Plasminogen activator inhibitor type 1 is the most significant of the usual tissue prognostic factors in node-negative breast ductal adenocarcinoma independent of urokinase-type plasminogen activator.

PURPOSE: The aim of the present investigation was to evaluate the prognostic significance of urokinase-type plasminogen activator (uPA) and plasminogen activator inhibitor-1 (PAI-1) tissue contents in primary breast adenocarcinoma. PATIENTS AND METHODS: Patients from 3 medical centers were included between 1994 and 2001. Biologic factors in tumor extracts were all assayed in the same laboratory. PAI-1 and uPA were treated as continuous or dichotomized variables. Metastasis-free survival analyses were performed using the Cox model and the classification algorithm and regression tree (CART) in the whole population and in the subsets of node-negative (pN0) or positive (pN+) cases. Kaplan curves of metastasis-free survival were designed for different groups in relation to uPA/PAI-1 combinations. Urokinase-type plasminogen activator tumor level appears related to the anatomic degree of extension; conversely, PAI-1 tumor content is independent of tumor size and nodal extension. RESULTS: In univariate analysis, adjusted on usual prognostic factors, the metastasis risk increased with PAI-1 level in all patients (HR [hazard ratio], 3.1; P < .001), in pN0 (HR, 4.3; P < .001), and pN+ patients (HR, 2.3; P = .019). It increased also with uPA in all patients (HR, 2.6; P = 0.006). In multivariate analysis, when both variables were included, PAI-1 remained significant in all patients (HR, 2.4; P = .002) and pN0 patients (HR, 3.2; P = .003) but not uPA. CART analyses confirmed that the best partitioning factor was PAI-1. CONCLUSION: There was no evidence for any additional impact of uPA. PAI-1 is an independent prognostic factor in particular in pN0 breast ductal carcinoma.

Skin Sparing Mastectomy and Immediate Breast Reconstruction (SSMIR) for early breast cancer: eight years single institution experience.

BACKGROUND: Skin Sparing Mastectomy (SSM) and immediate breast reconstruction has become increasingly popular as an effective treatment for patients with breast carcinoma. The aim of this study was to evaluate the clinical outcome of skin sparing mastectomy in early breast cancer at a single population-based institution. METHODS: Records of ninety-five consecutive patients with operable breast cancer who had skin-sparing mastectomy and immediate breast reconstructions between 1995 and 2003 were reviewed. Patient and tumor characteristic, type of reconstruction, postoperative complications, aesthetic results and incidence of recurrence were analyzed. RESULTS: Mean age of the patients was 51.6(range 33-72) years. The AJCC pathologic stages were 0 (n = 51, 53.7%), I (n = 20, 21.1%), and II (n = 2, 2.1%). Twenty of the patients had recurrent disease (21.1%). The immediate breast reconstructions were performed with autologus tissue including latissimus dorsi musculocutaneous flap in 63 (66.3%) patients and transverse rectus abdominis myocutaneous (TRAM) flap in 4 (4.2%) patients. Implants were used in 28 (29.4%) patients. The average hospital stay was 7.7 days. Flap complication occurred in seven (10.4%) patients resulting in four (6%) re-operations and there were no delay in accomplishing postoperative adjuvant therapy. At a median follow-up of 69 months (range 48 to 144), local recurrence was seen in one patient (1.1%) and systemic recurrence was seen in two patients (2.1%). CONCLUSION: Skin sparing mastectomy and immediate breast reconstruction for early breast cancer is associated with low morbidity and low rate of local recurrence.

[To be cured of breast cancer]. / Guérie d'un cancer du sein.

Can we say the magic word "cured", "cancer free" for breast cancer patients or can we say only survivors? This litterature review was focused on what mean cured of breast cancer with the long term effects on quality of life of locoregional and systemic therapies and the role of breast reconstruction. Finally changes in the intimacy, sex and love live and psychosocial live were stressed.

[Epithelial ovarian carcinomas: what to do after recurrences?]. / Cancers épithéliaux de l'ovaire: que faire après une récidive?

Follow up for epithelial ovarian carcinomas is not standardized. A close follow-up every three months during three years, and then twice a year during five years seems to be acceptable. Recurrences after primary treatment of ovarian cancer have very bad prognosis. The major treatment must be chemotherapies. Salvage cytoreduction surgery is effective only in very selected cases.

Predictors of non-sentinel lymph node metastasis in breast cancer patients with positive sentinel lymph node (Pilot study).

BACKGROUND: Sentinel Lymph Node Biopsy (SLNB) procedure was found to be an accurate method of staging the axilla in patients with early stage breast cancer. The standard of care for breast cancer patients with positive SLN metastasis includes complete Axillary Lymph Node Dissection (ALND). However, in 40-70% of patients, the SLN is the only involved axillary node. Factors predicting non SLN metastasis should be identified in order to define subgroups of patients with positive SLN in whom the axilla may be staged by SLNB alone. OBJECTIVES: To identify the factors predicting metastatic involvement of the non-SLNs in breast cancer patients having SLN metastasis. PATIENTS AND METHODS: Data were collected and analyzed from 80 patients with early stage invasive breast cancer (T1, T2, N0, M0) who underwent SLNB at the Surgical Oncology Department, Kuwait Cancer Control Center (KCCC) between November 2004 and February 2009. SLNB was performed using a combined technique (radioactive colloid, and blue dye) in the majority of cases. In some cases, only one technique was used. Complete ALND was performed in the case of failure of SLN identification and in patients with positive SLN. Multiple variables (patient, tumor, and SLN characteristics) were tested as possible predictors of nonsentinel lymph node metastasis. RESULTS: The mean age of patients at diagnosis was 46.6years. The median tumor size was 2cm. The SLN identification rate was 96.2% (77 out of 80 patients). The SLN was positive in 24 patients (31%), and half of these showed evidence of capsular invasion. The median number of SLNs removed was two. The median number of positive SLNs was one. The incidence of non-SLN metastasis associated with positive SLN was 50% (12 out of 24 patients). Lymphovascular invasion was found to be the only factor associated with non-SLN metastases. In addition, two trends were observed, though they did not reach the statistical significance: the first is that the majority of patients having capsular invasion of the SLN (8 out of 12 patients, 67%) had positive non-SLN metastasis, and the second is that the patients having more than one SLN metastasis were more likely to have non-SLN metastasis (4 out of 5, 80%). CONCLUSION: In the current pilot study, only the lymphovascular invasion in the area of the primary tumor was found to be significantly related to the nonsentinel lymph node metastasis. There was a tendency toward higher incidence of nonsentinel lymph node metastasis associated with the number of positive SLN and capsular invasion of SLN, though this did not reach the statistical significance. This could be attributed to the small number of patients recruited. Further evaluation of the predictors of nonsentinel lymph node metastasis on a larger number of patients is required. The validation of these predictors in prospective studies may enable approximately half of early stage breast cancer patients with positive SLN to be staged with SLNB alone while avoiding the morbidity of unnecessary ALND.

Inflammatory pseudotumor of the liver--another case report. Is this the beginning of an established hepatic entity?

BACKGROUND: Inflammatory pseudotumor of the liver is an infrequent, fibroinflammatory non-neoplastic process of unknown etiology, generally following a benign inflammatory condition. The importance of knowledge of it resides in its similar presentation to other hepatic tumors in clinical picture, radiological appearance, and macroscopic pattern. CASE REPORT: A 71-year-old woman presented with acute abdominal pain. Ultrasonography and a computerized tomography (CT) scan showed a 3.2 cm hepatic tumor (segment IV) and a CT-guided liver biopsy revealed possible histological features of hepatic fibrosarcoma. The patient underwent a wedge resection. The pathologist identified a well-defined, 4-cm inflammatory pseudotumor of the liver associated with possible sclerosing cholangitis lesion. CONCLUSIONS: Inflammatory pseudotumor is a fibroinflammatory non-neoplastic process that should be suspected in patients with a hepatic tumor with significant infectious-inflammatory history. Percutaneous hepatic biopsy does not provide certainty in confirming the lesion since it does not discard focuses of hidden malignancy. The treatment is surgical resection followed by histopatological study to eliminate a hepatocarcinoma, a low-grade fibrosarcoma, or a hidden focus of adenocarcinoma. The inflammatory pseudotumor of the liver has changed from being an extremely rare pathology to becoming an established liver disease.

Contribution of BRCA1 and BRCA2 germ-line mutations to the incidence of breast cancer in young women: results from a prospective population-based study in France.

The prevalence of BRCA1/2 germ-line mutations was assessed in a prospective population-based series of early-onset breast cancer (BC) patients in France, and the usefulness of a clinical assessment of hereditary BC risk, based on multiple criteria including pedigree structure, was evaluated. Through the Rhone region BC registry, 232 women diagnosed with BC before 46 years of age were included. They were tested for BRCA1/2 mutations an average of 10 months after diagnosis. All the women were classified according to their family history of cancer: high risk of hereditary breast cancer (HBC), low risk of HBC, isolated BC, and unknown HBC risk. Deleterious mutations were observed in 21 women (9.1%): 15 (6.5%) BRCA1 and 6 (2.6%) BRCA2. Mutations were more prevalent in women who developed BC before age 41 than in women who developed BC between ages 41 and 45 (12.8% versus 5.2%, respectively, P = 0.04). A high prevalence of BRCA1/2 mutations was found among women in the high-risk category with particular family features (i.e., small family size, predominantly male pedigree, specific cancers; 23.5%) and among women with isolated BC before age 41 and with five or fewer close adult female relatives (16.6%). According to the 10% probability level recommended by the American Society of Clinical Oncology guidelines for genetic testing of cancer, BRCA1/2 mutation screening should be considered for all women diagnosed before age 41, except for those with isolated BC in a large pedigree including multiple unaffected female relatives. The clinical assessment of HBC risk that we have developed should help in the decision to perform genetic testing.

Primary melanoma of the adrenal gland, a continuous dilemma: report of a case.

The adrenal gland can frequently be the site of metastatic deposits, including malignant melanocytic tumors; however, primary melanoma of the adrenal gland is exceptional. We reviewed 18 cases reported in the English literature to date, and here add another case which occurred in a 78-year-old man. The patient underwent right suprarenalectomy and the pathology report showed a malignant melanoma of the adrenal gland. Immunohistochemical staining revealed a positive antibody-specific cytoplasmic reactivity to S-100 and HMB-45 proteins with a negative reaction for cytokeratin (AE1, AE3), synaptophysin, chromogranin and neuron-specific enolase. There are diagnostic criteria for accepting an adrenal melanoma as primary; however, an autopsy is the final step to confirm this infrequent pathology.