Mondor's disease in a patient after a mammotome biopsy

Mondor's disease is a rare, benign condition characterised by thrombophlebitis affecting subcutaneous veins of the chest and/or abdomen without an accompanying inflammatory response. The disease has a multifactorial etiology and its course is benign. It is usually self-limiting or it is eliminated by local treatment. Mondor's disease in the thoracoepigastric region may be a rare complication of mammotome biopsy. The case presentation describes a 32-year-old patient with Mondor's disease in the thoracoepigastric region after an ultrasound-guided mammotome biopsy of a breast. In the histopathological examination the lesion was diagnosed as fibroadenoma. Regardless of the disease's etiology, it is recommended to carry out diagnostic examinations to exclude co-occurring breast cancer

Solid and papillary neoplasm of the pancreas (SPNP) - a rare pancreatic neoplasm detected by fine needle aspiration biopsy : a case report

Autorzy opisują przypadek kobiety z rzadkim guzem nowotworowym trzustki (SPNP), rozpoznanym w biopsji aspiracyjnej cienkoigłowej, wykonanej pod kontrolą badania USG. U chorej wykonano obwodową resekcję trzustki wraz ze śledzioną w 1989 r. – od tego czasu pacjentka pozostaje w obserwacji ambulatoryjnej. Chora jest w dobrym stanie ogólnym, w wykonanych badaniach obrazowych nie stwierdzono cech nawrotu nowotworu. Rozpoznanie SPNP w biopsji aspiracyjnej cienkoigłowej wskazuje na wartość tego badania w diagnostyce guzów trzustki, w tym SPNP.We present the case of a woman with a rare pancreatic tumor detected by fine needle aspiration biopsy guided by ultrasonography. The patient underwent left resection of the pancreas with splenectomy in 1989 and has been followed-up on an ambulatory basis since then. She remains in good general condition without any features of recurrent disease. SPNP detected in fine-needle aspiration biopsy points to the value of this method in the diagnosing of pancreatic tumors, including solid and papillary neoplasms of the pancreas

Ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of focal lesions of the breast : own experience

INTRODUCTION: Vacuum-assisted core biopsy (VACB) guided by ultrasound is a minimally invasive method used in diagnosis and treatment of breast focal lesions. Vacuum-assisted core biopsy is an interesting minimally invasive alternative to open surgical biopsy. AIM: To assess the value of ultrasound-guided vacuum-assisted core biopsy in the diagnosis and treatment of breast focal lesions. MATERIAL AND METHODS: In the period 2009-2010, 397 ultrasound-guided vacuum-assisted core biopsies were performed. Mean age of the patients was 41.7 years (18-92 years), and size of the lesions ranged from 3 mm to 65 mm, mean size being 12 mm. All women with diagnosed atypical ductal hyperplasia or cancer were qualified for surgery. The patients with histopathologically benign lesions were under follow-up. RESULTS: Samples sufficient for histopathological examination were obtained from 394 cases (99.2%). Of all 397 lesions, 293 (73.7%) were diagnosed as benign, there were 6 (1.6%) cases of atypical ductal hyperplasia and 98 (24.7%) malignant lesions. Three hundred and sixty-nine lesions were below 15 mm in diameter, of which 339 (91.9%) were totally removed during the VACB. CONCLUSIONS: The results obtained confirm high efficiency of ultrasound-guided VACB in the differential diagnosis of breast focal lesions, including impalpable ones. It is a safe method with a low complication rate. In the case of benign lesions with a diameter not exceeding 15 mm, it allows one to excise the whole lesion and is a very good alternative to an open surgical biopsy. Vacuum-assisted core biopsy should be a standard and the method of choice in diagnosing breast lesions

The use of magnetic resonance mammography in women at increased risk for developing breast cancer

INTRODUCTION: The use of conventional imaging techniques, namely mammography (MMG) and ultrasound (US), for breast cancer (BC) detection in women at high risk for the disease does not bring optimal results in many cases. AIM: The present study evaluated the effectiveness of magnetic resonance (MR) mammography (MRM) in cases where US and MMG failed to detect suspected breast lesions. MATERIAL AND METHODS: The study group consisted of 379 women who had had no breast pathologies detected by US and MMG. This group was then divided into 4 groups according to the relative risk of breast cancer development. All the women underwent MRM, and any breast pathology detected by MRM was then verified by open surgical biopsy (OSB). RESULTS: Based on the MRM findings, 37 women with breast pathologies were identified. All detected pathologies were then classified into one of the BIRADS (Breast Imaging Reporting and Data System) categories. Of these, 33 patients underwent open surgical biopsy. There were a total of 17 benign and 16 malignant breast pathologies that were not visualized by US and MMG. The types of malignancies found, in order of their frequency, were as follows: invasive ductal carcinoma (11 cases), ductal carcinoma in situ (2 cases), invasive lobular carcinoma (2 cases), and lobular carcinoma in situ (1 case). An analysis of MRM effectiveness in detecting BC showed 93.7% sensitivity and 64.71% specificity. CONCLUSIONS: All women with a 20% or greater lifetime risk of developing BC should undergo annual MRM as a diagnostic adjunct to US and MMG

Evaluation of serum concentrations of vascular endothelial growth factor (VEGF) in breast cancer patients

The aim of the study was to assess the value of vascular endothelial growth factor (VEGF) measurements in breast cancer patients with respect to recognized clinicopathological prognostic factors. The study was conducted in 87 women with histologically confirmed breast cancer who underwent surgical treatment and 37 healthy women. Vascular endothelial growth factor concentration levels in the blood samples of patients were correlated with the size of the primary tumor, lymph nodes in the armpit, cancer stage, histological type, grading, multifocality, status of estrogen and progesterone receptors and HER-2 protein expression. Statistical analysis did not show any correlation between concentrations of VEGF and any of the selected parameters. The comparison of VEGF concentrations showed a slightly raised level of VEGF in women with the disease as opposed to the healthy subjects but the differences were not statistically significant (p=0.472). Similar results were obtained for marker CEA (p = 0.09), while the level of Ca 15-3 in both groups differed significantly (p<0.001) reaching higher values in the patients with diagnosed breast cancer. Vascular endothelial growth factor concentrations in breast cancer patients do not correlate with recognized clinicopathological prognostic factors and CEA and Ca 15-3 markers, which does not preclude the potential role of VEGF as an independent prognostic factor

Effectiveness of mesh hernioplasty in incarcerated inguinal hernias

INTRODUCTION: The use of mesh is still controversial in patients undergoing emergency incarcerated hernia repair, mostly because of potential infectious complications. AIM: The main aim of this study was to assess the efficacy of tension-free methods in treating incarcerated inguinal hernias (IIH), with and without intestine resection. The secondary aim was to establish an algorithm on how to proceed with incarcerated hernias. MATERIAL AND METHODS: A retrospective analysis of patients who underwent surgery due to an inguinal hernia at the First Department of General Surgery Jagiellonian University Medical College in Krakow, in the period 1999–2009. Operative methods included Lichtenstein, Robbins-Rutkow and Prolene Hernia System. The rate of postoperative complications was compared in patients who underwent elective and emergency surgery. RESULTS: The study group consisted of 567 patients (546 male) age 19–91 years. In this group 624 hernias were treated using the three tension-free techniques – 295 using the Lichtenstein method, 236 using PHS and 93 using the RR technique. Out of the 561 operations 89.9% were elective. No correlation (p > 0.05) was found between the type of surgery and such complications as postoperative pain duration and intensity, fever, micturation disorders, wound healing disorders, testicle hydrocoele, testicle atrophy, spermatic cord cyst, sexual dysfunction, wound dehiscence, wound suppuration, seroma, haematoma and hernia recurrence. CONCLUSIONS: Mesh repairs can be safely performed while operating due to an IIH. The use of a synthetic implant, in emergency IIH repairs, does not increase the rate of local complications. Synchronous, partial resection of the small intestine, due to intestinal necrosis, is not a contraindication to use mesh

Assessment of inguinal hernia treatment results in patients operated on with mesh using Lichtenstein, PHS and Robbins-Rutkow techniques

ntroduction: The inguinal region is a locus of minor resistance in the abdominal wall. Hernias in this area occur in the spacedescribed as the myopectineal orifice (Fruchaud). Among tensionless hernia repairs the most popular methods nowadaysare: Lichtenstein technique, Prolene Hernia System (PHS), ULTRAPRO Hernia System (UHS), mesh-plug and laparoscopicmethods (TAPP, TEP). It has not been established yet which one of the methods leads to the best treatment results.Aim: To evaluate treatment results of inguinal hernias in patients operated on with mesh using three techniques:Lichtenstein, PHS and mesh-plug.Material and methods: Between the years 2000 and 2007, 758 men and 35 women were operated on. The mean age was46.7. Spinal or general anaesthesia was used. One hundred and forty-four patients (18.1%) were operated on withoutantibiotic prophylaxis.Results: Seven hundred and ninety-three operations were performed: Lichtenstein technique was carried out in301 patients (37.9%), mesh-plug in 325 patients (40.9%) and PHS in 167 patients (21.2%). Spinal anaesthesia was performedin 787 patients (99.2%). General anaesthesia was necessary in 6 patients (0.8%) due to degeneration of thevertebral column. Complications observed include: wound suppuration, haematoma and seroma formation, chronicpain and hernia recurrence. Patients were discharged on the first postoperative day. Return to physical activity wasobserved usually 14 days after the operation.Conclusions: 1. The analysed methods did not differ according to complication and recurrence rates.2. In the authors’ opinion the Lichtenstein method should remain the standard treatment of inguinal hernia.3. There are no indications for routine antibiotic prophylaxis in patients undergoing elective hernia operations with mesh