Clinicopathologic Features and Prognostic Impact of Lymph Node Involvement in Patients With Breast Implant-associated Anaplastic Large Cell Lymphoma.

Breast implant-associated anaplastic large cell lymphoma (BI-ALCL) is a rare T-cell lymphoma that arises around breast implants. Most patients manifest with periprosthetic effusion, whereas a subset of patients develops a tumor mass or lymph node involvement (LNI). The aim of this study is to describe the pathologic features of lymph nodes from patients with BI-ALCL and assess the prognostic impact of LNI. Clinical findings and histopathologic features of lymph nodes were assessed in 70 patients with BI-ALCL. LNI was defined by the histologic demonstration of ALCL in lymph nodes. Fourteen (20%) patients with BI-ALCL had LNI, all lymph nodes involved were regional, the most frequent were axillary (93%). The pattern of involvement was sinusoidal in 13 (92.9%) cases, often associated with perifollicular, interfollicular, and diffuse patterns. Two cases had Hodgkin-like patterns. The 5-year overall survival was 75% for patients with LNI and 97.9% for patients without LNI at presentation (P=0.003). Six of 49 (12.2%) of patients with tumor confined by the capsule had LNI, compared with LNI in 8/21 (38%) patients with tumor beyond the capsule. Most patients with LNI achieved complete remission after various therapeutic approaches. Two of 14 (14.3%) patients with LNI died of disease compared with 0/56 (0%) patients without LNI. Twenty percent of patients with BI-ALCL had LNI by lymphoma, most often in a sinusoidal pattern. We conclude that BI-ALCL beyond capsule is associated with a higher risk of LNI. Involvement of lymph nodes was associated with decreased overall survival. Misdiagnosis as Hodgkin lymphoma is a pitfall.

[SPECT/CT with 99mTc-HMPAO in progressive encephalitis mediated by anti-GAD antibodies]. / SPECT/TC con 99mTc-HMPAO en la encefalitis progresiva mediada por anticuerpos anti-GAD.

TITLE: SPECT/TC con 99mTc-HMPAO en la encefalitis progresiva mediada por anticuerpos anti-GAD.

SPECT/TC con 99mTc-HMPAO en la encefalitis progresiva mediada por anticuerpos anti-GAD / SPECT/TC with 99mTc-HMPAO in progressive encephalitis mediated by anti-GAD antibodies

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Clinical features and 123I-FP-CIT SPECT imaging in vascular parkinsonism and Parkinson's disease.

OBJECTIVES: To analyse the differences in the clinical features and characteristics of (123)I-labelled 2ß-carbomethoxy-3ß-(4-iodophenyl)-N-(3-fluoropropyl) nortropane ((123)I-FP-CIT) single photon emission CT (SPECT) imaging among patients with vascular parkinsonism (VP) and Parkinson's disease (PD). METHODS: We performed a case-control study to compare clinical features and qualitative and semi-quantitative analyses of (123)I-FP-CIT SPECT images between 106 patients with VP and 280 patients with PD. A case series study was used to search for clinical features related to SPECT or neuroimaging findings among patients with VP. RESULTS: Patients with VP had a higher age at symptom onset and lower disease duration than patients with PD. The most frequent symptom at onset was gait disorder in VP and tremor in PD. Gait disorder, postural instability and falls were more frequent in VP. Rest and mixed tremor were more prevalent in PD. Of the patients who received levodopa treatment in the VP group, only about half had a good response. Qualitatively (123)I-FP-CIT SPECT images were normal in 32.5% of patients with VP and abnormal in all patients with PD. The use of different visual score patterns showed higher ability to differentiate VP from PD. Semi-quantitative analysis showed significantly higher uptake in the striatum, caudate and putamen in VP. The asymmetry index was higher in patients with PD. Among patients with VP, falls were the only clinical feature that demonstrated a correlation with the SPECT visual pattern. CONCLUSION: Our data contribute to the confirmation that VP and PD are two different clinical entities. Neurological signs, response to treatment and qualitative and semi-quantitative (123)I-FP-CIT SPECT analyses may help to make the diagnosis.

Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacional / Travel time and participation in breast cancer screening in a region with high population dispersion

Objetivo: Análisis de ámbito municipal de la asociación entre el tiempo de viaje y la participación en el programa de cribado del cáncer de mama ajustando por variables contextuales en la provincia de Segovia.MétodoEstudio ecológico utilizando como fuentes de datos el Programa de Detección Precoz de Cáncer de Mama de la Gerencia de Atención Primaria de Segovia, el Censo de Población y Vivienda de 2001, y el Padrón municipal de habitantes de 2006-2007. El periodo de estudio fue de enero de 2006 a diciembre de 2007. Como variables dependientes se consideraron la tasa de participación municipal y el nivel deseado de participación municipal (≥70%). La variable independiente principal fue el tiempo de viaje del municipio a la Unidad Mamográfica, y las covariables agregadas por municipio fueron las características sociodemográficas y socioeconómicas. Se realizó un análisis univariado y multivariado por regresión de Poisson de la tasa de participación municipal, y por regresión logística del nivel deseado de participación.ResultadosLa muestra estuvo formada por 178 municipios. La tasa de participación media fue del 75,2%. Ciento diecinueve (67%) municipios tuvieron la participación deseada (≥70%). En el análisis multivariado por regresión de Poisson y logística, el mayor tiempo de viaje se asoció tanto a una menor tasa de participación como a un menor nivel de participación, una vez ajustado por la densidad geográfica, la edad, el nivel socioeconómico y la razón de dependencia, con un índice de riesgo relativo de 0,88 (intervalo de confianza del 95% [IC95%]: 0,81-0,96) y una odds ratio de 0,22 (IC95%: 0,1-0,47), respectivamente.ConclusiónEl tiempo de viaje hasta la Unidad de Mamografía puede ayudar a explicar la participación poblacional en los programas de detección precoz del cáncer de mama (AU)

Objective: To analyze the association between travel time and participation in a breast cancer screeningprogram adjusted for contextual variables in the province of Segovia (Spain).Methods: We performed an ecological study using the following data sources: the Breast Cancer EarlyDetection Program of the Primary Care Management of Segovia, the Population and Housing Census for2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December2007. Dependent variables consisted of the municipal participation rate and the desired level of municipalparticipation (greater than or equal to 70%). The key independent variable was travel time from themunicipality to the mammography unit. Covariables consisted of the municipalities’ demographic andsocioeconomic factors. We performed univariate and multivariate Poisson regression analyses of theparticipation rate, and logistic regression of the desired participation level.Results: The sample was composed of 178 municipalities. The mean participation rate was 75.2%. Thedesired level of participation (≥70%) was achieved in 119 municipalities (67%). In the multivariate Poissonand logistic regression analyses, longer travel time was associated with a lower participation rate andwith lower participation after adjustment was made for geographic density, age, socioeconomic statusand dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95%CI: 0.1-0.47), respectively.Conclusion: Travel time to the mammography unit may help to explain participation in breast cancerscreening programs (AU)

[Travel time and participation in breast cancer screening in a region with high population dispersion]. / Tiempo de viaje y participación en el cribado del cáncer de mama en una región de alta dispersión poblacional.

OBJECTIVE: To analyze the association between travel time and participation in a breast cancer screening program adjusted for contextual variables in the province of Segovia (Spain). METHODS: We performed an ecological study using the following data sources: the Breast Cancer Early Detection Program of the Primary Care Management of Segovia, the Population and Housing Census for 2001 and the municipal register for 2006-2007. The study period comprised January 2006 to December 2007. Dependent variables consisted of the municipal participation rate and the desired level of municipal participation (greater than or equal to 70%). The key independent variable was travel time from the municipality to the mammography unit. Covariables consisted of the municipalities' demographic and socioeconomic factors. We performed univariate and multivariate Poisson regression analyses of the participation rate, and logistic regression of the desired participation level. RESULTS: The sample was composed of 178 municipalities. The mean participation rate was 75.2%. The desired level of participation (≥ 70%) was achieved in 119 municipalities (67%). In the multivariate Poisson and logistic regression analyses, longer travel time was associated with a lower participation rate and with lower participation after adjustment was made for geographic density, age, socioeconomic status and dependency ratio, with a relative risk index of 0.88 (95% CI: 0.81-0.96) and an odds ratio of 0.22 (95% CI: 0.1-0.47), respectively. CONCLUSION: Travel time to the mammography unit may help to explain participation in breast cancer screening programs.