Anna W. Poniecka

Measurement of Residual Breast Cancer Burden to Predict Survival After Neoadjuvant Chemotherapy

PURPOSE To measure residual disease after neoadjuvant chemotherapy in order to improve the prognostic information that can be obtained from evaluating pathologic response. PATIENTS AND METHODS Pathologic slides and reports were reviewed from 382 patients in two different treatment cohorts: sequential paclitaxel (T) then fluorouracil, doxorubicin, and cyclophosphamide (FAC) in 241 patients; and a single regimen of FAC in 141 patients. Residual cancer burden (RCB) was calculated as a continuous index combining pathologic measurements of primary tumor (size and cellularity) and nodal metastases (number and size) for prediction of distant relapse-free survival (DRFS) in multivariate Cox regression analyses. RESULTS RCB was independently prognostic in a multivariate model that included age, pretreatment clinical stage, hormone receptor status, hormone therapy, and pathologic response (pathologic complete response [pCR] v residual disease [RD]; hazard ratio = 2.50; 95% CI 1.70 to 3.69; P < .001). Minimal RD (RCB-I) in 17% of patients carried the same prognosis as pCR (RCB-0). Extensive RD (RCB-III) in 13% of patients was associated with poor prognosis, regardless of hormone receptor status, adjuvant hormone therapy, or pathologic American Joint Committee on Cancer stage of residual disease. The generalizability of RCB for prognosis of distant relapse was confirmed in the FAC-treated validation cohort. CONCLUSION RCB determined from routine pathologic materials represented the distribution of RD, was a significant predictor of DRFS, and can be used to define categories of near-complete response and chemotherapy resistance.

Change in tumor cellularity of breast carcinoma after neoadjuvant chemotherapy as a variable in the pathologic assessment of response

Complete pathologic response of breast carcinoma to neoadjuvant chemotherapy is a well defined outcome that correlates with prolonged survival. Categorization of incomplete response depends on accurate measurement of residual tumor size but is complicated by the variable histopathologic changes that occur within the tumor bed. In the current study, the authors investigated the contribution of assessing tumor cellularity in the pathologic evaluation of response to chemotherapy.

Case Report: Collagenous Colitis Treated Successfully with Bismuth Subsalicylate

Collagenous colitis is a relatively recently described well-recognized entity. Considered a unique variety of idiopathic inflammatory bowel disease, it was initially grouped along with lymphocytic colitis and called microscopic colitis. Its distinctive histological characteristics include a thickened subepithelial collagen band, evidence for chronic inflammation in the lamina propria, and increased intraepithelial lymphocytes. Multiple therapeutic approaches have been attempted including mesalamine compounds and corticosteroids with variable responses, usually requiring either maintenance therapy or repeated courses to maintain a state of remission. We describe a case of collagenous colitis treated with a short course of open-label bismuth subsalicylate (PeptoBismol) with prompt resolution of symptoms and histological abnormalities, and a prolonged clinical remission.

Kaposi's sarcoma of the thyroid gland in an HIV-negative woman : A case report

BACKGROUND Kaposis sarcoma (KS) is a neoplastic disease that affects primarily the skin, but visceral involvement is not uncommon. Most of the cases are seen in AIDS patients and transplant recipients; however, rare HIV-negative cases have also been reported. Involvement of the thyroid is exceedingly rare, with only a fw cases reported, all of them associated with AIDS. CASE A 45-year-old, black, Haitian woman presented with a slowly enlarging left side of the thyroid. Computed tomography showed multiple thyroid nodules, and there was no uptake of iodine on the nuclear scan. Fine needle aspiration of the lesion was performed. The smears were composed of spindle and plasmacytoid cells, which raised the possibility of medullary carcinoma. The patient underwent left hemithyroidectomy. Histologic examination showed KS in the thyroid. CONCLUSION We present the first case of KS of the thyroid in a HIV-negative patient. Familiarity with the cytologic features can be useful in making the diagnosis.

The diagnostic challenge of peritoneal mesothelioma

Abstract  The differential diagnosis of diffuse malignant intraabdominal process in women may be a strenuous and long process. We report such a challenging, problematic case of peritoneal mesothelioma and present review of literature in search for best diffeentiating technique.

Epiduroscopy: Review of technique and results

AbstractBack pain is a common medical problem with significant impact on society. It is estimated that 80% of adults in USA have back pain at some point in their life. It leads to over

Intrapartum spontaneous rupture of liver hemangioma.

24 billion per year in direct medical costs. In 95% cases, the symptoms subside without treatment within 3 months. The rest (5%) require extensive, expensive diagnostic work-up and treatment. Surgical treatment, often repeated, although able to release stenotic changes, tends to create new scar tissue. Unfortunately, from 40% to 80% of these patients experience persistent pain — referred to as postlaminectomy syndrome (Manning and Rowlingson, 1998; North et al., 1991). Introduction of epiduroscopy into clinical practice has revolutionized the visualization of the epidural space and offered new options in the treatment of postlaminectomy syndrome. The authors describe the technique and demonstrate the image obtained during the procedure. The outcome of epidural steroid injections under epiduroscopic guidance, in 22 patient...