Nanoparticle Formulation of Indocyanine Green Improves Image-Guided Surgery in a Murine Model of Breast Cancer

Molecular Imaging and Biology - Negative surgical margins (NSMs) have favorable prognostic implications in breast tumor resection surgery. Fluorescence image-guided surgery (FIGS) has the ability...     

A (9;11)(q34;q13) translocation in a hibernoma

The diagnosis of hibernoma has historically been made by histopathologic examination and finding of characteristic brown fat cells with granular multivacuolated cytoplasm. The diagnosis of hibernoma may be complicated, however, because seemingly diagnostic cells could be mistakenly identified as lipoblasts, leading to the erroneous diagnosis of well-differentiated liposarcoma. Cytogenetic alterations in lipomatous tumors are well established and could be used for diagnostic purposes. Previous cytogenetic abnormalities reported in hibernomas have included alteration of 11q13 region. Here, we present a case of a hibernoma with a novel cytogenetic alteration involving a reciprocal translocation between 9q and 11q that was useful in establishing the final diagnosis.     

Hereditary diffuse gastric cancer: prophylactic surgical oncology implications

Hereditary diffuse gastric cancer (HDGC) is an autosomal dominantly inherited syndrome attributed to mutations of the E-cadherin gene, CDH1. There is no proven effective screening for early HDGC, and symptomatic disease is almost universally fatal. The only available effective option for CDH1 carriers is prophylactic total gastrectomy, but the variable age of onset of HDGC and the reduced penetrance (about 70%) of the CDHI gene further complicate patients' decision making.     

Genetic counseling and clinical management of newly diagnosed breast cancer patients at genetic risk for <Emphasis Type="Italic">BRCA</Emphasis> germline mutations: perspective of a surgical oncologist

Women with a family history of breast cancer who are diagnosed with breast cancer are often counseled to undergo prophylactic mastectomy as part of their treatment for breast cancer. The majority of such individuals make these decisions in haste and without appropriate genetic counseling or testing. Most of them when tested for BRCA or other established mutations find that they are not mutation carriers. In retrospect, this realization leads many to question the wisdom of their prophylactic surgery which is often associated with complications and quality of life problems which they never envisioned. We have designed an algorithm for the management of these patients which minimizes these lifelong problems.     

Targeted Tailored Management of the Breast Cancer Patient at Risk for Harboring a Germline Mutation—Current Trends Affecting the Selection of Patients Considering Surgical Prophylaxis for Breast Cancer

Abstract: Recent reports have documented the increasing use of mastectomy in women with breast cancer otherwise amenable to breast conservation. Similarly, other reports document an increase in the number of women undergoing contra‐lateral prophylactic mastectomy for a single unilateral breast cancer. These trends are abetted by increasing use of MRI, inadequate risk counseling, and patient fear. Adequate and reliable risk assessment and genetic counseling are indispensable for the appropriate and personalized treatment of these individuals. In all of these instances, such counseling should be instituted well before the patients are submitted to any surgical intervention. An algorithm is presented which permits the orderly selection of patients who may benefit from such aggressive surgical intervention.     

High resolution intra-operative two-dimensional specimen mammography and its impact on second operation for re-excision of positive margins at final pathology after breast conservation surgery

Background

In the United States, about 50% to 66% of women undergoing breast conservation surgery for cancer undergo subsequent mastectomy for positive margins on initial lumpectomy. This is despite the fact that screening mammography has resulted in a decrease in the size of newly diagnosed breast cancer to <2 cm.

Methods

A retrospective review of 128 patients who underwent breast conservation surgery for early breast cancer was performed using intraoperative 2-dimensional Faxitron high-resolution specimen mammography without specimen compression as the only margin assessment technique. Of these, 29 patients had histories of lumpectomy with positive margins.

Results

A total of 131 procedures were performed. Margins were histologically clear at initial breast conservation surgery in 84.3% of patients who underwent primary lumpectomy. Subsequent reexcision for positive margins was required in 14.7% of patients. Two-dimensional Faxitron mammographically guided intraoperative reexcision cleared the margins in 95.8% of patients (23 of 24) who would have otherwise required subsequent reexcision.

Conclusions

Intraoperative 2-dimensional Faxitron high-resolution specimen mammography can decrease rates of margin positivity and has the potential to diminish the number of subsequent undesired mastectomies for positive margins.     

Giant pelvic solitary fibrous tumor obstructing intestinal and urinary tract: a case report and literature review

We are reporting a giant pelvic neoplasm, a rare solitary fibrous tumor that presented with a large bowel obstruction and bilateral ureteral obstruction because of its size and location. Preoperative diagnosis required complex pathological studies to exclude a high-grade sarcoma suspected clinically. Complete resection was required for resolution of obstructive symptoms. Prognosis for solitary fibrous tumors is usually good after complete resection. Recurrence and metastasis may be related to rare aggressive histological features, including nuclear atypia, hypercellularity, greater than four mitoses/10 high power fields, and necrosis. Because histology is not always a reliable predictor of prognosis, careful long-term follow-up is necessary for this tumor. Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms most likely arising from mesenchymal cells. SFTs were originally described in the pleura, the most common site for this tumor; however, extrathoracic SFTs are seemingly diagnosed with increased frequency. We report a case of a giant pelvic SFT that required complicated clinical management.