Pleomorphic Liposarcoma Arising in a Lipoleiomyosarcoma of the Uterus: Report of a Case With Genetic Profiling by a Next Generation Sequencing Panel.

Uterine tumors with adipocytic differentiation are very uncommon. Mature adipocytes are sometimes seen as an element of smooth muscle neoplasms, more often as lipoleiomyoma, but also in the rare lipoleiomyosarcoma. Exceptional cases have been reported of various subtypes of liposarcoma associated with uterine smooth muscle tumors with or without adipocytic differentiation. We present a case of pleomorphic liposarcoma arising in a lipoleiomyosarcoma of the uterus. Genomic profiling was performed using a validated next generation sequencing panel covering 410 common cancer genes. Alterations were identified in TP53, PTEN, RB1, FAT1 and TERT. The patient's presentation and clinical course as well as the tumor's morphologic, immunohistochemical and molecular genetic findings are reviewed.

Vesicovaginal fistula: diagnosis and management.

Vesicovaginal fistula (VVF) is still a major cause for concern in many developing countries. It represents a significant morbidity in female urology. Continual wetness, odor, and discomfort cause serious social problems. The diagnosis of the condition has traditionally been based on clinical methods and dye testing. A successful repair of such fistulas requires an accurate diagnostic evaluation and timely repair using procedures that exploit basic surgical principles and the application of interposition flaps. The method of closure depends on the surgeon's training and experience. The main complication of VVF surgery is recurrent fistula formation.

Dermatofibrosarcoma protuberans: a rare entity and review of the literature.

Dermatofibrosarcoma protuberans (DFSP) is an uncommon malignant mesenchymal tumor. The incidence of DFSP is 0.1% of all cancers and less than 2% of all soft tissue sarcomas (STS). It can appear at any age, most commonly in individuals aged between 20 and 50 years. The usual location of DFSP is the trunk and it is limited to the dermis. Wide radical excision is the preferred surgical method for therapy of DFSP without distant metastasis. The probability of regional or distant metastases is less than 5%. Patients with positive or close surgical margins have an elevated risk of local recurrence after resection. Adjuvant radiotherapy administered either before or after the surgical treatment reduces the risk of local recurrence.

Surgical approach to the management of medullary thyroid cancer: when is lymph node dissection needed?

OBJECTIVE: Medullary thyroid cancer (MTC) is a rare and particularly aggressive type of thyroid cancer of neuroendocrine origin. It occurs in hereditary and sporadic forms and its aggressiveness is related to the clinical presentation and the type of RET mutation. METHODS: In this article, we present the criteria, as reviewed in contemporary literature, regarding lymph node dissection and radical neck dissection in patients with either sporadic or hereditary MTC. RESULTS: Early diagnosis and treatment remains the key to a 100% cure rate. CONCLUSIONS: Routine central lymph node dissection is the minimum procedure recommended for all sporadic and hereditary MTCs. Routine lateral lymph node dissection on either side is necessary when lymph node metastases are found in the central neck compartment.

Correlation between Ki67 and breast cancer prognosis.

BACKGROUND: Ki67 is an immunohistochemical proliferation marker in many types of cancer and has been widely studied among breast cancer patients mostly through retrospective studies. METHODS: The MEDLINE/PubMed database was searched for publications with the medical subject heading 'Ki 67' and the key words 'breast', 'cancer', and 'prognosis'. We restricted our search to articles published until 2012. RESULTS: In this review, we included 78 articles and abstracts that were accessible and available in English. An effort to further explain the role of Ki67 in the prognosis of breast cancer has been made. CONCLUSIONS: The debate on the prognostic role of Ki67 in breast cancer is still open, although most of the studies have established a relation between Ki67 and overall and disease-free survival. Further research should be made in order to establish Ki67 as a standard prognostic marker in breast cancer.

Role of deregulated microRNAs in breast cancer progression using FFPE tissue.

MicroRNAs (miRNAs) contribute to cancer initiation and progression by silencing the expression of their target genes, causing either mRNA molecule degradation or translational inhibition. Intraductal epithelial proliferations of the breast are histologically and clinically classified into normal, atypical ductal hyperplasia (ADH), ductal carcinoma in situ (DCIS) and invasive ductal carcinoma (IDC). To better understand the progression of ductal breast cancer development, we attempt to identify deregulated miRNAs in this process using Formalin-Fixed, Paraffin-Embedded (FFPE) tissues from breast cancer patients. Following tissue microdissection, we obtained 8 normal, 4 ADH, 6 DCIS and 7 IDC samples, which were subject to RNA isolation and miRNA expression profiling analysis. We found that miR-21, miR-200b/c, miR-141, and miR-183 were consistently up-regulated in ADH, DCIS and IDC compared to normal, while miR-557 was uniquely down-regulated in DCIS. Interestingly, the most significant miRNA deregulations occurred during the transition from normal to ADH. However, the data did not reveal a step-wise miRNA alteration among discrete steps along tumor progression, which is in accordance with previous reports of mRNA profiling of different stages of breast cancer. Furthermore, the expression of MSH2 and SMAD7, two important molecules involving TGF-ß pathway, was restored following miR-21 knockdown in both MCF-7 and Hs578T breast cancer cells. In this study, we have not only identified a number of potential candidate miRNAs for breast cancer, but also found that deregulation of miRNA expression during breast tumorigenesis might be an early event since it occurred significantly during normal to ADH transition. Consequently, we have demonstrated the feasibility of miRNA expression profiling analysis using archived FFPE tissues, typically with rich clinical information, as a means of miRNA biomarker discovery.

Gastrocolic fistulae; From Haller till nowadays.

Gastrocolic Fistula is, in the majority of cases the pathological communication between stomach and transverse colon, because cases involved with the small intestine, pancreas and skin have been also documented, even though are rare. It occurs mostly in adults, but they can be present to infants, as well, as a result of congenital abnormalities or iatrogenic procedures (i.e. migration of PEG tube that placed before). In the Western Countries, the most common cause is the adenocarcinoma of the colon, while in Japan, adenocarcinoma of the stomach is the most frequent cause. It seldom appears, as a complication of a benign peptic ulcer, in Crohn's disease and as a result of significant intake of steroids or NSAIDs. The typical symptoms of a gastrocolic fistula are abdominal pain, nausea-vomiting, diarrhea and weight loss. Radiology has been used for the detection of the fistulae all these years but the golden standard remained the barium enema. Barium meal and CT findings play a smaller role in the diagnosis. Although the management of gastrocolic fistulae has historically been surgical, medical treatment has recently been recommended as the first line when a malignancy can be excluded.

Mechanisms in endocrinology: primary HT and risk for breast cancer: a systematic review and meta-analysis.

OBJECTIVE: The association between hypothyroidism and breast cancer has been described from very early on. Breast and thyroid tissue are interconnected on a molecular level mainly through activation of thyroid hormone receptors expressed on cells of the mammary gland as well as on the plasma membrane of breast cancer cells. Despite the experimental evidence the true value of hypothyroidism as a risk factor for breast cancer remains controversial. METHODS: We searched the PubMed database through February 2011 to identify studies that evaluated the association between hypothyroidism and risk for breast cancer as well as the effect of thyroid hormone replacement therapy on breast cancer incidence. RESULTS: A meta-analysis performed in 12 studies showed that hypothyroidism was not associated with risk for breast cancer (pooled risk ratio (RR)=1.06, 95% confidence intervals (CIs) 0.82-1.35, P = 0.672). The effect of treatment was assessed in seven studies and no evidence for an association between thyroid hormone replacement and breast cancer was observed with an overall RR of 0.99 (95% CI 0.73-1.35, P = 0.965). CONCLUSIONS: Our meta-analysis showed that hypothyroidism is not associated with increased risk for breast cancer and thyroid hormone replacement therapy does not reduce breast cancer prevalence; however, the heterogeneity of the studies analyzed precludes firm conclusions.

Lipomatous angiomyofibroblastoma: a case report of a unique vulvar mass.

BACKGROUND: Vulvar masses are commonly biopsied in the outpatient setting. They may present as clinically benign masses, but the pathological evaluation and diagnosis is important in establishing the correct management. CASE: A 41-year-old El Salvadoran woman presented with a nontender vulvar mass of over 12 years' duration that had enlarged rapidly over the past 8 months. After surgical excision, the pathologic diagnosis was a rare lipomatous variant of angiomyofibroblastoma. CONCLUSION: The lipomatous form of angiomyofibroblastoma is a very rare vulvar tumor, and to our knowledge 8 have been identified and we present the ninth. Although it is benign, there is an aggressive variant of angiomyofibroblastoma that is locally invasive and requires wide local excision to prevent recurrence.

Breast cancer in reproductive age. The new plaque or just myth?

It is interesting to assess the hitherto knowledge, on breast cancer in reproductive and young females, aged <35. Even if breast cancer is rare in this group, it is, also physically and emotionally devastating. It is characterized by worse prognosis and outcome, in a stage of life, which is delicate for the female patients. This rare subgroup of breast cancer patients is ought to be the center of investigation in future studies. This paper's mail goal is to elucidate this entity, by presenting several aspects of the disease including risk factors, therapy, natural history and major differences between the groups of breast cancer patients and last but not least, the psychosocial features of this clinical entity, by reviewing the current and past medical literature till April 2011.

Combined side-to-end anastomosis with temporary end colostomy for the management of selected left-sided colonic emergencies.

Management of surgical emergencies of the left colon commonly requires excision of the colonic segment bearing the lesion, creation of an end colostomy, and closure of the rectosigmoid stump. Closure of the end stoma may be technically challenging. During this study, we used a new surgical technique involving the creation of an end-to-side anastomosis of the rectosigmoid stump to the base of the proximal colonic segment in association with an end colostomy. During a 15-year period, 23 patients were offered this type of surgery. Mortality was zero. Complications were observed in seven patients (morbidity, 7/23). Mean hospitalization time was 12.3 days. Closure of the colostomy was performed approximately 1 month after initial surgery and was easily performed using a mechanical stapler, either intraperitoneally or even extraperitoneally. No complications were observed after closure of the colostomy. The described technique is a useful alternative for the management of selected patients with left-sided colonic surgical emergencies. Its main advantage is that it greatly facilitates colostomy closure, which is performed earlier compared with the colostomy closure after a typical Hartmann's procedure.

Lymphedema and breast cancer: a review of the literature.

Breast cancer continues to be the most common malignancy among women in the United States. Despite its high incidence, early detection and modern treatment have made long-term survival more common. One of the most important sequelae of the treatment of breast cancer is the development of lymphedema. There are many issues for women to deal with after treatment for breast cancer. Focusing on the quality of life after breast cancer means dealing with issues such as an altered body image, changes in relationships with partner and children, living with any ongoing side effects, and the fear of tumor recurrence. The objective of this paper is to elucidate these issues concerning lymphedema.

Medullary thyroid carcinoma: The third most common thyroid cancer reviewed.

Medullary thyroid cancer is a type of thyroid cancer of neuroendocrine origin. It occurs in hereditary and sporadic forms, and its aggressive behavior is associated with the clinical presentation and type of RET mutation. Total thyroidectomy remains the ideal choice of treatment. Early diagnosis and treatment are the fundamental for a 100% cure rate. In this study, we present our experience of 3 cases, along with a complete review of the literature derived from a Pubmed Database search.

Intracystic Papillary Carcinoma of the Breast in Males. In Search of the Optimal Treatment for this Rare Disease.

Intracystic papillary carcinoma (IPC) of the breast in men is an extremely infrequent disease, and it appears to have a good prognosis. Because of this, histological findings are of great importance in the decision-making process regarding treatment. Clinical examination, radiological and histological assessments are required for early detection. Adequate surgical excision with negative margins is mandatory. However, the role of sentinel node biopsy has not been evaluated in male IPC. It appears that sentinel node biopsy may be an excellent alternative to radical axillary dissection in patients with IPC and associated ductal carcinoma in situ or invasive carcinoma. Nevertheless, due to the rarity of IPC and its confusing histopathological classification and staging, there are still no clear guidelines as far as IPC treatment is concerned.

Cell cyclins: triggering elements of cancer or not?

Cyclins are indispensable elements of the cell cycle and derangement of their function can lead to cancer formation. Recent studies have also revealed more mechanisms through which cyclins can express their oncogenic potential. This review focuses on the aberrant expression of G1/S cyclins and especially cyclin D and cyclin E; the pathways through which they lead to tumour formation and their involvement in different types of cancer. These elements indicate the mechanisms that could act as targets for cancer therapy.

Recapitulation of ras oncogene mutations in breast cancer.

Several human breast cancer cell lines have been shown to contain mutational activation of Ras oncogenes. The goal of this review is to clarify the physiology and biochemical pathways of Ras family oncogenes in order to understand thoroughly the mechanisms behind Ras gene mutations. Ras genes are involved in the early stages of mammary oncogenesis through augmented expression of the normal p21 protein. Recognition of the mechanisms resulting in aberrant expression of Ras, as well as unveiling the influence of the Ras family gene activation in the Ras signaling pathway, should have a major impact on clarifying the oncogenetic process, possibly offering candidate therapy and prevention strategies.

Walled-off pancreatic necrosis.

Walled-off pancreatic necrosis (WOPN), formerly known as pancreatic abscess is a late complication of acute pancreatitis. It can be lethal, even though it is rare. This critical review provides an overview of the continually expanding knowledge about WOPN, by review of current data from references identified in Medline and PubMed, to September 2009, using key words, such as WOPN, infected pseudocyst, severe pancreatitis, pancreatic abscess, acute necrotizing pancreatitis (ANP), pancreas, inflammation and alcoholism. WOPN comprises a later and local complication of ANP, occurring more than 4 wk after the initial attack, usually following development of pseudocysts and other pancreatic fluid collections. The mortality rate associated with WOPN is generally less than that of infected pancreatic necrosis. Surgical intervention had been the mainstay of treatment for infected peripancreatic fluid collection and abscesses for decades. Increasingly, percutaneous catheter drainage and endoscopic retrograde cholangiopancreatography have been used, and encouraging results have recently been reported in the medical literature, rendering these techniques invaluable in the treatment of WOPN. Applying the recommended therapeutic strategy, which comprises early treatment with antibiotics combined with restricted surgical intervention, fewer patients with ANP undergo surgery and interventions are ideally performed later in the course of the disease, when necrosis has become well demarcated.