电视纵隔镜在纵隔肿物诊断和肺癌分期中的价值

目的探讨电视纵隔镜在纵隔肿物诊断和肺癌分期中的价值. 方法 2001年9月～2003年7月全麻下共行电视纵隔镜手术80例,其中颈部电视纵隔镜手术65例,胸骨旁电视纵隔镜手术11例,联合颈部与胸骨旁电视纵隔镜手术4例. 结果术前未获得明确病理诊断纵隔疑难疾病36例,除1例因术前放化疗未能明确诊断外,其余35例均获得明确诊断,确诊率97.2%(35/36).高度怀疑或病理已确诊为肺癌但CT提示伴纵隔淋巴结肿大(直径＞1.0 cm)44例,电视纵隔镜检查病理证实30例,阴性14例,阴性者行手术探查,切除标本未发现纵隔淋巴结转移.所有患者无术后并发症及手术死亡.结论电视纵隔镜手术视野好,清晰度高,操作灵活,安全可靠,可作为纵隔疑难疾病诊断和肺癌诊断、分期的常规方法.     

Uncemented arthroplasty for metastatic disease of the hip: preliminary clinical experience

Improved longevity among patients with metastatic bone disease led to increasing incidence of pathologic and impending fractures around the hip. Cemented hip arthroplasty is considered to be the standard of care for this condition. The purpose of this study is to evaluate the outcome of uncemented hip arthroplasty in those patients. We performed a retrospective review of clinical and radiologic data of 57 consecutive patients (60 hips) who underwent an uncemented hip arthroplasty due to metastatic hip disease. Mean follow-up was 18.6 months (range, 5-60 months); overall 1-year survival and mortality rates were 58.5% and 38.3%, respectively. Multiple myeloma and metastatic prostate carcinoma patients had better outcome over other metastasis origin. At last follow-up, no prosthesis failure or operation-related major complication has been recorded.     

Paget's disease of the male breast in the 21st century: A systematic review

Paget's disease of the breast is characterized by eczematous changes of the nipple-areolar complex and is associated with an underlying in situ or invasive breast carcinoma in most cases. Histologically, Paget's disease is identified by epithelial cells with abundant basophilic or amphophilic, finely granular cytoplasm with a large, centrally situated nucleus, most abundant in the lower epidermal layers. Due to the rarity of the condition among breast cancers, compounded by the rarity of breast cancer in men, understanding of the disease's presentation, course, and optimal treatment in men is largely derived from case reports and extrapolation of findings from studies in female patients. Paget's disease must be differentiated from other conditions including eczema, Bowen's disease, squamous cell carcinoma, and melanoma. Recognition of Paget's disease clinically and pathologically is critical as the superficial lesion may be the only sign of an underlying ductal carcinoma and its presence may be of prognostic significance. This article provides an update on cases of Paget's disease of the breast in men reported in the published literature together with a comprehensive analysis of the National Cancer Institute's Surveillance, Epidemiology, and End Results Data, 1973–2012. Current understanding and management of the disease in the context of male patients is reviewed. However, additional research is required to further understand the overall pathogenesis and molecular profile of Paget's disease to provide improved insight for personalized, precision-based therapeutic options.     

Summary of the 42nd Annual Meeting of the Pancreas Club

The annual meeting of the Pancreas Club, traditionally held during the same week as the meetings of the Society for the Surgery of the Alimentary Tract and Digestive Disease Week was held at the University of California San Diego on May 18, 2008 and consisted of both oral presentations and selected poster sessions. Submissions for the program numbered 143 abstracts of which 29 were chosen for oral presentation. There were 19 10-min presentations and ten were 3 min in length. Each was followed by 5- and 2-min discussion periods, respectively. In addition, 50 of the submitted abstracts were chosen for a designated poster session. Summaries of the presentations comprise the body of this report. A summary of the work presented at the 42nd Pancreas Club Meeting, May 18, 2008, University of California San Diego.     

Primary squamous cell carcinoma of the breast after cured Hodgkin's disease

An unusual case of primary squamous cell carcinoma of the breast occurring after cured Hodgkin's disease is reported herein. A 27-year-old woman developed a left breast mass 2 years after chemotherapy and radiation for nodular sclerosing stage IIB Hodgkin's disease. Excisional biopsy revealed squamous cell carcinoma of the breast and a modified radical mastectomy was performed, however, no metastasis was found in the axillary nodes. She received etoposide, mitomycin-C, and doxifluoridine as adjuvant chemotherapy, and remains well without any evidence of recurrent Hodgkin's disease or breast cancer. To our knowledge, this is the first reported case of primary squamous cell carcinoma of the breast associated with Hodgkin's disease. The risk of patients treated for Hodgkin's disease developing breast cancer as a second malignant neoplasm is discussed following the report of this case.     

Effect of 0.5 Tesla magnetic resonance imaging on the surgical management of breast cancer patients

BACKGROUND: This trial examines the utility of breast magnetic resonance imaging (MRI) for detection of occult breast disease and its effect on surgical treatment. METHODS: Between October 2000 and March 2002, 76 of 1289 patients underwent bilateral breast MRI within 4 months of a mammogram. The MRI scan, mammogram, pathology reports, and physicians' notes were reviewed to determine impact of MRI on surgical treatment. RESULTS: Magnetic resonance imaging detected 23 additional lesions in 19 patients not detected by mammogram. Cancer occult to mammography was detected by MRI in 6 women, constituting 7.9%. Magnetic resonance imaging impacted surgical treatment plans in 10 of 76 (13.2%) patients. CONCLUSIONS: Magnetic resonance imaging is effective at identifying new subclinical breast disease not seen on mammography. Ten of 76 patients (13.2%) who underwent MRI had their surgical management altered due to MRI findings. Specific criteria should be studied to know which subgroups would benefit most from breast MRI.     

Metastatic disease of the breast and local recurrence

Multimodality primary therapies for breast cancer combined with earlier detection have led to a sharp decline in the death rate from breast cancer in the UK over the last 40 years in the face of a rising incidence. The latest UK statistics from Cancer Research UK report 55,122 new cases of breast cancer in 2015 with 11,563 deaths from breast cancer recorded in 2016. Crudely, this equates to a cure rate of around 80% for all comers and demonstrates a clear improvement in outcome with 50,285 new cases in 2011 and 11,716 deaths in 2012. Despite this good news, there are still significant numbers of women (and men) who suffer from either a local recurrence or metastatic disease following apparently successful treatment for early breast cancer (Stage I to III). Only a minority of individuals, 6.6% with the stage recorded at diagnosis, present with stage IV disease. This review considers the treatment options available to individuals with locally recurrent and advanced breast cancer (ABC).     

Metastatic disease of the breast and local recurrence

Multimodality primary therapies for breast cancer combined with earlier detection have led to a sharp decline in the death rate from breast cancer in the UK over the last 40 years in the face of a rising incidence. The latest UK statistics from Cancer Research UK report 50,285 new cases of breast cancer in 2011 with 11,716 deaths from breast cancer recorded in 2012. Crudely, this equates to a cure rate in excess of 75% for all comers. Despite this good news, there are still significant numbers of women (and men) who suffer from either a local recurrence or metastatic disease following apparently successful treatment for early breast cancer (Stage I–III). Only a minority of individuals, 6.6% with the stage recorded at diagnosis, present with stage IV disease. This review considers the treatment options available to individuals with locally recurrent and advanced breast cancer (ABC).     

Metastatic disease of the breast and local recurrence of breast cancer

Breast cancer is a major health problem worldwide with over one million new cases diagnosed each year. The aim of treatment is to achieve good loco-regional control, provide appropriate adjuvant therapy and treat potential micro-metastasis. Good loco-regional control is essential to minimize local recurrence rates with histological clear margin being the most important factor. Several prognostic factors can be used to guide suitable adjuvant therapy. The most important is hormone sensitivity and the use of hormone manipulation has improved both recurrence rates and overall survival. Early detection with breast screening and better treatment options have improved outcome, but still 35–40% of patients will eventually present with metastatic disease. Metastatic disease is incurable, but several therapies have been shown to maintain a good quality of life whilst prolonging survival. A multidisciplinary team approach is essential to obtain the diagnosis and plan the appropriate treatment. The diagnosis of metastatic disease brings distress to patients and their relatives and support should be available from palliative care teams.     

Mondor's disease of the axilla: a rare complication of sentinel node biopsy

Three cases of Mondor's disease of the axilla following sentinel lymph node biopsy (SLNB) are described. In all cases we used the combination of blue dye and radiocolloid, and complete axillary dissection was not performed. The numbers of lymph nodes removed in each case were five, four, and two, respectively. All the events of Mondor's disease resolved spontaneously or following a short therapy of anti-inflammatory agents.     

The Significance of Nipple Discharge of the Male Breast

Abstract: Although male breast cancer typically presents as a palpable mass, failure to recognize the significance of other symptoms may lead to a delay in diagnosis. Here we present our experience with male patients presenting with a chief complaint of nipple discharge (ND). Using the ICD‐9 code for “breast symptoms,” we identified 2,319 patients without a current cancer diagnosis who presented to Memorial Sloan‐Kettering Cancer Center for evaluation; 24 (1%) patients were male (1995–2005). Data were collected by retrospective review. Among 24 male patients presenting for evaluation, 14 (58%) presented with a chief complaint of ND, while the remaining 10 (42%) presented for evaluation of a palpable mass in the absence of ND. Among 14 patients presenting with ND, subsequent clinical breast examination identified a breast mass ± nipple changes in 7 of 14 patients. In total, 8 of 14 (57%) patients had an underlying malignancy; two of seven patients with ND alone had DCIS (median interval from onset of ND to presentation 3 weeks, range 2–4 weeks), and six of seven patients with ND and a palpable mass had invasive disease (median interval between onset of ND and presentation 16 weeks, range 2–52). The remaining 10/24 patients presented with a painless palpable mass of whom 8 (80%) were found to have underlying invasive disease (median interval between onset of mass, and presentation was 4 weeks, range 2–20 weeks). All patients with invasive disease were node‐positive. At 23.7 months median follow‐up (range, 7.7–88.3 months), 14 of 16 cancer patients remain free of disease and two have died as a direct result of metastatic disease. The incidence of cancer among males presenting with ND was 57%. In the absence of additional clinical findings, ND may be a herald for early, non‐invasive disease. Increased awareness of subtle features of malignancy may represent a window of opportunity for early diagnosis and improved outcomes for male breast cancer patients.     

Assessment of tumor size for multifocal primary breast cancer

Background: Tumor size affects the choice of surgical procedure and patient prognosis. It is standardly assessed as the largest unidimensional measurement and, for multifocal disease, as the largest size of the largest focus. We examine some different methods of assessing tumor size: the standard method; the sum of the largest sizes for all foci; surface area; and volume. Methods: Data for a cohort of 678 primary invasive breast cancer patients accrued from 1971 to 1990 were updated to 1996; there were 571 patients with unifocal disease and 107 patients with multifocal disease. We used step-wise Cox regression to investigate the effects on time to death of the prognostic factors tumor size (estimated in one of the four ways), age, nodal status, ER, PgR, adjuvant radiotherapy, adjuvant hormonal therapy, and adjuvant chemotherapy. We also examined the association between tumor focality and nodal status. Results: For all patients, tumor size was included in the multivariate model, regardless of estimation method. For patients with multifocal disease, tumor size was included in the final model only when it was estimated as the total surface area (P=.03) or volume (P=.01) of the foci. More multifocal patients were N+ (P=.056). Conclusions: For patients with multifocal disease, the significance association with mortality for total surface area or volume may imply a biologic relevance or mode of tumor activity for the foci.     

Postradiation Sarcoma of the Chest Wall: Report of Two Cases

Postradiation sarcoma is a rare late complication of external radiotherapy. We herein present two cases with this disease. A 54-year-old man had undergone a lobectomy and chest wall resection for Pancoast type lung cancer 7 years previously. He had undergone irradiation with a total dose of 50 Gy. Computed tomography (CT) demonstrated a tumorous expansion of the right lateral thoracic wall. A pathological examination confirmed a diagnosis of osteosarcoma. A 60-year-old woman had undergone a resection of the lateral chest wall mass, which was diagnosed to be Hodgkin's disease in 1991. Chemotherapy was given postoperatively. A tumorous lesion arose again and irradiation was performed with a total dose of 110 Gy. In 2000, two tumors appeared in the irradiation field. A pathological examination showed a sarcoma with divergent differentiation. In 2003, a tumor recurred and was diagnosed to be a liposarcoma. Patients who have received radiotherapy should therefore be followed up while taking into consideration the possible development of postradiation sarcoma.     

Primary Melanoma of the Third Metatarsal

Melanoma is a well-known malignant neoplasm of the skin, although it can also arise from other structures. Bone metastasis is not an uncommon event associated with melanoma, although primary osseous melanoma is very rare. In the present report, we describe a case of primary melanoma arising from the left third metatarsal in an adult male. The lesion was treated with surgical excision without adjunct chemotherapy, and recurrence developed approximately 12 months after the foot surgery. The patient died of the cancer 34 months after it had been identified. Primary melanoma arising in a metatarsal is rare, and we wished to highlight this unusual presentation.     

Effects of tamoxifen and aromatase inhibitors on the risk of acute coronary syndrome in elderly breast cancer patients: An analysis of nationwide data

BackgroundAromatase inhibitors (AIs) are the preferred endocrine treatment for postmenopausal hormonal receptor-positive breast cancer. However, there is controversy on the long-term cardiovascular and cerebrovascular safety of AIs over that of tamoxifen.MethodsWe analyzed the National Health Information Database (NHID) of 281,255 women over a 20-year-old diagnosed with breast cancer between 2009 and 2016. Cardiovascular events (CVEs) were defined as the development of the following, acute coronary syndrome (ACS), ischemic and hemorrhagic stroke, defined by using insurance claim records. The model was constructed by Cox proportional hazard regression and this model was used to analyze the effects of AI and tamoxifen on CVE.ResultsWe included 47,569 women for the final analysis. Patients were classified into ‘No hormonal treatment (n = 18,807), ‘Switch (n = 2097)’, ‘Tamoxifen (n = 7081)’ and ‘AI (n = 19,584)’. There were 2147 CVEs in 2032 patients (4.1%). Univariate analysis showed that women with tamoxifen had significantly lower risk for CVEs compared to no-treatment (hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.74–0.97) while AI showed no such effect (HR 0.93, 95% CI 0.84–1.02). After adjusting for other risk factors (hypertension, dyslipidemia, family history), the use of tamoxifen was associated with significant protective effect against ACS (HR 0.63, 95% CI 0.47–0.84).ConclusionsOur results, based on the NHID, supports the protective effect of tamoxifen against CVE in Korean breast cancer patients aged 55 and older that is not seen with AIs. Our results can guide the selection of adjuvant hormonal treatment agents for Korean breast cancer patients based on their risk of developing CVE.     

Evaluation of the role of laparoscopic ultrasonography in the staging of oesophagogastric cancers

Introduction  The role of laparoscopic ultrasound (LUS) during staging laparoscopy for pancreatic cancers is established but remains debatable in evaluating oesophagogastric cancers. Methods  A retrospective consecutive case series consisting of patients undergoing staging laparoscopy in two centres (centre A and B) was carried out over a 5-year period (2000–2005). Patients in centre B underwent LUS following laparoscopic assessment using a 7.5-MHz probe. Staging laparoscopy in both centres was performed using a standardised three-port protocol using a 30° laparoscope. All suspicious lesions were sent for histological assessment for confirmation of malignancy. Results  There were 201 patients in centre A (83 gastric, 138 lower oesophageal/junctional cancers) and 119 patients in centre B (51 and 68, respectively). There were no differences between the two centres for patient demographics and tumour site. There was no difference between the two centres for the detection of metastatic disease using laparoscopic assessment alone (A 13% versus B 20%, p = 0.12). However, there was a significant difference (13% versus 28%, p = 0.001) with the additional use of LUS in centre B. The findings in the additional 8% (n = 9) were para-aortic lymphadenopathy (n = 5), liver metastasis (n = 3) and local extension (n = 1). Five had gastric and four lower oesophageal/junctional cancers. The negative predictive value was 6.4% for centre A and 4.5% for centre B. Conclusion  The addition of LUS increased the detection rate of metastasis by 8% but there was little impact on the false-negative rate. LUS is useful in detecting metastatic lymphadenopathy beyond the limits of curative resection and liver metastasis.     

Changing pattern in the clinical presentation of breast cancer in the absence of a screening program over a period of thirty-three years in Iran

ObjectiveTo survey the proportion of stages at the presentation of the disease without a screening program, among a population of breast cancer patients that is as a representative sample of the country in a distinct period.Materials and methodsThe population of the current study is found among the female breast cancer patients who were referred to oncology centers in northeastern Iran over a thirty-three-year period from 1980 to 2012.ResultsFour thousand patients were divided into three time periods consisting of 521 cases from 1980 to 1990, 1178 cases from 1991 to 2001, and 2302 cases from 2002 to 2012. While there was no difference in the proportions of T1 and T3 tumors, T2 tumors showed an increase (P = 0.001) and T4 tumors a decrease (P = 0.000) during these periods. There was no change in the proportion of stage I, however the proportion of stage II had risen (P = 0.000), while that of stage III (P = 0.002), and stage IV (P = 0.000) had fallen. The study's urban and rural populations experienced a similar trend in this respect, with the exception that the rural population exhibited more striking changes during the study's recent years.ConclusionAfter a thirty-three-year follow up on breast cancer in northeastern Iran, it is obvious that this disease is now presented in its earlier stages even in the absence of a screening program. In spite of this, the proportion of T1 disease and those tumors are discovered by a screening program has not significantly changed.     

肺癌术后支气管切缘癌的临床分析

目的　研究肺癌手术后支气管切缘癌与临床因素的关系。方法　对 114 4例接受肿瘤切除的肺癌患者进行统计 ,分析其中 8项临床因素。结果　 89例发生支气管切缘癌。不同病理类型肺癌其切缘癌的发生率不同 ,小细胞肺癌的切缘癌发生率最高。支气管切缘与肿瘤的距离≥1.5cm时 ,93 .1%的切缘无癌残留。结论　行肺癌切除术时 ,支气管切缘与肿瘤的距离应≥ 1.5cm。     

Synchronous Bilateral Breast Cancer with Paget's Disease and Invasive Ductal Carcinoma: Report of a Case

We report a case of synchronous bilateral breast cancer with Paget's disease and invasive ductal carcinoma. A 60-year-old Japanese woman presented with an 8-month history of discharge from the left nipple with eczema and itching. Mammography showed grouped fine calcification in the right breast, which was highly suggestive of right breast carcinoma with an intraductal component. Ultrasonography did not reveal any mass lesions in the bilateral breasts, and computed tomography and bone scintigraphy showed no site of distant metastasis. We performed a modified radical mastectomy for Paget's disease in the left breast and breast-conserving surgery for ductal carcinoma in the right breast. The histological diagnosis was Paget's disease in the left breast and invasive ductal carcinoma with a predominant intraductal component in the right breast. There was no metastasis in any of the 24 left axillary lymph nodes resected. We also gave her postoperative adjuvant chemoendocrine therapy, comprised of tamoxifen (20mg) and UFT (uracil/tegafur) (400mg) daily. The patient has been disease-free for 4 years since her operation.