Synchronous Bilateral Paget's Disease of the Nipple Associated with Bilateral Breast Carcinoma

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Penile cancer metastasizing to the breast: a case report

BACKGROUND: Penile cancer is a relatively uncommon cancer in developed nations. Metastatic disease is rare, but lymphatic or vascular spreading has been previously reported to the liver, lungs, bones, brain, heart and skin. CASE PRESENTATION: We report a case of a 49-year-old white man with a penile squamous cell carcinoma previously treated with partial penectomy and bilateral inguinal lymph node dissection, followed by adjuvant therapy. Three years after treatment, the primitive neoplasm metastasized to the breast, presenting as a painful lump. Differentials of a secondary versus a malignant primary tumor were considered and in view of a diagnostic dilemma the lesion was excised. CONCLUSIONS: This case is unusual in its site of metastatic progression as well as in its pattern of clinical presentation. Awareness of such a condition by physicians is mandatory in order to make an early diagnosis and start prompt and correct therapeutic planning

Early onset lactating adenoma and the role of breast MRI: a case report

<p>Abstract</p> <p>Introduction</p> <p>Lactating adenoma is a benign condition, representing the most prevalent breast lesion in pregnant women and during puerperium; in this paper, a case of a woman with lactating adenoma occurring during the first trimester of pregnancy is reported. There have been no reports in the literature, according to our search, focusing on magnetic resonance imaging findings in cases of lactating adenomas. Also the early onset of the lesion during the first trimester of pregnancy is quite unusual and possibly unique.</p> <p>Case presentation</p> <p>We report the case of a primiparous 30-year-old Caucasian woman, who noted an asymptomatic lump within her left breast during the 9^thweek of gestation, slightly increasing in size over the next few weeks. Ultrasound demonstrated a hypoecoic solid mass, hypervascularized and measuring 4 cm. On magnetic resonance imaging, performed in the first month after delivery, the lesion appeared as an ovoidal homogeneous mass, with regular margins and a significant contrast enhancement indicative of a giant adenoma.</p> <p>Conclusion</p> <p>Magnetic resonance imaging could play an important role in the differential diagnosis of pregnancy-related breast lumps, particularly during puerperium, thus avoiding unnecessary surgical biopsies.</p

Abdominal angina due to recurrence of cancer of the papilla of Vater: a case report

Abdominal angina is usually caused by atherosclerotic disease, and other causes are considered uncommon. This is the first report of a case of abdominal angina secondary to neoplastic vascular stenosis caused by local recurrence of an adenocarcinoma of the papilla of Vater. CASE PRESENTATION: An 80-year-old woman of Caucasian origin presented with abdominal pain and diarrhea. She had undergone a pancreaticoduodenectomy for adenocarcinoma of the papilla of Vater four years earlier. Computed tomography revealed a mass surrounding her celiac trunk and superior mesenteric artery. Her abdominal pain responded poorly to analgesic drugs, but disappeared when oral feedings were withheld. A duplex ultrasonography of the patient's splanchnic vessels was consistent with vascular stenosis. Parenteral nutrition was started and the patient remained pain free until her death. CONCLUSION: Pain relief is an important therapeutic target in patients with cancer. In this case, abdominal pain was successfully managed only after the ischemic cause had been identified. The conventional analgesic therapy algorithm based on nonsteroidal anti-inflammatory drugs and opioids had been costly and pointless, whereas the simple withdrawal of oral feeding spared the patient of the discomfort of additional invasive procedures and allowed her to spend her remaining days in a completely pain-free state

Axillary Nodal Metastases from Carcinoma of Unknown Primary (CUPAx): Role of Contrast-Enhanced Spectral Mammography (CESM) in Detecting Occult Breast Cancer

Axillary lymph node metastases of occult breast cancer (CUPAx) is an unusual condition that represents both a diagnostic and therapeutic challenge. The first steps in the diagnostic work-up of patients with CUPAx are the histological analysis of the lymph node metastasis and the execution of basic breast diagnostic imaging (mammography and ultrasound). In the case of occult breast cancer, breast Magnetic Resonance (MR) must be performed. Breast MR identifies a suspicious lesion in many patients and second-look ultrasound detects a corresponding ultrasound alteration in about half of cases, allowing the performance of a US-guided biopsy. In the case of an MR-only lesion, MR-guided biopsy is mandatory. We present a case of CUPAx in which contrast-enhanced spectral mammography (CESM) is used to help the detection of occult breast cancer and to guide stereotactic vacuum breast biopsy (VABB). CESM is a new breast imaging technique that is proving to have good performance in breast cancer detection and that is showing potential in the identification of occult breast cancer in a CUPAx setting. The use of an innovative and personalized breast imaging approach in breast cancer patients improves diagnostic possibilities and promises to become the focus in decision strategies

Tratamiento grupal para la ansiedad y la evitación conductual en exámenes orales

Oral test are social situations that can activate unpleasant emotions like anxiety, shame, angry and guilty. To cope this emotions, students use several strategies, like increasement preparation, seeking emotional and instrumental social support, relaxation or distraction, as others. Postponement of the confrontation and expression inhibition, are two ways of behavioural avoidance that alleviate  emotional distress associated with oral exams but, if there turn frequently can generate low achievement, delay or drop out the career and several mental symptoms. To decrease anxiety and behavioural avoidance in oral test, a group treatment was designed, with techniques of Cognitive Behavioural Therapy, Mindfulness and Acceptance and Commitment Therapy. Intervention´s impact was assessed through and empirical study, with 22 participants of diverse university careers.  Pre and post intervention measures were administered. Significant differences were corroborated in total anxiety; emotionality, worry, interference and self-confidence subscales, and postergation and expression inhibition scales, with medium to high effect sizes.  Majority of the participants get better, some no report positive changes and few impair.   Variability of the effects were no related with comorbid mental symptoms.  The components perceived like more useful, were relaxation, revising study strategies, cognitive restructuring and self-instructions.            Los exámenes orales son situaciones sociales que pueden activar emociones displacenteras como ansiedad, vergüenza, enojo o culpa. Para afrontarlas, los estudiantes utilizan estrategias como incrementar la preparación, buscar apoyo emocional o instrumental, relajación o distracción, entre otras. La postergación de la confrontación o la inhibición de la expresión, son dos formas de evitación conductual que permiten aliviar el malestar emocional asociado al examen oral, pero al volverse habituales pueden generar bajo rendimiento, demora o abandono de la carrera y diversos síntomas mentales. Para disminuir la ansiedad y la evitación conductual frente a los exámenes orales, se diseñó un tratamiento grupal con técnicas cognitivo–comportamentales, de mindfulness y de la terapia de aceptación y compromiso. Se evaluó su impacto mediante un estudio empírico con 22 participantes de diferentes carreras universitarias. Se constataron disminuciones estadísticamente significativas entre las medidas pre y post intervención en las escalas de Ansiedad frente a los Exámenes Total,  Emocionalidad, Preocupación y Falta de Confianza y en Postergación e Inhibición de la Expresión, con tamaños de efecto entre medianos y grandes. La mayoría de los participantes presentó mejoras, algunos no informaron cambios, pocos desmejoraron. Esa variabilidad no se relaciona con la presencia de síntomas comórbidos. Los componentes percibidos como más útiles fueron la relajación, revisión de estrategias de estudio, reestructuración cognitiva y autoinstrucciones

Overcoming the Limitations of Kolbe Coupling via Waveform-Controlled Electrosynthesis

The Kolbe reaction has seen limited applications owing to its extremely poor chemoselectivity and reliance on precious metal-based electrodes, despite its potential to be one of the workhorse reactions of organic synthesis for C–C bond formation in both discovery and process settings. Although hundreds of studies over a century aimed to improve its efficiency and selectivity, general solutions have yet to be found. Herein, an exceedingly simple solution to this long-standing challenge is presented by merely tuning the waveform employed. Thus, switching from classic direct current (DC) to rapid alternating polarity (rAP), a broad range of functional groups can now be tolerated using inexpensive and sustainable carbon-based electrodes. A variety of high-value molecules ranging from useful unnatural amino acids to promising polymer building blocks are now accessible from readily available carboxylic acids, including biomass-derived acids. The practicality of the rAP-Kolbe reaction enables facile implementation of large-scale reactions, realizing access to novel degradable polymers from biomass. Preliminary mechanistic studies implicate the role of waveform in modulating the local pH around electrodes, which in turn affects the underlying redox processes. The ease, efficiency, and chemoselectivity of the rAP-Kolbe reaction finally opens the door to the widespread mainstream adoption of this classic reaction

Abdominal angina due to recurrence of cancer of the papilla of Vater: a case report

Abstract Introduction Abdominal angina is usually caused by atherosclerotic disease, and other causes are considered uncommon. This is the first report of a case of abdominal angina secondary to neoplastic vascular stenosis caused by local recurrence of an adenocarcinoma of the papilla of Vater. Case presentation An 80-year-old woman of Caucasian origin presented with abdominal pain and diarrhea. She had undergone a pancreaticoduodenectomy for adenocarcinoma of the papilla of Vater four years earlier. Computed tomography revealed a mass surrounding her celiac trunk and superior mesenteric artery. Her abdominal pain responded poorly to analgesic drugs, but disappeared when oral feedings were withheld. A duplex ultrasonography of the patient's splanchnic vessels was consistent with vascular stenosis. Parenteral nutrition was started and the patient remained pain free until her death. Conclusion Pain relief is an important therapeutic target in patients with cancer. In this case, abdominal pain was successfully managed only after the ischemic cause had been identified. The conventional analgesic therapy algorithm based on nonsteroidal anti-inflammatory drugs and opioids had been costly and pointless, whereas the simple withdrawal of oral feeding spared the patient of the discomfort of additional invasive procedures and allowed her to spend her remaining days in a completely pain-free state.</p

Diagnostic Challenge of Invasive Lobular Carcinoma of the Breast: What Is the News? Breast Magnetic Resonance Imaging and Emerging Role of Contrast-Enhanced Spectral Mammography

Invasive lobular carcinoma is the second most common histologic form of breast cancer, representing 5% to 15% of all invasive breast cancers. Due to an insidious proliferative pattern, invasive lobular carcinoma remains clinically and radiologically elusive in many cases. Breast magnetic resonance imaging (MR) is considered the most accurate imaging modality in detecting and staging invasive lobular carcinoma and it is strongly recommended in pre-operative planning for all ILC. Contrast-enhanced spectral mammography (CESM) is a new diagnostic method that enables the accurate detection of malignant breast lesions similar to that of breast MR. CESM is also a promising breast imaging method for planning surgeries. In this study, we compare the ability of contrast-enhanced spectral mammography (CESM) with breast MR in the preoperative assessment of the extent of invasive lobular carcinoma. All patients with proven invasive lobular carcinoma treated in our breast cancer center underwent preoperative breast MRI and CESM. Images were reviewed by two dedicated breast radiologists and results were compared to the reference standard histopathology. CESM was similar and in some cases more accurate than breast MR in assessing the extent of disease in invasive lobular cancers. Further evaluation in larger prospective randomized trials is needed to validate our preliminary results

DIFFUSION-WEIGHTED IMAGING IN BREAST LESION EVALUATION

The purpose of this study was to investigate the ability of diffusion-weighted imaging (DWI) and the apparent diffusion coefficient (ADC) in the detection and characterisation of breast lesions. MATERIALS AND METHODS: From September 2005 to September 2007, 86 patients with breast lesions who underwent magnetic resonance imaging (MRI) in our department were included in our study. MRI was performed with a 1.5-T unit using a standard protocol including DWI sequence. For each breast lesion, the ADC value was calculated and compared with that of normal breast tissue and to the definitive pathological diagnosis. Mann-Whitney U and Kruskal-Wallis tests were used for statistical analysis. RESULTS: A total of 126 breast lesions were detected. Pathology results revealed 100 malignant and 26 benign lesions. Mean diameter of lesions was 26.02 mm (range 4-90 mm), including 52 lesions </=15 mm in size. Mean ADC value of normal glandular tissue was 1.55x10(-3) mm(2)/s. Mean ADC value of malignant lesions was 0.97x10(-3) mm(2)/s. Mean ADC value for benign lesions was 1.66x10(-3) mm(2)/s. Benign lesions showed ADC values significantly higher than malignant lesions (p<0.0001). CONCLUSIONS: DWI provides reliable information to support MRI diagnosis of breast masses. ADC value appears a promising adjunctive parameter in distinguishing malignant from benign breast lesions