Intracystic breast carcinoma. A case report

Intracystic breast carcinoma is a malignant which develops within breast ducts. The clinical examination reveals a breast cyst containing a blood fluid which persists after the puncture. Fine-needle aspiration cytology may be benign. The endocystic mass is detected well by the ultrasound and US-guided puncture is possible. Papillary carcinoma is the most frequent histological type. Conservative prophylactic radiotherapy with surgery can be proposed. Prognosis is poorer with stromal involvement.     

A case of epidermoid tumor inside the Meckel's cave

An epidermoid tumor inside the Meckel's cave is rare. The symptoms caused by this tumor include trigeminal neuralgia, facial hypesthesia and paresis of the 3rd, 4th and 6th nerves. A case of epidermoid tumor inside Meckel's cave was presented. A 54-year-old female who had complained of 3rd nerve palsy with right facial hypesthesia since 3 years before was referred to our clinic. Magnetic resonance imaging (MRI) showed the tumor at Meckel's cave. The tumor removal was performed using the orbito-zygomatic approach. To avoid injury of the internal carotid artery and nerves inside the cavernous sinus, removal of the tumor inside the capsule was carried out leaving the capsule. Postoperatively, the tumor removal was confirmed by MRI and improvement of the 3rd and the 5th nerve palsy was obtained three months after surgery. This case suggests that the capsule of the tumor inside the Meckel's cave should be allowed to remain to avoid injury of the adjacent 4th, 5th and 6th nerves and of the internal carotid artery.     

A case of loco-regional recurrence of carcinoma of the male breast

The case of a 47-year-old man surgically treated with Halsted mastectomy for breast cancer and submitted to Tamoxifen therapy for more than four years is reported. A loco-regional recurrence following withdrawal of oestrogen antagonist therapy was observed and surgically treated by local excision. Normal karyotype analysis of peripheral leucocytes, normal male phenotype of the patient, his height and the lack of family history for breast cancer, as well as a possible dysfunction of the endocrine system were considered in the aetiopathogenesis of the disease.     

Metastasis to the penis of pulmonary epidermoid carcinoma

Presentation of one case of penial metastasis originated in a epidermic-like carcinoma of the lung. In spite of the rich vascularization of this organ penial metastasis are uncommon; prostate, bladder and rectum tumours being the ones which metastatize more often. Lung metastasis are extremely rare, and only one case has been published in the reviewed national literature. Diagnosis must be established by biopsy of the lesion, ruling out any other benign disease. The treatment used is generally palliative, although the options of surgery, radiotherapy and chemotherapy are available. Prognosis is, however, very poor and unrelated to the type of treatment applied.     

Fine needle aspiration cytology of lipid-secreting carcinoma of the breast. A case report

A renotropic factor was partially purified by sequential gel filtration and anion exchanger chromatography from plasma of human kidney transplantation donors and a renal cancer patient after uninephrectomy. This activity increased the rate of [3H]thymidine incorporation into DNA in rat cortical tubules, but not in rat liver cells, within the range of 100-200 ng/ml protein. The renotropic activity was detected between 7 and 12 days after uninephrectomy, and at least in 1 case decreased thereafter. This activity was undetected in gel-filtrated plasma of patients after a nonurological surgical procedure. The potency of this renotropic activity and its elution by gel filtration are similar to those displayed by a renal growth factor activity isolated from uninephrectomized rat plasma, as recently reported.     

Bilateral orbital metastases from breast carcinoma. A case of false pseudotumor

OBJECTIVE: To inform clinicians of a metastatic orbital neoplasm that frequently masquerades as an orbital inflammatory syndrome and to stimulate thought regarding this neoplasm's fundamental pathobiology specific to its orbital involvement. DESIGN: Interventional case report and literature review. PARTICIPANTS: A 47-year-old woman with an acquired, bilateral, diffusely infiltrative orbital process is described. INTERVENTION: The clinical and radiographic features of the patient's orbital process are reported. The review of two prior fine-needle aspiration biopsy specimens failed to reveal a diagnosis. Histopathologic examination of an open surgical biopsy specimen included standard light microscopy of frozen and formaldehyde-fixed, paraffin-embedded tissue. RESULTS: Characteristics light microscopy findings suggested the diagnosis of metastatic lobular carcinoma of the breast. The patient refused all therapeutic intervention and died 9 months after orbitotomy. CONCLUSION: The presentation of breast carcinoma metastatic to the orbit as a bilateral infiltrative process is far more common than appreciated previously. Its rate of bilateral orbital involvement is 20%, whereas this rate for other adult neoplasms is much lower. The authors report an additional case, review the clinical features of previous case reports and series, and discuss aspects of the metastatic process. Breast carcinoma must be included in the differential diagnosis of infiltrative orbital processes encountered in adult female patients. When "orbital pseudotumor" is detected in an adult female patient, a thorough medical history must be obtained and physical examination performed. If a possible primary breast carcinoma is indicated, one must be wary of metastatic disease, and a histologic orbital diagnosis is warranted. The frequency of orbital metastasis and bilateral orbital involvement of this neoplasm reinforces the possibility for organ-specific metastases.     

Calpain-calpastatin interactions in epidermoid carcinoma KB cells

We examined the activation of mu-calpain in human epidermoid carcinoma KB cells following a rise in intracellular calcium concentration using antibodies specifically recognizing different activation states of mu-calpain. KB cells possess calpastatin activity in large excess of calpain activity as analyzed by ion exchange HPLC. Stimulation of the cells with a calcium ionophore, ionomycin, caused production of the autolytic intermediate form (M(r) = 78 k) of mu-calpain derived from the preautolysis form (80 k), while the fully autolyzed postautolysis form (76 k) remained below detectable levels at all times. The appearance of the autolytic intermediate paralleled limited proteolysis of the membrane-associated calpastatin fractions (110 k and 106 k); the resulting fragments (68 k and 45 k) were released into the cytosol. Both the production of the autolytic mu-calpain intermediate and the limited proteolysis of calpastatin in cell lysates in the presence of calcium were inhibited by a synthetic calpastatin peptide, indicating that proteolysis of calpastatin was indeed catalyzed by calpain and that the autolytic intermediate may have exerted the proteolytic activity. Furthermore, mu-calpain autolysis and calpastatin degradation, upon ionomycin treatment, were both augmented by epidermal growth factor (EGF). These results suggest that calpastatin serves not only as an inhibitor but also as a substrate for calpain at cell membranes and that intracellular conditions associated with the cell cycle may affect the activation of mu-calpain.     

Analysis of DNA content in supraglottic epidermoid carcinoma

DNA analysis by flow cytometry is considered to be of prognostic value in epidermoid carcinoma of the head and neck. However, few and contradictory studies have been made on laryngeal carcinomas. We studied 48 epidermoid carcinomas in patients subjected to horizontal supraglottic laryngectomy with a 5-year- followup. The technique described by Hedley for fixated and paraffin-embedded tumors was used. Thirteen tumors were excluded on the grounds of presenting variation coefficients in excess of 10. Of the 35 cases analyzed, 28 (80%) were diploid and seven (20%) aneuploid. No correlation was observed between tumor ploidy and patient survival, recurrence, or any of the histopathological variables studied.     

A rare case of a preauricular fistula

A female patient with a preotic fistula caused by a defect in the development of the first branchial arch is described. Repeated surgeries for lateral fistula of the neck brought no success. The pathogenesis of the defect and difficulties in its diagnosis are discussed; the authors claim that fistulography with contrast agents may be effective. Histologic verification is needed in all the cases.     

Extremely rare case of prostatic carcinoma metastasis to the subglottic region of the larynx]

Compared with vaccine delivery by injection, oral vaccines offer the hope of more convenient immunization strategies and a more practical means of implementing universal vaccination programs throughout the world. Oral vaccines act by stimulating the immune system at effector sites (lymphoid tissue) located in the gut. Genetic engineering has been used with variable success to design living and non-living systems as a means to deliver antigens to these sites and to stimulate a desired immune response. More recently, plant biotechnology techniques have been used to create plants which contain a gene derived from a human pathogen; the resultant plant tissues will accumulate an antigenic protein encoded by the foreign DNA. In pre-clinical trials, we found that antigenic proteins produced in transgenic plants retained immunogenic properties when purified; if injected into mice the antigen caused production of protein-specific antibodies. Moreover, in some experiments, if the plant tissues were simply fed to mice, a mucosal immune response occurred. The present study was conducted as a proof of principle to determine if humans would also develop a serum and/or mucosal immune response to an antigen delivered in an uncooked foodstuff.     

Muscle metastasis in a patient with epidermoid carcinoma of the lung

Diagnosis of vertically acquired human immunodeficiency virus (HIV) infection is often difficult because of transplacentally acquired maternal antibodies. The polymerase chain reaction (PCR) test is commercially available and has high sensitivity and specificity. To evaluate the usefulness of PCR testing in the early diagnosis of perinatally acquired HIV infection, we reviewed records of 122 children having follow-up in the Northeast Florida Pediatric AIDS Program. Seventy-two children were excluded for various reasons. Of the remaining 50 children, 37 had PCR testing. In 5 children, the initial PCR test was done at > 18 months of age. Results of PCR testing were positive in 8 of 13 (62%) at birth, 12 of 18 (67%) by 1 month of age, 18 of 23 (78%) by 2 months of age, and 20 of 24 (83%) by 3 months of age. In 24 of 27 (85%), results were positive by the time the children reached 4 months of age. Our data suggest that the PCR test is a useful tool for early diagnosis of vertically transmitted HIV infection.     

Fine needle aspiration of secretory breast carcinoma resembling lactational changes. A case report

The purpose of the study was to determine if exhaled nitric oxide levels in children varied according to their asthmatic and atopic status. Exhaled nitric oxide was measured in a sample of 93 children attending the North West Lung Centre, Manchester, United Kingdom, for the clinical evaluation of a respiratory questionnaire being developed as a screening tool in general practice. The clinical assessment included full lung function, skin prick testing, and exercise challenge. Children were said to be asthmatic either by consensus decision of three independent consultant pediatricians, who reviewed all the clinical results except the nitric oxide measurements, or by positive exercise test. Atopic asthmatic children had higher geometric mean exhaled nitric oxide levels (consensus decision, 12.5 ppb [parts per billion] 95% CI, 8.3 to 18. 8; positive exercise test, 12.2 ppb 95% CI, 7.6 to 19.7) than did nonatopic asthmatic children (3.2 ppb 95% CI, 2.3 to 4.6; 3.2 ppb 95% CI, 2.0 to 5.0), atopic nonasthmatic children (3.8 ppb 95% CI, 2. 7 to 5.5; 5.7 ppb 95% CI, 4.1 to 8.0), or nonatopic nonasthmatic children (3.4 ppb 95% CI, 2.8 to 4.1; 3.5 ppb 95% CI, 3.0 to 4.1). Thus, exhaled nitric oxide was raised in atopic asthmatics but not in nonatopic asthmatics, and these nonatopic asthmatics had levels of exhaled nitric oxide similar to those of the nonasthmatics whether atopic or not.     

A strong predictor in carcinoma of the breast

A case of sustained lung fistula after lung surgery is reported here. This case of a sustained pulmonary fistula was diagnosed by sustained air leak through the chest drain and a positive culture of the drainage fluid. The third re-operation was performed successfully by omentopexy via median sternotomy. Careful postoperative observation with chest radiography, bronchial fiberscopy, and determining whether infection is present in the drainage fluid are important for precise diagnosis and therapy for complications following pulmonary lobectomy.     

Oncoprotein p21-ras expression in epidermoid carcinoma of the laryngopharynx

Ras genes can acquire transforming properties by qualitative and quantitative mechanisms. The mutated products of ras oncogenes (p21 protein) exhibit a decreased ability to hydrolyze GTP that lead to the stabilization of ras proteins in their active state and cause a continuous flow of signal transduction which may result in malignant transformation. These biochemical aberrant properties can also be achieved by an increased expression of the normal p21 protein. In this work we have analyzed the presence of ras gene mutations and the overexpression of the oncogene product p21 in the same series of squamous cell carcinoma of pharynx and larynx. Of 13 cases studied we have detected mutations in seven cases and in nine we have observed overexpression of the p21 protein. There is no correlation between ras mutations and overexpression of the p21 protein.     

Small cell carcinoma of the male breast: report of a case

An uncommon type of breast carconoma in a male studied by light and electron microscopy, is reported. Light microscopy reveals histologic characteristics and a pattern similar to infiltrating lobular carcinoma in the female breast. The ultrastructural study, because of close similarities in cellular characteristics with previously published reports, gives firm support to the light microscope findings.     

A rare case of a perforated diverticulum of the cecum

A rare case of peritonitis by cecal perforated diverticulum which was diagnosed after surgery by histology is reported. Preoperative diagnosis is often ignored and, in rare cases, is not always clear at laparotomy. Clinical aspects, diagnostic procedures, histological picture and surgical treatment are described. In the literature diverticula are classified as "solitary" and "multiple", "congenital" and "acquired", "true" and "false" and finally "usual type" and "hidden variant". The treatment of cecal acute diverticulitis is, in the majority of patients, surgery. Simple resection of the diverticulum and suture of the breach in double layer is the elective operation of non-complicated diverticulum or with an inflamed projection from the cecal wall ("usual type"). Segmental resection of colon or "right hemicolectomy" is recommended when a precise diagnosis is not possible and in complicated diverticula ("hidden variant"). On the basis of personal experience it is underlined that diagnosis is rarely made preoperatively since the clinical picture suggests an acute appendicitis. If there are some doubts for appendicitis, a incidental tumor or possible perforated diverticulum of the cecum should be considered and urgent surgery is mandatory.