Clinical validity of new ultrasound methods in the differential diagnosis of breast diseases.

The clinical application of the extended-field-of-view (EFOV) technique, 3D ultrasonography (3D US) and a newly developed US method using a homogeneous tissue equivalent phantom, the so-called attenuation in phantom (AIPH) method, was evaluated in 200 patients with breast disease. These methods improved differentiation both in the preoperative diagnostic and in the postoperative follow-up. EFOV made possible to see large or multiple lesions and also their vasculature in a single image, allowing exact measurement, comparison and better assessment of traditional criteria. In addition, costs and examination time were also reduced. The possibility of viewing the spatial arrangement and the internal and external surfaces of the lesions improved preoperative decision making. Finally, the newly developed AIPH method allowed excellent evaluation of the posterior acoustic pattern of the lesions even when the mass was near the chest wall. For this reason, it was easier to distinguish malignant lesions from benign lesions of the breast.

[Retrospective evaluation of surgically treated cases of non-palpable breast tumor]. / A nem tapintható emlótumor miatt operált eseteink retrospektív értékelése.

Between 10.01.1997 and 09.30.1999 authors performed operations on 78 patients who had nonpalpable breast tumors. If mammography was considered abnormal during breast screening program patients were recalled. Besides clinical investigation complimentary mammograms were performed. After sonogram, and if needed, aspiration biopsy cytology (ABC) if necessary core biopsy (CB) was the next investigation. 79 operations were performed on 78 patients (one was patient had synchronous breast tumor). The mean age of the patients was 56.3 years. If the radiological investigations (R4-R5) and/or the ABC (C4-C5) or CB suggested malignancy operation was performed. Mammography suggested malignancy in 60.75% of the patients, it was suggested by ABC in 30.18%, and by CB in 55.5%. The nonpalpable tumor, suspected to be malignant was marked with a wire loop and was excised under anesthesia along with the affected breast sector. The excision and tissue-border around the tumor was checked by specimen mammography performed during the narcosis. No cryohistology was performed. After the specimen mammography, the wound was closed. The final histology of the operations showed malignancy in 40.5%. In their retrospective study the authors evaluated the complete sensitivity and the positive predictive value (PPV) of the preoperative investigations regarding the final histology. They analyse the value of preoperative mammogram, the ABC and CB in malignant and in benign cases. Early diagnosis and surgical treatment is expected to improve significantly the survival of patients with breast cancer. Reduction in the number of unnecessary operations can be expected from increasing the accuracy of radiological and cytological investigations and the adequate usage of core biopsy.

The efficacy of a combination of etoposide, ifosfamide, and cisplatin in the treatment of patients with soft tissue sarcoma.

BACKGROUND: Successful chemotherapy for patients with soft tissue sarcoma (STS) has been limited by a lack of active drugs. The most effective single agents are doxorubicin, dacarbazine, and, more recently, ifosfamide. Previously the most widely used combination has been CYVADIC (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). In one randomized trial, ifosfamide was superior to cyclophosphamide; two nonrandomized studies also reported favorable results. Etoposide monotherapy was successful in 8%; the effectiveness of cisplatin was 5-23%. In view of these findings, the authors treated STS patients with an etoposide, cisplatin, and ifosfamide (VIP) combination. METHODS: The eligibility criteria included histologically confirmed, inoperable, metastatic or locally recurrent STS; a World Health Organization (WHO) performance status of 0-2; a maximum age of 75 years; and progressive, measurable disease. A total of 104 patients were treated from January 1990 to June 1997. The median age of the patients was 42.4 years. The patients were treated with a combination of etoposide (100mg/m(2) for 5 days), ifosfamide (2000 mg/m(2) for 2 days), and cisplatin (20mg/m(2) for 5 days) once a month via a peripheral vein. The treatment response and the toxicity were assessed according to WHO criteria. RESULTS: Of 104 evaluable patients, 47 responded. The overall response rate was 46% (complete response: 10%; partial response: 36%). In 43 patients the disease remained stable (41%). Remission duration was 4.6 months. Toxicity was moderate. The main adverse events were alopecia (100%), nausea and vomiting (73%), and leukopenia (29%). CONCLUSIONS: This new combination is promising for the treatment of patients with advanced STS.

Angiolymphoid hyperplasia with eosinophilia: report of a lesion mimicking soft tissue tumor of extremely long duration.

We present a large sized lesion of the right upper arm in which characteristics of the angiolymphoid hyperplasia with eosinophilia (ALHE) intermingled with those of Kimura's disease (KD). The laboratory findings, the prominent vascular proliferation and the features of endothelial cells were suggestive of ALHE. However, the long duration of the disease, the site of involvement, the abundant lymphoid component forming lymph follicles with germinal centers and the fibrosis are features of KD. In agreement with other reports, our case shows that clinicopathologically there is an overlap between ALHE and KD.

Fibrous dysplasia associated with intramuscular myxoma (Mazabraud's syndrome): a long-term follow-up of three cases.

The association between of fibrous dysplasia and intramuscular myxomas is extremely rare. The authors summarize the characteristics of Mazabraud's syndrome, as well as its clinical course on the basis of 24 cases reported in the literature and 3 cases of their own. The syndrome is quite uniform, and mostly occurs in women. Usually the presentation of poliostotic fibrous dysplasia bilaterally in the lower limbs and pelvic bones is followed by the appearance of multifocal intramuscular myxomas in the adjacent muscles, mostly decades later. These hamartomas tend to recur locally or symmetrically in the ipsilateral muscle groups and may reach enormous size without treatment. Malignant transformation (osteosarcoma, fibrosarcoma) on the basis of fibrous dysplasia in Mazabraud's syndrome has been reported in the literature. In our cases, however, in spite of the many recurrences, and the enormous size of the tumours, no malignant transformation was noted in either the fibrous dysplasias or the intramuscular myxomas during the long follow-up time (31 years for fibrous dysplasia and 16 years for myxomas). Early wide surgical excision and a careful long-term follow-up for the often very late recurrences of the myxomas is suggested in Mazabraud's syndrome.

Surgical chemotherapy in the management of melanoblastoma of the lower extremities.

The therapy of advanced melanoblastomas of the lower extremities is limited. Surgery alone is insufficient due to the extent of the tumor, the radicality of mutilating surgery is questionable because of the existing or suspected subclinical metastasis. To avoid amputation, regional chemoperfusion and simultaneous hemofiltration may be the choice of treatment. Between 1993 and 1995 the authors performed surgical chemotherapy on 21 occasions in 14 patients with advanced melanoblastoma of the lower limb. Partial remission of 4 to 11 months developed in 10 patients, 3 patients achieved subjective improvement for 3 to 6 months, 1 patient had disease progression. Simultaneous application of surgical regional chemotherapy and hemofiltration offers an alternative approach in the management of patients suffering from advanced melanoblastoma.

Tumor surgery of the pelvic region.

During the past ten years the authors operated on 27 tumors of the pelvic region, 12 of them involving the pelvic blade, 6 the periacetabular region, further 9 the os pubis and ischii, respectively. Most of the cases (16) were chondrosarcomas. The mean age of the patients--13 male and 14 female--was 41 years. As to surgical radicality 11 wide, 10 marginal and 6 intralesional resections were performed. After a mean follow-up period of 3 years (0.5-11 years) 19 patients are alive tumor-free, 2 with tumor, 4 died and 2 were lost to follow-up. As postsurgical complication wound-healing disorder and inguinal hernia occurred in 5 cases, on the surgical field thrombosis with secondary compartment syndrome and renal insufficiency developed in one case. The authors draw the attention to the difficulties and indications of the pelvic resections (internal hemipelvectomies).

[Sclerosing hemangioma of the lung]. / A tüdö úgynevezett sclerotisáló haemangiomája.

The authors review the theories of origin of the so-called sclerosing heamangioma of the lung. The results of immunohistochemical studies--epithelial membrane antigen positivity and vimentin and factor VIII. related antigen negativity--support the hypothesis of epithelial origin. The problems of clinical and pathological differential diagnosis are discussed.

Results of preoperative neoadjuvant chemotherapy and surgery in the management of patients with soft tissue sarcoma.

Between 1977 and 1991 653 patients were treated for soft tissue sarcoma. Since 1985 limb saving surgery following preoperative neoadjuvant regional chemotherapy has taken place in 53 patients with stage III/A,B disease. In 56.6% (30 patients) treatment was indicated by tumour recurrence. Intra-arterial chemotherapy cycles were performed with doxorubicin (ADM) and cisplatin (cDDP) in the form of rapid infusion. In 25 patients (47%) partial or complete remission (PR,CR) and in 28 patients (53%) minimal response (MR) could be observed. Following neoadjuvant therapy 52 patients underwent limb saving surgery. The patients were followed up for 3-77 months. Due to recurrence, reoperation was required in 22.4% of the cases (11/49 patients). Distant metastases developed in 32.6% (16/49 patients). No intraoperative mortality occurred, the perioperative mortality was 5.7% (three patients).

[Breast-preserving operations in surgically treatable breast cancer]. / Szervmegtartásos mütétek operábilis emlörákban.

Since 1980, based on international experience, breast conserving operations have been introduced at the Surgical Department, in the National Oncological Institute, Budapest. In 12 years, out of 4622 primary breast cancer operations, 1055 breast preserving interventions were carried out. For all patients adjuvant radiotherapy was indicated. In lymph node positive premenopausal cases chemo-radio-chemotherapy, for postmenopausal patients radiotherapy with tamoxifen has been provided. The first 604 patients (10 years) have been evaluated and 489 of them could be followed. The mean follow-up time was 49 months. During this period of time metastases have developed in 61 patients (12.5%); 26 (5.3%) of them died with the disease. Local recurrences occurred in 29 patients (5.9%). For small recurrences reexcision, for the others mastectomy or/and radiotherapy was carried out. Critical evaluation of the local recurrences was done.

Fine needle aspiration cytology of biphasic synovial sarcoma of soft tissue. Report of a case with ultrastructural, immunohistologic and cytophotometric studies.

A case of biphasic synovial sarcoma initially diagnosed by fine needle aspiration cytology is described. The diagnosis was confirmed by electron microscopic studies on a repeat aspirate and histologic and immunohistochemical studies on the surgical specimen. The cellular DNA content was also measured. The differential diagnosis and histogenesis of this neoplasm are discussed.

[Malignant fibrous histiocytoma of the breast]. / Malignus fibrosus histiocytoma az emlöben.

In connection with the mammary tumor of a 41-year-old woman the authors draw attention to the rare occurrence of malignant fibrous histiocytoma in the mamma. The histology of the mammary malignant fibrous histiocytoma, role of immunohistochemical reactions in the diagnosis are described. The literature dealing with the malignant fibrous histiocytoma in the mamma is reviewed. This is the 11th case reported in the literature. The authors discuss the possibilities of the therapy of the malignant fibrous histiocytoma in the mamma.

Correlation between the results of carcinoembryonal antigen (CEA) test and the clinical stage of colorectal carcinoma.

Correlation between results of CEA test and clinical stage of colorectal carcinoma is described. No correlation was found between the different stages and the actual CEA titre. Normalization of an increased preoperative serum CEA level indicated, however, nearly always the radical character of the intervention. Critically high (above 30 ng/per ml) CEA value observed in Dukes' stages C and D can be considered bad prognostic signs. Patients like these died within one year. Results of CEA tests are also useful complementary data contributing to the diagnosis of recurrence or distant metastases.

Gastric carcinoma associated with other malignant tumours.

Authors report on 25 patients treated for gastric cancers associated, synchronously or metachronously, with other malignant tumour. Hypotheses for the development of multiple malignant tumours are reviewed. They state that the prognosis of the second tumour is worse for its late detection and stress the importance of follow-up that also considers the possible development of a new tumour.

Primary inflammatory carcinoma of the breast.

Among 2775 cases of breast cancer examined over a 10-year period, primary inflammatory carcinoma was diagnosed in 35 patients. The symptomatology, the clinical and pathological features and problems of differential diagnosis of primary inflammatory carcinoma of the breast are discussed in detail. On the basis of data in the literature and their own experience, the authors do not recommend surgical treatment of the disease.

Investigation of circulating immune complexes in patients with breast cancer.

Circulating immune-complex (IC) levels of patients with breast cancer were measured before and after surgery using a complement-consumption technique. 16 of 26 patients showed raised pre-operative IC values. In 15 out of 16 patients the pathological IC levels decreased within 2--10 days following surgery. Suggestions about the applicability of this test not only for prognosis, but also for monitoring the course of breast cancer need to be confirmed by further investigations.