Effect of time to breast cancer surgery after neoadjuvant chemotherapy on survival outcomes.

BACKGROUND: Neoadjuvant chemotherapy (NACT) is a cornerstone in managing breast cancer. There is no defined consensus on the optimal time between NACT and surgery. We analyze the effect of time between the end of NACT and surgery on overall survival (OS) and disease-free survival (DFS) in breast cancer patients who received NACT followed by surgery. METHODS: This is a retrospective analysis of 468 patients with breast cancer (stage I-III) who received and completed the same regimen of NACT (Anthracyclines and Taxanes B27 protocol) at King Hussein Cancer Center (KHCC) (2006-2014). Patients have been divided into three groups according to the duration between the end of NACT and surgery, <4 weeks, 4-8 weeks and >8 weeks. RESULTS: Most patients were stages II-III breast cancer with only four patients with stage I. Almost all patients (99%) had either invasive ductal or invasive lobular carcinomas. Adjuvant radiotherapy was given to 96% of patients. Most patients were alive at the time of analysis (84%). Complete pathological response was achieved in 20% of patients. Local recurrence rate was 6.6% with a median follow up of 3.8 years (interquartile range 0.6-10.9). Analysis showed that the groups had equivalent DFS. However, OS was adversely affected if patients had their surgery after 8 weeks of NACT compared to those who had their surgery between 4 and 8 weeks. CONCLUSIONS: Breast cancer surgery post NACT within the first 8 weeks had no impact on survival. However, surgery after 8 weeks of NACT showed negative impact on OS. Therefore, delaying surgery after 8 weeks is not recommended.

Amphicrine carcinoma of the right colon, a report of a case and review of literature.

Mixed neuroendocrine and non-neuroendocrine neoplasms, recently recognized in the WHO classification as (MiNEN), are rare tumors of the gastrointestinal tract. These tumors are composed of two distinct cellular components; a well- or poorly differentiated neuroendocrine tumor and a non-neuroendocrine tumor, usually in the form of an adenocarcinoma, either admixed with or adjacent to one another. A rarer phenotype is a tumor in which the endocrine and epithelial cell features occur within the same cell; i.e. amphicrine carcinoma. Herein, we report the case of an 80-year-old female patient who presented with melena, and who, on biopsy was diagnosed as amphicrine carcinoma that was mismatch repair deficient (MMRd) with loss of MLH1/PMS2 nuclear expression by immunohistochemistry. The histological and immunohistochemical findings of this rare entity are presented with review of pertinent literature.

Solitary fibrous tumour of the gallbladder: A rare case report.

INTRODUCTION AND IMPORTANCE: Solitary fibrous tumours are rare mesenchymal neoplasms with limited malignant potential that can occur anywhere in the body, with a predilection towards body cavities such as the pleura. It has been reported to arise in the peritoneum and the mesentery. CASE PRESENTATION: This is a case of a female patient who presented with an incidental abdominal mass compressing the duodenum. Differential diagnosis included GIST and intra-operatively was found to be arising from the gallbladder. En-bloc cholecystectomy was done and diagnosed a solitary fibrous tumour. CLINICAL DISCUSSION: This is the second case of gallbladder solitary fibrous tumour reported in the literature. CONCLUSION: Awareness of this rare entity is important for diagnosis and treatment.

Inverted appendix in a patient with colon cancer: a case report and long-term follow-up.

Appendiceal inversion is a rare entity that can potentially mimic serious pathology and provide diagnostic uncertainty. They are mostly diagnosed intraoperatively or during endoscopies and scans for other reasons. We report a case of an asymptomatic patient treated for colon cancer without previous history of appendectomy. We provide long-term follow-up and aim to review the relevant literature.