PRIMARY MALIGNANT LYMPHOMA OF THE BREAST A Case Report and Review of the Japanese Literature

A 26-year-old pregnant woman was admitted to Nagasaki University Hospital complaining rapid enlargement of masses in the bilateral breasts and the right axilla. Biopsy of the right breast revealed malignant lymphoma. Simple mastectomy plus axillary node dissection on the right side (Br+Ax) and excision of the tumor in the left breast were performed. Histologically, the tumor was a diffuse lymphoma of the medium-size cell type according to the LSG classification, originated from B cells. After operation, Vincristine, Adriamycin, and Cyclophosphamide were administrered, but chemotherapy was terminated because of marked leukopenia. The patient has remained asymptomatic for 7 years without any treatment, and there is no evidence of recurrence. We have collected 79 cases of malignant lymphoma of the breast reported in the Japanese literature, including the present case, and examined factors that might affect the prognosis of patients. However, age, size of tumor, axillary lymph node involvement, histological findings, and type of therapy did not exert a significant influence. The most critical factor in a poor prognosis was the extramammary involvement of malignant lymphoma

PRIMARY MALIGNANT LYMPHOMA OF THE BREAST A Case Report and Review of the Japanese Literature

A 26-year-old pregnant woman was admitted to Nagasaki University Hospital complaining rapid enlargement of masses in the bilateral breasts and the right axilla. Biopsy of the right breast revealed malignant lymphoma. Simple mastectomy plus axillary node dissection on the right side (Br+Ax) and excision of the tumor in the left breast were performed. Histologically, the tumor was a diffuse lymphoma of the medium-size cell type according to the LSG classification, originated from B cells. After operation, Vincristine, Adriamycin, and Cyclophosphamide were administrered, but chemotherapy was terminated because of marked leukopenia. The patient has remained asymptomatic for 7 years without any treatment, and there is no evidence of recurrence. We have collected 79 cases of malignant lymphoma of the breast reported in the Japanese literature, including the present case, and examined factors that might affect the prognosis of patients. However, age, size of tumor, axillary lymph node involvement, histological findings, and type of therapy did not exert a significant influence. The most critical factor in a poor prognosis was the extramammary involvement of malignant lymphoma

Usefulness of vacuum-assisted closure after stoma closure with purse string suturing: a retrospective trial

OBJECTIVES: Surgical site infection (SSI) is a problematic complication after stoma closure. The purse string suture (PSS) technique eliminates this problem, but the area takes longer to heal. The present retrospective study was performed to evaluate the usefulness of a vacuum-assisted closure (VAC) system for the promotion of wound healing after stoma closure. METHODS: Consecutive patients undergoing stoma closure with the PSS technique were divided into two groups: those treated with and without use of the VAC system. The volume of dead space and the size of the wound were measured after stoma closure in both groups. The same measurements were performed on days 3 and 7 after closure. The time needed for wound closure was also examined in both groups. Outcomes were also evaluated according to age, body mass index, operative time, bleeding volume, wound consistency, patient satisfaction, perioperative inflammatory response, occurrence of SSI, and hospitalization days. RESULTS: The VAC group comprised 31 patients, and the non-VAC group comprised 34 patients. The volume of dead space on days 3 and 7 after closure was significantly smaller in the VAC group than in the non-VAC group (P=0.006 and P<0.001, respectively). The number of SSIs was significantly lower in the VAC group than in the non-VAC group (P=0.014). CONCLUSION: The dead space volume on days 3 and 7 after stoma closure with PSS significantly decreased by using the VAC system. The incidence of SSI after stoma closure also significantly decreased by using the VAC system

Surgical management of colorectal cancer for the aging population—A survey by the Japanese Society for Cancer of Colon and Rectum

Objective: The treatment policy of colorectal cancer in elderly patients is controversial due to a lack of specific guidelines. To clarify the present management of colorectal cancer for aged patients, a questionnaire survey was conducted by the Japanese Society for Cancer of the Colon and Rectum. Methods: Questionnaire forms were sent to the 430 member institutions of the Japanese Society for Cancer of the Colon and Rectum. Results: The response rate of the surgical department to the questionnaire was 39%. Performance status was used for preoperative assessments, and electrocardiogram and ultrasonic cardiograms were conducted for cardiovascular evaluations in many institutions. The same extent of surgical procedures was often adopted for elderly and younger patients, and the frequency of a laparoscopic procedure was the same regardless of a patient's age. A simultaneous hepatectomy for hepatic metastasis was considered in one-third of institutions. In many institutions, intersphincteric resection for patients with possible sphincter-saving surgery was not considered for elderly patients with low rectal cancer. Conclusion: Japanese Society for Cancer of the Colon and Rectum member institutions often used the same surgical treatment strategies for both elderly and younger patients with the exception of performing intersphincteric resection