Invasive lobular carcinoma of the breast presenting as retroperitoneal fibrosis: a case report

<p>Abstract</p> <p>Introduction</p> <p>Invasive lobular carcinoma of the breast represents approximately 6.3% of mammary malignancies. Distant metastasis of invasive lobular carcinoma to the peritoneum or retroperitoneum has been reported fairly frequently.</p> <p>Case presentation</p> <p>We report the case of a 59-year-old Caucasian-Canadian woman with invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis and bilateral ureteral obstruction. Intra-operative pathology consultation did not reveal malignancy. The diagnosis, however, was confirmed on permanent sections by histological appearance in addition to immunohistochemistry. To the best of our knowledge, this is the first reported case of invasive lobular carcinoma of the breast presenting with retroperitoneal fibrosis.</p> <p>Conclusion</p> <p>In a case of unexplained ureteric obstruction and retroperitoneal fibrosis, more comprehensive physical examination and additional ancillary studies may be warranted to rule out malignancy as an underlying etiology. This case also emphasizes that intra-operative frozen section consultation cannot always be fully relied upon to exclude a malignancy as the etiology of retroperitoneal fibrosis. Moreover, in permanent histopathology sections, immunohistochemistry testing can be of value to rule out metastatic disease where the morphology is not salient. There is a need for a thorough physical examination of patients with retroperitoneal fibrosis, including the breast and gynecological organs.</p

Kinetic Measurements of Di- and Tripeptide and Peptidomimetic Drug Transport in Different Kidney Regions Using the Fluorescent Membrane Potential-Sensitive Dye, DiS-C3-(3).

Tri- and dipeptides are transported in the kidney by PEPT1 and PEPT2 isoforms. The aim of this study was to investigate differences in transport kinetics between renal brush border (BBMV) and outer medulla (OMMV) membrane vesicles (where PEPT1 and PEPT2 are sequentially available) for a range of di- and tripeptides and peptidomimetic drugs. This was accomplished through the use of the potential-sensitive fluorescent dye 3,3'-dipropylthiacarbocyanine iodide [DiS-C3-(3)]. BBMV and OMMV were prepared from the rat kidney using standard techniques. The presence of PEPT1 in BBMV and PEPT2 in OMMV was confirmed using Western blotting. Fluorescence changes were measured when extravesicular medium at pH 6.6 containing 0-1 mM substrates was added to a cuvette containing vesicles pre-equilibrated at pH 7.4 and 2.71 μM DiS-C3-(3). An increase in fluorescence intensity occurred upon substrate addition reflecting the expected positive change in membrane potential difference. Of the range of substrates studied, OMMV manifested the highest affinity to cefadroxil and valacyclovir (K m 4.3 ± 1.2 and 11.7 ± 3.2 µM, respectively) compared to other substrates, whilst the BBMV showed a higher affinity to Gly-His (K m 15.4 ± 3.1 µM) compared to other substrates. In addition, OMMV showed higher affinity and capacity to Gly-Gln (K m 47.1 ± 9.8 µM, 55.5 ± 2.8 ΔF/s/mg protein) than BBMV (K m 78.1 ± 13.3 µM and 35.5 ± 1.7 ΔF/s/mg protein, respectively). In conclusion, this study successfully separated the expression of PEPT1 and PEPT2 into different vesicle preparations inferring their activity in different regions of the renal proximal tubule

Impedance Analysis of Necturus Gallbladder Epithelium Using Extra- and Intracellular Microelectrodes

Publisher Summary: This chapter reviews the impedance analysis of Necturus gallbladder epithelium using extra- and intracellular microelectrodes. Because epithelia consist of serial and parallel arrays of resistive barriers, it is impossible to determine the properties of an individual barrier from transepithelial measurements alone. Therefore, transepithelial alternating current spectroscopy are combined with intracellular measurements. The data are analyzed by least squares computer, which fits with model equations in order to derive the magnitude of the equivalent-circuit parameters of the cell membranes and of the shunt path. Two electrical analog circuits are tested: (1) the lumped model in which the cell membranes and the shunt path are represented by RC elements and by a single resistor, respectively and (2) the distributed model in which the resistances of the lateral cell membrane and of the lateral space fluid are distributed in the form of a cable-like structure, which extends from the tight junction to the serosal fluid compartment. Under control conditions with extended lateral spaces, both models describe the data almost equally as well. This is because the lateral space resistance is rather small. However, when the spaces are collapsed by passage of lumen-negative current the lumped model fits are no longer adequate, particularly in the high-frequency region of the impedance plots. Under those conditions, the distributed model fits indicate that the lateral space resistance can increase to 50% or more of the transepithelial resistance. These experiments allow resolving the paracellular shunt resistance into its contributions from the tight junction proper and from the lateral space

Robot-assisted ureterolysis, retroperitoneal biopsy, and omental wrap: Pilot series for the treatment of idiopathic retroperitoneal fibrosis

Background and Purpose: Retroperitoneal fibrosis (RPF) is an uncommon disease of vague cause distinguished by a chronic inflammatory response. Traditionally, RPF with ureteral involvement has been managed with open ureterolysis and transposition, with excellent success rates. More recently, laparoscopic ureterolysis has been described. Here, we report our experience of managing idiopathic RPF with robot-assisted ureterolysis, retroperitoneal biopsy, and ureteral omental wrapping. Patients and Methods: We performed robot-assisted ureterolysis, retroperitoneal biopsy, and ureteral omental wrapping on five consecutive patients between April and October 2006. The same technique was used for all five patients, except for the omental wrapping. Initially, omental wrapping was performed laparoscopically, but in the last two patients, it was performed entirely robotically. We analyzed our patients\u27 data retrospectively. Results: The mean operative time was 220.5 minutes and 390 minutes for unilateral and bilateral cases, respectively; mean blood loss 33.4 mL; mean length of stay 2.8 days; and mean follow-up was 5.6 months. All patients have remained free of obstruction since surgery and no longer need pain medication. Conclusions: Our study suggests that robot-assisted ureterolysis with laparoscopic or robot-assisted omental wrapping is a feasible alternative to the more morbid open procedure and compares favorably to the purely laparoscopic technique with respect to operative times, estimated blood loss, length of stay, and postoperative relief of obstruction. This procedure can be performed entirely robotically, which provided several advantages over the other techniques. © Mary Ann Liebert, Inc. 2008