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

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

Risk factors in superficial infections of surgical sites in colorectal carcinoma surgery

AimThe aim of the paper was to conduct a retrospective analysis of a group of patients after surgery for colorectal cancer: to define aetiological factors for, and assess drug-sensitivity of bacteria causing infection.Materials/MethodsBetween January 2000 and June 2004, 350 patients underwent surgery for colorectal cancer. Within that group 17 (4,86%) patients developed postoperative wound infections within 30 days of the operation. In all cases we performed microbiological examinations. All the cases of infections were analysed, with special attention being paid to the following groups of risk factors: patient-related and perioperative procedures.ResultsIn all, 17 cases of superficial infections were identified within the skin and subcutaneous tissues. The most frequently identified aetiological factors were colibacillus species and Enterococcus faecalis. Targeted antibiotic therapy was applied, based on the results of antibiograms. Rapid recovery was observed in all patients. The most important patient-related risk factors included: BMI over 25 kg/m2 in 11 (64.7%) patients, high (3rd) degree of neoplastic advancement in 13 (76.5%) patients and preoperative radiotherapy in 7 (41.2%) patients. All infections were found in patients after resection of the sigmoid colon or rectum.ConclusionsThe most frequent aetiological factor identified, on the basis of cultures, was bacterial fl ora of the colorectum. 1. The most important risk factors include: degree of neoplastic advancement, obesity and preoperative radiotherapy. 2. The application of appropriate systems for the preparation of the patient during the perioperative period has a great infl uence on the frequency of infections. 3. Because high drug-resistance in bacterial cultures is a real possibility, it is essential to perform antibiograms in order to help select the most appropriate antibiotics for the treatment of infections

An assessment of the value of Stereotactic Mammotomy Biopsy (SMB) in the diagnosis of impalpable breast lesions

BackgroundBreast cancer is the most common malignancy for women in Poland and represents 19.7% of all neoplasms diagnosed in this group. It is also the most frequent cause of cancer related deaths among women (14.1% of total).An improvement in these results has been achieved by the popularisation of prophylactic mammography. An increase in awareness among women, of the dangers of breast cancer, and an increase in the availability of mammography testing has resulted in impalpable breast lesions being diagnosed increasingly frequently. These diagnoses require histopathological verification.AimTo demonstrate the usefulness of stereotactic mammotomy biopsy (SMB)in the diagnosis of impalpable breast lesions, and its effects on the processes of diagnosis, classification and treatment of pre-invasive growths within the breast.Materials/MethodsStereotactic mammotomy biopsy is a minimally invasive method for the collection of tissue from impalpable changes in the breast which are visible in mammography images and require histopathological diagnosis. The procedure may be carried out on an ambulant patients, under a local anaesthetic.Between April, 2000, and August, 2003, the First Surgical Department carried out 2000 SMB procedures. Changes suitable for biopsy fall into three groups: clusters and areas of microcalcification – 929 (46.45%), small tumours and soft tissue density – 975 (48.75%), radial structures – 96 (4.80%).Results365 patients (18.25%)required surgery for the purpose of obtaining a histopathological diagnosis, including 150 (7.50%)with invasive cancer, 120 (6.00%)with preinvasive cancer – DCIS and 95 (4.75%)with atypical ductal hyperplasia – ADH.Among the remaining 1635 patients (81.75%)changes were found to be benign and the patients avoided surgery.ConclusionsIt is demonstrated that stereotactic mammotomy biopsy is the method of choice for the diagnosis of mammographically detected, inpalpable lesions of the breast, and furthermore, contributes to the process of diagnosis, classification and treatment of pre-invasive growths in the breast

Intraperitoneal administration of radiolabelled monoclonal antibody pemtumomab (Yttrium-90-HMFG1) in gastric cancer

AimTo evaluate the feasibility of treatment method (intraperitoneal administration of radiolabelled monoclonal antibody) for patients with gastric cancer.MethodA total of 15 eligible patients, with histologically proven adenocarcinoma of the stomach or gastro-oesophageal junction, who had undergone resection to remove the primary tumour mass, were enrolled in the study. Eight patients were treated with the study drug and 7 of patients were enrolled into the standard care control arm.Materials and ResultsMean blood radioactivity peaked between 36 and 48 hours, with a mean peak value of approximately 15% ID. Data previously reported on intraperitoneal Y-HMFG1 treatment of patients with ovarian cancer show peak values of 25 – 35% ID seen at 48 hour post-injection. The present results require confirmation in a large population of gastric cancer patients, but suggest that the transfer of radioactivity into the blood pool is decreased compared with the ovarian cancer patients.ConclusionsA HAMA response was detected in all patients after treatment, and there is some suggestion that is follows a bi-phasic pattern. If as hypothesised, a HAMA response provides a boost to the immune system, leading to a potential longer term benefit, then the HAMA response seen in this study following pemtumomab treatment is encouraging

Quality of life assessment in patients with a stoma due to rectal cancer

The AimThe aim of the study was to assess the quality of life in patients with a stoma, created for various reasons in the course of rectal cancer treatment.Material and MethodsThe study included 50 patients in the early post-surgery follow-up period, visiting the Stoma Outpatient Clinic in the Great Poland Centre in Poznań. All patients underwent surgery due to rectal cancer. Quality of life was assessed using anonymous questionnaires. Participation in the study was voluntary, and patients were informed about the proceedings. Standardized EORTC QLQ-C30 questionnaire for quality of life assessment in cancer patients and QLQ-CR38 module for colorectal cancer patients were used.ResultsIn all domains assessed, stoma patients showed significant impairment of functioning, which negatively influenced their quality of life. In our study group scores in all functional scales (physical – 70.6, role – 71.0, emotional – 61.8, cognitive – 75.6, social – 65) differed significantly from the reference values for the healthy population. QLQ-CR38 questionnaire was used to assess which symptoms were most disturbing for the patients. Negative influence of stoma on sexual functioning in men (mostly erectile and ejaculation dysfunctions) turned out to be the most significant (54.6). In women sexual dysfunctions were significantly less expressed (26.8). Another large group of symptoms having an unquestionable influence on level of functioning comprised direct stoma-related symptoms (47.8).ConclusionsCreation of a stoma still has a large negative impact on patients' quality of life. Influence of the stoma is most pronounced in the area of social functioning. In spite of improvement in support, the problems pertaining directly to the fact of having a stoma bag remain significant for this group of patients

Czerniaki skóry - zasady postępowania diagnostyczno-terapeutycznego

Excisional biopsy of suspicious melanomatous skin lesions likely to be diagnosed as early melanomas is crucial in establishing diagnosis and prognostic factors. Early diagnosis and surgical removal of cutaneous melanoma not only improves patients’ prognosis, but it is also associated with approximately 90% likelihood of cure. Next steps in the therapeutical management of cutaneous melanoma following excisional biopsy are radical scar excision with adequate margins and sentinel lymph node biopsy. Radical lymph node dissection is recommended in case of regional lymph node metastases. High-risk patients should be enrolled into prospective clinical trials on adjuvant therapy. The treatment of melanoma patients with distant metastases is of limited value. Long-term survival is confined to selected group of patients (metastases to extra-regional nodes, subcutaneous tissue and lungs). The benefits of immunotherapy/immunochemotherapy as compared to dacarbazine monotherapy have not been proven. Patients with metastatic disease should be treated within the frame of clinical trials.Dla rozpoznawania i ustalenia najważniejszych czynników rokowniczych podstawowe znaczenie ma biopsja wycinająca podejrzanych zmian barwnikowych skóry, które mogą być wczesnymi czerniakami. Wczesne rozpoznanie i chirurgiczne usunięcie czerniaka nie tylko poprawia rokowanie, ale daje szansę wyleczenia u około 90% chorych. Kolejne etapy postępowania terapeutycznego obejmują kwalifikację chorych do radykalnego wycięcia blizny po biopsji wycinającej z właściwymi marginesami oraz wykonania biopsji węzła wartowniczego. W przypadku przerzutów do regionalnych węzłów chłonnych postępowaniem z wyboru jest wykonanie radykalnej limfadenektomii. Zaleca się włączanie chorych na czerniaki skóry o wysokim ryzyku nawrotu do prospektywnych badań klinicznych nad leczeniem uzupełniającym. Leczenie chorych z przerzutami ma obecnie bardzo ograniczoną wartość. Długoletnie przeżycia dotyczą niewielu chorych (przerzuty w pozaregionalnych węzłach chłonnych, tkance podskórnej lub płucach). Nie udowodniono przewagi immunoterapii lub immunochemioterapii nad monoterapią z zastosowaniem dakarbazyny. U chorych w stadium uogólnienia najwłaściwsze jest stosowanie leczenia w ramach klinicznych badań