Paget disease of the anterior tibial tubercle

A study was done of 13 cases of biopsy-proved Paget disease in which the disease involved the anterior tibial tubercle with extension into the metaphysis and diaphysis, but without apparent involvement of the proximal tibial epiphysis. Case data were obtained from archives containing more than 350 cases of Paget disease. Age, sex, symptoms, serum alkaline phosphatase level, and histologic and radiographic appearance of the lesions were evaluated. Patients were young at clinical presentation, averaging 36 years of age. In five of six patients the serum alkaline phosphatase level was normal. The proximal extent of the disease was the anterior tibial tubercle rather than the proximal epiphysis. Radiographic patterns ranged from predominantly lytic to mixed lytic and blastic to predominantly blastic, and the lesion was marginated by a flame-shaped configuration. The radiographic appearance of Paget disease of the anterior tibial tubercle is characteristic and should be sufficient to suggest the diagnosis and preclude biopsy.     

Needle tract seeding after vacuum-assisted breast biopsy

Background: A matter of substantial concern regarding all needle biopsy techniques is seeding along the biopsy needle tract.

Purpose: To assess cell seeding along the needle tract of vacuum-assisted breast biopsy (VABB).

Material and Methods: The study included 21 patients with ductal carcinoma in situ (DCIS) and 10 patients with invasive ductal carcinoma (IDC) diagnosed by VABB for nonpalpable mammographic lesions. VABB (11G, on a Fischer table) was performed, and the duration of the procedure was measured. After surgery, the whole needle tract was embedded in paraffin blocks, stained with hematoxylin-eosin, and examined by a pathologist.

Results: Cases with dissemination of cancer cells in the needle tract were not observed (one-sided 97.5% CI 0-10.0%). In 2/31 (6.5%) cases (95% CI 0.8-21.4%), benign epithelial cell displacement was observed, and the duration of VABB was significantly longer in these two cases (52.5±3.5 min vs. 42.0±4.4 min for cases without benign cell displacement; P = 0.018, Mann-Whitney-Wilcoxon test for independent samples).

Conclusion: No displacement of malignant cells within the 11G needle tract was documented. Benign cell displacement was associated with longer VABB duration. The phenomenon of tumor cell dissemination along the needle tract is of questionable clinical significance when the treatment guidelines are followed.     

The effect of the plasticizer di-2-ethylhexyl phthalate on the survival of stored RBCs

Recent in vitro studies have shown that di-2-ethylhexyl-phthalate (DEHP) inhibits the deterioration of RBCs during refrigerated storage in containers that use this compound as a plasticizer. The experiments described in this report were designed to assess whether this in vitro protective effect of DEHP would result in a prolonged in vivo survival of RBCs infused into normal human recipients. Whole blood collected from ten normal donors was stored for 35 days in citrate-phosphate- dextrose-adenine (CPDA-1) anticoagulant contained in polyvinylchloride (PVC) bags plasticized with DEHP or a trimellitate compound that is known to have low leachability. Aliquots of RBCs from each container were then labeled with chromium-51 and were reinfused into the original donors. For blood stored in DEHP-plasticized PVC bags, 24% more red cells survived in vivo 24 hours after reinfusion than was observed when the blood had been stored in trimellitate-plasticized bags (P less than .001). Whole blood stored in glass bottles showed a similar improvement in in vivo survival when DEHP was added in weekly increments to mimic the accumulation of this plasticizer seen during storage in plastic containers. Survival of packed red cells stored in the presence of DEHP increased by 14% compared with storage in trimellitate-plasticized bags (P less than .05). In agreement with previous studies, hemolysis and microvesicle formation were also reduced in the presence of DEHP. These results suggest that proposed new storage systems lacking DEHP should be carefully evaluated to determine whether adequate post-transfusion survival of RBCs may be achieved.     

Ocular Surface Disease in Breast Cancer Patients Using Aromatase Inhibitors

Aromatase inhibitors (AIs) are widely used as adjuvant hormonal therapy in postmenopausal women with hormone receptor‐positive breast cancer. The purpose of this study was to investigate the potential impact of AIs on the anterior segment of the eye and especially the ocular surface. Participants in our study were 41 hormone receptor‐positive early stage breast cancer patients (80 eyes), treated with AIs, while 80 eyes of 40 age‐ and gender‐matched healthy controls, not previously used AIs for any purpose, were also evaluated. All participants underwent a complete ophthalmological examination, including best corrected visual acuity (BCVA) assessment, slit‐lamp biomicroscopy, and dilated fundus examination. Ocular surface disease‐related symptoms and signs were also recorded. The most common symptom was found to be blurred vision, while other symptoms included foreign body sensation, tearing, redness, and photophobia. Slit‐lamp examination revealed blepharitis and meibomian gland dysfunction in 75% and 42.5% of patients, respectively. Superficial punctate keratitis and conjunctival injection were also present. Our results demonstrated a high prevalence of ocular surface disease‐related symptoms and signs in patients receiving AIs compared to healthy controls. This study may raise a flag regarding the use of AIs. However, further and larger prospective longitudinal studies are needed to examine the possible effect of AIs alone or in combination with chemotherapy in the eyes of breast cancer patients.