Angiosarcoma of the breast. Two cases following breast conserving treatment for invasive carcinoma.

Angiosarcoma of the breast is a rare malignant tumour. It can be primary or secondary in women who have been treated of a ductal carcinoma of the breast. There are some differences between both them. We present two clinical cases secondary to radiotherapy and a review of the literature, discussing about aetiology, incidence, diagnostic, treatment and prognostic of this tumours.

UFT-induced haemolytic anaemia.

A case of haemolytic anaemia in a patient under treatment with UFT for metastatic colon cancer is reported. Haemolytic anaemia has previously been associated with many other chemotherapeutic agents, but not with UFT, an oral anticancer agent combining tegafur (Ftorafur, a prodrug of 5-fluorouracil) and uracil.

[Evolution of white coat hypertension to sustained hypertension. One year follow-up by ambulatory blood pressure monitoring]. / Evolución de la hipertensión de bata blanca a hipertensión mantenida. Seguimiento durante un año mediante monitorización ambulatoria de la presión arterial.

BACKGROUND: To analyse the evolution of the white coat hypertension (WCH) to sustained hypertension, by means of ambulatory blood pressure monitoring (ABPM) during the first year after its diagnosis. SUBJECTS AND METHOD: A prospective study of cohorts was designed in La Orden Health Center of Huelva, Spain. 86 individuals divided in two groups: a) group not exposed (GNE): 43 voluntary normotensives, and b) group exposed (GE): 43 individuals with WCH, defined as the blood pressure was superior or above 140 and/or 90 mmHg, respectively, with a mean diurnal ABPM below 135 and 85 mmHg in both cases. A ABPM was performed (Spacelabs 90207) at the beginning of the study, after 6 months and after 12 months. The clinical and ambulatory blood pressure and the incidence of sustained hypertension by ABPM in the two groups were compared. Sustained hypertension was considered when the diurnal blood pressure was superior to 135 and/or 85 mmHg for SBP and DBP. RESULTS: At the end of the study, 82 patients were evaluate. The incidence of hypertension at 6 months of follow-up was of 4,76% (CI, 0-26.9) in GNE and 19.04% (95% CI, 0-42,6) in GE (RR: 3.8; 95% CI, 0.86-16.9) (p = 0.052). At one year of follow-up the incidence of hypertension in GNE was of 9.8% (95% CI, 0.31-1) as opposed to 46.3% (95% CI, 20.5-72.1) in GE (RR: 4.63; CI, 1.7-12.4) (p = 0.001). CONCLUSIONS: The patients with WCH present a higher incidence of hypertension as compared to the normotensives, after 12 months of our follow-up.

Individualization of treatment strategies.

This section focuses on different aspects of the individualization of hormone treatment in breast cancer. This includes tumor-related biological factors such as expression of hormone receptors, HER-2, and Ki-67; host-related factors such as CYP2D6 or body mass index, and risk and/or development of specific toxicities and treatment adherence. The best predictor of response to hormonal interventions is the expression of hormone receptors, in particular, estrogen receptors. Treatment adherence and compliance are key factors and strategies aiming to identify and intervene when patients are at risk of abandoning treatment. Currently, routine assessment of CYP2D6 is not recommended to guide tamoxifen treatment. Likewise, there are no criteria regarding bone mass density, lipid profile, or arthralgias to recommend one class of agent versus another. Aromatase inhibitors should not be administered to patients who are pre- or perimenopausal.

[Adjuvant chemotherapy of non-seminoma stage I germ cell tumors of the testis]. / Tratamiento con quimioterapia adyuvante en los tumores germinales no seminoma de testículo estadio I.

OBJECTIVE: To review the treatment of stage I nonseminomatous germ cell testicular tumor with adjuvant chemotherapy. METHODS: The literature on this subject was reviewed. RESULTS/CONCLUSIONS: Overall, 30% of stage I nonseminomatous germ cell testicular tumors that are followed recur within two subsequent years. Several factors associated with a higher risk have been described. The most important are the presence of venous or lymphatic infiltration, the presence of a carcinoembryonic component and the absence of tumor of the endodermal sinus. Patients with the foregoing characteristics have a recurrence rate of approximately 50%. Over the last few years, some experience using two cycles of BEP adjuvant chemotherapy in patients at a higher risk have shown that this recurrence rate can be reduced to less than 5% with minimal late toxicity.

[Metastatic cáncer presentation. Validation of a diagnostic algorithm with 221 consecutive patients]. / Cáncer de presentación metastásica. Validación de un algoritmo diagnóstico en 221 pacientes consecutivos.

BACKGROUND: The use of a diagnostic algorithm for metastatic cancer presentation (MCP) might enhance the diagnosis of primary tumors amenable to treatment with considerable savings both in time and diagnostic examinations. MATERIALS AND METHODS: From January 1992 to April 1997, all patients admitted with the diagnosis of MCP were prospectively studied. From each patient, a basic study consisting in a clinical interview, complete physical examination, standard blood testing with tumoral markers and chest X-ray were obtained. Patients with a negative basic study were classified as having a metastatic cancer of unknown origin (MUO); in these patients, a protocolized study (abdominal CT scan and mammography among women) were performed. Patients who after the application of the basic and protocolized studies had no primary tumor detected underwent an exhaustive investigation in order to validate the efficiency of the diagnostic algorithm. RESULTS: Two hundred twenty-one patients were included in the study. The mean age of patients was 63 years (range: 23-82). The main symptom was of bone (30%), neurological (24%), thoracic (16%) and abdominal (16%) origin. The basic study was positive for 138 patients (62.4%), with chest X-ray and physical examination yielding the highest number of diagnoses among these patients. The histology of metastases contributed to the definite diagnosis in 31 patients. Only PSA had a high sensitivity and specificity. Eighty-three patients were classified as MUO. The protocolized study diagnosed the primary tumor in 24 patients (30%), 20 by abdominal CT scan and four by mammography; eight of these patients were deemed to be amenable to treatment. The remaining 59 patients underwent an exhaustive study, and a diagnosis was made in 13; nevertheless, none of them was considered candidate for a specific treatment. Finally, 47 patients (21%) remained undiagnosed. The predominant primary tumors included sites at the lung (42%), prostate (6%) and breast (6%). The most common metastatic locations included bone (42%), central nervous system and liver (24%), and the most common histological types were adenocarcinoma (61%) and undifferentiated carcinoma (15%). CONCLUSIONS: Lung cancer and MUO represented 62% of MCP. The basic study oriented in two thirds of cases, and the physical examination and chest X-ray showed the highest diagnostic yield. The histology of metastases and PSA had a key, diagnostic relevance. A protocolized study based on abdominal CT scan and mammography (females) can identify the remaining treatable tumors.