Treatment of Patients with Distant Metastases from Phyllodes Tumor of the Breast.

BACKGROUND: Here, the treatment methods and results of patients with phyllodes tumor of the breast (PT) with distant metastases at a single institution are presented. METHODS: A retrospective analysis was performed on a group of 295 patients with PT treated from 1952 to 2010. RESULTS: Distant metastases developed in 37 (12.5 %) patients; 3/160 (1.9 %) patients had benign PT, 6/36 (16.7 %) were considered borderline, and 28/99 (28.3 %) had malignant PT. Most frequently, the metastases were located in the lungs; 28 (75.7 %), bone 7 (18.9 %), brain 4 (10.8 %), and liver 2 (5.4 %). Metastases occurred on overage 21 months (2-57) after surgery. Patients with lung metastases were generally treated with monochemotherapy or polychemotherapy. In one patient Testosterone and in two patients resection of metastases combined with Doxorubicin were used. Patients with bones or brain metastases were treated with palliative radiotherapy only or combined with Doxorubicin. The mean survival (MS) from diagnosis of distant metastases (DM) was 7 months (2-17). The longest mean survival in patients with bones metastases was 11.8 months, the worst survival was for patients with brain metastases--2.8 months. Hormone therapy appeared to have low efficacy (MS: 2 months) as well as monochemotherapy (MS: 3-5 months). Improved MS was obtained using Doxorubicin (7 months) and Doxorubicin with Cisplatin, Cyclophosphamide, or Ifosfamide (9 months). CONCLUSION: The prognosis of patients with DM from PT is poor. The role of surgery and irradiation of such patients is very limited. There appears to be no role for the use of hormone therapy. This study showed that polychemotherapy with Doxorubicin and Ifosfamide suggest that it might be more effective than once thought.

'Venous lakes' - a corrosion cast scanning electron microscopy study of regular and myomatous human uterine blood vessels.

BACKGROUND: The aim of this study was to evaluate the venous structure of regularand myomatous human uteri, using corrosion casting and scanning electron microscopy (SEM). Special attention was paid to the endometrium and the socalled 'venous lakes'. MATERIALS AND METHODS: Uteri collected at autopsy (n = 67) were injected with Mercox CL-2R resin, which penetrated the capillary bed and filled both arteriesand veins. After the polymerisation of the resin, the corrosion was performed. The obtained vascular casts, visualising all vessels including capillaries, were examinedusing scanning electron microscopy. RESULTS: Amongst the 67 uteri prepared for the corrosion casting, only 22 (15 containing leiomyomata) yielded casts of acceptable quality for SEM assessment. Veins of the endometrium and the myometrium were present in the form of a chaotic network, which did not run parallel to the arterialsystem, but was rather independent. Microscopic venous dilations ('venouslakes') were observed both within the functional layer of the endometrium and the myometrium. They were digit-like in shape and could be compared to venous sinuses. They drained the subendothelial capillary plexus and were supplied by numerous capillaries and venules. Their size ranged from 270 to 420 µm. Those dilatations were absent in the outer myometrium and the perimetrium, as well as the uterine cervix. We have not observed any arteriovenous anastomoses. CONCLUSIONS: The myomatous uteri tend to have larger venous lakes than the normal uteri. The number and size of venous lakes increases with menstrual cycle progression. Further data on morphology and changes in venous lakesusing scanning electronic microscopy should be acquired.

Impact of preoperative information on anxiety and disease-related knowledge in women undergoing mastectomy for breast cancer: a randomized clinical trial.

INTRODUCTION: Despite the large number of clinical trials on breast cancer, patient-related factors such as perioperative anxiety and level of knowledge about the disease and treatment have not been included in mainstream research efforts. This randomized trial was performed to evaluate the impact of information, provided preoperatively, on anxiety and knowledge of women undergoing mastectomy for breast cancer. METHODS: Sixty consecutive patients with breast cancer, admitted for a mastectomy, as primary treatment for breast cancer, with no previous cancer history, were randomized to receive structured information (short video about practical aspects of the hospital stay, surgical and adjuvant treatment) in addition to the routine informed consent procedure for surgery or the routine informed consent only. Anxiety and subjective knowledge levels were measured with the visual analogue scales; in addition, knowledge was assessed with a questionnaire. RESULTS: There was no significant effect of the additional information on perioperative anxiety or knowledge (subjective). Significantly more patients in the additional information group correctly listed all major available treatment options compared to the patients that received routine information (preoperatively 54% vs. 19%; p = 0.0101; 7 days postoperatively 50% vs.19%; p = 0.0367). CONCLUSIONS: Use of an informational video, preoperatively, did not significantly affect perioperative anxiety or subjective knowledge. Additional research is needed on effective delivery of disease- and treatment-specific information perioperatively.

Phyllodes tumors of the breast. The treatment results for 340 patients from a single cancer centre.

PURPOSE: The primary treatment of choice for patients with phyllodes tumor of the breast (PTB) is surgery. Two major problems regarding the treatment of such patients remain unclear: what is the appropriate surgical margin and what role is played by adjuvant radiotherapy (ART). METHODS: The study provides a retrospective review of all patients with PTB treated between 1952 and 2013 at a single institute. The histology slides were re-examined based on WHO criteria. The clinical characteristics and therapy outcomes were obtained. The five-year survival with no evidence of disease (NED) was used as the end point. RESULTS: The study population comprised 340 women with PTB. Fifty-five percent of the patients were diagnosed with the benign, 11.8% with borderline and 33.2% with malignant PTB. All the patients received primary treatment with surgery (mastectomy-27.1%, and BCS- 72.9%). Local recurrence (LR) was found in 28 (9.1%) of these patients. Four patients with borderline and 8 with malignant PTB who were treated with BCS and had tumor-free margins < 1 cm received ART. None of these patients had LR and all survived 5 years NED. Of the 340 patients from our group, 294 (86.4%) survived five-years NED. CONCLUSION: The prognosis for benign PTB is excellent and can be cured with surgery alone. A sufficient margin would be 0.1 cm (data from the literature) or 0.2-0.4 cm (our study). We recommend application of ART for such patients but the role of ART in patients with borderline and malignant PTB treated with BCS and with surgical margin < 1 cm remains uncertain.

[Follow-up of 70 patients with advanced ovarian cancer after negative second-look laparotomy]. / Abstention thérapeutique dans les cancers ovariens avancés après laparotomie de second look négative.

OBJECTIVES: To analyze the results of treatment of 70 patients with stage III and IV ovarian cancer after second look laparotomy with negative findings and to identify causes of failure and prognostic factors. MATERIALS AND METHODS: Between 1985 and 1998, seventy patients with ovarian cancer stage III and IV were treated with surgery and at least six courses of chemotherapy with cisplatin doxarubicin and cyclophosphamide. Then a second look laparotomy was performed. RESULTS: The actuarial survival rate without evidence of disease was 50% at 5 years. Locoregional failure was observed in 31 patients (88%) and distant metastases in 9, but they were the sole reason for unsuccessful treatment in only 4 (12%). Adverse prognostic factors were: grade 3 differentiation, primary stage IIIC and IV, and residual infiltration exceeding 2 cm after first laparotomy. CONCLUSION: Our results are comparable with reports in the literature. The actuarial survival rate without evidence of disease at 5 years in patients with advanced ovarian cancer after second look negative laparotomy is 50%.

Metastasis to the breast--a clinical challenge in outpatient.

Metastatic tumours of the breast are often misdiagnosed as a primary breast malignancy. This erroneous diagnosis can lead to unnecessary mutilating surgery and to delays in applying appropriate treatment. We have analyzed the clinical features of seven patients presenting initially with a breast mass which, after further investigation, proved to be metastasis from a non-breast primary tumour. The treatment of metastatic breast tumours depends on the nature of the primary tumour. Metastases of solid tumours are treated with local excision. Lymphomas are treated with appropriate systemic therapy. The prognosis for patients with metastatic tumours in the breast is poor.

Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases.

55 cases of malignant phyllodes tumours of the breast are described. 36 patients (i.e. 65.5%) of the studied group survived 5 years with no evidence of disease after surgery. It was proved that a simple mastectomy is sufficient therapy for patients with tumour limited to the breast. Metastases to the axillary lymphatic nodes are very rare. The main reason for treatment failure is distant metastases in the lungs. The only prognostic factor in the studied group was the grade of histological malignancy, determined by such criteria as the ratio between the malignant sarcomatous tissue and that typical for phyllodes tumour, the degree of cell polymorphism, mitotic activity, and possible multidirectional differentiation (towards malignant neoplasms of soft tissue and bones).

Pure immature teratoma of the ovary: analysis of 22 cases.

Between 1970 and 1991, 22 patients with pure immature teratoma were treated at the Center of Oncology in Krakow. Sixteen (72.7%) patients had stage I, four (18.2%) stage II, and two (9.1%) stage III of disease, nine (40.9%) patients had grade 1, 11 (50%) grade 2, and two (9.1%) grade 3 tumors. Eight stage Ia, grade 1 patients were treated with surgery only, the remaining 14 (63.6%) received postoperative chemotherapy. Five-year NED (no evidence of disease) survival was achieved in 81.8% of patients. Out of 16 stage I patients, 15 (93.8%) survived 5-year NED, out of six stage II and III, three (50%) patients only survived this period. We cured all grade 1 patients, and 81.8% (9/11) grade 2; two grade 3 patients died because of tumors. We also cured all six stage Ia patients, treated with unilateral salpingo-oophorectomy (with or without chemotherapy), and all eight stage Ia grade 1 patients treated with surgery only.

[Breast cancer in women under the age of 35]. / Rak sutka u kobiet do 35 roku zycia.

A retrospective analysis of a group of 102 women younger than 36 years is reported. All patients were treated initially only surgically by Halsted or Patey mastectomy. Disease-free 10-year survival was noted in 39.2% of the patients. The effectiveness of the treatment proved to be the same in the group of women under and over the age 35. For all patients with breast cancer, despite their age, identical prognostic factors were observed.

[Infiltrating lobular carcinoma of the breast. Clinical picture, treatment and prognosis]. / Naciekajacy rak zrazikowy sutka. Obraz kliniczny, leczenie i rokowanie.

An analysis of 80 patients with infiltrating lobular carcinoma of the breast treated at Center of Oncology in Kraków is presented. All patients underwent radical mastectomy. The evaluation of treatment results showed stage, pathological tumor size, and involvement of axillary nodes as the prognostic factors. The ten-year survival rate NED in all group was 38.8%; for stage I, II, and III it was 62.5%, 48.8%, and 19.4% respectively.

[Adenoid cystic carcinoma of the breast. Analysis of 7 patients]. / Rak gruczolowo-torbielowaty gruczolu sutkowego. Analiza 7 chorych.

A retrospective analysis of 7 patients with adenoid cystic carcinoma of the breast operated at Center of Oncology in Kraków is presented. Ten years without evidence of disease survived 6 (85.7%) patients. One patient only, with poorly differentiated carcinoma, presented axillary metastases and died of metastases to the lungs and hepar.

[Primary fallopian tube carcinoma. Analysis of 32 cases]. / Pierwotny rak jajowodu. Analiza 32 przypadków.

A retrospective analysis of 32 patients with primary fallopian tube carcinoma treated at Center of Oncology in Kraków is presented. In all cases therapy consisted of primary total abdominal hysterectomy with bilateral salpingo-oophorectomy followed by adjunctive radiotherapy. Five year without evidence of disease survived 53.1% of the patients. Stage of disease was the only prognostic factor: survival at 5 years was 76.9% for stage Io, 55.6% for stage IIo, and 20% for stage III.

[Synchronous bilateral carcinoma of the lung cured with surgery and radiotherapy]. / Synchroniczny obustronny rak pluca wyleczony chirurgicznie i napromienianiem.

A case of a primary synchronous bilateral lung cancer is presented. Tumor of the left lung was treated with lobectomy, tumor of the right lung with radiotherapy. Patient survived 5-years without evidence of disease recurrence.

[20-year survival in women with breast cancer]. / 20-letnie przezycia kobiet chorych na raka sutka.

We analysed 170 women with carcinoma of the breast who survived 20 years after local or loco-regional therapy, without adjuvant chemo-hormonotherapy. Patients with axillary lymph nodes metastases constitute thirty-six percent of this group.