Radiation induced sarcoma: a risk that is almost forgotten.

Radiotherapy has been widely use as an adjuvant therapy in the breast cancer management. The usage has increased the incidence of radiation induce sarcoma. We here present a case of radiation induce sarcoma of the axilla following mastectomy and axillary lymph node dissection for infiltrating ductal carcinoma

Breast and Axillary Lymph Nodes Metastasis five years after Radical Nephrectomy for Renal Cell Carcinoma A Case Report and Review of the Literature

Breast is an uncommon and rare site for metastasis. Primary and secondary tumors of the breast need to be differentiated as management is different. We present a 67 year old female patient with two breast lumps and an axillary lymph node, 5 years after nephrectomy for Renal Cell Carcinoma (RCC). Mammogram report showed a dense spiculated mass at right upper outer quadrant and a retroareolar mass associated with clustered micro calcifications. Fine Needle Cytology and trucut biopsy were inconclusive. Computer Topography (CT) abdomen did not show evidence of RCC recurrence. After discussion with the patient, she underwent mastectomy with axillary clearance and the final histopathology report was consistent with metastasis from RCC. The management of this case is discussed

Depression, Anxiety, Stress and Perceived Social Support Among Breast Cancer Survivors in Tertiary Hospital in Malaysia

The emotional distress and psychosocial factors are links to the worst quality of life among cancer patients as well as survivors. It gives a negative impact on the survivors and their families. The objective of the study was to determine the correlation of depression, anxiety, and stress with perceived social support among breast cancersurvivors. This is a baseline finding of an educational intervention study. A total of 131 female breast cancer survivors were recruited while they went for their appointment at the Oncology clinic in one of the Tertiary Hospital in Kuala Lumpur. Baseline data was collected using the Depression, Anxiety and Stress (DASS) and Multidimensional Scale of Perceived Social Support (MSPSS) questionnaires. Descriptive analysis andcorrelation tests were used to determine the strength of a linear relationship between depression, anxiety and stress with perceived social support. The descriptive analysis showed that breast cancer survivors had a higher prevalence of anxiety (30.5%) as compared to depression (14.5%) and stress (12.2%). Perceived social support was higher among family support (96.2%) as compared to significant others (84.7%) and friends (71.8%). There was a fair negative correlation between: (i) depression and family support (r = -0.372, p < 0.001), and (ii) stress and family support (r = -0.342, p < 0.001). Other domains had a poor correlation (r < 0.030). The finding showsthat social support from the family and significant others have a significant but fair inverse association with the emotional aspect (depression and stress) of breast cancer survivors. Keywords: Correlation, DASS, MSPSS, breast cancer, Malaysia

Lymphocytic mastopathy: a great mimicry of carcinoma

Three elderly ladies presented with clinical suspicion of breast cancer. Lumpectomy was performed in all 3 cases and histopathological examination came back as lymphocytic mastopathy. Only one of them had a classical long history of diabetes to suggest diabetic mastopathy. The other two cases was non-diabetic and not associated with autoimmune disease. Clinicopathologic and imaging revisited. The disease posed a diagnostic challenges and management dilemma

Challenges in the Perioperative Localization in Secondary Hyperparathyroidism, a Case Report

To detect hyperfunctioning glands, noninvasive procedures such as ultrasound, sestamibi scan, and magnetic resonance imaging (MRI) are widely available. Preoperative localization studies give important information and enable unilateral exploration or minimal invasive parathyroidectomy. Localization studies and parathyroid hormone assays have not clearly modified the conventional surgical approach of the disease. Controversy regarding the surgery to be favored, between subtotal parathyroidectomy and total parathyroidectomy with autotransplantation, continues against the background of relevant recurrence rates, persistent SHPT, and markedly increased complication rates in reoperation. We are presenting a case of 54-year-old male, on regular hemodialysis (HD) referred by his nephrologist for symptomatic hyperphosphatemia and osteoporosis. Phosphate binders and vitamin D failed to control the disease. Patient underwent neck exploration aiming for total parathyroidectomy, but during surgery we were able to find only the left inferior parathyroid gland. For the few months after the surgery, patient phosphate, iPTH and alkaline phosphatase still deranged. So, the decision was made to do preoperative localization study to confirm the presence and location of the remaining 3 parathyroid gland before re-exploration of the neck. Ultrasonography, computerized tomography of the neck and thorax as well as sestamibi scan done. The results were inconclusive. Re-exploration was performed only right and left superior parathyroid glands. Still unable to localize right inferior gland. Postoperatively, biochemical derangement started to improve slowly

The Risk of Recurrence in Breast Cancer Patients Treated with Tamoxifen: Polymorphisms of CYP2D6 and ABCB1

CYP2D6 plays a major role in the metabolism of tamoxifen, and polymorphism of Pglycoprotein has been associated with resistance of many drug therapies. This study investigates the clinical impact of genetic variants of CYP2D6 and ABCB1 in breast cancer patients treated with tamoxifen. Blood samples from 95 breast cancer patients treated with tamoxifen were collected and genotyped for CYP2D6 and ABCB1 variants using allele-specific PCR method. Recurrence risks were calculated using Kaplan–Meier analysis and compared using the log-rank test. Patients carrying CYP2D6*10/*10 and heterozygous null allele (IM) showed higher risks of developing recurrence and metastasis (OR 13.14; 95% CI 1.57–109.94; P=0.004) than patients with CYP2D6*1/*1 and *1/*10 genotypes. Patients with homozygous CC genotypes of ABCB1 C3435T showed a shorter time to recurrence. Patients who were CYP2D6 IM and homozygous CC genotype of C3435T have statistically significant higher risks of recurrence (P=0.002). Similarly, median time to recurrence in these patients was only 12 months (95% CI=0.79–23.2) compared to those without this combination which was 48 months (95% CI=14.7–81.2). Patients with CYP2D6 IM and homozygous CC genotype of ABCB1 C3435T have shorter times to recurrence. The results confirmed the findings of previous studies and support FDA recommendation to perform pre-genotyping in patients before the choice of therapy is determined in breast cancer patients

Metaplastic breast carcinomas: a report of six cases

Metaplastic breast carcinomas (MBCs) are rare primary breast malignancies characterized histologically by carcinoma of two epithelial types or co-existence of carcinoma with non-epithelial cellular elements. They are aggressive tumours that carry poor prognosis. We reviewed the pathologic features and clinical outcomes of MBCs seen in our institution between the years 2000 to 2007. Out of 471 breast cancer patients, six female patients were histologically-proven to have MBCs giving an incidence rate of 1.3%. The patients comprised four Malays and two Indians and their mean age was 51 years old. Five patients underwent mastectomy (four with axillary clearance and one without) and one had wide local excision with axillary clearance. Axillary lymph node involvement was seen in four patients (three with epithelial only type tumour and one with the biphasic tumour). In all the cases, the tumours were bigger than 5 cm in diameter (T3), grade 3 and estrogen receptor negative. Five patients received chemotherapy while one refused. All of the patients had tumour recurrence with a mean time of recurrence of 9 months. In conclusion, metaplastic breast carcinomas are rare and aggressive tumours usually affect the post menopausal age group. They present as aggressive, large sized, high grade tumours that are estrogen receptor negative. Tumour size and axillary lymph node involvement indicate poor prognosis. Despite treatment with chemotherapy and radiotherapy, these patients have high risk of local recurrence and distant metastases which are potentially fatal

Inverse correlation between P53 and Bcl-2 expression in breast carcinoma of Malaysian patients

Gen penindas p53 dan proto-onkogen Bcl-2 mengkodkan fosfoprotin nuklear dan protin membran mitokondria yang terlibat dalam pelbagai fungsi sel. Kedua-dua protin mempunyai hubung kait dengan tapak jalan kematian sel berprogram disamping memberi informasi prognostik karsinoma payudara. Objektif kajian ini adalah untuk menentukan kaitan onko-protin p53 dan Bcl-2 pada karsinoma payudara dan hubungannya dengan umur pesakit, saiz tumor, peringkat kanser dan gred histologi. Lima puluh sembilan kes kanser payudara dari Pusat Perubatan Universiti Kebangsaan Malaysia (PPUKM) telah dikaji menggunakan teknik imunohistokimia. Keputusan menunjukkan 45.8% (27/59) kanser payudara adalah imunopositif untuk p53 dan 40.7% (24/59) adalah imunopositif untuk Bcl-2. Terdapat korelasi signifikan di antara ekspresi Bcl-2 dengan peringkat awal kanser (p=0.01). Variabel lain tidak menunjukkan kaitan signifikan. Kaitan songsang didapati di antara p53 dan Bcl-2 (p=0.001). Hasil keputusan mencadangkan regulasi menurun Bcl-2 oleh p53 dalam karsinogenesis kanser payudara

Primary Thyroid Lymphoma: two different presentations of a rare disease

Primary thyroid lymphoma is a rare disorder accounting for about 2% of all malignant lymphomas and less than 5% of thyroid malignancies. It is an aggressive disease with poor outcome. The majority of thyroid lymphomas are non-Hodgkin lymphomas of Bcell origin. Majority of cases occur in women in the sixth decade. We report two cases of primary thyroid lymphoma and highlight the clinical issues and challenges posed by this rare disease. Both cases presented with respiratory obstructive symptoms that required surgical intervention. The optimal management for a primary thyroid lymphoma be it chemotherapy, radiotherapy, surgery or monoclonal antibodies is still debatable. The role for surgery has evolved through the years but its importance in emergency situations should not be overlooked. Both our patients had to undergo surgery but only one patient received additional chemotherapy and radiotherapy. These two case reports illustrated the difficulties in managing this rare disorder

Fine Needle Aspiration (FNA) cytology of the thyroid: A Cyto-Histopathological study of 361 cases in Hospital Universiti Kebangsaan Malaysia

Thyroid nodules are common but thyroid malignancies are not. Fine needle aspiration (FNA) cytology is a diagnostic tool used to screen patients with thyroid nodules who require surgery. We study the diagnostic accuracy of FNA as the initial diagnostic modality in the clinical assessment of thyroid nodules. Between January 1995 until December 2000, 2131 FNA of thyroid nodules were performed. Four hundred and forty-one (20.7%) of these were unsatisfactory and 1690 (79.3%) cases were satisfactory for cytological evaluation. Histopathological diagnosis were available for 361 cases. Cyto-histopathological correlation was carried out for these cases. Our results showed a diagnostic accuracy of 96.2% with sensitivity and specificity rates of 87.7% and 98.4% respectively. Our positive predictive value is 93.4% and our negative predictive value is 96.8%. From this study, we conclude that fine needle aspiration is an important initial screening diagnostic tool for the investigation of thyroid nodule