64 research outputs found
Breast cancer or metastasis? An unusual case of metastatic malignant pleural mesothelioma to the breast
Background: Metastases to the breast from extramammary malignancies are very rare, and ruling out the
diagnosis of primary breast tumor is important in order to decide on clinical management and predict prognosis.
Case presentation: Clinical examination revealed in a 49-year-old hairdresser a 3-cm hard lump adherent to
the underlying layers in the right breast. Trucut biopsy was performed. Histology showed a solid proliferation of
medium-sized neoplastic polygonal cells. Immunohistochemical analysis showed tumor cells diffusely positive for
cytokeratin 8/18 and calretinin and focally positive for cytokeratin 5/6 and Wilms’ tumor 1, e-cadherin, and human
bone marrow endothelial-1. Estrogen receptors and progesterone receptors were negative. The final diagnosis was
metastatic epithelioid malignant pleural mesothelioma.
Conclusions: Immunohistochemistry is an important tool for a conclusive diagnosis of malignant pleural
mesothelioma. Owing to the degree of histological and immunohistochemical overlap, a high level of clinical
suspicion is essential in order to avoid unnecessary mutilating surgery
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy for patients with peritoneal metastases from endometrial cancer
Background: More information is needed for selection of patients with peritoneal metastases from endometrial cancer (EC) to undergo cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). Methods: This study analyzed clinical, pathologic, and treatment data for patients with peritoneal metastases from EC who underwent CRS plus HIPEC at two tertiary centers. The outcome measures were morbidity, overall survival (OS), and progression-free survival (PFS) during a median 5 year follow-up period. Uni- and multivariate analyses were performed to identify significant factors related to outcome. Results: A total of 33 patients met the inclusion criteria and completed the follow-up period. At laparotomy, the median peritoneal cancer index (PCI) was 15 (range 3–35). The CRS procedure required a mean 8.3 surgical procedures per patient, and for 22 patients (66.6%), a complete cytoreduction was achieved. The mean hospital stay was 18 days, and major morbidity developed in 21% of the patients. The operative mortality was 3%. When surgery ended, HIPEC was administered with cisplatin 75 mg/m2for 60 min at 43 °C. During a median follow-up period of 73 months, Kaplan–Meier analysis indicated a 5 year OS of 30% (median 33.1 months) and a PFS of 15.5% (median 18 months). Multivariate analysis identified the completeness of cytoreduction (CC) score as the only significant factor independently influencing OS. Logistic regression for the clinicopathologic variables associated with complete cytoreduction (CC0) for patients with metachronous peritoneal spread from EC who underwent secondary CRS plus HIPEC identified the PCI as the only outcome predictor. Conclusions: For selected patients with peritoneal metastases from EC, when CRS leaves no residual disease, CRS plus HIPEC achieves outcomes approaching those for other indications such as colon and ovarian carcinoma
Epirubicin. A new entry in the list of fetal cardiotoxic drugs? Intrauterine death of one fetus in a twin pregnancy. Case report and review of literature
BACKGROUND: Current knowledge indicate that epirubicin administration in late
pregnancy is almost devoid of any fetal cardiotoxicity. We report a twin
pregnancy complicated by breast cancer in which epirubicin administration was
causatively linked to the death of one twin who was small for gestational age
(SGA) and in a condition of oligohydramnios and determined the onset of a
transient cardiotoxicity of the surviving fetus/newborn.
CASE PRESENTATION: A 38-year-old caucasic woman with a dichorionic twin pregnancy
was referred to our center at 20 and 1/7Â weeks for a suspected breast cancer,
later confirmed by the histopathology report. At 31 and 3/7Â weeks, after the
second chemotherapy cycle, ultrasound examination evidenced the demise of one
twin while cardiac examination revealed a monophasic diastolic ventricular
filling, i.e. a diastolic dysfunction of the surviving fetus who was delivered
the following day due to the occurrence of grade II placental abruption. The role
of epirubicin cardiotoxicity in the death of the first twin was supported by
post-mortem cardiac and placental examination and by the absence of structural or
genomic abnormalities that may indicate an alternative etiology of fetal demise.
The occurrence of epirubicin cardiotoxicity in the surviving newborn was
confirmed by the report of high levels of troponin and transient left ventricular
septal hypokinesia.
CONCLUSION: Based on our findings we suggest that epirubicin administration in
pregnancy should be preceded by the screening of some fetal conditions like SGA
and oligohydramnios that may increase its cardiotoxicity and that, during
treatment, the diastolic function of the fetal right ventricle should be
specifically monitored by a pediatric cardiologist; also, epirubicin and
desamethasone for lung maturation should not be closely administered since
placental effects of glucocorticoids may increase epirubicin toxicity
Does anthracycline-based chemotherapy in pregnant women with cancer offer safe cardiac and neurodevelopmental outcomes for the developing fetus?
BACKGROUND:
Cancer treatment during pregnancy is a growing problem especially now that women delay childbearing. Systemic treatment of these malignancies during pregnancy centers mainly on the anticancer drugs anthracyclines, widely used in treating hematological and breast cancer during pregnancy and sometimes associated with early and late toxicity for the fetus. Owing to concern about their cardiac and neurodevelopmental toxicity more information is needed on which anthracycline to prefer and whether they can safely guarantee a cardiotoxicity-free outcome in the fetus.
DISCUSSION:
The major research findings underline anthracycline-induced dose-dependent effects, including cardiotoxicity, many avoidable. Partly because the placenta acts mainly as a barrier, research findings indicate low transplacental anthracycline transfer. Anthracycline-induced teratogenicity depends closely on when patients receive chemotherapy. Anthracycline cardiac toxicity may depend on the association with drugs that inhibit or induce placental P-glycoprotein (P-gp). P-gp-induced drug interactions may alter placental P-gp barrier function and subsequently change fetal exposure. Though many anthracyclines have acceptable safety profiles clinical studies suggest giving idarubicin with special caution. Patients and doctors who care for pregnant women should whenever possible avoid prematurity and hence reduce prematurity-induced medical complications at birth and in the long-term. Information is lacking on long-term anthracycline-induced effects.
CONCLUSION:
Pregnant women receiving anthracycline-based chemotherapy should undergo regular, state-of-the-art diagnostic imaging to detect fetal drug-induced cardiac damage early, and allow alternative therapeutic options. Recognizing drug-induced interactions and understanding the most vulnerable fetuses will help in choosing tailored therapy. Future research on placental transport, blood-brain barrier drug passage and pharmacokinetics will improve the way we manage these difficult-to-treat patients and their fetuses
Secondary cytoreduction versus chemotherapy alone in the treatment of patients with recurrent ovarian cancer: is a randomized trial worthwhile?
[No abstract available
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