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

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

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

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

Wyniki paliatywnego przezskórnego drenażu dróg żółciowych

BackroundThe aim of palliative treatment of advanced malignant tumours involving the hilus of the liver is to decompress mechanical jaundice. In some cases, percutaneous drainage of biliary ducts is the only possible effective treatment. The aim of this paper is to evaluate the results of palliative percutaneous drainage of biliary ducts.Materials and methodsPercutaneous drainage of biliary ducts was carried out under ultrasound and x-ray control with a picture channel. A PIGTAIL catheter (9F diameter, 45 cm length) was installed by entering its end-part into intrahepatic billiary ducts and bile diversion. In 5 patients bile was inserted in back to the gastrointestinal tract by simultaneous endoscopic microgastrostomy. In 1996–2003, 52 percutaneous drainages of biliary ducts were installed in 38 patients. All of them suffered from mechanical jaundice with the bilirubin level of 170–510 umol/l caused by neoplasm constricting biliary ducts. The neoplastic disease in all cases was histologically confirmed. The quality of life was evaluated one month after installing percutaneous drainage of biliary ducts. Regression of symptoms connected with mechanical jaundice, independence and self-service when using a catheter and the physical and mental state of patients were taken into consideration.ResultsIn all patients a decrease in the bilirubin level below 170 umol/l was observed 14 days after the procedure. In 20 patients jaundice regressed completely 4 weeks after the drainage. In a later period increased bilirubin levels were connected with temporary impairment of catheter patency or with infection of biliary ducts. Despite the advanced neoplastic disease patients showed total independence and selfservice. However neoplastic cachexia and the necessity to take analgesics deteriorated their quality of life.Conclusions1) Percutaneous drainage of biliary ducts decompresses mechanical jaundice and decreases ailments typical of cholestasis. 2) Percutaneous drainage of biliary ducts requires specialized long-term care and cooperation with the patient and or his or her family. 3) Deterioration in the quality of life in return for its prolongation is accepted by patients and their families.WstępCelem leczenia paliatywnego zaawansowanych nowotworów złośliwych zajmujących wnękę wątroby jest odbarczenie żółtaczki mechanicznej. W niektórych przypadkach przezskórny drenaż dróg żółciowych jest jedynym skutecznym i możliwym do wykonania zabiegiem. Celem pracy jest ocena wyników paliatywnego przezskórnego drenażu dróg żółciowych.Materiał i metodaPrzezskórny drenaż dróg żółciowych wykonywano pod kontrolą aparatu usg i rtg z torem wizyjnym. Zakładano cewnik PIGTAIL o średnicy 9F i długości 45cm wprowadzając końcówkę w wewnątrzwątrobowe drogi żółciowe i odprowadzając żółć na zewnątrz. U 5 chorych wprowadzono żółć z powrotem do przewodu pokarmowego poprzez jednoczasowo endoskopowo założoną mikrogastrostomię. W latach 1996–2003 założono 52 przezskórne drenaże dróg żółciowych u 38 chorych. Wszyscy chorzy cierpieli na żółtaczkę mechaniczną z poziomem bilirubiny (170–510 umol/l) spowodowaną nowotworem zaciskającym drogi żółciowe. Choroba nowotworowa była u wszystkich leczonych potwierdzona histopatologicznie. Oceniono jakość życia w miesiąc po założeniu przezskórnego drenażu dróg żółciowych uwzględniając ustąpienie dolegliwości związanych z żółtaczką mechaniczną, samodzielność i samoobsługę, także w obsłudze cewnika oraz subiektywny stopień satysfakcji chorych.WynikiU wszystkich chorych wystąpił spadek poziomu bilirubiny poniżej 170 umol/l po 14 dniach od zabiegu. U 20 chorych żółtaczka ustąpiła całkowicie po 4 tygodniach od drenażu. W późniejszym okresie podwyższenie poziomu bilirubiny związane było z przejściowym upośledzeniem drożności cewnika lub wystąpieniem zakażeń dróg żółciowych. Pacjenci mimo zaawansowanej choroby nowotworowej wykazywali pełną samodzielność i samoobsługę. Jakość życia pogarszało wyniszczenie nowotworowe i konieczność przyjmowania leków przeciwbólowych.Wnioski1) Przezskórny drenaż dróg żółciowych odbarcza żółtaczkę mechaniczną i zmniejsza dolegliwości typowe dla cholestazy. 2) Przezskórny drenaż dróg żółciowych wymaga długotrwałej opieki specjalistycznej oraz współpracy z chorym lub jego rodziną. 3) Pogorszenie jakości życia celem jego przedłużenia jest akceptowane przez pacjentów i ich rodziny

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

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL)

Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) has recently been recognised, and so far approximately 200 cases have been described worldwide. From a histopathological and molecular perspective, it does not differ from classical breast anaplastic large cell lymphoma without ALK kinase expression. However, it has a different clinical course and prognosis, with a five-year survival rate about 92% as compared to 20–50% in patients with the classic form. A 60-year-old female patient had undergone bilateral mastectomy at the age of 45 years due to fibrocystic mastopathy and frequent breast cancer in her family history. Her implants were changed twice due to rupture. In 2018 the patient noticed a growing swelling of the right breast and fluid accumulation in the implant pouch; in September 2018 both implants were removed together, with the pouch also thoroughly removed during the procedure, and other PolyTech implants were inserted. Histological examination revealed the following: breast implant-associated anaplastic large cell lymphoma, immunophenotype: CD30+, ALK–, CD68, PGM–, CKAE1/AE3–, Ki 67 in 90% of cell nuclei. The patient was in very good general condition and without abnormalities in haematological tests. In PET-CT with 18F-FDG (13/12/2018), areas of slightly increased 18F-FDG activity were found in the vicinity of the implants on the right side (SUV max = 1.9) and on the left side (SUV max = 2.3), in addition to left axillary lymph node 12 × 7 × 8 mm (SUV max = 2.0). The patient did not decide to go ahead with the proposed removal of the implants, and a suspicious node was taken for examination — no cancer architecture was found. A control PET-CT test was performed after four months, the result of which was comparable to the previous one. The patient is under observation