RESUMEN
BACKGROUND: Lymph node status, established by a single hematoxylin and eosin (H&E) section from each node, remains an important prognostic indicator in patients with breast cancer, but used alone it is insufficient to identify patients who will develop metastatic disease. This study was conducted to assess the significance of detecting occult metastases in 86 patients with breast cancer originally reported to be histologically node negative. None of the patients received adjuvant systemic therapy. METHODS: Five additional levels from formalin-fixed, paraffin-embedded nodes were examined at 150-microns intervals with H&E staining and a cocktail of antikeratin antibodies (AE1/AE3) recognizing low molecular weight acidic keratins. RESULTS: Nodes from 11 (12.8%) of 86 patients contained occult metastases. All metastases identified by cytokeratin antibody were also detected in H&E-stained sections. With median follow-up of 80 months, distant metastases occurred in five of 11 occult node-positive patients (45%) and 13 of 75 patients whose nodes were negative on review (17%). Median time to recurrence was 89 months for occult node-positive patients and not yet reached for node-negative patients (p = 0.048). The disease-specific 5-year survival rate was 90% for occult node-positive patients and 95% for node-negative patients. CONCLUSIONS: The presence of occult metastases shortened the disease-free interval and suggested that more diligent axillary staging would more accurately identify patients who would benefit from systemic adjuvant treatment.
Asunto(s)
Neoplasias de la Mama/patología , Ganglios Linfáticos/patología , Biomarcadores de Tumor/análisis , Neoplasias de la Mama/química , Neoplasias de la Mama/mortalidad , Colorantes , Supervivencia sin Enfermedad , Eosina Amarillenta-(YS) , Femenino , Estudios de Seguimiento , Hematoxilina , Humanos , Inmunohistoquímica , Queratinas/análisis , Ganglios Linfáticos/inmunología , Metástasis Linfática , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
The most common complication of total thyroidectomy is hypocalcemia. Following thyroidectomy, especially total thyroidectomy, the serum calcium usually falls gradually and patients do not usually require supplementary medication before 24 hours. Two cases of total thyroidectomy are presented in which the preoperative serum calcium levels were normal and hypocalcemic tetany developed in the recovery room immediately after the operation. The hypocalcemia was a temporary phenomenon, and neither patient requires supplementary calcium at the present time. There is no good explanation for this precipitous drop in the serum calcium levels in these two patients.