Karl von Smitten

Motion restriction and axillary web syndrome after sentinel node biopsy and axillary clearance in breast cancer

BACKGROUNDnWe evaluated the prevalence of motion restriction and axillary web syndrome (AWS) after sentinel node biopsy (SNB) and axillary clearance (AC) in a prospective study. AWS is a self-limiting cause of early postoperative morbidity after axillary surgery. Limited range of motion associated with palpable cords of tissue in the axilla are typical for AWS.nnnMETHODSnAltogether 85 breast cancer patients who underwent SNB only (49 patients) or SNB and AC (36 patients) were examined before and after surgery. The range of shoulder flexion and abduction and the presence of AWS were registered.nnnRESULTSnThe range of shoulder movements was restricted in 24 (45%) patients after SNB only and in 31 (86%) patients who also underwent AC (P = 0.002). AWS was encountered in 10 (20%) patients with SNB and in 26 (72%) with AC (P <0.00005).nnnCONCLUSIONSnIn the SNB group, significantly less early postoperative morbidity was observed.

VEGF-D in Association With VEGFR-3 Promotes Nodal Metastasis in Human Invasive Lobular Breast Cancer

We assessed the expression of vascular endothelial growth factors (VEGF-C and VEGF-D) in breast cancer cells and the density of lymph vessels and VEGF receptor-3 (VEGFR-3)-positive vessels in and around the tumor in invasive lobular breast cancer. We found significant correlation between peritumoral lymph vessel density and presence of lymph node metastases (P=.001) and the number of metastatic lymph nodes (P<.001). A significant correlation was detected between tumor cell VEGF-D expression and lymph node status (P=.001) and density of lymphatic vessel endothelial receptor (LYVE)-1-positive vessels (P=.035). VEGFR-3+/VEGF-D+ and VEGFR-3+/VEGF-C+ tumors had a significantly higher number of metastatic lymph nodes than tumors with other staining patterns (P<.001). Tumors positive for neither VEGF-D nor VEGFR-3 had a lower density of LYVE-1+ vessels than tumors with other staining patterns (P=.033). Our results indicate that peritumoral lymph vessel density is associated with lymph node metastases in invasive lobular breast cancer and that invasive lobular cancer producing VEGF-D, surrounded by VEGFR-3+ vessels, has a significantly higher peritumoral lymph vessel density and a higher number of metastatic lymph nodes.

Case report: Vas deferens aspiration and intracytoplasmic injection of frozen-thawed spermatozoa in a case of anejaculation in a diabetic man

By using aspiration from the vas deferens, apparently good quality spermatozoa can be obtained for in-vitro fertilization (IVF) in cases of non-treatable anejaculation. Being squeezed from the epididymis during aspiration, the spermatozoa may be immature and their fertilizing capacity lower than that of ejaculated spermatozoa. Our case report describes a couple who achieved pregnancy when intracytoplasmic sperm injection (ICSI) was carried out with frozen-thawed spermatozoa aspirated from the vas deferens of a man whose anejaculation was associated with diabetes mellitus. In the aspiration, 50 x 10(6) spermatozoa were obtained. One half of them was frozen, and the other half was used fresh for conventional IVF, resulting in total fertilization failure of all the oocytes. The second treatment was ICSI, in which eight out of 11 oocytes injected with frozen-thawed spermatozoa showed normal fertilization. The second frozen embryo transfer resulted in a normal pregnancy.

Ultrasonography of the axilla in the follow-up of breast cancer patients who have a negative sentinel node biopsy and who avoid axillary clearance

The clinical value of ultrasonography of the axilla in detection of breast cancer recurrence is not known among patients who have a negative sentinel node biopsy and avoid axillary clearance. We studied a cohort of 205 such patients using ultrasonography one and three years after breast surgery. A recurrent tumour was found in the axilla in only two (0.5%) of the total of 383 ultrasound examinations performed during the study, and only one (0.3%) of the 369 examinations performed at the scheduled study visits revealed cancer. None of the ultrasound examinations was false positive, and no study participant was subjected to unnecessary surgery due to ultrasound monitoring. We conclude that the rate of breast cancer recurrence in the ipsilateral axilla is low following sparing of the axillary contents, and that monitoring of such patients with repeated ultrasound examinations is unlikely to be cost-effective.

Long-term Prognostic Impact of Immunohistochemical Estrogen Receptor Determinations Compared with Biochemical Receptor Determination in Primary Breast Cancer

The estrogen receptor content of primary breast cancer is predictive for the outcome and response to hormonal manipulation ( I ) . Most data on the prognostic implication of estrogen receptor determinations have been generated with biochemical receptor determinations utilising the dextran-coated charcoal (DCC) method and more recently the RIA assay (2). During the last decade immunohistochemical (IH) receptor determinations have gained in popularity due to their lower costs and the lower requirements for sample size as well as the possibility to perform the determination on archival tumour material. A large number of publications have demonstrated a good correlation between IH and biochemical receptor determinations, but also clearly discrepant findings have been reported (for a review see (2)). Few studies have assessed the clinical utility of IH. A number of studies have shown that the predictive value of IH receptor determinations for endocrine treatment response are at least as good as those of biochemical assays for estrogen receptor binding (2). Only a few studies have compared the prognostic value of IH and biochemical estrogen receptor determinations (3-5). The purpose of the present investigation was to study the correlation between IH and DCC estrogen receptor determination as well as their prognostic value for recurrence and death. Material und Methods. A total of 142 consecutive cases of invasive breast cancer analysed at the Department of Pathology, University of Helsinki, during the years 1987-1988, were included in the study. The distribution of TNM-classes and the proportion of estrogen receptor positivity are shown in the Table. In 9 cases the determination was performed on a local recurrence. These patients are excluded from the analysis on the prognostic value of receptor determinations. One patient with previous metastatic contralateral breast cancer was excluded from analysis of survival and disease-free survival. Other patients with synchronous or metachronous bilateral breast cancer (n = 18) were included in all the analyses. In 5 cases TN-status was not known, all were cases with receptor determinations from a local recurrence. The turnour samples were sent to the laboratory on ice and arrived unfixed to the histological laboratory for diagnosis and estrogen receptor (ER) staining. Immunohistochemical staining for ER was performed on frozen sections using the ER-ICA kit (Abbott Laboratories, Chicago, IL, USA). The sections were fixed and stained for ER following the manufacturer’s directions, counterstained lightly in Mayer’s hematoxylin and mounted. The percentage of positively stained turnour cell nuclei was estimated by counting 5001 000 morphologically malignant cells in multiple random fields in every sample. The turnours were divided into four categories according to the number of positive nuclei found: 0-9% = negative, 10-39% = weakly positive (+), 40-69% moderately positive (+ +) and 70% or more = strongly positive ( + + +). Only nuclear immunohistochemical staining was regarded as positive. A sample of each tumour was taken by the surgeon, immediately frozen in liquid nitrogen and analysed at the Department of Clinical Chemistry for cytosol ER by the dextran-coated charcoal method (6) . Cause-specific disease-free survival (DFS) and cause-specific overall survival (0s) were estimated by the Kaplan-Meier method, and the statistical significance of differences tested by the log-rank test. For analysis of both 0s and DFS only breast cancer-related deaths were classified as events, i.e., patients dying from other causes without breast cancer recurrences were classified as censored at the time of death. Follow-up times ranged from 7 to 9 years with a median of 8 years. Fifty-eight patients (42%) had TI tumours, 62 (45%) T2, 12 (9%) T3 and 4 (4%) T4 tumours. Sixty-two patients (45%)) had axillary metastases. Only one patient had distant metastases at diagnosis. Fifty-four patients have died, 13 from causes other than breast cancer without evidence of recurrence. Results. The correlation between IH ER score and ER positivity by DCC assay was studied using a cut-off point of 10 fmol/rng protein (Table). In 44 cases (31%) the result was discrepant. Thirty-three cases (23%) were IH positive and DCC negative, whereas 11 cases (8%) were IH negative and DCC positive. The