F. Mariani

Breast Cancer Local Recurrence: Risk Factors and Prognostic Relevance of Early Time to Recurrence

BackgroundLocal recurrence occurs in 10%–20% of patients treated with breast-conserving surgery for stage I–II breast cancer. The aim of the present study was to investigate breast cancer local recurrence, potential risk factors, and prognostic impact.MethodsA total of 503 patients treated with breast-conserving surgery were included in the study. All patients underwent axillary dissection and postoperative radiotherapy, and all patients had negative margins at pathological examination. Median follow-up was 82 months. Local recurrence was classified as early when it occurred within 2 years from surgery. The risk factors for local recurrence and overall survival were estimated by univariate and multivariate analyses.ResultsForty-six cases (9.1%) of local recurrence were observed, 11 of which occurred within 24 months of surgery; the other 35, sometime later. Statistically significant risk factors for local recurrence were premenopausal status, peritumoral vascular invasion, multifocality, and absence of estrogen receptors. Independent negative prognostic factors for overall survival at 5 and 10 years were N stage, absence of estrogen receptors, and early time to recurrence. Overall survival at 10 years was 10.0% for patients with early recurrence, 87.5% for patients with late recurrence, and 87.9% for patients without recurrence.ConclusionsNone of the studied clinicopathological characteristics alone is a determinant for the choice of surgical treatment. Younger patients treated with breast-conserving surgery should receive aggressive postsurgical treatment and should be followed with an intensive follow-up program when metastatic axillary lymph nodes, negative estrogen receptors, or peritumoral vascular invasion are present.

Prognostic relevance of proliferative activity evaluated by Mib-1 immunostaining in node negative breast cancer.

AIM The purpose of this prospective observational study was to analyze the role of Mib-1 immunostaining as a proliferation index in breast cancer. Correlations between Mib-1 expression and clinico-pathological characteristics as well as its prognostic value have been studied in a series of 432 node negative breast cancers. METHODS Mib-1 expression was evaluated by immunohistochemistry. Tumor sections from highly cellular invasive areas of cancer were stained by monoclonal antibody Mib-1 (Dako) and cells whose nuclei stained positive were counted in 10 randomly chosen HPFs and expressed as percentages of all epithelial cells. A minimum of 400 cells were counted. Correlation between Mib-1 staining and clinico-pathological factors was investigated by means of univariate and multivariate analyses. The prognostic impact on actuarial disease free (DFS) and overall survival (OS) was evaluated by univariate analysis using the log-rank test and by multivariate analysis using Cox regression model. RESULTS Tumors were considered as positive for Mib-1 expression when more than 15% of cells counted were stained. Mib-1 positivity was found in 190/432 cases and resulted in being significantly related to tumor grade, tumor size and absence of estrogen receptors at multivariate analysis. With a median follow-up of 66 months, Mib-1 positivity resulted in being the only independent predictor of OS (RR 2.92), and an independent predictor of DFS (RR 2.01) together with absence of estrogen receptors (RR 2.15). CONCLUSIONS Mib-1 index of proliferative activity correlates well to other established prognostic factors of breast cancer. Mib-1 index may improve the tailoring of adjuvant therapy in early breast cancer, and our experience adds evidence to its effectiveness as prognostic factor. Efforts to reach uniformity in the methodology and in the scoring system should be done to warrant a standardized procedure and make Mib-1 determination definitively reliable in the current clinical practice.

Prediction of lymph node status by analysis of prognostic factors and possible indications for elective axillary dissection in T1 breast cancers.

OBJECTIVE To identify those patients with T1 breast cancers with lower risk of nodal metastases who can safely be spared axillary dissection. DESIGN Retrospective study. SETTING University hospital, Italy. SUBJECTS Review of clinical records and histopathological slides of 547 patients with T1 breast cancer, operated on between 1984 and 1997. MAIN OUTCOME MEASURES Incidence of axillary metastases in relation to age, menopausal status, diameter and grade of tumour, vascular invasion, DNA ploidy, S-phase fraction and hormone receptor state, by univariate and multivariate analysis. RESULTS Axillary metastases were present in 159 patients (29%). On univariate analysis, diameter of tumour 10 mm or less (pT1a/pT1b cancers), no vascular invasion, and grade 1 tumour were significantly correlated with a lower risk of nodal metastases, but only vascular invasion (p = 0.0001, odds ratio = 3.1) and diameter of tumour (p = 0.04, odds ratio = 1.6) were independent predictors on multivariate analysis. Among 34 pT1a/pT1b cancers, with low grade of tumour and no vascular invasion, only 2 (6%) had axillary metastases. When only one favourable predictive factor was associated with diameter of tumour of 10 mm or less, the incidence of axillary metastases ranged from 12% for 43 patients with grade 1 cancers to 13% for 76 patients with no vascular invasion. CONCLUSIONS Axillary dissection may be avoided in pT1a and pT1b breast cancers (< or = 10 mm), with low grade of tumour or no vascular invasion. T1 breast cancers 10 mm or less in diameter should be treated by a two-step approach, first wide excision of the tumour and then axillary dissection or not depending on pathological examination of the primary tumour.

Initial Experience with Laparoscopic Adjustable Gastric Banding and Pouch Dilatation: Two Cases

Background: Late proximal pouch dilatation (LPPD) has occurred occasionally following gastric banding for morbid obesity. At present, laparoscopic conservative resetting and oversuturing of the band is considered the standard procedure for pouch dilatation without any important posterior component. Methods: Two cases of LPPD are presented, which occurred in our initial experience with the LapBand®, corrected via a laparoscopic approach. Results: The reintervention was necessary in both patients, with conservative laparoscopic repositioning and oversuturing of the band in the first case and laparoscopic substitution of the gastric band in the second. We have not observed further complications, and weight loss has been maintained in a midterm outcome in both cases (30 and 18 months follow-up). Conclusions: LPPD can be corrected with a conservative laparoscopic surgical approach, without complications and negative functional effects on mid-term outcome.

Malignant rhabdoid tumor of the small intestine in adults: a brief review of the literature and report of a case

A malignant rhabdoid tumor was first described as a subtype of Wilms tumor in 1978. The most frequent location of these tumors is the kidney, and they are common in childhood. The extrarenal localization of these tumors has been described mainly in the central nervous system (called atypical teratoid–rhabdoid tumors), liver, soft tissues and colon. Localization in the small intestine is uncommon and since the 1990s, only a few cases of malignant rhabdoid tumors in the small intestine have been reported. This tumor is very aggressive and the prognosis is poor. We herein present our personal experience with a rhabdoid tumor of the jejunum in a 76-year-old male, and also provide an analysis of the cases of malignant rhabdoid tumor of the small intestine previously described in the literature as for a brief review. We also compared the previous reports and our present case to try to identify prognostic factors.

Chondroid Syringoma: Report of a Case with Uncommon Location

‘‘The mixed tumor’’ of the skin was originally defined by Billroth in 1859 as an entity having the same histopathologic properties of the mixed tumors of the salivary glands [1]. The term ‘chondroid syringoma’ was first used by Hirsch and Helwig in 1961 to describe this sweat gland tumor, because of the presence of sweat gland elements which are set in a cartilaginous stroma [2]. The reported incidence of CS among primary skin tumor is low, ranging between 0.010.098% [3]. This uncommon eccrine sweat gland tumor clinically presents as a slow-growing, painless, subcutaneous or intracutaneous nodule located usually in the head and neck region, and it affects middle-aged or older men [3,4]. Less commonly, this tumor can develop in the axillary region, penis, vulva, and scalp. We report a rare case of a chondroid syringoma with an atypical location on the back.