Locally recurrent carcinoma of the breast. Results of radiation therapy

Local and regional recurrences are frequent problems in breast cancer management. Radiation therapy is effective in producing long term remission. This study evaluates the results of radiation therapy of 215 patients with recurrent disease limited to the chest wall and/or regional lymph node areas. The local results showed complete control in 67% of cases (mean and median durations 32 months and 22 months, respectively), partial control in 24% of cases (mean and median 11 and 8 months, respectively) and no control in the remaining 9%. The radiation dose recommended for the treatment of recurrent mammary carcinoma is 5000 rads in 5 weeks for relatively small lesions. Supplementary local doses of 500-1000 rads in 1 week may be given to bulky lesions as necessary for residual disease. Although local relapse indicates a poor prognosis, it is by no means totally hopeless. Of 215 patients treated 44 (21%) survived 5 years and 10 (5%) survived 10 years following radiation therapy of recurrent disease. There were seven patients, or 3%, who were free of cancer at 5 to 15 years. Radiation therapy was valuable in controlling local lesions, and thus, in improving quality of survival, even in those patients who eventually died of metastatic disease.     

Sarcomatoid renal carcinoma. A case report

Renal sarcomas are rare tumors. Prognosis is overall dismal. Adjuvant therapies should follow radical nephrectomy but no standardized regimen has been at present defined. We report a case of a patient affected by a sarcomatoid renal tumor to detect the best therapeutic approach to this rare tumor.     

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.     

Surgical management for instability and paraplegia caused by spinal sarcoidosis. A case report

STUDY DESIGN: Report of a patient with paraplegia caused by vertebral sarcoidosis. OBJECTIVES: To report a rare case of vertebral sarcoidosis accompanied by progressive neurologic symptoms from the lower extremities, and to discuss the diagnostic and therapeutic approach to its management. SUMMARY OF BACKGROUND DATA: Vertebral sarcoidosis is a rare condition, and only a few case reports exist in the literature. A needle or open biopsy is required to establish the diagnosis. In most cases, treatment with steroids improves associated neurologic symptoms. Operative intervention is necessary in cases with progressive vertebral destruction, spinal instability, and impending or progressive neurologic deterioration. METHODS: Operative treatment by a two-stage anterior vertebrectomy and fusion followed by posterior stabilization was given to a patient with vertebral sarcoidosis and progressive neurologic deterioration of the lower extremities. RESULTS: After surgery, the patient had a complete neurologic recovery and satisfactory spinal fusion. CONCLUSIONS: In the absence of any spinal instability, neurologic symptoms associated with vertebral sarcoidosis respond satisfactorily to nonoperative treatment with steroids. Progressive neurologic deterioration or spinal instability caused by bone destruction requires operative intervention. Anterior vertebrectomy and fusion combined with posterior stabilization provided a satisfactory result for the patient in this report.     

Bronchogenic carcinoma accompanied with gynecomastia. A case report

A case of bronchogenic carcinoma accompanied with gynecomastia was reported. The enlargement of bilateral breasts was discovered for 3 months before admission with continuous low grade fever, dyspnea and weight loss. The patient was a heavy smoker and had chronic bronchitis. Physical examination revealed bilateral enlargement of breasts, the diameter of each breast was 12 cm and the height was 6 cm. Serum human chorionic gonadotropin (HCG) was > 2000 miu/ml, prolactin (PRL) 41.5 ng/ml, luteinizing hormone (LH) > 200 miu/ml. The chest X-ray film showed scattered nodular shadows in both lung fields. Tumor cells were found in the lung tissue obtained by biopsy after death suggesting of adenocarcinoma. The pathogenesis of gynecomastia was discussed.     

Hepatocellular carcinoma complicating biliary cirrhosis caused by biliary atresia: report of a case

A case of hepatocellular carcinoma complicating biliary cirrhosis caused by biliary atresia is reported. The patient had persistent severe jaundice with hepatosplenomegaly. A liver tumor was suspected because of the elevated serum alpha-fetoprotein and was shown by ultrasonography at 6 years of age. The tumor was treated with percutaneous ethanol injection therapy (PEIT). Nine months after initiation of PEIT, the patient died of massive bleeding from a metastatic tumor.     

Aetiology of nasopharyngeal carcinoma. A review

The present overview is based on recent available information on nasopharyngeal carcinoma (NPC) from various parts of the world including India. The available data suggests that NPC is a rare tumour in most parts of the world. But the incidence is higher in China and South East Asia and also among the Chinese wherever they have migrated. NPC is also relatively higher especially among the mongoloid group of the people in the North Eastern Region of India as compared to other parts of the country. The distinct geographical and ethnic distribution of NPC have stimulated much research to find out its etiology. The results suggest that Epstein Barr Virus (EBV) infection and genetic susceptibility are the constant aetiological factors for the higher incidence of NPC among various ethnic groups while other factors such as ingestants and inhalants may depend on the distinct dietary practices and living environment adopted by various ethnic groups in different geographical region of the world.     

Cytology of pigmented renal cell carcinoma. A case report

We used a new combined chemo- (COP/ABVD), radiation and interferon-alpha (10 x 10(6) IU s.c. 3x per week/12 months) therapy regimen to treat severe multicentric Castleman's disease (CD) complicated by relapsing Behcet's disease (BD) manifestations. More than 16 years after diagnosis of CD the patient remains in very good clinical condition, with remission of all CD and BD manifestations 13 months after discontinuation of the interferon-alpha treatment. In addition, our clinicopathological, immunohistological and virological data suggest a pathogenetic link between CD and BD via activation of pre-existing BD-specific plasma cells due to CD-related HHV8-induced overexpression of interleukin-6.     

Squamous cell carcinoma in ovarian endometriosis. A case report

A primitive squamous cell carcinoma of the ovary arose in ovarian endometriosis. The patient underwent a radical hysterectomy and radiotherapy. The other few similar reported cases had a poor prognosis. In our case the patient died 11 months after surgery.     

Cognitive therapy of psychotic depression: A case report.

Treatment with cognitive therapy (milieu therapy and 12 individual sessions) was associated with significant clinical improvement and reduction of symptoms on measures of mood and cognition in a 21-yr-old female psychotic depressive. Cognitive restructuring as proposed by A. T. Beck et al (1979) was emphasized. Improvements were noted through the use of the Beck Depression Inventory and the Hamilton Rating Scale for Depression. Results were achieved without the use of medication. (13 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Management of iatrogenic spinal stenosis complicating placement of a fusion cage. A case report

STUDY DESIGN: A case of iatrogenic spinal stenosis secondary to fusion cage retropulsion is presented. OBJECTIVES: To highlight fusion cage retropulsion, a potential complication that may become more prevalent as the use of fusion cage instrumentation expands. The difficulty in management of this complication is emphasized. SUMMARY OF BACKGROUND DATA: Early reports regarding fusion cage instrumentation have been encouraging. At this point, however, the potential benefits are better defined than the potential complications. METHODS: A significant complication of fusion cage instrumentation and the limited literature on this subject are reviewed. RESULTS: The patient underwent successful revision surgery after retropulsion of a fusion cage, however, an extensive surgical procedure including partial vertebral body resection was required. CONCLUSIONS: The frequency and severity of complications related to fusion cage instrumentation remain poorly defined. Caution should be used in patient selection until additional experience more clearly defines the risk-to-benefit ratio for a given application of this new technology.     

Treatment of progressive cervical spinal instability secondary to hydatid disease. A case report

STUDY DESIGN: A case report of a patient with progressive cervical spinal instability secondary to hydatid disease and the operative therapy. OBJECTIVE: To document how the combination of contemporary imaging, medical, and operative methods has obviated severe neurologic sequelae in a patient's cervical spine ravaged by hydatidosis. SUMMARY OF BACKGROUND DATA: The incidence of hydatid disease in the vertebral column is unusual and rare in the cervical spine. Until recently, patients with spinal hydatid disease have had guarded prognoses, because the various medical and surgical therapies could not effect curative or even palliative results. METHODS: The use of contemporary imaging methods, including computed tomography and magnetic resonance imaging, is described, in conjunction with current anthelminthic therapy and operative spinal instrumentation in this patient with recurrent quadriparesis from progressive hydatid spinal erosion. RESULTS: With the operative and medical therapies described in this case report, the patient has had six successful operative results in 6 years for cervical spinal hydatidosis and remains neurologically normal, with a stable cervical spine. CONCLUSIONS: It is hoped that this case presentation will justify a spirit of guarded optimism in the patient whose spine has been rendered unstable by hydatid disease and that, though a cure is still not likely, at least the past inexorable prognosis of paralysis and death is ameliorated.     

The usefulness of radiation therapy for hepatocellular carcinoma

BACKGROUND/AIMS: The usefulness of radiation therapy (RT) for hepatocellular carcinoma (HCC) is still controversial. To clarify whether RT has its role in the management of HCC as a single modality or in combination with other modalities, we analyzed the clinical features of the patients treated with RT retrospectively. METHODOLOGY: Twenty-two patients who underwent RT for intrahepatic lesions with total dose ranging from 58 to 68 Gy were studied. Regression rate for 21 of the irradiated lesions was calculated using the computed tomographic scans. RESULTS: After the size of the irradiated intrahepatic tumor initially decreased, it remained unchanged for a long period. Tumor size at the latest follow-up never exceeded pre-RT tumor size except in one patient who was treated by RT only. In 3 of 20 cancer deaths, the irradiated tumors were the direct cause of death. CONCLUSION: Local RT for HCC at potentially curative dose can be performed safely in patients with preserved liver function even if they have already been treated with other therapies. Radiation therapy has a role in strengthening the therapeutic efficacy when combined with other therapy.     

Tetracycline-induced pleural symphysis for recurrent hydrothorax complicating cirrhosis. A new approach to treatment

Two patients with cirrhosis and ascites complicated by extensive unilateral pleural transudates refractory to therapy with dietary sodium restriction, diuretics, and repeated thoracentesis were successfully managed by tetracycline-induced pleural symphysis. The intrapleural instillation of this antibiotic prevented the recurrence of the effusion and substantially relieved the patients' symptoms with minimal undesirable side effects.