Malignant giant solitary fibrous tumor of the mediastinum.

Malignant giant solitary fibrous tumor (SFT) of the mediastinum is a rare neoplasm derived from mesenchymal tissue. Owing to its large size, a complete resection of the tumor can present many challenges, particularly given its proximity to vital neighboring structures. We report a successful en-bloc resection of a massive mediastinal SFT, which was compressing the inferior trachea and heart, by means of a median sternotomy and an anterior left thoracotomy.

Tolerance of adjuvant letrozole outside of clinical trials.

Recently aromatase inhibitors have become a standard care as an adjuvant treatment for many postmenopausal patients with hormone receptor positive early breast cancer. Adjuvant letrozole was made available either immediately postoperative, after 2-3 years of tamoxifen, or as an extended treatment after 5 years of tamoxifen. Between October 2003 and October 2005, we analyzed the subjective tolerance in 185 postoperative early breast cancer patients receiving letrozole outside of a clinical trial.

Granulomatous lobular mastitis: a rare chronic inflammatory disease of the breast which can mimic breast carcinoma.

Granulomatous lobular mastitis is a rare chronic inflammatory disease of the breast. The differential diagnosis with malign breast disease is often not easy. In most cases a surgical biopsy is needed for correct diagnosis.

Breast imaging. Preoperative breast cancer staging: comparison of USPIO-enhanced MR imaging and 18F-fluorodeoxyglucose (FDC) positron emission tomography (PET) imaging for axillary lymph node staging--initial findings.

Magnetic resonance (MR) imaging after ultra-small super paramagnetic iron oxide (USPIO) injection and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) for preoperative axillary lymph node staging in patients with breast cancer were evaluated using histopathologic findings as the reference standard. USPIO-enhanced MR and FDG-PET were performed in ten patients with breast cancer who were scheduled for surgery and axillary node resection. T2-weighted fast spin echo, T1-weighted three-dimensional (3D) gradient echo, T2*-weighted gradient echo and gadolinium-enhanced T1-weighted 3D gradient echo with spectral fat saturation were evaluated.

Drainage pattern of the upper medial quadrant of the breast in young healthy women after subdermal injection: a lymphscintigraphic study.

This study examines the lymphatic drainage after injection of a radiotracer in the upper medial quadrant of the right breast in young healthy female subjects. Most studies concerning lymphatic drainage pathways have focused on the upper lateral quadrant of the breast because of the high incidence of carcinoma in this quadrant while the drainage pattern of the medial quadrant has been less studied. We injected radiotracer (Human Serum Albumin labeled with 99 technetium) subdermally into the upper medial quadrant of the right breast tissue of 33 young healthy female volunteers and obtained static images with a scintillation camera briefly after injection and approximately one hour after injection.

Use of a Port-a-Cath system in the home setting for the treatment of symptomatic recurrent malignant pleural effusion.

Symptomatic malignant pleural effusions represent a common problem in metastatic cancers and are associated with a significant morbidity. Pleurodesis still remains the primary therapy of choice. In a few cases, however, pleurodesis is unsuccessful because of a limited lung expansion and pleuroperitoneal shunts have been used.

Lymphedema development following breast cancer surgery with full axillary resection.

Several studies have investigated the influence of disease related, treatment related, and patient related risk factors on the development of postmastectomy edema (PME). The aim of the present study was to determine which factors present a higher risk of developing PME after breast surgery with full axillary resection (level I, II and III). To accomplish this aim, we investigated 245 women who underwent unilateral breast cancer surgery in the Academic Hospital of the Vrije Universiteit, Brussels.

A key to understanding postoperative lymphoedema: a study on the evolution and consistency of oedema of the arm using ultrasound imaging.

Post-mastectomy oedema is a very serious complication that, in the course of time, will transform into fibrotic tissue. The aim of our study is to evaluate when and in which layer liquid oedema transforms into fibrotic tissue. To do so, ultrasonographic images were taken of 22 patients and 9 control women at the shoulder and 10 cm proximal and distal from the olecranon, with the images then being scanned and imported into a computer program to determine echogenicity of the dermis, subcutis, subcutis on dermal side and subcutis on fascial side.

Incidence of invasive versus non-invasive carcinoma in comparing palpable and non-palpable solid breast lesions.

A retrospective study was done of all patients with a suspicious mammographic breast lesion surgically biopsied in our institution within the last 5 years. Incidence of invasive versus non-invasive carcinoma and stage at presentation (according to TNM classification system) of palpable and non-palpable lesions were compared. We found a significant difference of non-invasive carcinoma in non-palpable and palpable cancers: 42.

Can primary breast cancer patients sense the presence of lymph node metastasis? An unexpected research finding.

We found that primary breast cancer patients with lymph node metastasis, compared to patients without apparent metastasis, had a greater expectation that their breast lump biopsy would be malignant. This difference in expectation between the two groups remained after controlling for a range of possible confounding variables.

What determines primary breast cancer patients' hope to recover.

The main purpose was to offer evidence for the hypothesis that the stronger an acute real life stressor, namely, hearing from the physician that one has breast cancer and that one has to undergo mastectomy, the greater the induced noradrenaline (NA) depletion in the central nervous system (CNS) and the more the patient loses hope to recover. The data were derived from answers to interviews, questionnaires, and analyses of blood samples obtained from the patients on the day of admission to the hospital for a biopsy and 24 hours after the surgeon communicated the results of the biopsy to the patients. Analysis showed that a decline in 3-Methoxy 4-Hydroxy Methoxy 4-Hydroxy Phenylethylene Glycol (MHPG) concentration in blood plasma samples after being informed of the diagnosis is associated with less hope of recovery.

Emergency treatment of life-threatening spontaneous haematopneumothorax.

We report two cases of spontaneous life-threatening haemopneumothorax, successfully treated by early thoracotomy. In the first patient no source of bleeding could be identified. The second patient presented bleeding from a torn vascular adhesion at the apex of the lung.

Patterns of axillary lymph node metastasis in breast cancer.

The pattern of axillary lymph node involvement was analyzed in a review of 377 cases of T1-4 breast cancers. Clinical judgment of the axillary status proved to be wrong in approximately one-third of the cases. In univariate analysis, a strong correlation (P < .

[Tumors of the submaxillary gland].

The tumors of the submaxillary gland are rare. The authors are reviewing 23 cases gathered from three Departments over ten years. The tumors of the submaxillary gland are malignant in as many as 50% of all cases! When the lesion is benign, pleiomorphic adenoma is the most frequent possibility.

Metastasizing neuroendocrine carcinoma of the larynx with calcitonin and somatostatin secretion and CEA production, resembling medullary thyroid carcinoma.

A 55-year-old man presented with a metastasizing moderately differentiated neuroendocrine carcinoma of the larynx (atypical carcinoid). Immunocytochemical demonstration of neuroendocrine markers (neuron-specific enolase and chromogranin-A) and presence of membrane-bound neurosecretory granules in the cells established the neuroendocrine nature of the tumour. In addition, the tumour was found to produce calcitonin, somatostatin and carcino-embryonic antigen (CEA).

Cervicofacial actinomycosis in a patient treated for tonsillar carcinoma.

A 50-year-old patient who underwent locoregional radiotherapy and surgery for a tonsillar carcinoma, developed osteomyelitis with Actinomyces israelii with fistulization in the treated area, during chemotherapy treatment. This rare complication is discussed.

Modern thoughts on lymph nodes in breast cancer.

Axillary lymph node status remains the single most useful prognostic parameter in breast cancer patients. As clinical examination, imaging techniques, and lymph node sampling methods cannot accurately assess the axillary node involvement, a complete axillary dissection should always be performed. Moreover, this technique provides an excellent treatment modality for regional disease, abolishing the need for radiotherapy to the axilla.

Immunocytochemical and ultrastructural findings in a mature retroperitoneal teratoma.

Report is made of a mature retroperitoneal teratoma in a 32-year-old man. Investigation of the tumor revealed cells immunoreactive for ACTH, Met-enkephalin, beta-LPH, serotonin, FSH, BPP, S100, Neuron-specific-enolase. These cells were mainly present in the glandular epithelium, lining the cysts of the tumor.

[Adenocarcinoma of the thyroglossal duct].

Carcinoma of the thyroglossal duct is a rare entity. In most cases, papillary carcinomas are reported. Follicular or squamous cell carcinomas are seldom.

[Breast-sparing surgery in T1 breast carcinoma].

31 female patients with a T1 No N1a Mo breast tumour (diameter smaller or equal to 2 cm) were treated by segmental resection with complete axillar dissection, followed by radiotherapy. Chemotherapy was given in any case of axillary lymph node involvement. The mean follow-up period was 44 months.

Management of large oral tumours by mandibular swing and myocutaneous flap.

Median mandibulotomy with mandibular swing combined with immediate reconstruction by a myocutaneous flap has been carried out in 11 patients with large intraoral tumours. Mandibular swing appeared to achieve better local control and caused less problems in resection of these T3 and T4 tumours compared to lateral mandibulotomy. The use of a myocutaneous pectoral flap instead of a deltopectoral skin flap reduced the need for reintervention and abolished that for delayed reconstruction.

Clinical evaluation of axillar lymph nodes compared to surgical and pathological findings.

Reviewing the axillar lymph node status in 196 consecutive breast cancer patients and comparing clinical assessment to pathological findings, the author found an overall erroneous appraisal of 39% with 45% false negative and 29% false positive cases. In more than 15% of the cases there were skip metastases. In the T1 group, stratification to the greatest diameter of the tumor gave a significant difference (P less than 0.