Intratumoral heterogeneity of HER2 gene amplification in occult breast cancer

Occult breast cancer （OBC） is an uncommon type of breast cancer, with palpable masses in the axillary area as the initial symptom. We report a case of OBC with HER2 genetic heterogeneity and discuss the impact of an unusual HER2 amplification pattern.A 56-year-old female was discovered a palpable mass in the right axillary area. She underwent a lymph node excisional biopsy at another hospital approximately one month before referral to our hospital service for further evaluation. The biopsy showed lymph tissue with tumor cell infiltrating in the form of sheets or nests. The tumor cells were larging in size, obviously atypical, and showed prominent nucleoli and intracellular keratosis. Mammography, chest X-ray, chest computed tomography （CT）, abdominal ultrasonography （US）, and positron emission tomography- CT （PET-CT）, which were also performed at the initial hospital, showed no abnormal findings.     

Misdiagnosed myeloid sarcoma of the vulva

A25-year-old woman presented with a lump in the vulva associated with progressive difficulty in urination that had persisted for approximately half a year.A diagnosis of Bartholin's abscess had been made in another hospital.Incision revealed no pus and ultrasonography showed a solid lesion in the left vulva.Partial excision of the tumor was implemented and histopathology showed a small round cell tumor.There were no other significant findings in her present or past medical history.She was admitted to our hospital with vulvar cancer.On gynecological examination,a 7 cm × 6 cm firm,hard,painless mass was found in the left labium majora.The right labium was inflamed but painless.Results of hematological investigations were mild anemia,with hemoglobin 84 g/L,red blood cell count 2.7× 109/L,white blood cell count 6.53×109/L and platelet count 195× 109/L.Magnetic resonance imaging revealed vulvar cancer with lymphadenopathy in the pelvic cavity.     

Amplatzer PDA occluder used in adult patent ductus arteriosus with serious pulmonary hypertension after testing balloon occlusio

A 36-years-old female had heart palpitation and chest press for five years and the symptoms had been worsening for half a year. She was diagnosed with patent ductus arteriosus with moderate pulmonary hypertension in a local hospital 5 years before but was not operated. Physical examination showed: T 37℃, P 87?bpm, R 18?bpm and BP 130/70?mm?Hg. There was no distension of the jugular vein, and the lungs were clear. There was continuous mechanic murmur at the second intercostal space, and grade 2 systolic blowing murmur at the apex. P2 was strengthened. The liver and spleen were not enlarged and there was no edema in either leg. ECG showed a pulmonary P wave and right ventricular hypertrophy. Chest X-ray film showed pulmonary segment projection 3?cm, and the dimension of the right inferior pulmonary artery bed increased to 3?cm in diameter. On echocardiography, both atria, the pulmonary artery and the right ventricle were enlarged.     

Amplatzer PDA occluder used in adult patent ductus arteriosus with serious pulmonary hypertension after testing balloon occlusio

A 36-years-old female had heart palpitation and chest press for five years and the symptoms had been worsening for half a year. She was diagnosed with patent ductus arteriosus with moderate pulmonary hypertension in a local hospital 5 years before but was not operated. Physical examination showed: T 37℃, P 87?bpm, R 18?bpm and BP 130/70?mm?Hg. There was no distension of the jugular vein, and the lungs were clear. There was continuous mechanic murmur at the second intercostal space, and grade 2 systolic blowing murmur at the apex. P2 was strengthened. The liver and spleen were not enlarged and there was no edema in either leg. ECG showed a pulmonary P wave and right ventricular hypertrophy. Chest X-ray film showed pulmonary segment projection 3?cm, and the dimension of the right inferior pulmonary artery bed increased to 3?cm in diameter. On echocardiography, both atria, the pulmonary artery and the right ventricle were enlarged.     

Late recurrence and metastasis of an appendiceal goblet cell carcinoid 24 years after appendectomy

A 36-year-old woman presented with right iliac fossa pain in March 1988.Abdominal ultrasound showed nothing unusual and an appendectomy was performed for acute appendicitis.The resected appendix appeared inflamed without perforation.No enlarged lymph nodes were seen during surgery.Microscopic examination of the resected specimen showed acute appendicitis and a tumor in the lamina propria and submucosal layer,infiltrating to the deep muscular layer.Groups of four to ten tumor cells were arranged in small clusters which lacked central lumens and were widely separated by stroma.The tumor cells,which were distended with mucin and had crescentic nuclei,resembled signet ring cells （Figure 1A）.Keywords：recurrence; metastasis; appendiceal neoplasm; appendectomy; carcinoid tumor     

Local injection of liposomal adriamycin to inhibit metastatic cell proliferation in axillary nodes in rabbits bearing breast tumors

Objective： To assess the inhibitory effects of local injection of liposomal adriamycin （LADR） on the proliferation of lymph node metastases in rabbits bearing VX2 carcinoma in the mammary gland. Methods：Thirty female New Zealand white rabbits were divided into 3 groups, with 10 in each. VX2 tumor mass suspensions were injected into the breast tissues of rabbits. Treatment initiated once the axillary lymph node reached 5 mm in the maximum diameter. Group 1 received a sham treatment. Group 2 received a subcutaneous injection of LADR adjacent to tumor. Group 3 received an intravenous injection of free ADR （FADR） at the same dose and concentration to group 2. The breast tumors and axillary lymph nodes were resected after the treatment was repeated 3 times. The tumor and node sizes before and after treatment were measured. PCNA mRNA expressions in breast tumors and axillary nodes were determined using RT-PCR. Results： The mean growth ratios of lymph nodes after treatment were 3. 70, 1.55, and 2.89, respectively, in groups 1, 2, and 3. The slowest node growth was observed in animals of group 2, with significant differences from group 1 （P〈0. 001） and group 3 （P= 0. 002）. The relative values of PCNA mRNA expression in lymph nodes were 0. 541, 0. 329, and 0. 450, respectively, in groups 1, 2, and 3. Group 2 exhibited a significantly reduced PCNA mRNA expression in metastatic lymph node, as compared to group 1 （P〈0. 001） and group 3 （P=0. 004）. Intravenous FADR injection effectively lowered the mRNA expressions of PCNA in breast tumors, which were not apparently altered after local LADR injection. Conclusion： Local injection of LADR holds a strong inhibitory effect on the proliferation of metastatic tumor cells in lymph nodes and appears to be an effective method for the treatment of lymphatic metastases of breast cancer.     

Contribution of minute axillary lymph nodes to accurate staging for patients with breast cancer

Background Axillary lymph node metastasis is a very important metastatic pathway in breast cancer and its accurate detection is important for staging tumour and guiding therapy. However, neither the accuracy of routine detection of lymph node in surgical specimens nor the significance of minute lymph node with metastases in breast cancer is clear. A modified method for conveniently detecting minute lymph node in specimens of axillary dissections in patients with breast cancer was used to analyze their influence on staging breast cancer. Methods Lymph nodes in fresh, unfixed, specimens of axillary dissections from 127 cases of breast cancer were detected routinely. Then the axillary fatty tissues were cut into 1 cm thick pieces, soaked in Carnoy’s solution for 6 to 12 hours, taken out and put on a glass plate. Minute lymph nodes were detected by light of bottom lamp and examined by routine pathology. Results Lymph nodes (n= 2483, 19.6±8.0 per case) were found by routine method. A further 879 lymph nodes up to 6 mm (781 < 3 mm, 6.9±5.3 per case, increasing mean to 26.5±9.7) were found from the axillary tissues after soaking in Carnoy’s solution. By detection of minute lymph nodes, the stages of lymph node metastasis in 7 cases were changed from pathological node (pN) stage pN(0) to pN(1) in 4 cases, from pN(1) to pN(2) in 2 and from pN(2) to pN(3) in 1. Conclusions The accurate staging of axillary lymph node metastasis can be obtained routinely with number of axillary lymph nodes in most cases of breast cancer. To avoid neglecting minute lymph nodes with metastases, small axillary nodes should be searched carefully in the cases of earlier breast cancer with no swollen axillary nodes. Treatment with Carnoy’s solution can expediently detect minute axillary nodes and improve the accurate staging of lymph nodes in breast cancer.     

A rare case of extraosseous Ewing sarcoma primarily arising in the ovary

To the editor： An 18-year-old woman, GOP0, presented with a l-month history of abdominal distention. She had 2-year of sexual history. She had regular menstrual cycles and was not using drugs. No other significant history was noted. Clinically, her general condition was dissatisfactory, with anemic face, weight-loss. Systemic examination was normal. Pelvic examination revealed a mass of 9 cmx 10 cmx 10 cm on the right adnexa and a mass of 8 cm~6 cm x6 cm on the lift adnexa. A Pap smear taken was normal. Computerized tomography （CT） of the chest was normal, but of the pelvic cavity showed there was mixed masses of bilateral adnexa and predominant ascites. Initial laboratory test showed she was tall in anemia （hemoglobin 63 g/L） and hypoproteinemia. CA125 value was 196 U/ml and CA199 value was 45 U/ml. The preliminary diagnosis was ovarian genital-cell tumor.     

Cervical granulocytic sarcoma

To the editor:a 34 year-old (gravida one,para one) female with a 1-year history of menorrhagia diagnosed 5 days earlier with cervical cancer was admitted to our hospital on April 16th,2009.Previous medical history and family history were not remarkable,and physical examination was normal.Gynecologic examination showed normal vagina with an 8 cm diameter hard cervical mass that bled easily.The uterus was normal and movable.No mass was found in the adnexal area.Lateral ligaments were not thickened.Ultrasound indicated cervical diameter was 5.9 cm with 5.7 cm × 5.8 cm low echo mass be identified.A cervical biopsy done after admission,the pathologic finding showed diffuse,medium-sized oval or round cells with high nuclear/cytoplasm ratio.Nuclei had an oval shape with weak basophilic staining and reticular-like chromatin with scantly distributed eosinophils.Nucleoli was small and immature.     

Using Tc-99m MIBI scintimammography to differentiate nodular lesions in breast and detect axillary lymph node metastases from breast cancer

Objective To test the clinical value of using Tc-99m MIBI scintimammography (Tc-99m MIBI SMM) to differentiate nodular lesions in breasts and detect axillary lymph node metastases of breast cancer. Methods The subjects consisted of sixty female patients exhibiting unilateral palpable breast mass. The early and delay static acquisitions were undertaken in all subjects at 10 and 90 min after injection with Tc-99m MIBI. The acquisition included three positions: anterior supine, left lateral prone and right lateral prone. A special device for SMM which was developed by our laboratory was used. The ratio of ［(T-B)/(NT-B)］ was calculated as radioactivity of mass to that of opposite corresponding tissue, and ［(T-B)/(NT-B)］≥1.21 was used as the cut-off for semi-quantitative discrimination of malignancy from benignity in semi-quantitative analysis. The final diagnosis was obtained from histology examination in all subjects. Results Using Tc-99m MIBI SMM to differentiate between nodular lesions in breasts, the diagnostic sensitivity and specificity were 92.9% and 90.6% respectively, the positive predictive value 89.7%, the negative predictive value 93.5%, and the accuracy 91.7%. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy obtained with Tc-99m MIBI SMM for detecting axillary lymph node metastases were 83.3%, 86.1%, 80%, 88.6% and 85% respectively. Conclusions It is suggested that Tc-99m MIBI SMM may be not only valuable in differentiating malignant lesions from benign nodular masses of breast, but also helpful in detecting axillary lymph node metastases of breast cancer.     

Carcinoma of breast co-existing with non-Hodgkin's lymphoma of axillary lymph nodes

The co-existence of breast carcinoma and lymphoma in the axillary lymph nodes, without a history of previous chemotherapy or radiotherapy is rarely described. We present a case of a 50-year-old female with right breast mass, proved by pathological examination to be invasive mucinous carcinoma. Examination of the axillary lymph nodes as axillary clearance showed concomitant small lymphocytic lymphoma and chronic lymphocytic leukemia, with no evidence of metastatic mammary carcinoma deposits.     

Granular cell tumor of the breast: report of a case

A case of granular cell tumor of the breast in a 43-year-old woman is described. The patient presented with a painless mass in the upper-outer quadrant of her right breast. Mammography showed a spiculated tumor and ultrasonography demonstrated a hypoechoic mass with an irregular border. Magnetic resonance (MR) mammography revealed a homogeneous enhanced mass in T1-weighted images using Gd-DTPA and a ringed high-intensity area around the mass in T2-weighted images. Fine-needle aspiration cytology failed to show any malignant cells. A partial resection of the breast was performed and histological examination revealed a granular cell tumor. Granular cell tumors are generally always benign, but they may be misdiagnosed as malignant tumors because of their mammographic and ultrasonographic findings. MR mammography did not reveal a typical breast cancer in either T1- or T2-weighted images in the present case. This case illustrates the need for care in preoperative examinations in order to avoid overdiagnosis of breast cancer.     

高频彩超诊断小儿肠系膜淋巴结炎的临床价值

目的探讨使用高频彩超经腹壁诊断小儿肠系膜淋巴结炎的临床价值。方法应用高频彩超对临床疑似肠系膜淋巴结炎患儿58例进行检查,常规检查肝,胆,胰,脾,肾,阑尾后,加压探头重点扫查右下腹,注意观察淋巴结的大小,数量,形态及其内部及周边的血流情况,并于抗炎治疗7天和14天后复查。结果49例患儿在右下腹探及肿大的淋巴结回声,并具有较典型的声像图特征,抗炎治疗后复查淋巴结有明显减少和缩小,其内的血供也明显减少。2例在右下腹探及肿大的阑尾回声,并被术后病理所证实,7例超声检查无异常,经胃肠道解痉治疗后,症状缓解。结论应用高频彩超能为临床诊断肠系膜淋巴结炎提供可靠依据。     

高频彩超诊断小儿肠系膜淋巴结炎的临床应用体会

目的研究高频彩超在小儿肠系膜淋巴结炎中的诊断价值.方法对30例儿科急腹症经超声显像诊断为小儿肠系膜淋巴结炎的门诊及住院患儿和30例正常健康儿童行高频超检查并对结果进行回顾性分析.结果 30例患儿均有不同程度的淋巴结肿大,超声显示肿大淋巴结在脐周及右下腹,而且淋巴结最大长轴直径大于1.0 cm,最大短轴直径大于0.5 cm,纵横比又称圆形指数大于2,彩色多普勒（CDF）I显示淋巴结内见血流信号增多,呈点、条状沿淋巴门分布.结论高频彩超检查可作为诊断小儿肠系膜淋巴结炎的首选方法,将肠系膜淋巴结L〉1.0 cm、R〉0.5 cm、L/R〉2,CDFI显示淋巴门样血流信号,作为诊断标准.     

术前超声造影对乳腺癌前哨淋巴结转移的预测价值

目的：分析术前超声造影对乳腺癌前哨淋巴结转移的预测价值。方法：选择乳腺癌病人276例,术前均行超声造影检查寻找前哨淋巴结,将病理学检查结果和超声造影结果进行对比,计算超声造影敏感性、特异性、阳性预测值、阴性预测值及准确率。结果：276例病人中,124例肿瘤位于左乳,152例位于右乳;100例肿瘤部位在外上象限,47例在外下象限,60例在内上象限,69例在内下象限;所有病人均经病理证实为原发性乳腺癌,其中183例为浸润性导管癌,65例为导管内原位癌,16例为黏液癌,12例为其他;原发肿瘤直径0.6～4.9 cm,前哨淋巴结直径0.3～3.2 cm。术前超声造影共检出497枚前哨淋巴结,手术共切除518枚前哨淋巴结,术前超声造影对前哨淋巴结的检出率为95.95%(497/518);病理学检查确认存在120枚转移前哨淋巴结。术前超声造影预测前哨淋巴结阳性病人73例,阴性病人203例,其对有无前哨淋巴结的预测灵敏性76.12%,特异性89.47%,阳性预测值69.86%,阴性预测值92.12%,准确率86.23%。结论：术前超声造影还需联合其他示踪方式对乳腺癌前哨淋巴结转移情况进行预测,才能获...     

高频超声对小儿肠系膜淋巴结炎的诊断价值

目的探讨高频超声对小儿肠系膜淋巴结炎的诊断。方法回顾性分析77例腹痛小儿超声检查结果。采用高频探头超声检查,记录内容包括淋巴结的部位、大小、形态、回声强度及类型,并测量其长短轴比值（L/S）,病变的变化结果均经临床和随访证实。结果 77例患儿均显示腹腔淋巴结肿大,脐周及右下腹均见肿大淋巴结者72例,最大者24×12mm,其中19例血流丰富;仅右下腹见肿大淋巴结者4例,最大者14×5mm,1例血流丰富;左上腹及脐周均见肿大淋巴结者1例,大小11×5mm,血流较丰富。治疗后肿大的淋巴结逐渐回缩,但肿大淋巴结的回缩比腹痛消失明显滞后。结论高频超声诊断小儿肠系膜淋巴结炎经济简便,重复性强,准确率高（〉95%）,是诊断小儿肠系膜淋巴结炎的首选检查方法,能够为临床诊断、治疗及随访提供重要依据。     

乳腺叶状囊肉瘤(附12例报告)

本文报道乳腺叶状囊肉瘤12例,占同期乳腺恶性肿瘤的0.68％(12/1760)。全部为女性,平均年龄34.2岁。均为单乳发病,局限于乳腺-象限内,其中外上象限8例、中央区3例、内下象限1例。肿瘤直径最小3cm,最大12cm。病程长短不一,但均有近期生长迅速史。12例患者有腋淋巴结肿大2例。行乳腺根治切除术2例,改良根治术1例,乳腺单纯切除术7例,局部切除术2例,12例分别为术后1 ～16年健在。术后腋淋巴结病理检查均未见转移。     

A case of primary malignant lymphoma of the breast with an unusual ultrasound image

The patient was a 50-year-old woman with a palpable tumor and pain in the right breast in May of 2008. The tumor was then diagnosed as an atheroma. The tumor enlarged rapidly in June, and the pain and the redness had worsened. The patient was then referred to our hospital. The tumor was in the upper inner quadrant of the right breast with surface redness, measuring about 3 cm. In the mammographic (MMG) findings, the tumor shadow was in the upper inner quadrant of the right breast and was observed to be circular and have a high density with a plain boundary and slightly roughed edges. In the ultrasonographic (US) findings, an oval-shaped high echoic region was found subcutaneously in the right breast. Because the high echoic area was subdivided in the partition of the low echoic string, it looked like a pebbled wall. Upon core needle biopsy, this case was diagnosed as malignant lymphoma. After comparing the histopathology and the US image, it was determined that the pebbled wall-shaped image was due to lymphocyte infiltration of the tissue. The US image was peculiar and we report this case as a peculiar example of malignant lymphoma.     

超声学检查在乳腺肿块鉴别诊断中的应用价值

目的:探讨超声学检查在乳腺肿块鉴别诊断中的应用价值。方法:选择单发乳腺肿块患者109例,所有患者术前均于我院行超声学检查,术后均行病理学检查明确肿块性质。以病理学结果为标准,观察超声对乳腺良、恶性肿块的诊断符合率。比较良、恶性乳腺肿块的超声学特征及血流特点。结果:①超声对良、恶性肿块的诊断符合率分别为94.9%和93.5%。②恶性乳腺肿块形态不规则、边缘不清晰、包膜不完整、内部回声不均匀、纵横比≥1、后方回声衰减、伴有对周围组织侵润及腋窝淋巴结肿大的比例均明显高于良性乳腺肿块(P<0.01)。③恶性乳腺肿块平均动脉收缩期峰值流速(PSV)约为(20.8±3.9)cm/s,阻力指数(RI)均值约为0.9±0.3,均明显高于良性乳腺肿块(P<0.05)。结论:超声学检查诊断准确率高,在乳腺肿块的鉴别诊断中有重要的意义。     

Contradiction of clinical expectations in lymphoscintigraphy sentinel node mapping in detecting microscopic melanoma metastasis

A 51-year-old man presented with lower back skin pigmentation tag that he had had for 2 years. Physical examination showed a 10 x 10 mm ulcerated, protruding pigmented skin mass at the midline of back at the 4th lumbar spine level. Skin biopsy disclosed a 5 mm thickness nodular melanoma, which had invaded the reticular dermis. In addition, a 20 x 20 mm lymph node in the right inguinal region was noted. A pelvic computed tomography scan revealed no definite evidence of lymph node enlargement in the left inguinal, bilateral iliac or para-aortic region. However, the 99mTc-sulfurcolloid dynamic lymphoscintigraphy revealed a sentinel lymph node (SLN) in the left inguinal area. The histological examination of the 4-mm SLN demonstrated a small cluster of metastatic melanoma, which was confirmed using HMB-45 immunohistochemical stain. Meanwhile, no melanoma cells were seen in the right enlarged inguinal lymph node. Subsequently, complete left inguinal lymph node dissection was performed, which confirmed that there was no melanoma metastasis in any of remaining 14 nodes. The patient underwent regular follow-up for 9 months and had no evidence of malignancy recurrence to date.