Mastopathy in insulin-requiring diabetes mellitus.

Diabetic mastopathy is a recently described collection of histopathological features found in dense fibrous breast masses in insulin-requiring diabetics. Fifty-seven breast biopsy specimens showing nonspecific benign disease were examined in a blinded fashion from 21 diabetics (seven insulin-requiring, 14 non-insulin-requiring), 30 age-matched controls and six patients with thyroid disease. Five diabetics had the constellation of extensive keloidal fibrosis, mononuclear perivasculitis, and mononuclear ductitis and/or lobulitis, whereas none of the controls or patients with thyroid disease had all of these features. All five patients with diabetic mastopathy were insulin-requiring (two type I, three type II). Epithelioid fibroblasts in the stroma, a previously described component of this constellation, were present in three of the five cases but do not appear to be essential in making the diagnosis. Four of the five diabetics were hypertensive, and three had secondary diabetic complications. The mean duration of diabetes in the five patients was greater than 13 years. Based on a previous report and the current study, this constellation of histological features appears to be relatively specific for insulin-requiring diabetes mellitus. The single clinical factor common to all patients with diabetic mastopathy in this article and in a previous study was exogenous insulin use.

Special considerations when treating breast cancer in the elderly.

The growing aging population of the U.S. will lead to an absolute and proportional increase in elderly women with breast cancer. While the underlying biologic characteristics of the disease will not likely change, the health status and life expectancy of the patients will improve. Our decisions regarding therapy must take into account not just the disease we are treating, but the characteristics of the host as well.

Relationship of the size of the invasive component of the primary breast carcinoma to axillary lymph node metastasis.

BACKGROUND: Invasive ductal carcinomas of the breast frequently have an intraductal (in situ) component at the tumor periphery that, in some cases, is included in the measurement of the tumor and thereby increases the size of the tumor beyond that of the invasive component. METHODS: Thirty-seven ductal carcinomas containing intraductal and invasive components were analyzed. The total tumor size, the size of the invasive component, the percentage of intraductal component, and the estimated tumor volume were assessed for each tumor. RESULTS: The mean size of the invasive component was 6.5 mm in axillary lymph node negative patients and 14.3 mm in those with axillary lymph node metastasis (P = 0.0001). The mean total tumor size was 13.7 mm and 17.6 mm (P = 0.035) and the mean percent of intraductal component was 52% and 26% (P = 0.015) in patients with negative and positive axillary lymph nodes, respectively. Ninety-two and four tenths percent of the difference in mean estimated total tumor volume between patients with negative and positive axillary lymph nodes was attributable to the difference in the volume of the invasive component alone. CONCLUSIONS: In small ductal carcinomas of the breast, the size of only the invasive component, as determined by microscopic measurement, is a better predictor of axillary lymph node status than is the total tumor size. The well established prognostic value of total tumor size largely is due to its reflection of the size of the invasive component.

A prospective randomized study of sutured versus stapled bowel anastomoses in patients with cancer.

Eighty-eight cancer patients with the presence of one or more adverse factors for healing (carcinomatosis, adhesions, prior chemotherapy and radiation therapy, bowel obstruction, anemia, and low leukocyte count or albumin value) were prospectively randomized to undergo conventional two-layer hand suturing (45 patients) or mechanical stapling with a GIA/TA instrument (U.S. Surgical Corp., Norwalk, CT) (43 patients) of the large or small bowel anastomosis. Age, sex, complete blood count findings, and all biochemical plasma values were comparable in both groups. The anastomosis took an average of 19 minutes for the sutured and 9 minutes for the stapled technique (P = 0.0001), but the average length of operation, postoperative return of bowel function, and hospital stay were comparable in both groups. Bowel fistula was seen in one case of stapled anastomosis (P = not significant). The pulmonary and wound complication rates were the same in both groups. Of the four deaths (4.5%) due to causes unrelated to bowel anastomosis, three occurred in the stapled and one in the sutured group. It was concluded that a stapled anastomosis is as safe as a sutured one in patients with advanced-stage cancer. It saves time in anastomosis, but does not save time in postoperative return of the bowel function and hospital stay.