Intrathecal miR-183 delivery suppresses mechanical allodynia in mononeuropathic rats.

Members of the miR-183 family are unique in that they are highly abundant in sensory organs. In a recent study, significant downregulation was observed for miR-96 and miR-183 in the L5 dorsal root ganglion (DRG) 2 weeks after spinal nerve ligation (SNL). In this study, we focused on miR-183, which is the most regulated member of the miR-183 family, to look at the specific role on neuropathic pain. Persistent mechanical allodynia was induced with the L5 SNL model in 8-week-old male Sprague-Dawley rats. Paw withdrawal thresholds in response to mechanical stimuli were assessed with Von Frey filaments. Expression of miR-183 in the L5 DRG was assessed with quantitative real-time polymerase chain reaction (qPCR) analysis. Lentivirions expressing miR-183 were injected intrathecally into SNL rats. Changes in mechanical allodynia were assessed with Von Frey filaments. In addition, changes in the predicted target genes of miR-183 were assessed with qPCR. L5 SNL produced marked mechanical allodynia in the ipsilateral hindpaws of adult rats, beginning at postoperative day 1 and continuing to day 14. L5 SNL caused significant downregulation of miR-183 in adult DRG cells. Intrathecal administration of lentivirions expressing miR-183 downregulated SNL-induced increases in the expression of Nav1.3 and brain-derived neurotrophic factor (BDNF), which correlated with the significant attenuation of SNL-induced mechanical allodynia. Our results show that SNL-induced mechanical allodynia is significantly correlated with the decreased expression of miR-183 in DRG cells. Replacement of miR-183 downregulates SNL-induced increases in Nav1.3 and BDNF expression, and attenuates SNL-induced mechanical allodynia.

Pulsed radiofrequency reduced complete Freund's adjuvant-induced mechanical hyperalgesia via the spinal c-Jun N-terminal kinase pathway.

Pulsed radiofrequency (PRF) treatment involves the pulsed application of a radiofrequency electric field to a nerve. The technology offers pain relief for patients suffering from chronic pain who do not respond well to conventional treatments. We tested whether PRF treatment attenuated complete Freund's adjuvant (CFA) induced inflammatory pain. The profile of spinal c-Jun N-terminal kinases (JNKs) phosphorylation was evaluated to elucidate the potential mechanism. Injection of CFA into the unilateral hind paw of rats induced mechanical hyperalgesia in both the ipsilateral and contralateral hind paws. We administered 500-kHz PRF treatment in 20-ms pulses, at a rate of 2 Hz (2 pulses per second) either to the sciatic nerve in the mid-thigh, or to the L4 anterior primary ramus just distal to the intervertebral foramen in both the CFA group and no-PRF group rats. Tissue samples were examined at 1, 3, 7, and 14 days following PRF treatments. Behavioral studies showed that PRF applied close to the dorsal root ganglion (DRG) significantly attenuated CFA-induced mechanical hyperalgesia compared to no-PRF group (P < .05). And western blotting revealed significant attenuation of the activation of JNK in the spinal dorsal horn compared to no-PRF group animals (P < .05). Application of PRF close to DRG provides an effective treatment for CFA-induced persistent mechanical hyperalgesia by attenuating JNK activation in the spinal dorsal horn.

Effectiveness of question prompt lists in patients with breast cancer: A randomized controlled trial.

OBJECTIVES: To evaluate the effectiveness of a question prompt list (QPL) in decision self-efficacy, decision-making participation, patient-physician communication, decisional conflict or regret, and health status in patients with breast cancer. METHODS: A total of 240 patients with breast cancer were randomly assigned to a QPL group or control group (n = 120 each). The intervention and control groups received an additional educational QPL booklet and routine care, respectively. RESULTS: The intervention group exhibited significant improvements in decision self-efficacy, perceived patient-physician interactions, and patient-physician communication compared with the control group. Multilevel modeling analyses revealed significant group-time interaction effects on decision self-efficacy (ß = 9.99, P < 0.01), perceived patient-physician interactions (ß = 8.10, P < 0.01), patient-physician communication (ß = 5.02, P < 0.01), and anxiety status (ß = -3.78, P < 0.05). The QPL intervention exerted more favorable effects than routine care, with repeated measurements of the same patients and the data of patients under the care of the same surgeons accounted for. CONCLUSIONS: The QPL intervention exerted multidimensional effects on decision-making outcomes among patients with breast cancer. PRACTICAL IMPLICATIONS: Clinicians can integrate a QPL into routine care for patients with breast cancer.

Cellular changes in hepatocytes and intestinal endothelium after hepatoduodenal ligament occlusion and protective effects of caspase inhibition.

INTRODUCTION: Hepatic vascular control is used by many surgeons to prevent massive hemorrhage during hepatectomy. However, this may carry a risk of ischemic damage to the hepatocytes. Another major drawback of intraoperative occlusion of the hepatoduodenal ligament is portal stasis with resultant intestinal congestion which may cause adverse effects on the intestinal functions. CD44 is a transmembrane glycoprotein present in many types of epithelial cells. By mediating the attachment of dividing crypt cells to the basal lamina via hyaluronan, CD44 is considered to play a role in maintaining the intestinal villus integrity. Apoptosis is a pathway of cell death orchestrated by a family of proteases called caspases. ZVAD-fmk is a cell-permeable irreversible inhibitor of caspase and might block the processing of many caspases. This study is designed with the purpose to evaluate the impact of intraoperative occlusion of the hepatoduodenal ligament on hepatocyte and intestine functions and also to evaluate the potential influence of ZVAD-fmk on the hepatocyte and intestine functions. MATERIALS AND METHODS: Male Sprague-Dawley rats were randomized to 5 groups. Group 1(C) underwent sham operation. Group 2 (HDL30) underwent occluding the hepatoduodenal ligament by for 30 minutes. Group 3 (HDL 15) underwent occluding the hepatoduodenal ligament by for 15 minutes, releasing for 5 minutes, underwent occlusion for another 15 minutes. Group 4 (ZHDL30) first received ZVAD-fmk, then underwent occluding the hepatoduodenal ligament by for 30 minutes. Group 5 (ZHDL15) first received ZVAD-fmk, then underwent occluding the hepatoduodenal ligament for 15 minutes, releasing for 5 minutes, underwent occlusion for another 15 minutes. After removing the temporary occlusion, liver tissue and proximal jejunum were harvested. Hepatocyte and intestine apoptosis were quantitated using the TUNEL method. CD 44 status of jejunum were determined by immunohistochemical staining. RESULTS: Hepatocyte apoptosis was significantly increased in group (HDL30) and group (HDL15) when compared with group (C). ZVAD-fmk effectively attenuated this phenomenon in both groups. There was no significant difference between group (HDL30) and group (HDL15). Jejunal apoptosis was significantly increased in group (HDL30) and group (HDL15) when compared with group (C). ZVAD-fmk effectively attenuated this phenomenon in both groups. There was no significant difference between group (HDL30) and group (HDL15). CD44 expression on jejunum was significantly increased in group (HDL30) and group (HDL15) when compared with group (C). ZVAD-fmk failed to effectively diminish this phenomenon. CONCLUSION: Occlusion of the hepatoduodenal ligament significantly increased both hepatocyte and jejunal apoptosis and pretreatment with ZVAD-fmk could effectively diminish such phenomenon. CD44 expression on jejunum was also significantly increased by intraoperative occlusion of the hepatoduodenal ligament, yet pretreatment with ZVAD-fmk failed to show significant effect on such phenomenon.

GADD45A protects against cell death in dorsal root ganglion neurons following peripheral nerve injury.

A significant loss of neurons in the dorsal root ganglia (DRG) has been reported in animal models of peripheral nerve injury. Neonatal sensory neurons are more susceptible than adult neurons to axotomy- or nerve growth factor (NGF) withdrawal-induced cell death. To develop therapies for preventing irreversible sensory cell loss, it is essential to understand the molecular mechanisms responsible for DRG cell death and survival. Here we describe how the expression of the growth arrest- and DNA damage-inducible gene 45α (GADD45A) is correlated with neuronal survival after axotomy in vivo and after NGF withdrawal in vitro. GADD45A expression is low at birth and does not change significantly after spinal nerve ligation (SNL). In contrast, GADD45A is robustly up-regulated in the adult rat DRG 24 hr after SNL, and this up-regulation persists as long as the injured fibers are prevented from regenerating. In vitro delivery of GADD45A protects neonatal rat DRG neurons from NGF withdrawal-induced cytochrome c release and cell death. In addition, in vivo knockdown of GADD45A expression in adult injured DRG by small hairpin RNA increased cell death. Our results indicate that GADD45A protects neuronal cells from SNL-induced cell death.

Gene transfer of IGF1 attenuates hepatocellular apoptosis after bile duct ligation.

BACKGROUND: Cholestasis occurs in a wide variety of human liver diseases, and hepatocellular injury is an invariant feature of cholestasis, causing liver dysfunction and inflammation, promoting fibrogenesis, and ultimately leading to liver failure. Insulin-like growth factor 1 (IGF1) acts in an autocrine and paracrine manner to promote glucose utilization, using phosphatidylinositol 3 kinase (PI3 K)/Akt, the downstream glycogen synthase kinase 3ß (GSK3ß), and anti-apoptotic pathways. This study investigated whether gene transfer of IGF1 could attenuate hepatocellular injury after bile duct ligation in rats. MATERIALS AND METHODS: Experiments were performed in 80 male Sprague-Dawley rats. Thirty minutes after bile duct ligation, hydrodynamics-based gene transfection with IGF1 plasmid via rapid tail vein injection. The rats were randomly divided into the following four groups: sham operated; BDL treated with pCMV-IGF1 gene; BDL treated with vehicle for pCMV-LacZ gene; and BDL only. RESULTS: IGF1 expression in liver after a single administration of IGF-1 plasmid was demonstrated. Liver function index, including serum alanine aminotransferase and aspartate aminotransferase, were significantly reduced in IGF1 gene transfer rats. We determined the mechanism of IGF1 gene transfer after BDL in terms of activation of Akt, inhibition of GSK3ß, and blockage of caspase-9 cleavage. Furthermore, hepatocyte stellate cell activation was markedly inhibited in IGF1 gene-treated rats. Apoptosis was significantly attenuated by IGF1 gene therapy. CONCLUSIONS: This study demonstrated that gene transfer of IGF1 could attenuate hepatocellular apoptosis and injury after bile duct ligation in rats.

Noninvasive positive pressure ventilation in the management of post-thyroidectomy tracheomalacia.

BACKGROUND: Post-thyroidectomy tracheomalacia is a rare but complicated problem. It has often been treated with tracheostomy or prolonged endotracheal intubation. However, noninvasive positive pressure ventilation (NPPV) has been successfully employed with increasing frequency in patients with respiratory failure from other causes. In the present study we describe the use of NPPV in the management of respiratory distress in patients with post-thyroidectomy tracheomalacia. METHODS: All 606 patients who underwent thyroidectomy in Chung Gung Memorial Hospital - Kaohsiung Medical Center, Taiwan, from January 2009 to August 2010 were reviewed. If tracheomalacia was diagnosed intraoperatively, the patients were left intubated and taken to the intensive care unit (ICU) (n = 5). If tracheomalacia was diagnosed in the recovery room (stridor and airway compromise not from other causes), the patient was reintubated promptly and taken to the ICU (n = 4). When subsequently re-extubated in the ICU (24-72 h later), NPPV was used to treat recurrent stridor and airway compromise. RESULTS: A total of nine patients (1.5 %) were diagnosed with post-thyroidectomy tracheomalacia, five intraoperatively and four postoperatively. The patients were intubated with an endotracheal tube and then taken to the ICU. After early re-extubation in the ICU, three of the patients with intraoperatively diagnosed tracheomalacia were found not to have respiratory problems, whereas the other six patients developed stridor and airway compromise, which resolved immediately with the initiation of NPPV. Hemoglobin oxygen saturation on pulse oximetry was also elevated. No further respiratory support was required and no complications occurred in these patients. CONCLUSIONS: Noninvasive positive pressure ventilation is effective and appears safe in the management of stridor and airway compromise following early extubation in patients with post-thyroidectomy tracheomalacia.

Sonoporation-mediated gene transfer into adult rat dorsal root ganglion cells.

BACKGROUND: Gene transfer into many cell types has been successfully used to develop alternative and adjunct approaches to conventional medical treatment. However, effective transfection of postmitotic neurons remains a challenge. The aim of this study was to develop a method for gene transfer into rat primary dorsal root ganglion neurons using sonoporation. METHODS: Dissociated cells from adult rat dorsal root ganglion (DRG) cells were sonicated for 1-8 s at 2.5-10 W to determine the optimal ultrasound duration and power for gene transfection and cell survival. Transfection efficiency was compared between sonoporation, liposome and lentiviral vector gene transfer techniques. RESULTS: The optimum ultrasound intensity was 5 W for 2 s and yielded an efficiency of gene transfection of 31% and a survival rate of 35%. CONCLUSIONS: Sonoporation can be optimized to minimize cell death and yield a high percentage of transfected neurons and that this technique can be easily applied to primary cultures of rat dorsal root ganglion neurons.

Antithrombin-III attenuates hepatocyte apoptosis in bile duct ligated rat: a striking cellular change.

BACKGROUND AND PURPOSE: Retention and accumulation of toxic hydrophobic bile salts within hepatocyte may cause hepatocyte toxicity by inducing apoptosis. This study was designed with the purpose of evaluating the possible effect of antithrombin-III on hepatocyte apoptosis in bile duct ligated rat. MATERIALS AND METHODS: The rats were randomized to 3 groups: group 1 (control, C) underwent sham operation; group 2 (obstructive jaundice, OB) underwent common bile duct ligation; and group 3 (obstructive jaundice with antithrombin-III, OBAT-III) underwent common bile duct ligation and simultaneously were treated with antithrombin-III. Liver tissues were harvested on the fifth postoperative day. RESULTS: Hepatocyte apoptosis was significantly increased in bile duct ligated group when compared with the sham operation group. The administration of antithrombin-III effectively attenuates such phenomenon in obstructive jaundice with antithrombin-III group. CONCLUSION: Bile duct ligation significantly increased hepatocyte apoptosis and the administration of antithrombin-III effectively attenuates such phenomenon.

Afamin expression in breast cancer.

BACKGROUND: Breast cancer is a collection of molecularly and clinically distinct neoplastic disease. Recent research has shown the information regarding gene expression in breast cancer could be beneficial in the designing of an optimal treatment plan and may also provide with prognostic information. The creation of tissue microarrays (TMA) allows for the rapid immunohistochemical analysis of thousands of tissue samples in parallel with minimal damage to the original blocks. This study was designed with the application of tissue microarray (TMA) to analyze the afamin status in breast cancer with the hope of elucidating the possible relationship between afamin expressions and breast cancer. METHODS: Archival tissue specimens from 106 patients with primary invasive breast cancer were analyzed for afamin expression by immunhistochemical staining with TMA. Results were compared to clinicopathologic data by multivariate analysis. RESULTS: TNM stage has shown significant relationship to the overall 5-year survival rate. However, afamin expression was not significantly related to overall five-year survival. CONCLUSION: Immunohistochemical staining with TMA was convenient and feasible for analyzing afamin expression status in breast cancer. Our preliminary results show that afamin expression showed no significant prognostic value in breast cancer.

Insulin-like growth factor-binding protein-3 in breast cancer: analysis with tissue microarray.

BACKGROUND: IGFBP-3 has been reported to be growth-stimulatory. The creation of tissue microarray (TMA) allows for the rapid immunohistochemical analysis of thousands of tissue samples in a parallel fashion. This study was designed with the application of TMA to analyze the IGFBP-3 status in breast cancer with the hope to elucidate the possible relationship between IGFBP-3 expression and breast cancer biology. MATERIALS AND METHODS: Archival tissue specimens from 97 patients with primary invasive breast cancer were selected. The IGFBP-3 expression was analyzed by TMA. The data of primary tumor staging, age, estrogen receptor status, lymph node status, histological grading and TNM staging were also collected. RESULTS: There were 40 patients (41%) with 0-1 expression of IGFBP-3, 52 patients (54%) with 2 expression of IGFBP-3 and 5 patients (5%) with 3 expression in IGFBP-3. By multivariate analysis, the IGFBP-3 expression turned out to be significantly related to the overall five-year survival rate. CONCLUSION: The preliminary results about IGFBP-3 expression in breast cancer are intriguing and require further evaluation.

Z-LLY-FMK attenuates intestinal apoptosis after bile duct ligation in rats.

Apoptosis is an important process in a wide variety of different biological systems. In addition to caspases, recently, calpains, another family of proteases, have been found to be involved in apoptosis of many cell systems. This study is designed with the aims to evaluate the possible effect of Z-LLY-FMK (a calpain inhibitor) on intestine apoptosis after bile duct ligation in rats. Male Sprague-Dawley rats weighing 250-300 g were randomized to five groups (n = 6 in each group). Group 1 (CONTROL: C) underwent Sham operation and were simultaneously treated with the same amount of normal saline. Group 2 (CONTROL with DMSO: CDMSO) underwent Sham operation and were simultaneously treated with the same amount of dimethylsulfoxide (DMSO). Group 3 (Obstructive jaundice: OB) underwent common bile duct ligation without any other manipulation. Group 4 (Obstructive jaundice with Z-LLY-FMK: OBZLLY) underwent common bile duct ligation and were simultaneously treated with Z-LLY-FMK (dissolved in DMSO). Group 5 (Obstructive jaundice with ZFA-FMK: OBZFA) underwent common bile duct ligation and were simultaneously treated with ZFA-FMK (dissolved in DMSO). After 3 days, intestine tissue was harvested for apoptosis measurements. There was no significant difference between Sham operation group (C) and Sham operation with DMSO group (CDMSO) either in jejunum (P = 0.924) or in ileum (P = 0.996). When compared to Sham operation group (C), increased intestine apoptosis occurred in either jejunum (P < 0.001) or in ileum (P < 0.001) after common bile duct ligation (OB). After administration of Z-LLY-FMK (OBZLLY), the increased intestine apoptosis after common bile duct ligation (OB) was significantly diminished either in jejunum or in ileum (P < 0.001 and P < 0.001). Moreover, administration of ZFA (OBZFA) failed to show the same phenomenon in either jejunum (P = 0.993) or ileum (P = 0.485). There was a significant difference in intestine apoptosis in either jejunum (P < 0.001) or in ileum (P < 0.001) between OBZLLY group and OBZFA group. Significantly increased intestine apoptosis occurred after common bile duct ligation. The administration of Z-LLY-FMK could effectively diminish the intestine apoptosis after common bile duct ligation, whereas the administration of ZFA-FMK failed to show the same effect.

Prognostic value of signal transducers and activators of transcription 3 in breast cancer.

INTRODUCTION: Constitutively activated signal transducers and activators of transcription (STAT) proteins are found in various types of tumors. However, there is still very limited information about the role of STATs in breast cancer. The power of tissue microarray technique is the capability of doing a series of analyses of thousands specimens in a parallel fashion with minimal damage to the origin blocks. This study was designed with the application of tissue microarray to analyze the STAT3 status in breast cancer. MATERIALS AND METHODS: Archival tissue specimens from 102 patients with primary invasive breast cancer were selected, and STAT3 expression was analyzed by immunohistochemical staining with tissue microarray. The data of primary tumor staging, age, estrogen receptor status, lymph node status, histologic grading, and tumor-node-metastasis staging were also collected. RESULTS: By multivariate analysis, the STAT3 expression turned out to be significantly related to the overall 5-year survival rate (P = 0.024). CONCLUSION: Immunohistochemical staining with tissue microarray was convenient and feasible for the analysis of STAT3 expression status in breast cancer. Our preliminary results are promising and deserve further evaluation.

Squamous cell lung carcinoma metastatic to the breast.

Secondary malignancy metastatic to the breast is uncommon with an incidence of 0.5% to 3% of patients with extramammary malignancy. Here, an intriguing, rare case with metastasis to the breast from squamous cell lung carcinoma is reported. A 48-year-old women suffered from chronic cough with sputum for two months. The histological diagnosis, a achieved by bionchoscopic biopsy was squamous cell lung carcinoma. Concurrent chemoradiation therapy was given. Unfortunately, a left breast lump was noted eight months later and metastatic squamous cell lung carcinoma to the breast was diagnosed by surgical biopsy. Secondary malignancy metastatic to the breast is uncommon, yet this entity does exist. In view of the therapeutic implication, a metastatic breast lesion should not be mistaken for a primary breast carcinoma. Only with the awareness of such a possibility can prompt diagnosis and optimal treatment be achieved.

Effect of Boc-D-Fmk on hepatocyte apoptosis after bile duct ligation in rat and survival rate after endotoxin challenge.

BACKGROUND AND AIM: Retention and accumulation of toxic hydrophobic bile salts within hepatocytes may cause hepatocyte toxicity by inducing apoptosis. Apoptosis is a pathway of cell death orchestrated by a family of proteases called caspases. Boc-D-FMK is a cell-permeable irreversible inhibitor of caspase and recent data suggest that it might block the processing of many caspases. The purpose of the present study was to evaluate the possible effect of Boc-D-FMK on hepatocyte apoptosis and on survival rate after bile duct ligation in the rat. METHODS: Male Sprague-Dawley rats, weighing 280-300 g were randomized to three groups of eight rats each. Group 1 (OBBOC-D) underwent common bile duct ligation and simultaneous treatment with Boc-D-FMK-fmk (dissolved in dimethylsulfoxide [DMSO]). Group 2 (OBZFA) underwent common bile duct ligation and simultaneous treatment with ZFA-fmk (dissolved in DMSO). Group 3 (SHAM) underwent sham operation and simultaneous treatment with the same amount of dimethylsulfoxide (DMSO, n = 4) or the same amount of normal saline (n = 4). After 3 days, liver tissue was harvested for histopathological analysis and measurements of apoptosis. Survival rates were measured in a separate experiment in which animals underwent the same protocol. The animals received endotoxin (15 mg/kg) in the afternoon of the third postoperative day. Animals were observed for 48 h and the survival rates were recorded. RESULTS: When compared with sham operation, common bile duct ligation with ZFA-fmk (placebo) significantly increased hepatocyte apoptosis (P < 0.001). When compared with the OBZFA group, Boc-D-FMK significantly diminished the increased hepatocyte apoptosis in the OBBOC-D group (P < 0.001). There is no difference in hepatocyte apoptosis (P = 0.05) between OBBOC-D and SHAM groups. After endotoxin challenge, the 48 h survival rates were 100%, 87.5% and 62.5% for the SHAM, OBBOC-D and OBZFA groups, respectively. CONCLUSIONS: Boc-D-FMK-fmk effectively attenuated the hepatocyte apoptosis in bile duct-ligated rats and may improve the survival rates after endotoxin challenge.

Mammographic microcalcification in an autogenously reconstructed breast simulating recurrent carcinoma.

Breast cancer is a common cancer among women. The transverse rectus abdominis myocutaneous (TRAM) flap is a popular option because not only does it provide a breast with satisfactory bulk composed of autogenous tissue but it also provides an abdominal dermolipectomy to the patient. Fat necrosis remains a common problem following TRAM flap reconstruction, occurring in 10% to 36% of patients undergoing the procedure. A 44-year-old woman underwent a modified radical mastectomy followed by pedicled TRAM flap reconstruction after 5 months. Follow-up mammography 27 months after TRAM flap reconstruction showed a cluster of microcalcifications in the deep retroareolar area and recurrent breast carcinoma was highly suspected. Physical examination did not detect any abnormality of the reconstructed breast. Stereotactic hook localization was performed and an excisional biopsy was successfully done. The histological features of the resected specimens corresponded to fat necrosis change. Only with the awareness of the existence of such entity and careful follow-up can the occurrence of fat necrosis in TRAM flap reconstructed breasts be accurately detected and appropriately treated.

Hamartoma of the breast: an underrecognized disease?

Hamartomas of the breast are benign tumors composed primarily of dense, fibrous tissue with variable amounts of fat and associated ducts. A 48-year-old woman had noted a lump in her right breast for a number of years. She came to our clinics because of the recent progressive enlargement of this lump. Physical examination revealed a large, mobile, round, painless mass in the lower inner quadrant of the right breast. There were no palpable axillary lymph nodes. Mammography showed a circumscribed, 4.5 x 2.5 cm mass with a radiolucent periphery and moderately radiopaque center. On the basis of the clinical and mammographic findings, hamartoma of the breast was highly suspected. A lumpectomy was performed and histological examination of the specimen revealed overgrowth of mammary lobules and ductules, forming a well-circumscribed lesion with admixed fat tissue. Hamartoma of the breast was confirmed. With the awareness of this entity and good correlation of imaging findings, the clinical diagnosis of hamartoma of the breast should not be difficult. If careful attention is paid to the clinical information, histological underdiagnosis of hamartoma of the breast can be avoided.

Dermatofibrosarcoma protuberans of the breast.

BACKGROUND: Dermatofibrosarcoma protuberans is an uncommon, locally aggressive but rarely metastasizing tumor of the deep dermis and subcutaneous tissue. It may occur at almost any site but is most common in the trunk and extremities. Dermatofibrosarcoma protuberans of the breast has been rarely reported. CASE PRESENTATION: A 49-year-old woman without a significant medical history presented with a right breast mass that had been present for more than 10 years. Recently, progressive enlargement of the mass was noted. Physical examination showed a firm, well-defined, non-tender, mobile, erythematous 2 x 2 cm mass in the upper outer part of the right breast. Breast sonography showed a 2.3 x 1 cm slightly heteroechoic nodule with uneven anterior contours located in the dermal layer, highly suggestive of a dermal lesion. Wide excision of the mass was performed. Microscopically, the hypercellular tumor was composed of relatively monomorphic spindle cells forming a storiform pattern around the sweat glands of the deep dermis and the subcutaneous fat vacuoles. The tumor cells showed strong immunoreactivity for CD34. The final histological diagnosis was dermatofibrosarcoma protuberans. CONCLUSIONS: Dermatofibrosarcoma protuberans of the breast, though uncommon, does exist. With the awareness of this entity can a prompt diagnosis be made and the disease be properly managed.

Lack of prognostic value of insulin-like growth factor-1 in patients with breast cancer: analysis with tissue microarray.

BACKGROUND: Recent reports on the risk of prostate, breast, colorectal and lung cancer suggested that high circulating insulin-like growth factor-1 (IGF-1) concentrations are associated with an increased risk of cancer. The power of the tissue microarray (TMA) technique is the ability to perform a series of analyses of thousands of specimens in a parallel fashion with minimal damage to the original blocks. MATERIALS AND METHODS: Archival tissue specimens from 106 patients with primary invasive breast cancer were selected and IGF-1 expression was analyzed by immunohistochemical staining of tissue microarrays. The data regarding primary tumor staging, age, estrogen receptor status, lymph node status, histological grading and TNM staging were also collected. RESULTS: There were 2 patients (2%) with grade 1 expression for IGF-1, 39 patients (37%) with grade 2 expression and 65 patients (61%) with grade 3 expression. There was no significant relationship between IGF-1 expression and age (p=0.256), estrogen receptor status (p=0.921), histological grading (p=0.815), primary tumor staging (p=0.455), or TNM staging (p=0.194). No survival difference was noted among the three groups with different IGF-1 expression (p=0.462). CONCLUSION: Immunohistochemical staining of the tissue microarray was convenient and feasible for the analysis of IGF-1 expression in breast cancer, yet its expression did not show any significant correlation with the overall survival rate.