The association of benign and malignant ovarian adenofibromas with breast cancer and thyroid disorders

An unexpected association with breast cancer and thyroid disorders was found during a review of 91 cases of benign and malignant ovarian adenofibromas. Sixty-three tumors were benign, 11 had areas of borderline neoplasms, and 17 had a component of carcinoma. Such tumors were divided into glandular/cystic (61 cases) and papillary (30 cases) according to their gross and microscopic appearance. Among the 61 patients with glandular/cystic adenofibromas, 13 (21%) had breast cancer and 19 (31%) also had thyroid disorders. Among the 30 patients with papillary adenofibromas there were no cases of breast cancer and only 2 patients had thyroid disorders. The average age of the patients with ovarian adenofibroma and breast cancer or thyroid disorders was higher (66 years) than that of patients without breast cancer or thyroid disorders (55 years). More patients with breast cancer and thyroid disorders had bilateral adenofibromas than patients without breast cancer or thyroid disorders. We also reviewed the medical records of 100 patients with ovarian cancer without adenofibroma component, 100 patients with breast cancer, and 100 patients with ovarian and breast cancer. Six percent of patients with ovarian cancer had breast cancer and 16% of each one of these groups had thyroid disorders. This unexpected association found between glandular/cystic adenofibromas, breast cancer, and thyroid disorders might be explained by defects common to these organs. Disorders of some of these organs have been linked by common genetic changes and it is known that these organs are under the influence of similar hormones. Mutations of PTEN have been found in breast and thyroid cancer. The thyroid and ovaries are controlled by glycoprotein hormones of the pituitary gland, which have common alpha subunits.     

Electrospun Hydroxyapatite-Functionalized PLLA Scaffold: Potential Applications in Sternal Bone Healing

Sternal synthesis after median sternotomy, a conventional access practice in thoracic and cardiac surgery, is at the basis of severe complications, often impairing the clinical outcome of surgical interventions. In this work, we propose the use of an acellular biomaterial scaffold, to be interposed across the fracture rime during closure operations, directly exposing the biomaterial to bone marrow, in order to expedite healing process. A rabbit model of median sternotomy was performed and an electrospun scaffold composed of a hydroxyapatite-loaded absorbable biopolymer (poly-L: -lactide), shaped into a fibrillar structure, was used. CT follow-up confirmed a complete healing in the scaffold-treated group 1 week before the control. Histological evaluation demonstrated presence of newly formed bone trabeculae among scaffold fibers showing a higher degree of maturity with respect to the control untreated group. The proposed approach is able to both guide a more rapid healing and modulate inflammatory response across the wound site, resulting in improved healing and tissue remodeling with respect to conventional closure technique.     

Vascular pseudoinvasion in laparoscopic hysterectomy specimens for endometrial carcinoma: a grossing artifact?

Over several years, it has been a matter of debate whether or not the use of a uterine balloon manipulator during laparoscopic hysterectomies for endometrial carcinoma (EC) may cause tumor disruption resulting in a positive peritoneal cytology. More recently, this procedure has been associated with vascular pseudoinvasion in cases of low-risk EC. In this study, we evaluated a series of 21 cases of low-risk EC treated by laparoscopic hysterectomy (LH) to determine the incidence of this finding and to better characterize its histopathologic features. In addition, we reviewed 28 cases of low-risk EC treated by total abdominal hysterectomy (TAH) for comparison. Clinical information was obtained from patients' charts. Hematoxylin and eosin-stained slides were retrospectively reviewed in all cases. The following information was recorded: tumor grade and tumor stage according to the International Federation of Gynecology and Obstetrics, tumor shape (polypoid versus flat), presence or absence of vascular space involvement (VSI), size and location of the vessels with tumor involvement, concomitant presence of artifactual clefts in the myometrium with tumor involvement if applicable, presence or absence of lymph node sampling and the presence or absence of involvement at this site, and results of peritoneal cytology. Seven of 21 (33%) cases of low-risk EC treated by LH in this study showed VSI. None of the cases treated by TAH had VSI (P=0.001). In all of the cases of LH with VSI, the endometrial tumor was polypoid. VSI was detected only in large, thick-walled vessels in the outer myometrium or in ectatic vessels anywhere in the myometrium; no tumor fragments were seen in small vessels. The tumor in the VSI consisted of conspicuous fragments of tumors detached from the vascular wall. The VSI also lacked the inflammatory perivascular infiltrate seen in many cases of bona fide lymphovascular invasion. In addition, all of the cases with VSI also showed fragments of tumor in artifactual clefts in the myometrium. None of the cases of LH in which lymph node sampling and/or peritoneal cytology were obtained showed tumor at this site. In summary, our study confirms that LH is indeed associated with a higher rate of vascular pseudoinvasion when compared with TAH. However, we cannot attribute this phenomenon to mechanical disruption, displacement, and transport of tumor tissue into vascular spaces by the use of a uterine manipulator alone. Instead, we propose that pathologists may be generating postoperative pseudoinvasion by mechanically transporting tumor into vascular spaces during the grossing process. Proper recognition of this artifact is of utmost importance to avoid the overtreatment of patients undergoing LH for low-risk EC.     

Encephalopathy with status epilepticus during slow sleep: "The Penelope syndrome"

ESES (encephalopathy with status epilepticus during sleep) is an epileptic encephalopathy with heterogeneous clinical manifestations (cognitive, motor, and behavioral disturbances in different associations, and various seizure types) related to a peculiar electroencephalography (EEG) pattern characterized by paroxysmal activity significantly activated during slow sleep—that is, a condition of continuous spikes and waves, or status epilepticus, during sleep. The pathophysiologic mechanisms underlying this condition are still incompletely understood; recent data suggest that the abnormal epileptic EEG activity occurring during sleep might cause the typical clinical symptoms by interfering with sleep-related physiologic functions, and possibly neuroplasticity processes mediating higher cortical functions such as learning and memory consolidation. As in the myth of Penelope, the wife of Odysseus, what is weaved during the day will be unraveled during the night.     

Management of skin toxicity associated with cetuximab treatment in combination with chemotherapy or radiotherapy

Background.

Cetuximab was demonstrated by clinical trials to improve response rate and survival of patients with metastatic and nonresectable colorectal cancer or carcinoma of the head and neck. Appropriate management of skin toxicity associated with epidermal growth factor receptor inhibitor (EGFR-i) therapy is necessary to allow adequate drug administration and to improve quality of life and outcomes.

Methods.

A group of Italian Experts produced recommendations for skin toxicity management using the RAND/UCLA Appropriateness Method. Statements were generated on the basis of a systematic revision of the literature and voted twice by a panel of 40 expert physicians; the second vote was preceded by a meeting of the panelists.

Results.

Skin toxicity included skin rash, skin dryness, pruritus, paronychia, hair abnormality, and mucositis. Recommendations for prophylaxis and therapeutic interventions for each type of toxicity were proposed.

Conclusions.

Interventions that were considered appropriate to improve compliance and outcomes of cancer patients treated with EGFR-i were identified.     

Cellular mechanisms for methotrexate chemotherapy-induced bone growth defects

Methotrexate (MTX) is a commonly used anti-metabolite in childhood oncology and is known to cause bone growth arrest and osteoporosis; yet the underlying mechanisms for MTX-induced bone growth defects remain largely unclear. This study characterized damaging effects in young rats of acute chemotherapy with 5 once-daily doses of MTX (0.75 mg/kg) on the cellular activities in the growth plate in producing calcified cartilage and trabecular bone and on activities of osteoblastic cells in the metaphysis. MTX treatment significantly induced chondrocyte apoptosis. MTX also suppressed chondrocyte proliferation and reduced collagen-II mRNA expression and total thickness of the growth plate, with the damage being most obvious on day 9 after the first injection, and with the growth plate histological structure returning normal on day 14. In the adjacent metaphyseal bone, mirroring the decrease in the width of the growth plate, production of primary spongiosa bone was markedly reduced and bone volume of the secondary spongiosa was decreased. Furthermore, MTX treatment significantly induced osteocyte apoptosis in the primary spongiosa and reduced proliferation of osteoblasts and preosteoblasts particularly in the secondary spongiosa. These observations suggest that methotrexate chemotherapy may cause bone growth defects by arresting cellular activities in the growth plate in producing calcified cartilage and primary trabecular bone and by decreasing pools of metaphyseal osteoblastic cells. However, this short-term MTX treatment only caused transit suppressions on growth plate cartilage and trabecular bone, as most cellular and histological parameters had recovered by day 14 or 21.     

Unusual cases of infective endocarditis.

We report 2 patients with unusual cases of infective endocarditis. The first patient had a large, mural vegetation on left ventricle that was diagnosed with transthoracic echocardiography; and the second patient had a large, mobile vegetation in the descending prosthetic aorta with an abscess cavity around the vessel, diagnosed by transesophageal echocardiography. This report confirms the usefulness of transthoracic and transesophageal echocardiography in the diagnosis and management of uncommon cases of endocarditis.