of the thorax and abdomen showed moderate bilateral pleuresia, minimal pericardial effusion (15 mm) and multiple adenopathies on both sides of the diaphragm. Skin biopsy was performed, as well as bone marrow aspirate and excision of a right axillary lymph node. Pathological exams and immunohistochemistry tests confirmed the diagnosis of Plasma Cells Castleman disease.
Introduction. Macrophage activation syndrome (MAS) is a life-threatening hyperinflammatory state mediated by uncontrolled cytokine storm and haemophagocytosis. Although rarely reported, MAS might occur in systemic lupus erythematosus (SLE), notably as an inaugural manifestation. Glucocorticoids (GCs) are the cornerstone of SLE therapy. However, in some cases high doses of GCs are required to achieve remission (i.e. glucocorticoid-resistance), leading to significant side effects.
Case report. A 28-year-old Romani male was admitted to our hospital for polyarthralgia, polyserositis and fatigability. The patient had high-grade fever, jaundice and generalized lymphadenopathy. Laboratory tests revealed severe mixed hemolytic autoimmune anemia, leukopenia, hepatocytolysis, coagulation abnormalities, hypertriglyceridemia, biological inflammatory syndrome, hyperferritinemia and persistent proteinuria of nephritic pattern. Imaging studies showed pleuropericardial effusion, hepatosplenomegaly and polysynovitis. Additional blood tests revealed hypocomplementemia and positive ANA, anti-dsDNA and anti-Sm antibodies. Haemophagocytosis was not identified either on bone marrow or axillary lymph node biopsy specimens. However, SLE-associated MAS seemed to fit this set-up. High-dose corticotherapy (6.5 g methylprednisolone followed by prednisone, 1.5 mg/kg/day after discharge) and intravenous cyclophosphamide were necessary to induce and sustain remission.
Conclusion. MAS is a potentially severe manifestation that should be considered at SLE onset whenever high fever and elevated serum levels of aspartate aminotransferase, lactate dehydrogenase, C-reactive protein, ferritin and procalcitonin are noted. Early diagnosis and prompt treatment lead to remission in two thirds of cases.
Glucocorticoid-resistance leads to the use of high-dose corticotherapy or immunosuppressive agents that could elicit serious side effects. New insights into the molecular mechanisms of glucocorticoid-resistance are needed in order to conceive more adequate GC-therapies.