Triple negative breast cancer: therapeutic and prognostic implications.

Triple negative breast cancers (TNBC) lack oestrogen receptor (ER), progesterone receptor (PR), nor over-express human epidermal growth factor receptor 2 (HER2). Epidemiologic studies demonstrate that women diagnosed with TNBC manifest a significantly different set of clinic-pathologic features and risk factors when compared to women with other subtypes of breast cancer. They are associated with poor prognosis, as defined by low five-year survival. To date many studies have examined the utility of traditional chemotherapy for the treatment of patients with TNBC and have confirmed the benefits of these agents in both the adjuvant and neoadjuvant settings. Targeted therapy options involving PARP1 and EGFR inhibition, are currently in different phases of development and will hopefully change the paradigm of how patients with TNBC are treated. The present commentary aims to summarize the latest findings on chemotherapy in the treatment of TNBC in both the neoadjuvant and adjuvant setting and explore the ongoing development of newer targeted agents.

Multiple myeloma presenting as cervical lymphadenopathy in a 16-year-old boy.

A 16-year-old boy presented with cervical lymphadenopathy and histological features of a plasmacytoma. He was found to have lytic bone lesions, a serum IgA M-protein, and elevated beta 2-microglobulin. There was absence of anemia, hypercalcemia, and marrow plasmacytosis. He received local irradiation and 6 courses of chemotherapy comprising vincristine, adriamycin, and dexamethasone given at 4 weekly intervals. This was followed by complete resolution of his disease, and he remains clinically well 5 years after completion of therapy.

Ultrasonography of the lower limbs for deep vein thrombosis at the University Hospital of the West Indies

A study was conducted on all patients referred to the ultrasound service of the radiology department of the University Hospital of the West Indies, Kingston, Jamaica, for evaluation of a clinical diagnosis of thrombosis of the deep veins of the lower limb, during the period January 1, 1995, to December 31, 1999. The calf veins were not routinely examined; this study was limited to the popliteal, superficial and deep femoral veins. Two hundred and seventy-four females and 104 males were referred. Seventy females and 32 males had ultrasound findings of deep thrombosis (DVT). The significant findings were that the male: female ratio for confirmed DVT was approximately 1:2; 26 percent of referrals had DVT on ultrasound; DVT was more common on the left and the popliteal vein (48 percent) and the superficial femoral vein (47 percent) accounted for most documented cases of DVT but thrombosis of the profunda femoral vein was unusual accounting for only 5 percent of cases. (AU)

Male breast cancer - an analysis of four cases and review of the literature

We report the cliniopathological features and outcome of four cases of carcinoma of the male breast diagnosed at the University Hospital of the West Indies between 1988 and 1998. Male breast cancer is most commonly seen in men over age sixty years, and it exhibits the same prognosis, stage for stage, as the disease in females. However, some researchers report overall poorer survival in men, and explain this on the basis of advanced disease at presentation. Other researchers maintain that the majority of breast cancers in males present at early stages, and exhibits survival similar to that in females. The published literature concerning this uncommon malignancy is reviewed, and the data are compared with the features of our cases.(Au)

Clear cell sarcoma of soft parts. A case report and review of the literature

The case of a 25-year old woman with recurring and metastasizing clear cell sarcoma of parts (CCS) is presented. The clinical setting and pathological apperance were in agreement with the original cases described. This report serves to highlight the clinico-pathological features of this rare and aggressive malignancy with specific reference to prognostic markers and treatment. (AU)

Retrospective audit of blood donation at a Hospital-based blood centre: Implications for blood product supply and safety

An audit of blood donation at the University Hospital of the West Indies (UHWI) was performed between January 1995 and December 1998. During these four years, 21,733 persons attended the blood collection centre and 6,711 (30.8 percent) were rejected as donors. Females accounted for 3, 054 (45.6 percent) of rejected donors while 3,647 (54.4 percent) were males. Females were rejected primarily because of low haemoglobin levels, while rejection was most frequently attributed to symptoms of the common cold and recent drug use. One hunderd and two rejected donors (1.5 percent) admitted to recent treatment of a sexually transmitted disease, and 138 (2.0 percent) presented within 16 weeks of a prior donation. Of 15,022 units donated, altruistic voluntary donations accounted for 307 (2 percent) and 53 (0.3 percent) were autologous donations. Seven hundred and four units (4.6 percent) were discarded because of positivity on initial testing for a marker of transmissible infection. Overall prevalence for markers of infection was 2.5 eprcent for HTLV-1, 0.9 percent for Hepatitis B and 0.4 percent for HIV I/II. Donations at the University Hospital of the West Indies (UHWI) collection centre contributed 15.8 percent of the national blood supply for the period under study.(Au)

Prevalence of risk factors in breast cancer patients at the University Hospital of the West Indies

The records of 120 consecutive patients diagnosed with carcinoma of the breast were examined between July 1996 and June 1999 in order to estimate the prevalence of established risk factors for this disease. Early menarche was present in 5.5 percent of patients, while 36 subjects (30 percent) were mulliparous and 6 (5 percent) had a first live birth after age 30 years. Four subjects had a previous biopsy with histological features of atypical hyperplasia. Fifteen subjects (12.5 percent) had one or more affected first degree relatives. Fifty-four percent of subjects possessed none of the risk factors examined in this study while 36 percent had a single risk factor and 10 percent possessed two risk factors. There was no significant clustering of risk factors in the group of patients aged thirty-five years or less. Larger studies should be encouraged to identify the risk factors which operate in our population and the degree to which published predictive variables are applicable.(AU)

Solid and Papillary epithelial neoplasm. Ultrasound and CT features of an unusual pancreatic tumour

The ultrasonographic and computed tomography features of four cases of solid and papillary epithelial neoplasm (SPEN) - a rare pancreatic tumour - are described. Although not diagnostic, the presence of these imaging features in the typical clinical setting may permit pre-operative radiological diagnosis and facilitate planning for curative surgery for this malignant tumour which has an excellent prognosis even without further adjuvant therapy.(Au)

Young patients with stroke at the UHWI - the CT findings - Poster presentation

There is not much data on young patients with stroke (< 50 yrs) from the Caribbean. This paper sought to identify the types of stroke seen in young, Caribbean patients, with a view to noting trends and suggesting intervention strategies. The study is a retrospective review of patients (<50 yrs with stroke who had Computerised Tomography (CT scans) of the brain at the UHWI, from January 1, 1998 to December 31, 1998. Data were collated from the CT register of the Xray Department of UHWI. Results were available for 81 patients (43 females and 38 males). Overall, 62 percent of study sample had infarct (71 percent males, 38 percent females), 27 percent intra-cerebral bleed (15 percent males, 34 percent females); 11 percent subarachnoid haemorrhages. In females 11 - 40 yrs, 61 percent of CVAs were on the right and 39 percent on the left; between 41 and 50 yrs. 92 percent of CVAs were left sided and 8 percent on the right. In males 11 - 40 yrs, 66 percent of CVAs were on the right and 33 percent on the left; between 41 and 50 yrs, 45 percent were on the right and 55 percent on the left. This preliminary study suggests that in the population reviewed, there is a similar incidence of CVAs in males and female. Infarcts are the most common results of a CVA followed by intra-cerebral bleed and subarachnoid haemorrhage. Infarcts are more common in males than females whilst intracerebral bleeds are more common in females. Under the age of 41 yrs, CVA is more common on the right than the left whilst between 41 and 50 yrs, they are more common on the left; this is more so in females in whom 92 percent of lesions were on the left in the age group 41 - 50 years.(AU)

Cancrum oris (noma) in a patient with acute lymphoblastic leukaemia. A complication of chemotherapy induced neutropenia

Cancrum oris (noma) has been most commonly described in malnourished debilitated children with poor oral hygiene following systemic childhood infections such as measles, pertussis or scarlet fever. We describe a patient who developed this condition during a period of profound neutropenia following cytotoxic chemotherapy for acute lymphoblastic leukaemia(AU)

Autoimmune haemolytic anaemia, immune thrombocytopenia, and leucopenia - an unusual presentation of hodgkin's disease

We report an unusual case of modular sclerosing Hodgkin's disease in a 17 year old women presenting with intermittent fever, progressive weight loss and enlarged cervical and anxillary lymp nodes. Laboratory test revealed severe Coombs' positive haemolytic anaemia, and progressive thrombocytopenia and leucopenia, associated with erythroid, myeloid and megakaryocytic hyperplasia, but with no evidence of lymphomatous infiltration in the bone marrow. Transfusion of compatible blood became possible only after prednisone therapy and a single intravenous dose of vincristine. Appropriate chemotherapy led to normalization of the peripheral blood counts and a negative direct Coombs' test.(AU)