Magnetic resonance imaging-guided navigation with a thermoplastic shell for breast-conserving surgery.

BACKGROUND: The aim of this study was to evaluate the accuracy of a magnetic resonance imaging (MRI) marking technique with a drape-type thermoplastic shell for planning breast-conserving surgery (BCS). METHODS: A prospective review was performed on 35 consecutive patients who underwent MRI in the supine position and used the specified MRI marking technique. Eleven cases underwent pre-operative chemotherapy and 24 cases did not. After immobilizing the breast mound with a drape-type thermoplastic shell, patients underwent MRI, and the location of the lesion was marked on the shell. Resection lines were dyed blue by indigo carmine, which was pushed through the pores of the shell. Specimens obtained during BCS were sliced into 5-mm contiguous sections, and the margin was assessed for each specimen. Cancer foci less than 5 mm from the margin were classified as positive. RESULTS: Of 35 patients, 33 were included in the analysis; 2 were excluded due to a lack of effect of pre-operative chemotherapy. Of these 33 patients, 25 (75.8%) had negative margins and 7 (21.2%) had positive margins. CONCLUSIONS: Our MRI marking technique may be useful for evaluating the extent of tumors that were determined by MRI alone. Long-term outcomes of this technique should be evaluated further.

Mammographic density and the risk of breast cancer in Japanese women.

Using an automated method for detecting mammographic mass, the authors evaluated the relation between quantitatively measured density and the risk of breast cancer in a case-control study among Japanese women. The case subjects were 146 women newly diagnosed and histologically confirmed with breast cancer at a general hospital. A total of 659 control women were selected from those who attended a breast cancer mass screening at this hospital. Significantly increased odds ratios (ORs) of breast cancer were observed for breast densities of 25-49 and 50-74%, but not for densities of 75-100% as compared with 0% in premenopausal women after controlling for covariates (ORs = 4.0, 4.3, and 1.4, respectively). In postmenopausal women, ORs were significantly increased for breast densities of 25-50% (OR = 3.0) and 50-100% (OR = 4.2). Total breast area was significantly associated with the risk of breast cancer independent of density percent or dense area in postmenopausal women. These data suggested that mammographic density was associated with the risk of breast cancer in Japanese women as is the case in Caucasian women. However, the associations of the risk of breast cancer with breast size and a high breast density greater than 75%, needs to be confirmed in future studies.

A case of muscular hamartoma of the breast.

We describe a 74-year-old female presenting with a right breast mass. She had found the mass on self-examination. Physical examination revealed a 2.2 x 2.5 cm, firm, smooth, and mobile lump in the upper medial portion of the right breast. Mammography revealed a well marginated, oval-shaped, and isodense nodule. Calcification was not evident. On ultrasonography, the lesion was 17 x 18 x 9 mm and located 5 mm below the overlying skin. Excisional biopsy under local anesthesia was performed. The tumor was easily excised. Histopathologically, the lesion was composed of intersecting bundles of spindle-shaped smooth muscle cells, and involved peripheral ducts and fat tissue. Immunohistochemical staining showed positivity for alpha-smooth muscle actin (SMA), but was negative for S-100 protein, myoglobin, keratin, and vimentin. From these findings a muscular hamartoma of the breast, a rare subtype of hamartoma, was diagnosed.

Immunohistochemical expression of glutathione transferase-pi in untreated primary non-small-cell lung cancer.

Patients with unresectable non-small-cell lung cancer (NSCLC) usually have undergone chemotherapy; however, such problems as resistance to chemotherapeutic agents occur during the treatments. Recent studies have indicated that glutathione S-transferase-pi (GST-pi) may play an important role in the resistance of cancer cells to alkylating agents, including cisplatin compounds. We examined a possible relationship between immunohistochemical expression of GST-pi and the response to cisplatin plus etoposide chemotherapy in patients with untreated and unresectable primary NSCLC. Of the 89 patients, 50 (56.2%) were GST-pi-positive and 39 (43.8%) were GST-pi-negative. For the patients with negative GST-pi expression, the response rate was 66.7% (26 of 39 patients). In the patients with positive GST-pi expression, the response rate was 26% (13 of 50 patients). This difference was statistically significant (P = .0019). The results suggest that GST-pi expression in NSCLC tissues is related to response to cisplatin plus etoposide chemotherapy and may be useful as a predictor of chemotherapy response.

Technetium tin colloid test detecting symptomless dysphagia and ACE inhibitor prevented occurrence of aspiration pneumonia.

Symptomless dysphagia and swallowing disorders play a very important role in the pathogenesis of aspiration pneumonia. A videofluoroscopic examination and a simple two-step swallowing provocation test (STS-SPT) could be useful for detection of swallowing disorders in elderly patients with stroke, however, there is no report on such a test for detection of symptomless dysphagia. We administered 1 ml Technetium Tin Colloid (99mTC) to the patient during sleep via a nasal catheter placed in the mouth. At 09:00 h the next day, symptomless dysphagia was checked for by imaging. Improvement of the symptomless dysphagia was observed, and thus we could prevent the occurrence of aspiration pneumonia. The 99mTC test was particularly useful in detecting symptomless dysphagia in elderly patients with stroke.

Cytological diagnosis and telomerase activity of cells in effusions of body cavities.

Telomerase is a ribonucleoprotein that synthesizes telometric DNA on chromosome ends, and may be related to the aging and immortality of cells. Recently, a telometric repeat amplification protocol (TRAP) assay for telomerase activity, using the polymerase chain reaction, was developed. We examined the limitations of TRAP assay by applying it to a cultured colon cancer cell line (COLO320) and 58 human cytological materials from body cavity effusions, and obtained the following results; i) The limits of the TRAP assay were 20-50 cells for the COLO320 cell line; ii) One COLO320 cell per 100 normal blood white cells was detectable; iii) Seventeen of 58 samples were positive for telomerase activity in this study. The sensitivity was 69% (9/13) and the specificity was 87.5% (28/32) between cytological diagnosis and telomerase activity; iv) Among 29 malignant cases, 15 were positive for telomerase activity, while there were 11 cytologically positive cases. The positive cases detected by the combination of cytology and telomerase activity accounted for 21 of the total 29 cases (72.4%). These results suggest that the measurement of telomerase activity in body cavity effusions may be useful as an adjunctive tool for cytological and clinicopathological diagnosis and that this technique is potentially applicable to remnant cytological materials.

Application of telomerase activity for screening of primary lung cancer in broncho-alveolar lavage fluid.

Telomerase is a ribonucleoprotein that synthesizes telomeric DNA onto chromosomal ends using an RNA component as a template. Extension of telomeric repeats by telomerase prevents telomere shortening with cell divisions and contributes to chromosomal stability, possibly leading to immortalization of the cells. In the present study, we used a telomerase assay to detect primary lung cancer in broncho-alveolar lavage fluid (BALF). A total of 58 BALF samples were examined by telometric repeat amplication protocol assay. Thirty-five (29 cancers, 2 salcoidoses, 2 pulmonary tuberculoses and 2 normal samples) of 58 (60.3%) cases were found to be positive for telomerase activity. The sensitivity of telomerase activity was 78.4%, compared with 64.7% of BALF cytology. Among 37 primary lung cancer patients diagnosed histopathologically, 24 had positive cytology and 29 had positive telomerase activity. The number increased to 32 patients when cytodiagnosis and telomerase activity were considered. Of patients in whom the presence of primary lung cancer was strongly suspected clinically, although there was no histopathological evidence, two were telomerase-positive, initially diagnosed as normal by cytological examination and histological examination but finally diagnosed as primary lung cancer (adenocarcinoma) in subsequent histological examination using operation specimens. These findings suggest that telomerase assay using BALF samples might be a useful screening method for primary lung cancer especially when combined with BALF cytology.

Association of body mass index, physical activity, and reproductive histories with breast cancer: a case-control study in Gifu, Japan.

To further clarify risk factors for breast cancer in Japanese women, a self-administered questionnaire was completed by 157 cases with histologically confirmed breast cancer from 1989 to 1993 and by 369 age and residential area matched controls in Gifu, Japan. Conditional logistic regression model was used to assess the relations. Multivariate analyses showed that breast cancer risk decreased with body mass index for premenopausal women (RR = 0.45; 95 % CI = 0.22-0.92 for BMI > or = 23 vs. < 21 (kg/m2)), but the risk increased with body mass index for postmenopausal women (RR = 1.98; 95 % CI = 0.86-4.55 for BMI > or = 24 vs. < 21.5 (kg/m2)). The risk increased with a small number of births in pre- and post-menopausal women (1.83; 1.11-2.99 and 6.06; 2.40-15.3 for 1-2 births and nulliparity, respectively, vs. > or = 3 births). Ex- or current smoking increased the risk of breast cancer (2.31; 1.19-4.49). Reduced risk of premenopausal breast cancer was associated with high energy expenditure in physical activity during teenage, although the trend was not statistically significant.

Immunohistochemical study of a monoclonal antibody 115D8 against human milk-fat globule membrane (MAM-6) in some histological types of breast cancer.

An antigen, MAM-6, in human milk-fat globule membranes, was detected with a monoclonal antibody 115D8, in paraffin-embedded sections of 148 cases including human breast cancers and other breast diseases with immunoperoxidase technique. There were some differences on the staining portion in the cells among the different types of breast cancers, although we could not find any differences in intensity of reaction with 115D8 among the different histochemical types of breast cancers. MAM-6 was mainly localized in the apical portion of the cells or the cytoplasms of the papillo-tubular carcinoma. The antigen was chiefly localized in the margin of the cells or cytoplasms of the solid- tubular carcinoma and scirrhous carcinoma. Normal mammary glands, sweat glands and sebaceous glands were reacted with 115D8 but epidermis, esophagus, stomach, small intestines, large intestines, pancreas, liver, lung, kidney, urinary bladder, thyroid, adrenal glands, heart, striated and smooth muscles, spleen, lymphnodes and brain were not reacted with 115D8 in this study. Although the antibody was not sufficient for differential diagnosis among the types of breast cancer, it may be useful to detect the breast cancer.

Extrarenal Wilms' tumor in the adult patient. A case report and review of the world literature.

A case of an extrarenal Wilms' tumor arising in the retroperitoneal region of a 49-year-old male is reported. A review of the world literature indicates that the incidence of the tumor arising in the extrarenal region is extremely rare. A total of 14 cases have previously been reported, but the number of cases that occurred in adult patients is only 2. The clinical and pathologic features are briefly discussed.

Peculiar congenital parieto-occipital head tumor: report of 3 cases.

3 infantile cases of congenital parieto-occipital midline soft tumor, the clinical and pathological findings of which did not correspond precisely to a known congenital head tumor, are reported. One of them probably belongs to McLaurin's type of encephalocele with heterotopic glial rest, and the remaining two to McLaurin's type of meningocele without central connection. The types of anomaly shown by the present cases should generally be called 'atretic cephalocele' or 'rudimentary cephalocele'.