Simona Barberi

Focal segmental glomerulosclerosis as a complication of graft-versus-host disease.

Background. A 54-year-old man with multiple myeloma underwent peripheral blood stem cell transplantation (PBSCT) with cells donated by his human leukocyte antigen (HLA)-identical sister. Eight months after PBSCT, the patient experienced chronic graft-versus-host disease with skin involvement (generalized erythema), mucosal ulceration, sicca syndrome, and elevated liver enzymes. Two years after PBSCT, the patient developed nephrotic syndrome with massive proteinuria, which required hospitalization.Investigations. Physical examination, blood and urine analyses, liver function tests, 24 h urinary albumin excretion and renal biopsy.Diagnosis. Focal segmental glomerulosclerosis as a complication of graft-versus-host disease.Management. Prednisone, ciclosporin and an angiotensin-converting-enzyme inhibitor.

Use of Core Needle Biopsy rather than Fine-Needle Aspiration Cytology in the Diagnostic Approach of Breast Cancer

Background and Aims: In the following study case, we reviewed breast ultrasound-guided core needle biopsy (CNB), using Mammotome (vacuum-assisted breast biopsy) and Tru-cut, carried out on palpable and nonpalpable uncertain breast lumps or malignant large lesions to be submitted to neoadjuvant chemotherapy. Material and Methods: Examinations were conducted during a 4-year period of clinical activity in a highly specialized center, from December 2009 to December 2013, in 712 patients previously subjected to fine-needle aspiration cytology (FNAC). Results: The results demonstrated that among the 712 breast biopsies, in many cases FNAC was not conclusive, and therefore we proceeded with the echo-guided biopsy, through which we were able to collect sufficient material for the histological examination in order to direct patients to surgery or follow-up. Conclusions: CNB is far superior to FNAC, especially in cases of uncertainty, where it is preferable to proceed directly with CNB, which may also determine additional prognostic and predictive markers. Initially FNAC is less expensive, but the actual costs involved tend to be higher for FNAC as it is less accurate and a CNB is often required. In accordance with recent publications, we can confirm the full validity of CNB in the diagnostic approach of breast lesions.

Hemodialysis in patients requiring 131I treatment for thyroid carcinoma.

Purpose Thyroid malignancies can be treated by surgery followed by ablation of the remnant tissue with 131I. As iodide removal from the body occurs by renal extraction, in patients suffering from end-stage renal disease it is necessary to properly evaluate both timing and method of the extracorporeal treatment. Methods We present two patients on regular hemodialysis, admitted in isolation to the Nuclear Medicine Department and treated with 131I for thyroid carcinoma diagnosed during the check-up for transplantation. Both patients underwent two hemodialysis sessions with a portable machine for CRRT (continuous renal replacement therapy), 24 and 48 hours after the administration of 50 mCi of 131I. The nursing staff were monitored with a dosimeter. Radioactivity of the patients, dialysate and urines were measured during hemodialysis. Results The greater reduction was obtained with the first dialysis, but in both patients a further, though shorter, hemodialysis at 48 hours was necessary for reaching a patients radioactivity compatible with discharge. Radioactivity measured in the dialysate demonstrated the almost total removal of radioiodine by dialysis alone. In both patients, follow-up exams revealed a complete ablation of thyroid tissue, without signs of local recurrence. The dose of radioactivity of the dialysis staff was below allowable limits. Conclusions We conclude that a successful reduction of radioactivity, without dispersing its therapeutic efficacy, can be obtained with daily hemodialysis with a CRRT machine in patients in isolation treated with 131I. A therapeutic model is proposed.

Matrix-producing carcinoma of the breast: a case report.

Matrix-producing breast cancer (MPC) is a subtype of metaplastic carcinoma of the breast. It is a very rare tumor, which constitutes less than 1% of all malignant mammary tumors. The origin of this tumor is still unclear: there are molecular studies that suggest an origin from myoepithelial cells, whereas other studies underline the neoplastic transformation of a multipotent stem cell. Even the differential diagnosis of MPC and other breast neoplasms (phyllodes tumors and real sarcomas of the breast) is not always easy. In the literature, a certain chemoresistance has been demonstrated, and a standard treatment of this tumor does not exist at this time. We report the case of a 44-year-old, premenopausal, female patient with a 6-cm breast lump. Neither imaging nor fine needle aspiration biopsy was crucial in achieving a diagnosis. The patient underwent a simple mastectomy. In consideration of the negative lymph node status, the patient was not subjected to radiotherapy or adjuvant chemotherapy. Moreover, since the receptor status was negative, hormone therapy was not necessary. The patient has been disease free for 4 years now.

Multidisciplinary breast unit: the activity of the past 15 years.

To the Editor: The knowledge and interest regarding breast lesions have rapidly grown during the past 20 years and presently constitute a primary issue. Each year in our country approximately 30,000 new cases of cancer are reported (1), approximately 250,000 patients need a regular followup, more than 2 million diagnostic examinations are performed, with a total yearly cost of approximately

One-day surgery in a series of 150 breast cancer patients: efficacy and cost-benefit analysis.

150 billion; furthermore, a remarkable number of biopsies are performed for benign lesions (which could be reduced by improving diagnostics). The Service of Prevention, Diagnosis, and Therapy of Tumors, in the Surgery Department “Pietro Valdoni” of Rome University “La Sapienza,” has considered the importance of establishing a multidisciplinary unit of senology, with the aim of fighting cancer in an efficient manner. The objectives it has set include anticipated diagnostics by integrating clinical-instrumental investigations; a correct and rapid diagnosis exclusively performed through cooperation between highly specialized professionals who work together (2); and a therapeutic strategy suitable for the necessities of single patients, with particular concern for the psychological aspect. In this structure it is possible to perform, beside diagnostics, medical and surgical therapy as well as postoperational follow-up, and both symptomatic and nonsymptomatic women are attended. We report our experience regarding the past 15 years of activities. The Service of Prevention, Diagnosis, and Therapy of Tumors provides health care in accordance with the National Security Service, and patients are seen Monday through Friday from 9 a . m . to 2 p . m ., without an appointment, by bringing an order for a specialized examination written by the doctor in charge of the patient. The center was created with the aim of attending mainly symptomatic women, who need examinations performed within in a short period of time, but who would usually be obliged to undergo instrumental diagnostic tests in different centers, with long delays. Obviously nonsymptomatic women who require yearly monitoring screenings are also attended. The service is divided into several areas: wait, acceptance, clinic, diagnosis by images, day surgery, nuclear medicine, and laboratories. The various areas are arranged so that an obliged course must be followed. An average of 20 persons are seen daily and the time required for a monitoring screening includes the visit, mammography and/or echography, as well as a discussion with the doctor regarding the results of the examinations, which requires 1 to 3 hours. In the case of a follow-up patient, the time is extended because of the greater number of tests that must be performed. Patients are divided into three age ranges: less than 25 years, between 25 and 40 years, and more than 40 years. Women who are not yet 25 years of age have only a clinical examination. If an abnormality is detected, echography and possibly a needle aspiration (Fig. 1) are performed. Women between 25 and 40 years of age have echography performed, and whenever the breast shows an adipose involution, mammography (Fig. 2) is performed. Women who are more than 40 years of age have a mammogram