Early changes in functional dynamic magnetic resonance imaging predict for pathologic response to neoadjuvant chemotherapy in primary breast cancer.

Purpose: Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) allows noninvasive, in vivo measurements of tissue microvessel perfusion and permeability. We examined whether DCE-MRI done after two cycles of neoadjuvant chemotherapy could predict final clinical and pathologic response in primary breast cancers.

Experimental Design: Thirty-seven patients with primary breast cancer, due to receive six cycles of neoadjuvant 5-fluorouracil, epirubicin and cyclophosphamide chemotherapy, were examined using DCE-MRI before neoadjuvant chemotherapy and after two cycles of treatment.

Evaluation of ER, PgR, HER-2 and Ki-67 as predictors of response to neoadjuvant anthracycline chemotherapy for operable breast cancer.

Primary systemic therapy (PST) for operable breast cancer enables the identification of in vivo biological markers that predict response to treatment. A total of 118 patients with T2-4 N0-1 M0 primary breast cancer received six cycles of anthracycline-based PST. Clinical and radiological response was assessed before and after treatment using UICC criteria.

Tuberculosis of the breast: experience of a UK breast clinic serving an ethnically diverse population.

Tuberculosis (TB) of the breast is an uncommon disease in the West but its incidence is likely to increase. Five cases of breast tuberculosis are presented. The diagnosis and management of this condition are discussed.

Breast cancer after bilateral subcutaneous mastectomy in a female-to-male trans-sexual.

We describe a female-to-male trans-sexual, aged 33, who developed breast cancer 10 years after cosmetic bilateral subcutaneous mastectomy and nipple reimplantation. The complex hormonal pathways involved and the implications for women undergoing prophylactic mastectomy because of a high risk of familial breast cancer are discussed.

The use of carbon suspension as an adjunct to wire localisation of impalpable breast lesions.

Aim: To determine the accuracy and therapeutic success of localisation of impalpable breast lesions by hookwire with additional lesion marking with carbon suspension to mark screen detected abnormalities requiring surgical excision.

Materials And Methods: Retrospective review of all breast localisation procedures performed in our unit on women with a screen detected abnormality requiring excision over a 7 year period.

Results: One hundred and thirty eight women underwent breast localisation procedures.

Pectus excavatum complicating breast cancer surgery.

Breast cancer surgery in the presence of previous reconstruction for pectus excavatum has not been reported. Such a case is described where simultaneous chest wall resection was undertaken because of fibrous tissue distortion mimicking malignant infiltration. Furthermore, postoperative adhesions necessitated opening the pleural lining during rib resection.

Evaluation of good clinical response to neoadjuvant chemotherapy in primary breast cancer using [18F]-fluorodeoxyglucose positron emission tomography.

To determine whether [18F]-fluorodeoxyglucose (FDG) positron emission tomography (PET) can predict complete pathological response (pCR) in patients achieving a good clinical response to neoadjuvant chemotherapy for primary breast cancer, 10 patients underwent FDG PET scanning prior to definitive breast surgery. Scan reports were compared with histopathological findings. No abnormal uptake at the primary tumour site was visualised in any patient.

Recurrent pulmonary embolism in pregnancy managed with the Greenfield vena caval filter.

Recurrent embolisation from venous thrombosis despite anticoagulation, in pregnancy, constitutes a major diagnostic and management problem. We present just such a patient who was managed with a Greenfield vena caval filter, which enabled her pregnancy to continue, resulting in a vaginal delivery of a healthy female infant at 38 weeks gestation.

Diagnosis of soft tissue tumours by Tru-Cut biopsy.

Tru-Cut biopsies were obtained from 52 consecutive patients referred with soft tissue tumours. Forty-five patients had soft tissue sarcomas; seven had benign soft tissue tumours. Of the biopsies 96 per cent provided adequate material for diagnosis.

Pyomyositis mimicking soft-tissue sarcoma.

A case of pyomyositis mimicking a soft-tissue sarcoma of the adductor muscle group is described. The aetiology and several presentations of pyomyositis and their differential diagnosis from sarcoma are discussed.

The place of first rib resection in the management of axillary-subclavian vein thrombosis.

Eight patients with axillary-subclavian vein thrombosis were studied. Three presented acutely and five with chronic symptoms of pain and swelling exacerbated by and limiting normal use. Initial venography showed complete occlusion of the axillary vein in 7 cases and marked narrowing in the remaining patient.

Transurethral resection of the prostate and bladder neck incision: a review of 700 cases.

Transurethral resection (TUR) is regarded as the treatment of choice for relief of outflow tract obstruction in the male, but bladder neck incision (BNI) is an acceptable alternative when the gland is small. Seven hundred cases of TUR/BNI have been reviewed (TUR = 388; BNI = 312). BNI was performed when the gland was less than 35 g and where there was no clinical suspicion of malignancy.

Survival after extended resection for locally advanced carcinomas of the colon and rectum.

Two hundred and fifty five patients were treated surgically for adenocarcinoma of the colon or rectum on the Surgical Unit at Westminster Hospital in the years 1962-78. After 13 patients had been excluded on the grounds of inadequate data, 57 of the remaining 242 had tumours which, at laparotomy, were firmly adherent to neighbouring organs or the abdominal wall. These 'locally advanced' tumours were treated by an extended en-bloc resection of the tumour and neighbouring organs.

Further observations on mechanisms of bone destruction by squamous carcinomas of the head and neck: the role of host stroma.

Mechanisms of bone invasion by squamous carcinomas of the head and neck have been investigated using fresh tumours and established tumour cell lines in an in vitro bone resorption assay with 45Ca-labelled mouse calvaria. Fresh tumours regularly resorb bone in vitro. Activity is consistently reduced by indomethacin.

Patterns and mechanisms of bone invasion by squamous carcinomas of the head and neck.

Patterns and mechanisms of local bone invasion by squamous carcinomas of the head and neck have been investigated. Detailed surgical pathology has shown that these tumors invade contiguous skeletal or metaplastic bone principally through an indirect process; the normal bone resorbing cells of the host (osteoclasts) are activated and erode bone in front of the advancing tumor edge. Tumor cells take over the destructive process when the osteoclast response has waned.

Double-ended pigtail polyethylene stents in management of benign and malignant ureteric obstruction.

Surgical urinary diversion for incurable pelvic malignancy has a high morbidity and mortality, and external drainage provides less than ideal palliation. Six patients with ureteric obstruction caused by cancer have been managed by operative or endoscopic insertion of self-retaining polyethylene tubes. These techniques also have applications in non-malignant disease, and the treatment of two patients with benign ureteric stricture is described.