Metastatic involvement of the Meckel‘s cave and trigeminal nerve. A case report.

The case of a patient with a right atypical trigeminal neuralgiacaused by a metastatic tumor involving the Meckels cave is reported. His medical history was significant for colon-rectaladenocarcinoma. The preoperative diagnosis of Meckels cave neoplasmwas made by MR. The patient underwent surgery, consisting oftotal removal of tumor and peeling of the ganglion and of the branches of the nerve, obtaining a histological diagnosis anda resolution of pain. The clinical, radiological findings and the treatment of this rare entity are discussed.     

Measuring the clinical response. What does it mean?

The clinical response to treatment is an important indicator of the therapeutic effect of anticancer agents. Its value and interpretation has to be carefully considered within the context that it is used. In daily practice, response assessment is combined with other indicators of the patient's condition to contribute to the decision-making process. In clinical trials, it is widely used to identify and quantify the anti-tumour activity of new agents. In this context, response evaluation is conducted on the basis of strict predefined criteria such as the World Health Organization (WHO) or Response Evaluation Criteria In Solid Tumors (RECIST) criteria. The RECIST criteria have recently been proposed and offer a detailed guidance to perform a response evaluation. Clinical response is also used as an indicator of therapeutic efficacy in combination with other indicators. Its value as a surrogate indicator of a survival benefit remains unclear in most instances and can hardly be established within the framework of a single randomised trial. With the development of new anticancer agents that behave differently to cytotoxics, clinical benefit will have to integrate concepts of disease stabilisation or time to progression. Over the next decade, oncologists will be able to assess the biological response before the clinical response, and a lot of work and energy will have to be dedicated to assess the predictive and, possibly, the prognostic value of the biological response with regard to the clinical response, as well as more definitive measures of clinical benefit.     

Colorectal cancer screening among Latinos from U.S. cities along the Texas–Mexico border

Colorectal cancer (CRC) screening rates are comparatively low for U.S. Hispanics. To learn more about the factors influencing CRC screening among Hispanics living along the U.S.–Mexico border, 12 focus groups were conducted with Hispanic men and women aged 50 years and older in three Texas counties; Cameron County (Brownsville), Webb County (Laredo), and El Paso County, (El Paso). The focus group guide contained questions about health care behavior, knowledge about CRC, experiences with cancer, and factors that influence CRC screening. A total of 92 individuals participated with the majority aged 50–69 (75%). Twenty percent were born in the United States and 51% had lived in the United States for more than 20 years. Participants had low levels of education, income, and insurance coverage. The analysis revealed several overarching and contextual themes relating to knowledge, attitudes, beliefs, and emotions about cancer and CRC screening. A prevalent theme that emerged from all groups was frustration and a lack of confidence in the U.S. healthcare system. Few participants had been advised by their providers to obtain CRC screening. Lack of patient knowledge about colorectal cancer and screening appeared to be a critical factor influencing screening. Themes about death and pain due to cancer were prevalent as were cultural factors such as machismo and embarrassment. System level barriers such as cost, medical insurance and transportation also impacted screening. These findings suggest that strategies are needed to educate Hispanic residents of border communities about CRC and to motivate them to undergo CRC screening. The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the U.S. Centers for Disease Control and Prevention.     

Surgery in small-cell lung carcinoma. Where is the rationale?

Chemotherapy and radiotherapy are the keys of current management of SCLC. For many years, the diagnosis of small cell lung cancer has been considered a contraindication to surgery because radiotherapy was at least equivalent in terms of local control and the rate of resectability of SCLC patients was poor. The role of surgery has been defined by evidence accumulated in the last 30 years but conclusions are limited by the fact that the most important studies are dated and conducted when the main staging tool was exploratory thoracotomy. The rationale for surgery in the context of SCLC is based on 3 factors: 1) Several historical series on patients operated for limited SCLC reported some long term survivors, showing that permanent cure can be achieved. For this reason, it is now accepted that for the rare patients with very limited stage disease (T1-T2 tumors) surgical resection followed by platinum-based chemotherapy could be offered. 2) After chemotherapy and radiotherapy, the rate of local relapse is 20-30%. The assumption that surgery might be superior to radiotherapy in local control of limited SCLC has been suggested but not still proved. 3) Surgery can precisely assess pathological response to chemotherapy, identify carcinoids erroneously diagnosed as SCLC, treat the NSCLC component of tumors with a mixed histology. In the case of planned surgery, preoperative investigations should be completed by MRI of the brain, mediastinoscopy (to rule out subclinical N2/N3 patients) and probably PET scan. Even if some controversies exist, it is accepted that surgery can be proposed as the first treatment in patents with T1-T2 lesions without sign of lymph nodes involvement, followed by adjuvant chemotherapy. Surgery in stage II and III must be planned on a multidisciplinary basis, in the context of controlled clinical trials.     

Preferential replication of Sézary cells in the epidermis.

Skin biopsies from three patients with Sézary Syndrome have been labeled in vitro with H-3Thymidine. Labeled cells have been counted in semithin Epon embedded sections and characterized by electron microscopic autoradiography. The ratio of labeled Sézary cells to total lymphocytes was two to four times higher in the epidermis than in the dermis. It is concluded that Sézary cells replicate in the skin and that epidermal cells seem to possess new blastogenic properties in Sézary Syndrome.     

Glycogen-Rich Clear Cell Carcinoma of the Breast：. Two-Case Report

Primary clear cell carcinoma of the breast is a rare tumor with different morphological characteristics compared to ordinary breast carcinomas. The clear cell morphology of the neoplastic population in these tumors has been ascribed to the presence of intracellular lipid, mucin or glycogen, or to myoepithelaial, apocrine, or neuroendocrine differentiation. We describe 2 cases of glycogen-rich clear cell carcinoma of the breast as follows.