Gastric conduit reconstruction after esophagectomy with right gastroepiploic artery absence: a case report.

Gastric conduit reconstruction is the standard choice after esophagectomy. Conduit's vascular supply is of primary importance mainly based on right gastroepiploic vessels. A 57-year-old male with absent right gastroepiploic artery, due to a duodenal bleeding ulcer treated with gastroduodenal artery ligation 10 years ago, was treated for gastroesophageal cancer and required esophagectomy. Surgical merits of this troublesome scenario are highlighted. Previous surgical history is highly important for patients requiring complex surgery as esophagectomy. The use of the stomach as conduit after esophagectomy is always the primary option; however vascular supply of it should not be compromised. Variations are rare and careful planning may overcome obstacles as in this case.

Metastatic breast carcinoma initially presenting as acute cholecystitis: a case report and review of the literature.

INTRODUCTION: The gallbladder is an infrequent site of metastatic malignant disease. Although malignant melanoma, renal cell and cervical carcinoma have been documented, breast carcinoma has rarely been reported to metastasize in the gallbladder. CASE REPORT: We describe such a case that manifested as acute cholecystitis and was incidentally recognized after cholecystectomy, in an otherwise disease-free 46-year-old female who had undergone mastectomy for breast cancer two years before. The patient was subjected to adjuvant chemotherapy, but unfortunately died just a year after diagnosis because of generalized peritoneal seeding of the tumor. DISCUSSION: Metastatic gallbladder involvement is rare, especially in cases of primary breast carcinoma, usually leading to symptoms of abdominal pain, mimicking acute or chronic cholecystitis. Thus, abdominal pain in a patient with a previous history of breast carcinoma should raise suspicion of gallbladder metastasis.

Needle tract seeding after vacuum-assisted breast biopsy.

BACKGROUND: A matter of substantial concern regarding all needle biopsy techniques is seeding along the biopsy needle tract. PURPOSE: To assess cell seeding along the needle tract of vacuum-assisted breast biopsy (VABB). MATERIAL AND METHODS: The study included 21 patients with ductal carcinoma in situ (DCIS) and 10 patients with invasive ductal carcinoma (IDC) diagnosed by VABB for nonpalpable mammographic lesions. VABB (11G, on a Fischer table) was performed, and the duration of the procedure was measured. After surgery, the whole needle tract was embedded in paraffin blocks, stained with hematoxylin-eosin, and examined by a pathologist. RESULTS: Cases with dissemination of cancer cells in the needle tract were not observed (one-sided 97.5% CI 0-10.0%). In 2/31 (6.5%) cases (95% CI 0.8-21.4%), benign epithelial cell displacement was observed, and the duration of VABB was significantly longer in these two cases (52.5+/-3.5 min vs. 42.0+/-4.4 min for cases without benign cell displacement; P = 0.018, Mann-Whitney-Wilcoxon test for independent samples). CONCLUSION: No displacement of malignant cells within the 11G needle tract was documented. Benign cell displacement was associated with longer VABB duration. The phenomenon of tumor cell dissemination along the needle tract is of questionable clinical significance when the treatment guidelines are followed.

Spontaneous regression of rectal polyps following abdominal colectomy and ileorectal anastomosis for familial adenomatous polyposis, without sulindac treatment: report of four cases.

The only curative treatment for familial adenomatous polyposis (FAP) is prophylactic surgery and the two most popular options are total colectomy with ileorectal anastomosis and restorative proctocolectomy with ileal pouch-anal anastomosis. Today, ileal pouch-anal anastomosis has gained wider acceptance as a safer procedure, but ileorectal anastomosis still remains an option, especially for young patients with a moderate phenotype of the disease and limited polyps in the rectum. Partial or complete regression of rectal polyps after total colectomy with ileorectal anastomosis and treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) such as sulindac is reported in up to 80 % of patients. However, in some cases such regression can be spontaneous and long-lasting following total colectomy and ileorectal anastomosis, without further treatment with NSAIDs. We present the cases of four patients with FAP treated by colectomy and ileorectal anastomosis, who had immediate, complete spontaneous regression of multiple polyps in the rectal stump, with no further need for sulindac treatment.

Identification of germline BRCA1 and BRCA2 genetic alterations in Greek breast cancer moderate-risk and low-risk individuals--correlation with clinicopathological data.

The current study was designed to evaluate the prevalence of BRCA1 and BRCA2 germline mutations in Greek moderate- and low-risk individuals with respect to clinicopathological phenotype and clinical outcome of breast cancer. Ninety-four consecutive individuals were prospectively recruited from two University Breast Cancer Clinics (Hippokrateion Hospitan and Laikon Hospital) between 1989 and 1999 and were categorized as moderate-risk and low-risk individuals for carrying BRCA1/2 germline mutations. To identify the underlying mutations, protein-truncation test and single-strand conformation polymorphism methods were used, followed by direct sequencing. Three novel BRCA1 missense mutations, one novel BRCA1 intronic deletion, three novel (previously reported) BRCA2 truncating mutations, and one novel BRCA2 missense mutation were identified in the moderate-risk group of individuals studied. The BRCA1/2 missense mutations as well as the single intronic variant identified were designated as unclassified genetic variants. Two BRCA1 unclassified genetic variants (missense mutations) were detected in two of the three (66.7%) male breast cancer patients analyzed, while the third one was identified in a sporadic (low-risk) breast cancer patient. Clinicopathological characteristics of breast carcinomas originating from BRCA1/2 heterozygotes were consistent with those already reported and not different from those observed in BRCA1/2 mutation (-) breast cancer patients. Furthermore, BRCA1/2 mutation carriers presented an excellent 4.5-year overall survival (100%). Our results reveal the unique characteristics of BRCA1/2 mutation status, genotype-phenotype correlations, and prognosis, in moderate- and low-risk individuals of Greek ancestry. Breast cancer due to mutations in BRCA1 and BRCA2 genes appears to be a heterogeneous syndrome in the Greek population.