Cutaneous breast angiosarcoma after conserving treatment of breast cancer.

Cutaneous angiosarcoma is a rare malignancy that sometimes occurs as a late sequela of breast conservation therapy. We report on a 79-year-old female who developed well-differentiated angiosarcoma in a lymphedematous left breast 5.5 years after surgery and radiotherapy for early invasive ductal breast cancer. The initial appearance was very similar to late radiation dermatitis, and histologically interpreted as scar tissue with atypical vascular lesion. The lesion progressed further, and was clinically suspicious for angiosarcoma. Thus, a second biopsy was taken which confirmed the diagnosis. A complete mastectomy removed all the tumor with clear margins. However, within a period of 16 months she presented four local recurrences which were treated by wide local excision. At present, the patient is free of locally recurrent tumour for 7 months. The few cases of breast angiosarcoma after breast conservation therapy reported so far demonstrate that these lesions are difficult to diagnose due to their rarity and their highly variable and benign appearance, which sometimes may mimic radiation-induced cutaneous changes. Since chronic lymphedema possibly contributes to the development of angiosarcoma, long-term clinical surveillance of these patients is recommended. Biopsies should be taken if new skin lesions occur.

[Peliosis hepatis: problems of differential diagnosis]. / Peliosis hepatis--Differentialdiagnostische Problematik.

Peliosis hepatis is a syndrome manly known to internists and pathologists. It is described as roundish blood cysts up to 1 cm large to the found in the hepatic parenchyma and correlated to the hepatic sinusoids. The pathogenesis is still unclear. The presumably essential disturbance of the structure of the reticular fibres is etiologically associated with anabolic and androgenic steroid therapy. Peliosis hepatis is pathognomonic for treatment with contraceptives and for severe chronic diseases, as tuberculosis or tumour. Little is known of therapeutic methods on the diagnostic of peliosis alterations in the liver. As peliosis-type hepatic lesions are apt to involution, it is generally recommended just to wait and see, with controlling examinations for imaging diagnostics. A case is described where a female patient, aged 42, otherwise healthy, came to see the doctor for obscure pain in the upper abdomen. Sonography of the upper abdomen indicated multiple lesions. The diagnostic method is described taking into account possible malign differential diagnoses or associated malign results which finally lead to partial resection of the liver.

[Hyperplastic persistent pupillary membrane--surgical procedure]. / Hyperplastisch persistierende Pupillarmembran--Chirurgisches Vorgehen.

BACKGROUND: Persistent pupillary membranes are a common congenital anomaly seen in 95% of neonates. Extensive persistent pupillary membranes, occluding the visual axis and resulting in reduced visual acuity, are relatively uncommon. CASE REPORT: A 4-year-old male infant was seen in our hospital with reduced visual acuity of his left eye. Slit-lamp examination revealed a dense, extensive, persistent pupillary membrane associated with anterior polar cataract. We performed an excision of the pupillary membrane, lens aspiration of the lens material, posterior capsulorhexis, anterior vitrectomy and placement of a posterior chamber-intraocular lens in the capsular bag. 8 weeks after operation visual acuity improved to 0.25. CONCLUSIONS: Dense pupillary membranes associated with polar cataract require early surgical treatment. Membranectomy, lens aspiration and implantation of an intraocular lens clear the visual axis and optimize the treatment of amblyopia.

[Intraocular invasion of melanoma of the conjunctiva]. / Intraokulare Ausbreitung eines Melanoms der Bindehaut.

BACKGROUND: The treatment of a localised conjunctival melanoma usually requires local excision combined with cryotherapy, brachytherapy and/or local chemotherapy. CASE REPORT: A 71 year old woman suffering from a conjunctival melanoma located at the limbus of her left eye was treated by local excision and cryotherapy. After this therapeutic procedure two recurrences occurred which had been again treated by excision and cryotherapy and finally brachytherapy. Nevertheless, a third recurrent tumor developed and was treated again with deep lamellar sclerectomy and keratectomy. During this procedure the anterior chamber was opened inadvertently in a tiny spot. Some months later an intraocular invasion of the melanoma was diagnosed clinically and the eye had to be enucleated 5 years after the first treatment. Histological examination revealed extended melanoma growth into iris, ciliary body, anterior choroid, and tumor cell seedings in the antertior chamber. CONCLUSIONS: Removing a conjunctival melanoma especially such a tumor growing at the limbus, the surgeon has to pay attention not to open the anterior chamber during sclerectomy and keratectomy. The possibility that prior local surgical excision aided the intraocular extension is discussed.

[Luxation of the clavicle as rare cause of monstrous thrombus formation of the internal jugular vein]. / Clavikulaluxation als seltene Ursache einer monströsen Vena jugularis interna-Thrombosierung.

Summary.A 55-year-old female with massive painless swelling of the right cervical soft tissue was admitted for surgical exploration. The operation revealed an ectasia of the internal jugular vein with a diameter up to 7 cm which was obliterated by thrombotic material. We discussed a retrosternal dislocation of the clavicle proved by chest X-ray. We resected the internal jugular vein from the basis of the skull to the upper thoracic aperture. The postoperative course was uneventful.

[The radiological and surgical management of nonpalpable breast lesions]. / Radiologisches und chirurgisches Management der nichtpalpablen Mammaläsion.

In this retrospective study the results of surgical biopsy of suspected breast cancer in 319 outpatients are reported. In 113 cases (35.4%) the lesion was palpable, in 206 cases (64.6%) it was not. Concerning the nonpalpable lesions, mammography was performed in 98 patients (47.6%) for work-up of fibrocystic changes, in 41 patients (19.9%) for initial participation in a breast cancer prevention program, and in 33 patients (16.0%) for surveillance after breast conservation therapy. Prior to operation, 84.0% (n = 173) of the nonpalpable lesions were detected by mammography, 11.2% (n = 23) by sonography, and 4.8% (n = 10) by magnetic resonance imaging. Intra-operative specimen mammography was carried out in every case detected by mammography. In 19.4% (n = 40) of 206 nonpalpable lesions a malignant tumor was found. Twenty-five percent (n = 10) of all marked tumors were diagnosed and treated as in-situ stage tumors, while 65% (n = 26) were diagnosed and treated as tumors in the pT1 stage. As regards the nodal stage, 85% (n = 34) of the tumors were diagnosed and treated as pNO tumors, and 100% (n = 40) were found to be free from any distant metastases. Consequently, for improving prognosis and, at the same time, for reducing the rate of breast amputations as a means of curative therapy of breast cancer, regular screening in defined risk groups is necessary. Surgical treatment of patients with small and nonpalpable findings should be reserved for departments with marking and quick-freezing facilities.

Disseminated mycosis due to Scedosporium prolificans in an AIDS patient with Burkitt lymphoma.

A case of fatal disseminated infection caused by the dematiaceous hyphomycete Scedosporium prolificans diagnosed post mortem is reported in a 60-year-old male patient with acquired immunodeficiency syndrome who additionally suffered from Burkitt's lymphoma. The patient was significantly granulocytopenic following aggressive chemotherapy and irradiation. He developed dyspnoea at rest and chest pain despite a normal chest radiograph. Fluconazole treatment was carried out empirically because no sign of a fungal infection was detected ante mortem, either by mycological cultivation or by serological investigation. First post-mortem examination revealed a disseminated fungal infection involving the central nervous system. Scedosporium prolificans was cultured from the kidney, spleen and myocardium. In vitro, the fungal isolate was found to be highly resistant to all available systemic antimycotics.