Neutrophil-Lymphocyte Ratio in Different Stages of Breast Cancer

Despite many advances in the treatment of breast cancer, it is still the second most common cause of death in women in the United States. It has been shown that inflammation plays a major role in the treatment of these cancers and inflammatory factors enhance tumor growth, invasion, metastasis, and vascularization. In this study, we would like to analyze peripheral blood neutrophil-lymphocyte ratio (NLR) in breast cancer patients and its correlation with disease staging. This cross-sectional analytic study was conducted in Imam Hospital, affiliated with Tehran University of Medical Sciences; a total of 195 female patients with breast cancer met the inclusion criteria. All of the patients had a complete blood count with leukocyte differential performed before chemotherapy. Medical records including pathology reports were also available. Data for all patients were collected prior to any surgical intervention. Exclusion criteria included clinical evidence of active infection, presence of hematological disorders, acute as well as chronic inflammatory or autoimmune diseases, or prior steroid therapy. Higher platelet count was significantly associated with the higher stage. The stage was not associated with the hemoglobin level. There was no association between the tumor size and age of patients with NLR. There was a significant relationship between NLR and IDC. There was a significant relationship between IDC and NLRs of less than 8.1 and greater than 3.3. There was a significant relationship between NLR and vascular invasion. There was no association between NLR and estrogen receptor and HER2. There was no significant relationship between the PLR and the cancer stage. In this study, NLR showed a significant relation with the disease staging. As the NLR increases the stage increases as well. Therefore, this ratio may be helpful in the preoperative evaluation of patients with breast cancer

Does Time of Day Affect Quality of Breast Cancer Surgery?

Background: Time of day can affect the outcome of medical procedures and surgical operations. The current study was designed to assess whether time of day can influence the quality of breast cancer surgery or not. Methods: Patients who underwent breast cancer surgery and axillary lymph node dissection in Tehran, Iran between March 2012 and March 2013 were enrolled. Surgeries were categorized into two group based on the time of initiation (before and after 1 pm). We considered the number of dissected lymph node as an indicator of operation quality. In this way, dissection of at least six lymph nodes was considered as an adequate number of lymph node examinations. Results: A total of 134 patients were enrolled. Median start time of surgery was 11 am. Surgeries were performed before and after 1 pm in 105(78.4%) and 29(21.6%) patients, respectively. The association between time and the number of dissected lymph nodes was significant when they were considered either as a categorical (P = 0.002) or continuous variables (P = 0.039). Conclusions: Based on our results, it can be suggested that breast surgeries with later start time might have lower quality

Lobular Carcinoma of Breast Presenting with Skin and Stomach Metastases

Background: Skin  metastases occur  in  1-5%  of  solid  tumors  and  are  rarely the presenting sign of internal malignancies. Certain features in skin lesions raise suspicion of metastasis from solid tumors. Case Presentation: In this article a 61-year-old woman is presented with erythematous skin nodules  in  upper  abdomen  and  chest. Histopathological evaluation  of  lesions suggested  metastatic  carcinoma  and  a  thorough  search found  stomach  signet  cell adenocarcinoma and breast lobular carcinoma. Immunohistochemical staining confirmed diagnosis of lobular carcinoma with metastasis developed in skin and stomach. Conclusions: Clinicians  must  be  aware  that  malignancies  can  present  by skin metastases. Since   breast   and   stomach   cancer   can both metastasize to skin, immunohistochemistry evaluation is of great importance to diagnose the primary tumor

Axillary Reverse Mapping: A Potentially Safe Procedure in Oncology

Background: In an attempt to reduce the risk of developing lymphedema following breast cancer surgery, some researchers suggested that by identifying and preserving the lymphatic plexus which drains ipsilateral arm we can minimize the risk of lymphedema. The procedure is known as axillary reverse mapping (ARM). In the current study, we investigated the oncological safety of this technique. Methods: A total of 60 patients who were undergoing axillary lymph node dissection were involved. The indications for axillary dissection were whether clinically node-positive axilla or positive sentinel lymph node biopsy. ARM was performed by injecting 2 ml of methylene blue subcutaneously in the upper and medial part of ipsilateral patients’ arm along the intermuscular groove. Results: ARM nodes were identified by means of methylene blue injection in 51(85%) patients (identification rate = 85%). For the subgroup of clinically positive axillary lymph nodes, identification rate was 93.1%, and the corresponding figure was 77.4% for positive SLNB group (P = 0.148). Pathological evaluation of harvested ARM nodes demonstrated metastatic involvement in 8(27.5%) and 1(3.2%) patients in clinically positive and SLNB positive groups respectively (P = 0.026). Conclusions: Based on the findings of this study it seems that ARM could be considered as a safe procedure in patients who are a candidate for ALND when SLNB is positive. In contrast, in patients with clinically positive axillary nodes, there is a considerable risk of tumoral metastasis in ARM nodes

Superoxide Dismutase Activities in Plasma of Patients with Breast Cancer

Background: Superoxide radicals are produced during oxidative metabolic processes, and removed by superoxide dismutase (SOD) enzymes. Controversial results have been reported regarding the tissue and plasma concentration of SOD in patients with breast cancer. Methods: Venous blood was obtained from study participants and activity of SOD enzyme was determined in 100 women. Comparison was made between 50 patients with breast cancer and 50 individuals in control group. Results: The activities of SOD in patients with malignancy and control group were 553.56±53.67 U/gr Hb and 1218.60±98.55 U/gr Hb, respectively (P <0.001). Patients with higher stage and nuclear grade had lower SOD activity. Conclusions: lower levels of SOD activity was observed in women with breast cancer compared to healthy individuals. Considering the existing controversy regarding the SOD level in breast cancer patients, further studies to explore the reason of these differences are warranted

Nicolau Syndrome after Intramuscular Benzathine Penicillin Injection

A 3-year-old boy was admitted to the emergency department with right lower limb pain, edema, and livedoid discoloration that occurred immediately after intramuscular injection of benzathine penicillin. The patient was diagnosed with Nicolau syndrome, a rare complication of intramuscular injection presumed to be related to the inadvertent intravascular injection. It was first reported following intramuscular injection of bismuth salt, but it can occur as a complication of various other drugs. Fasciotomy was carried out due to the resultant compartment syndrome and medical therapy with heparin, corticosteroid, and pentoxifyllin was initiated

Hiatal Hernia From Misdiagnosis to Diagnosis

Complications of hiatal hernia are potentially lethal, and surgical intervention is necessary. This matter is more important in cases that have ambiguous symptoms and are diagnosed with a delay. Such patients may experience life-threatening course and events. Accordingly, in this report, a 23-year-old male patient with unusual findings is presented. A 23-year-old male patient with acute dyspnea and fever was admitted in infectious disease ward with diagnosis of empyema according to chest radiography and CT-scan findings (Figures 1 and 2). On physical examinations the right lung sounds were normal, and the left lung sounds could not be heard. Then a gastrography was performed because of suspicion to hiatal hernia based on physical examination findings showing the presence of stomach in the thorax (Figure 3). In the surgery, the stomach and the transverse colon were released and reputed in the abdomen (Figure 4). The diaphragm was primarily repaired due to small defect, and the patient was discharged after 4-5 days with good general conditions. This case had a learning note that in the case of acute dyspnea with a positive history of stab wound to the chest, hiatal hernia should be considered as an important diagnosis and in these cases performing a gastrography would help physicians to make true and certain diagnosis and therapeutic decision

Sentinel Node Ratio as a Predictor of Non-sentinel Lymph Node Involvement

Background: Sentinel lymph node biopsy (SLNB) has replaced axillary lymph node dissection (ALND) in early breast cancer patients as the first line surgical approach to axillary nodes. Further dissection is performed only when SLN is involved by tumor cells. However, in a significant proportion of patients, non-sentinel nodes are still not involved and axillary dissection has no additional therapeutic benefits. Selective axillary clearance has been considered to prevent unnecessary dissection. The purpose of this study was to define predictors of non-sentinel lymph node involvement in patients with positive SLNB. Methods: Patients with early stage breast cancer and positive SLNB who underwent ALNDin a referral hospital in Tehran, Iran between2010 and 2012 were recruited into the study. Relations between different clinico-pathological characteristics and involvement of non-sentinel nodes were investigated. Results: From 139 patients who had positive SLNB and underwent ALND, only in 71 cases (51%) positive non-sentinel lymph nodes (NSLNs) were detected. In univariate analysis, there was no association between tumor size, lymphovascular invasion, ER, PR and HER-2 expression and NSLN metastasis. In contrast, presence of more than one SLN (P = 0.016) and a sentinel node ratio (SNR) more than 0.5 showed a significant association (P< 0.001). Only the latter remained as the significant predictor of NSLN involvement in mutltivariate analysis (P < 0.001, OR = 3.706). Conclusions: Based on our results, patients with a SNR more than 0.5 were more commonly diagnosed with NSLN metastasis. Thus, it is recommended that surgeons think twice before skipping ALND in this subgroup of patients

Effects of Wound Irrigation with Topical Phenytoin Solution During Modified Radical Mastectomy on Postoperative Seroma Formation

Background: Modified radical mastectomy (MRM), as a surgical treatment in breast cancer patients, may lead to important complications with significant morbidities including seroma formation. In this study, we used topical phenytoin to evaluate its impact on breast and axillary wound drainage and seroma formation after MRM. Methods: In a double-blinded randomized clinical trial, patients with breast cancer who were candidates for modified radical mastectomy (MRM) were enrolled. The patients were randomly assigned to two groups using a simple randomization method. Group A received topical phenytoin 1% solution for the irrigation of the mastectomy wound during the MRM procedure while group B (control group) underwent wound irrigation with normal saline solution. In addition to demographic data, postoperative variables including daily drainage of breast and axillary drains, drain removal days, and possible complications including seroma formation and their management were recorded. Results: Except for daily drainage recorded on the fifth postoperative day, the drainage of both axillary and breast drains were significantly different between group A and B in the following days. Compared to group B, axillary drains could be removed significantly earlier in group A. In regard to the breast drains, they were removed earlier in group A with no statistically difference compared to group B, the difference was not statistically significant. Seroma was detected in 7(8.3%) patients, 3 patients in group A and 4 patients in group B, with no significant differences between the two groups. All the patients underwent repeated aspirations. Conclusions: Our findings showed that topical irrigation of the surgery site with phenytoin was effective in reducing axillary surgical wound drainage