Underestimation of cancer in case of diagnosis of atypical ductal hyperplasia (ADH) by vacuum assisted core needle biopsy

AbstractBackgroundWith the introduction of mammography screening, we are more often dealing with the diagnosis of precancerous and preinvasive breast lesions. An increasing number of patients are observed to show a premalignant change of ADH (atypical ductal hyperplasia). It also involves a wider use of the vacuum assisted core biopsy as a tool for verifying nonpalpable changes identified by mammography.AimThis paper describes our experience of 134 cases of ADH diagnosed at Mammotome® vacuum core needle biopsy.Material and methodsOf 4326 mammotomic biopsies performed at our institution in 2000–2006, ADH was diagnosed in 134 patients (3.1%). Patients underwent surgery to remove the suspected lesion. All histopathological blocks were again reviewed by one pathologist. Clinical, radiological and pathological data were collected for statistical evaluation.ResultsUnderestimation of invasive changes occurred in 12 patients (9%). The only clinicopathologic feature of statistical significance radiologically and pathologically was the presence of radial scar in the mammography.ConclusionsMore frequent diagnosis of precancerous changes in the mammotomic breast biopsy forces us to establish a clear clinical practice. The problem is the underestimation of invasive changes. The occurrence of radial scar on mammography for diagnosis of the presence of ADH increases the risk of invasive changes

The clinical importance of micrometastases within the lymphatic system in patients after total gastrectomy

AbstractBackgroundIn spite of radical gastrectomy with resection of the lymphatic system, where no metastases are found during histopathological examination, about 30% of patients have relapse of the neoplastic process. This situation may be caused by micrometastases or isolated neoplastic cells in the lymphatic system which were not identified during a standard histopathological examination.AimThe aim of the study was to evaluate the clinical importance of micrometastases within the lymphatic system in patients with gastric cancer.Materials and methodsA group of 20 patients treated for gastric cancer were subjected to retrospective analysis. Of all the patients who underwent surgery, a group with tumours classified as T1 or T2 was selected. No metastases within the lymphatic system were found in the standard evaluation – N0 mark. Paraffin-embedded blocks of lymph nodes were cut and new specimens were made, which were then stained again by means of immunohistochemistry. Antibodies against cytokeratin AE1/AE3 were used.ResultsA total of 319 lymph nodes were assessed in 20 patients in an H+E examination. After the immunohistochemical examination, micrometastases within the lymphatic system were found in 4 (20%) patients and isolated neoplastic cells in other 4 (20%) patients.ConclusionOn the basis of numerous publications and our own material, we think that the presence of micrometastases may be related to a worse prognosis. The clinical importance of micrometastases within the lymphatic system in patients after total gastrectomy

Breast implant-associated anaplastic large cell lymphoma — how to diagnose and treat?

Breast implant-associated anaplastic large cell lymphoma (ALCL) is a rare type of T-cell non-Hodgkin lymphoma arising around the capsule of breast implants. It has been diagnosed in an extremely small group of women with breast implants for breast reconstruction and augmentation. The pathogenesis of this disease is currently poorly understood, but it appears to be related to textured implants. The aim of this article is to provide patients, radiologists, pathologists, surgical oncologists and plastic surgeons with an evidence-based overview of the incidence, diagnosis, and management of BIA-ALCL according to real-world experience, because although it is very rare, early recognition and surgical resection is usually crucial and curative

27P Chirurgiczne leczenie powikłań powstałych w wyniku radioterapii nowotworów dróg rodnych i jąder

Jednym z elementów leczenia dróg rodnych i jąder jest radioterapia. W wyniku tego postępowania może dojść do uszkodzenia promieniami innych narządów. Szczególną wrażliwość wykazuje jelito cienkie oraz jelito grube. Na skutek popromiennego zapalenia jelit występują krwawienia do światła jelita, perforacje, pojawiają się zrosty i zwężenia prowadzące do niedrożności przewodu pokarmowego. Niedrożność może być też spowodowana atonią odcinków uszkodzonego jelita. Częstym powikłaniem popromiennym jest przetoka pochwowo- odbytnicza. W takich przypadkach konieczne jest leczenia operacyjne.Celem pracy jest ocena leczenia chirurgicznego powikłań popromiennych. W Oddziale Chirurgii I WCO w latach 1988–1998 z powodu powikłań popromiennych leczono 90 chorych w wieku 31 do 73 lat; 3 mężczyzn i 87 kobiet. Z rozpoznaniem Ca. colli uteri 79 Ca. endometri 6, Ca. ovariorum 2 kobiety, 3 mężczyzn z rozpoznaniem Ca testis.54 operowano z powodu przetoki pochwowoodbytniczej. 15 razy z powodu krwawienia do świateł jelita, przyczyną 20 operacji była niedrożność przewodu pokarmowego, 1 raz perforacja jelita.Metodę leczenia dostosowywano indywidualnie do poszczególnych przypadków. Stosowano chirurgiczne wywołanie odbytu na esicy lub poprzecznicy, wykonywano operacje Hartmana lub brzuszno-kroczowe odjęcie odbytnicy, stosowano odcinkowe resekcje jelita lub zespolenia omijające, podwiązywano naczynia biodrowe wewnętrzne. W ostatnim okresie w przypadkach krwawienia z odbytnicy z powodzeniem stosowano laseroterapię aparatem Nd: YAG. Należy zaznaczyć, że wymienione zabiegi operacyjne wykonywane były w trudnych warunkach spowodowanych uszkodzeniami popromiennymi; jelito o słabej ścianie wrażliwe na urazy, liczne zrosty oraz krótka zmieniona zapalnie krezka jelita. Niejednokrotnie dużym problemem decyzyjnym i diagnostycznym jest zróżnicowanie niedrożności popromiennej z niedrożnością spowodowaną rozsiewem procesu nowotworowego. Chorzy są w złym stanie ogólnym, a obraz kliniczny jest niejasny. Postępowanie w takich przypadkach wymaga pewnego doświadczenia w prowadzeniu chorych leczonych promieniami.Wnioski1.Metody chirurgicznego leczenia powikłań popro miennych muszą być dostosowane indywidualnie do każdego przypadku.2.Leczenie operacyjne pomimo trudności i ryzyka jest celowe i daje dobre efekty terapeutyczne.3.W przypadku krwawienia z odbytnicy uszkodzonej promieniami nową skuteczną metodą leczenia jest laseroterapia

Cases of giant Retroperitoneal Liposarcomas

AimLiposarcomas are the most common type of retroperitoneal tumours. The course of the disease is determined by histological subtype, grade, size of the tumour and completeness of resection. Surgical treatment is the basic therapy for retroperitoneal liposarcomas.Case DescriptionTwo cases of large retroperitoneal liposarcoma are reported. In both cases, the only sign of the disease was enlargement of the abdomen. Large masses filling the abdominal cavity were detected by ultrasound scans and by computed tomography. In both cases the abdominal organs were involved, with infiltration of the renal capsule, making unilateral nephrectomy necessary.ResultsThe histology result for the first patient showed a well differentiated liposarcoma while the result for the second patient was liposarcoma arising from the renal capsule. The postoperative course was uneventful and the latest follow-up tests showed no signs of recurrence.ConclusionsSurgical treatment is method of choice for liposarcoma tumours

Pathophysiological disorders, quality of life evaluation and recommendations after total resection of the stomach

In recent years, attention has been paid to the quality of life of patients after resection of the stomach as an additional factor of the therapeutic procedure. However, the consequences of total resection of the stomach (especially distant ones) and the influence of different methods of reconstruction of the alimentary tract on patients' quality of life are still controversial.This article sums up the current state of knowledge of patients' quality of life after total resection of the stomach. The first part discusses the pathophysiological disorders which occur after such operations. This will allow the reader to better understand the symptoms which may possibly occur and then decide on the appropriate procedure to improve the patient's everyday function. The subsection on the evaluation of the quality of life on the basis of literature discusses the following problems: questionnaire research, laboratory investigations, endoscopic examinations, and morphological/his-tological examinations.The final part of the paper is a collection of available recommendations to patients after total resection of the stomach. They refer to: optimisation of the diet, prevention of deficiencies, and follow-up examinations, all of which may influence the quality of life

LOADS ACTING ON THE LOCOMOTIVE SYSTEM OF PROFESSIONAL FEMALEVOLLEYBALL PLAYERS DURING THE LANDING PHASE OF SPIKES AND BLOCKS

The purpose of this study was to identify force and time characteristics of ground reaction forces produced during the landing phase of volleyball technical elements: blocks and spikes. Applying piezoelectric dynamometry and video recording, a series of tests were carried out with the participation of four female volleyball players of the first team of AZS AWF sports club competing in the Female Volleyball League. The recorded force vs time line graphs of ground reaction Rx(t), Ry(t) and Rz(t) were used to calculate the values of kinematic-dynamic parameters that describe the level of dynamic loads. Results show that the majority of loads in these movement tasks is significant and may be traumatogenic