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Long-term survival between total colectomy versus proctocolectomy in patients with FAP: a registry-based, observational cohort study FAP患者全结肠切除术与直结肠切除术的长期生存率:一项基于登记的观察性队列研究
Pub Date : 2020-04-01 DOI: 10.1177/0300891619868019
I. Ardoino, S. Signoroni, Enzo Malvicini, M. T. Ricci, E. Biganzoli, L. Bertario, S. Occhionorelli, M. Vitellaro
Background: The best surgical choice for patients with familial adenomatous polyposis (FAP) is still debated. No prospective trials have been carried out to evaluate the pros and cons of the recommended procedures: total colectomy (ileorectal anastomosis [IRA]) vs restorative proctocolectomy (ileal pouch–anal anastomosis [IPAA]). The aim of this study was to provide a basis for tailored precision surgery in patients with FAP. Methods: We conducted a retrospective review of patients with FAP who underwent surgery and were registered in a dedicated database in Milan, Italy. Twenty-year survival related to surgical approach and prognostic factors were investigated using a Cox regression model. Results: A total of 925 patients underwent surgery between 1947 and 2015: 340 (36.8%) IPAA and 585 (63.2%) IRA. Colorectal cancer (CRC) at surgery was diagnosed in 28.6% of patients and a pathogenic APC variant was identified in 88%. During a median follow-up of 129 months, 150 patients died. The survival probability was significantly higher in the IRA than the IPAA group: 0.82 vs 0.75 (hazard ratio [HR] 0.6, 95% confidence interval [CI] 0.42–0.84). Multivariable regression modeling adjusted for propensity scores showed a similar difference, although no longer significant. Multivariable analysis indicated as independent risk factors CRC (HR 4.68, 95% CI 3.04–7.20) and age at surgery (HR 1.03, 95% CI 1.02–1.06). Among patients without cancer, the main risk factor for shorter survival was older age (HR 1.06, 95% CI 1.04–1.09). Conclusion: The study confirms excellent long-term results of surgical approaches with IRA and IPAA, suggesting that the best surgical choice may be an individually and clinically tailored approach, preferably at a young age.
背景:家族性腺瘤性息肉病(FAP)患者的最佳手术选择仍有争议。目前还没有前瞻性试验来评估推荐手术的利弊:全结肠切除术(回直肠吻合术[IRA])和恢复性直结肠切除术(回肠袋-肛门吻合术[IPAA])。本研究的目的是为FAP患者的精准手术提供依据。方法:我们对在意大利米兰的一个专用数据库中登记的接受手术的FAP患者进行了回顾性研究。采用Cox回归模型研究与手术入路相关的20年生存率和预后因素。结果:1947年至2015年间共有925例患者接受了手术:340例(36.8%)IPAA, 585例(63.2%)IRA。28.6%的患者在手术中被诊断出结直肠癌(CRC), 88%的患者被鉴定出致病性APC变异。在平均129个月的随访期间,150名患者死亡。IRA组的生存率显著高于IPAA组:0.82 vs 0.75(风险比[HR] 0.6, 95%可信区间[CI] 0.42-0.84)。多变量回归模型调整倾向得分显示类似的差异,虽然不再显著。多变量分析显示,结直肠癌(HR 4.68, 95% CI 3.04-7.20)和手术年龄(HR 1.03, 95% CI 1.02-1.06)是独立危险因素。在没有癌症的患者中,缩短生存期的主要危险因素是年龄较大(HR 1.06, 95% CI 1.04-1.09)。结论:该研究证实了IRA和IPAA手术入路的良好长期效果,表明最佳手术选择可能是个体化和临床定制的入路,最好是在年轻时。
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引用次数: 16
Retrospective Evaluation of the Bifractionated Scheme in Utero-Vaginal Brachytherapy in the Treatment of Cervical Cancer : Experience of the Radiotherapy Oncology Service at Marrakech University Hospital 回顾性评价子宫阴道近距离放射治疗宫颈癌的分岔方案:马拉喀什大学医院放射肿瘤学服务的经验
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914118
A. Zayane, M. Elanigri, H. Abourrazek, Y. Bouchabaka, Issam Lalya, A. Elomrani, M. Khouchani
Objective: To retrospectively report the results in terms of local control and toxicities, of the 2 x 9 Gy fractionation used in our service, in high dose rate brachytherapy, during the treatment of locally advanced cervical cancer, preceded by a concomitant chemotherapy radiotherapy association. Material and method: Report and analyze data from 106 patients treated in our center between 2015 and 2018, for cervical cancer stage IIB and IIIB according to the FIGO classification. Results: The median follow-up was 29 months. Among the 106 patients analyzed, 75.5% had good local control at 3 years against 7.5% who had local progression, while 9.5% had local relapse and 7.5% had metastatic relapse. The average time for the occurrence of an event (progression, local or remote relapse) was 8 months. Most patients (90.6%) did not have acute toxicity. As for chronic toxicities, 66% had good long-term tolerance, while 27.4% had synechiae or even vaginal stenosis. The other toxicities were in the minority. Conclusion: Despite the considerable advantage of 2 x 9 Gy fractionation in uterovaginal brachytherapy in terms of reduction in treatment time, it is not the ideal choice in terms of local control and toxicity and the 3 x 8 Gy scheme seems a good alternative.
目的:回顾性报道在高剂量率近距离放疗治疗局部晚期宫颈癌过程中,2 x 9 Gy放射治疗的局部控制和毒性的结果。材料与方法:根据FIGO分级,报告分析2015 - 2018年在我中心治疗的106例宫颈癌IIB期和IIIB期患者的数据。结果:中位随访时间为29个月。在所分析的106例患者中,75.5%的患者在3年时有良好的局部控制,7.5%的患者有局部进展,9.5%的患者有局部复发,7.5%的患者有转移性复发。事件发生(进展、局部或远处复发)的平均时间为8个月。大多数患者(90.6%)无急性毒性反应。慢性毒性方面,66%长期耐受性良好,27.4%出现阴道粘连甚至阴道狭窄。其他的毒性是少数。结论:虽然子宫阴道近距离放射治疗中2 × 9 Gy分割在缩短治疗时间方面具有相当大的优势,但从局部控制和毒性方面来看,它不是理想的选择,3 × 8 Gy方案似乎是一个不错的选择。
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引用次数: 0
Treatment strategy for brain metastases from esophageal cancer 食管癌脑转移的治疗策略
Pub Date : 2020-04-01 DOI: 10.1177/0300891619869518
Yasushi Domeki, M. Nakajima, Masakazu Takahashi, M. Kikuchi, Haruka Yokoyama, Hideo Ogata, Kentaro Okamoto, S. Yamaguchi, K. Sasaki, T. Tsuchioka, H. Kato
Background: This study aimed to examine the treatment outcomes of patients with brain metastases from esophageal cancer. Brain metastases from esophageal cancer are rare and have a poorer prognosis than brain metastases from lung and breast cancer. Methods: This study included patients who were diagnosed with and treated for esophageal cancer in our department and subsequently developed brain metastases between April 2010 and December 2014. We examined the differences in survival in patients based on receiving chemotherapy. Results: In total, 8 patients (7 men and 1 woman) with a mean age of 65 years (range 51–73) were included. Seven presented with neurologic symptoms. Two were diagnosed via computed tomography (CT), 5 via magnetic resonance imaging, and 1 via positron emission tomography/CT. They were treated using whole-brain irradiation or with a gamma knife. In 5 patients, chemotherapy was administered after treatment of the brain metastases. The mean survival from the start of treatment was 358 days (range 31–1196). Conclusion: The relatively successful local control of brain metastases in these patients indicates that long-term survival may be attainable via concomitant chemotherapy.
背景:本研究旨在探讨食管癌脑转移患者的治疗结果。食管癌的脑转移很少见,预后比肺癌和乳腺癌的脑转移差。方法:本研究纳入2010年4月至2014年12月在我科诊断并治疗的食管癌脑转移患者。我们在接受化疗的基础上检查了患者的生存差异。结果:共纳入8例患者(7男1女),平均年龄65岁(51 ~ 73岁)。其中7人出现神经系统症状。2例通过计算机断层扫描(CT)诊断,5例通过磁共振成像诊断,1例通过正电子发射断层扫描/CT诊断。他们接受全脑照射或伽玛刀治疗。5例患者在脑转移治疗后给予化疗。从治疗开始的平均生存期为358天(范围31-1196天)。结论:这些患者脑转移的局部控制相对成功,表明通过联合化疗可以获得长期生存。
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引用次数: 3
The Study of Programmed Death-1 Receptor, Programmed Death-1 Ligand (Pd-1/Pd-L1) and Apoptosis in Breast Cancer Patients: A Potential Mechanism of Immune Escape 程序性死亡-1受体、程序性死亡-1配体(Pd-1/Pd-L1)和乳腺癌患者细胞凋亡的研究:免疫逃逸的潜在机制
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914124
S. A. Ali, A. El-daly, A. El-Sayed, H.G El-Shredy, G. Fadaly
Introduction: The associations between programmed cell death ligand 1 (PD-L1) and the prognosis of various cancers have always been a research topic of considerable interest.However, the prognostic value of PD-L1 in breast cancer patients remains a controversial subject. We aimed to evaluate the role of programmed death-1 receptor and programmed death ligand-1 (PD-1/PD-L1) expressing lymphocytes, monocytes and granulocytes, as potential mechanism of immune escape in breast cancer patients. Also, serum levels of Bcl-2 were analyzed among patients with different stages of breast cancer. Material and Methods: The study was conducted on a total of seventy-five females; fifty-five of them represented the breast cancer females at early (24 females) and advanced (31 females) stages and 20 ages matched female donors represented the control group. Patients were recruited from the Cancer Research and Management Department, Medical Research Institute, Alexandria University. Venous blood samples obtained from all females under study were used for determination of PD-1/PD-L1 expression using flowcytometry technique and measurement of Bcl-2 serum levels using ELISA technique. Results: Significantly higher expression levels of PD-L1 were found in patients with positive lymph node, advanced tumor stage, histological grade II, tumor size T2, ER, PR, Her-2 negativity and TNBC subtype. Whilst a general increase in PD-1 positive expression between the breast cancer patients and control group regarding percentage and MFI of positive PD-1 expressing monocytes and granulocytes. Also, the results showed a highly significant association between PD-1+ and PD-L1+ expression in early and advanced breast cancer patients (p<0.0001). There was a significant increase in the mean of Bcl-2 serum concentration in patients compared to healthy individuals. Finally, the results showed that Bcl-2 serum concentration correlated positively with positive PD-L1+ expressing granulocytes. While the correlation between serum Bcl-2 and PD-1+ expressing lymphocytes, monocytes and granulocytes did not show any statistical significance. Conclusions: Our study suggested that PD-L1 could serve as an important target for antibody based immunotherapies, especially in the TNBC, where treatment options are limited. The direct correlation between PD-L1+ expression and serum Bcl-2 concentration may explore a role of apoptotic machinery in the pathogenesis of breast cancer.
导读:程序性细胞死亡配体1 (PD-L1)与各种癌症预后的关系一直是备受关注的研究课题。然而,PD-L1在乳腺癌患者中的预后价值仍然是一个有争议的话题。我们旨在评估表达淋巴细胞、单核细胞和粒细胞的程序性死亡-1受体和程序性死亡配体-1 (PD-1/PD-L1)作为乳腺癌患者免疫逃逸的潜在机制的作用。此外,还分析了不同阶段乳腺癌患者的血清Bcl-2水平。材料与方法:研究对象为75名女性;其中55名女性乳腺癌患者处于早期(24名女性)和晚期(31名女性)阶段,20名年龄匹配的女性捐赠者代表对照组。患者从亚历山大大学医学研究所癌症研究与管理系招募。所有女性静脉血样本均采用流式细胞术检测PD-1/PD-L1表达,ELISA检测血清Bcl-2水平。结果:PD-L1在淋巴结阳性、肿瘤分期晚期、组织学分级、肿瘤大小T2、ER、PR、Her-2阴性、TNBC亚型患者中表达水平均显著升高。而在PD-1阳性表达的单核细胞和粒细胞的百分比和MFI方面,乳腺癌患者与对照组之间PD-1阳性表达普遍增加。此外,结果显示PD-1+和PD-L1+在早期和晚期乳腺癌患者中的表达高度显著相关(p<0.0001)。与健康个体相比,患者血清Bcl-2平均浓度显著升高。最后,结果显示Bcl-2血清浓度与阳性表达PD-L1+的粒细胞呈正相关。而血清Bcl-2与表达PD-1+的淋巴细胞、单核细胞和粒细胞的相关性无统计学意义。结论:我们的研究表明,PD-L1可以作为基于抗体的免疫治疗的重要靶点,特别是在治疗选择有限的TNBC中。PD-L1+表达与血清Bcl-2浓度之间的直接关系可能揭示凋亡机制在乳腺癌发病中的作用。
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引用次数: 0
Breast Fibromatosis, A Rare Benign Tumor Mimicking Breast Carcinoma: A Case Report 乳腺纤维瘤病,一罕见的类似乳腺癌的良性肿瘤:1例报告
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914129
R. Samaka, A. Abu-Zeid
Objectives: Fibromatosis is a rare breast lesion that is considered locally aggressive tumor without metastasis. It doesn't need more than surgical excision with clean margins as a treatment but the recurrence is very common. Breast fibromatosis clinically mimics other lesions as fibromatosis like metaplastic tumor of breast. Therefore, recognition of breast fibromatosis is important for surgeons and histopathologists, in order to set a proper plan for management and avoid unnecessary extensive surgery. Comprehensive search revealed only 33 case reports as it's compromising less than 0.2% of all primary breast tumor. Case summary Methods and Materials: A 35 years old female patient complained of palpable left breast mass for four months. Her imaging belonged to BI-RAD (4) assessment category. The pathological examination of the core biopsy showed B3; spindle cell lesion. The patient underwent surgical excision of the mass and the histopathologic assessment revealed an infiltrative uncapsulated lesion composed of proliferated spindle shaped cells (mixed fibroblasts and myofibroblast like cells) arranged in sweeping fascicles with occasional extravasated RBCs. There was no mitosis, necrosis or atypia. There was no associated hyperplasia, atypical hyperplasia, insitu or invasive components. Results: Immunohistochemical studies showed positivity for SMA and B- Catenine and negativity for Pan CK and P63 that confirm our diagnosis. Conclusion: The conclusion of this case report is to stress upon keeping breast fibromatosis in mind as a potential differential diagnosis for fibromatosis like metaplastic carcinoma and other mimics of spindle cell lesions in breast.
目的:纤维瘤病是一种罕见的乳腺病变,被认为是局部侵袭性肿瘤,无转移。它不需要更多的手术切除和干净的边缘作为治疗,但复发是很常见的。乳腺纤维瘤病在临床上与其他病变类似,如乳腺化生瘤。因此,对于外科医生和组织病理学家来说,识别乳腺纤维瘤病是很重要的,以便制定适当的治疗计划,避免不必要的广泛手术。综合搜索显示只有33例病例报告,因为它危害不到所有原发性乳腺肿瘤的0.2%。病例总结方法与资料:女性,35岁,主诉左乳可触及肿块4个月。影像属于BI-RAD(4)评估范畴。核心活检病理显示B3;梭形细胞病变。患者接受手术切除肿块,组织病理学检查显示浸润性无包膜病变,由增殖的梭形细胞(混合成纤维细胞和肌成纤维细胞样细胞)排列在横扫束中,偶有红细胞外渗。无有丝分裂、坏死或异型性。无相关增生、非典型增生、原位增生或侵袭性成分。结果:免疫组化检查显示SMA和B- Catenine阳性,Pan CK和P63阴性,证实了我们的诊断。结论:本病例报告的结论是强调在诊断纤维瘤病如化脓性癌和乳腺其他类似梭形细胞病变时,应注意乳腺纤维瘤病的鉴别诊断。
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引用次数: 0
Role of PET/CT in Breast Cancer PET/CT在乳腺癌中的作用
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914167
Z. Ali, M. Abdullah, M. Houseni, D. Hashem
Introduction: Breast cancer is the most common cancer type in women and the leading cause of cancer-related deaths in women worldwide. F-fluorodeoxyglucose (FDG) positron emission tomography with computed tomography (PET/CT) is widely used in the initial staging, evaluation of the therapeutic response, and detection of recurrent disease. However, with the increasing use of FDG PET/CT, sites of increased activity have been occasionally discovered in unexpected locations which may not correlate with the patient’s clinical history or the expected spread of the primary malignancy. The aim of this study is to detect the diagnostic value of PET/CT in breast cancer patients; comparing PET/CT performance with that of contrast enhanced CT in diagnosis of breast cancer and distant metastasis. Material and Methods: A prospective study carried out at National liver institute –Menoufia University from January 2016 to December 2017. It included 30 female patients. All patients had pathologically confirmed breast cancer. All patients underwent 18F-FDG PET/CT examination. Patients fasting for about 6 hours before study, then 370–550 MBq of 18F-FDG was injected. Approximately after 60 min from injection, PET/CT scans were performed. Following PET imaging, volumetric contrast enhanced CT scanning was performed from skull base to mid-thigh on the same PET/CT machine. Images were reconstructed and viewed on workstation. Results: The study included 30 female patients with breast cancer, mean age: 53.56 years ±10.64 (SD), age range: 33-73years. Detection of contralateral breast affection in 2 patients (6.7%) and distant metastasis were seen on PET/CT. Sites of distant metastasis included: bone (n=12), axillary lymph nodes (n=11), cervical lymph nodes (n=6), mediastinal lymph nodes (n=12), abdominal lymph nodes (n=8), liver (n=5), lung (n=11) and other visceral sites metastasis (n=9).PET/CT detected breast lesions with a sensitivity of 100% and specificity of 95.4%. In contrast, the sensitivity and specificity of CT alone were 81.2% and 90.4% respectively. Conclusion: PET/CT has superiority over CT alone in detecting breast lesions and distant metastases.
乳腺癌是女性中最常见的癌症类型,也是全球女性癌症相关死亡的主要原因。f -氟脱氧葡萄糖(FDG)正电子发射断层扫描与计算机断层扫描(PET/CT)广泛应用于疾病的初始分期、治疗反应的评估和复发性疾病的检测。然而,随着FDG PET/CT使用的增加,偶尔会在意想不到的位置发现活性增加的位点,这可能与患者的临床病史或原发恶性肿瘤的预期扩散无关。本研究旨在探讨PET/CT对乳腺癌患者的诊断价值;比较PET/CT与增强CT对乳腺癌及远处转移的诊断价值。材料和方法:2016年1月至2017年12月在menoufia大学国立肝脏研究所进行的一项前瞻性研究。其中包括30名女性患者。所有患者病理证实为乳腺癌。所有患者均行18F-FDG PET/CT检查。患者在研究前禁食约6小时,然后注射370-550 MBq的18F-FDG。注射后约60分钟,进行PET/CT扫描。PET成像后,在同一台PET/CT机上从颅底到大腿中部进行体积增强CT扫描。重建图像并在工作站上观看。结果:纳入30例女性乳腺癌患者,平均年龄:53.56岁±10.64 (SD),年龄范围:33-73岁。2例(6.7%)经PET/CT检查发现对侧乳腺病变及远处转移。远处转移部位包括:骨(n=12)、腋窝淋巴结(n=11)、颈部淋巴结(n=6)、纵隔淋巴结(n=12)、腹部淋巴结(n=8)、肝脏(n=5)、肺部(n=11)及其他内脏转移部位(n=9)。PET/CT检测乳腺病变的敏感性为100%,特异性为95.4%。单独CT检查的敏感性为81.2%,特异性为90.4%。结论:PET/CT对乳腺病变及远处转移的诊断优于单纯CT。
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引用次数: 3
Circulating Micro RNA 181A as Biomarker in Breast Cancer, Its Possible Association with Metastasis & Epithelial Mesenchymal Transformation 循环微RNA 181A作为乳腺癌的生物标志物及其与转移和上皮间充质转化的可能关联
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914122
L. Rashed, S. Faiz, Magdy M. Hassan, M. Elsebaie, AE Saad
Background: Recent studies have reported the involvement of micro RNA 181a in diverse cellular functions. Though some studies have shown that miR-181a expression is downregulated in several human solid tumors, others have demonstrated that upregulation of miR-181a may promote metastasis and invasion of human cancers. Aim of the Study: The aim of this work is to detect the level of circulating miRNA-181a in breast cancer cases at different stages and to study its role in metastasis & epithelial mesenchymal transformation (EMT) through the possible association between miRNA 181a and transforming growth factor beta (TGFβ) signaling pathway. Subjects and Methods: The present work included 70 female patients, with breast cancer at different stages 30 patients with metastatic disease and 40 patients with non-metastatic disease 20 healthy subjects were taken as a control group. We detected miRNA-181a expression in peripheral blood with qRT PCR, and TGF-beta, SMAD-4, SNAIL-1 and Bim expression by quantitative PCR. Results: miRNA-181a, TGF-beta, SNAIL-1 and SMAD-4 were significantly upregulated in patients with metastatic breast cancer compared to patients with non-metastatic disease while Bim is significantly downregulated in metastatic versus non-metastatic group. Also, miRNA-181a was a prognostic marker for disease progression and overall survival. Conclusion: signaling pathway of TGFβ-SMAD, regulate miRNA-181a which in turn play role in stabilizing SNAIL transcription factor that promote tumor aggressiveness and metastasis through epithelial mesenchymal transition, as well as down-regulation of Bim.
背景:最近的研究报道了微RNA 181a参与多种细胞功能。虽然一些研究表明miR-181a在几种人类实体肿瘤中表达下调,但也有研究表明miR-181a的上调可能促进人类癌症的转移和侵袭。研究目的:本工作旨在通过miRNA 181a与转化生长因子β (TGFβ)信号通路的可能关联,检测不同阶段乳腺癌患者循环miRNA-181a的水平,并研究其在乳腺癌转移和上皮间充质转化(EMT)中的作用。对象与方法:选取70例不同分期的女性乳腺癌患者,其中转移性患者30例,非转移性患者40例,健康受试者20例作为对照组。采用qRT PCR检测外周血miRNA-181a的表达,定量PCR检测tgf - β、SMAD-4、SNAIL-1和Bim的表达。结果:与非转移性乳腺癌患者相比,转移性乳腺癌患者的miRNA-181a、tgf - β、SNAIL-1和SMAD-4的表达显著上调,而Bim在转移性乳腺癌患者与非转移性乳腺癌患者的表达显著下调。此外,miRNA-181a是疾病进展和总生存期的预后标志物。结论:TGFβ-SMAD信号通路调节miRNA-181a,进而稳定SNAIL转录因子,通过上皮间质转化促进肿瘤侵袭转移,下调Bim。
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引用次数: 1
Apocrine Carcinoma of Breast in a Male Patient: Case Report 男性乳腺大汗腺癌1例
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914132
S. Touimi, D. N’chiepo, I. Mbarki, H. Elkacemi, S. ElMajjaoui, T. Kebdani, N. Benjaafar, C. Neftah, A. Saoud, J. Boulaarab, H. Jerguigue, Y. Omor, R. Latib, H. El Agouri, B. El khannoussi
Introduction: Apocrine carcinoma of breast is a rare type of malignant tumor, the incidence of which varies between 0.3 - 0.4 % of all female breast cancers.Apocrine carcinoma is exceptional in male patients and very few cases have been described in literature. This tumor shows distinct microscopic and immunohistological features. We report an exceptional observation of apocrine carcinoma of breast in a man. Patient and observation: He’s a 54 years old man who had for 2months a painless nodule at the left axillary..The patient had family history of breast and prostate cancers. Physical examination revealed a left axilary lymphadenopathy movable relative to superficial and deep plans with no evidence mass of breasts. MRI of the breast was performed and revealed a mass that was 38 x 10 mm in size.A biopsy of the lymphadenopathy was performed. It objectified a carcinomatous proliferation. An immunohistochemical study showed that tumor cells express Her 2, but do not express estrogenic and progesterone receptors. A tumorectomy of the left breast was performed and didn’t show any malignant lesion of the breast. The axiler dissection of 13 lymphnodes showed 11 metastatics ones with 3 breaking capsular. The diagnosis of apocrine carcinoma of the breast was made in despite of the result of the tumorectomy. The CT did not indicate metastasis. The patient was administered adjuvant chemotherapy then he received radiation therapy on left susclavicular, axila and breast with a total dose of 42Gy,15 fractions of 2.8 Gy on 21 days with no late effects. 1 year of trastuzumab was administrated. There was no recurrence or metastasis approximately 2 years after radiation therapy. Then the patient presented a susclavicular lymphnode that was comfirmed on the pet-scanner with multiple mediastinal lymphnodes. A biopsy of the susclavicular lymphnode comfirmed the progression of the disease. The patient started chemotherapy in association with pertuzumab and trastuzumab. Discussion: Apocrine carcinoma of the breast is a rare malignant tumor whose incidence varies between 0.3% and 4% of all female’s breast cancer and represents 0.5 % of all invasive breast cancers. This tumor is exceptional in men. Indeed, only a dozen cases have been described in the literature . Most neoplasms are slowly progressive, small in size, and are most frequently seen in the axilla. They can be recurrent and metastasize to the lymph node, lung, and bone. Male patients have been advanced disease at presentation compared to women which may be due to lack of public awareness of breast cancer in male. Histologically, it has glandular structures with apocrine features and decapitation secretions. There is cytoplasmic PAS positivity of the tumor cells. The presence of neoplastic glands high in the dermis and immediate subepidermis favors the primary origin of tumor cells from apocrine sweat glands. Apocrine adenocarcinomas are positive for cytokeratins, carcinoembryogenic antigen (CEA) and epithelia
简介:乳腺大汗腺癌是一种罕见的恶性肿瘤,其发病率在所有女性乳腺癌的0.3 - 0.4%之间。大汗腺癌在男性患者中是罕见的,文献中很少有病例描述。该肿瘤表现出明显的显微镜和免疫组织学特征。我们报告一个特殊的观察大汗腺癌的乳房在一个男人。患者与观察:54岁男性,左腋窝无痛性结节2个月,有乳腺癌、前列腺癌家族史。体格检查显示左侧腋窝淋巴结病变,相对于浅表和深部计划可移动,没有乳房肿块的证据。乳房MRI显示肿块大小为38 x 10mm。对淋巴结病变进行活检。这是一种癌性增生。一项免疫组织化学研究表明,肿瘤细胞表达Her 2,但不表达雌激素受体和孕激素受体。左乳房肿瘤切除后未发现任何恶性病变。13个淋巴结腋部解剖显示11个淋巴结转移,3个被囊破裂。乳腺大汗腺癌的诊断是尽管肿瘤切除术的结果。CT未见转移。患者给予辅助化疗后,行左锁骨、腋窝、乳房放射治疗,总剂量42Gy,15次2.8 Gy,持续21天,无迟发效应。给予曲妥珠单抗治疗1年。放疗后约2年无复发或转移。然后患者表现为锁骨淋巴结,pet扫描证实为多发纵隔淋巴结。锁骨淋巴结活检证实了病情的进展。患者开始化疗与帕妥珠单抗和曲妥珠单抗相关。讨论:乳腺大汗腺癌是一种罕见的恶性肿瘤,其发病率在所有女性乳腺癌的0.3%至4%之间,占所有浸润性乳腺癌的0.5%。这种肿瘤在男性中很少见。事实上,文献中只描述了十几个病例。大多数肿瘤进展缓慢,体积小,最常见于腋窝。它们可以复发并转移到淋巴结、肺和骨。与女性患者相比,男性患者在发病时已处于疾病晚期,这可能是由于公众对男性乳腺癌缺乏认识。组织学上,它具有腺状结构,具有大汗腺特征和头颅分泌物。肿瘤细胞胞质PAS阳性。肿瘤腺体位于真皮和直接表皮下,有利于肿瘤细胞主要来自大汗腺。大汗腺癌细胞角蛋白、癌胚性抗原(CEA)和上皮膜抗原(EMA)呈阳性。通常,这些肿瘤不表达雌激素受体- α、孕激素受体和bcl-2。大汗腺癌预后较差,其预后因素包括大小、组织学类型、淋巴结累及及远处转移。无淋巴结转移的10年无病生存率为56%。大汗腺癌的治疗方案与乳腺非大汗腺癌相似。然而,有关使用抗雄激素的研究正在进行中。治疗的选择是广泛的局部切除,边界清晰,有或没有区域淋巴结清扫。在缺乏临床试验的情况下,放射治疗的作用仍然不确定。大汗腺癌的治疗方式与复发无明显的相关性,大汗腺癌的生存率与其他乳腺癌无明显差异。结论:男性大汗腺癌是一种非常罕见、独特、形态独特的浸润性导管癌。虽然免疫组化染色可能在男性中显示差异,但预后与其他乳腺癌没有区别。它具有不同的激素谱,雄激素受体阳性使大汗腺癌患者适合靶向治疗。
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引用次数: 2
Local and Systemic Inflammatory Markers as Prognostic and Predictive Markers In Locally Advanced Triple Negative Breast Cancer 局部和全身炎症标志物作为局部晚期三阴性乳腺癌的预后和预测标志物
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914162
L. Mohamed, A. Elsaka, Y. Zamzam
Local inflammatory markers have been defined as prognostic and predictive markers in triple negative markers as proved by many studies. The prognostic and predictive value of systemic inflammatory markers such as neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR) remain to be elucidated. Aim of study: To evaluate pathological complete response (PCR) to neoadjuvant chemotherapy in locally advanced cancer breast in relation to tumor infiltrating lymphocytes(TILs), neutrophil lymphocyte ratio and lymphocyte monocyte ratio as well as overall survival and disease free survival. Patients and methods: In Tanta university Hospital, oncology department form January 2012 to December 2013, 67 patients with locally advanced TNBC stage IIB, IIIB 0r IIIC using TNM 8t h edition . All patients received neoadjuvant chemotherapy in the form of dose dense AC followed by paclitaxel (adriamycin & cyclophosphamide 60 mgm/m2 & 600 mgm/m2 respectively the cycle is repeated every 2 weeks for 4 cycles followed by paclitaxel 175mgm/m2 every 2 weeks for 4 cycles). All cycles with G-CSF support. Pre treatment TILs, NLR and LMR were evaluated with PCR and as prognostic factor of survival. Results: Low NLR has been detected in 74.6% of cases and has been associated with high TILs and this was statistically significant (p value=0.03). High LMR was observed in 80.6% of cases and correlated significantly with TILs (p value =0.003). Pathological CR was found to be associated with high TILs, low NLR and high LMR. In our study we evaluated the pre neoadjuvant systemic and local inflammatory markers as prognostic marker we found that in multivariate analysis, the lymphocyte monocyte ratio maintained their statistical significance with overall survival. While tumor infiltrating lymphocyte maintained their statistical significance as prognostic factors with overall survival and disease free survival. Conclusion: Systemic inflammatory markers can be used as marker of pathological complete response in locally advanced triple negative breast6 cancer with neoadjuvant chemotherapy.
许多研究证明,局部炎症标记物在三阴性标记物中被定义为预后和预测标记物。中性粒细胞淋巴细胞比率(NLR)和淋巴细胞单核细胞比率(LMR)等系统性炎症标志物的预后和预测价值仍有待阐明。研究目的:评价局部晚期乳腺癌新辅助化疗病理完全反应(PCR)与肿瘤浸润淋巴细胞(til)、中性淋巴细胞比率和淋巴细胞单核细胞比率以及总生存期和无病生存期的关系。患者与方法:2012年1月至2013年12月在坦塔大学医院肿瘤科,采用TNM 8t版对67例局部晚期TNBC分期IIB、IIIB 0期和IIIC期患者进行治疗。所有患者均接受新辅助化疗,剂量密集AC +紫杉醇(阿霉素60mgm /m2 +环磷酰胺600mgm /m2,每2周重复1次,共4个周期,紫杉醇175mgm/m2 / 2周,共4个周期)。所有周期G-CSF支持。采用PCR评估治疗前的TILs、NLR和LMR,并将其作为预后因素。结果:低NLR在74.6%的病例中被发现,并与高TILs相关,差异有统计学意义(p值=0.03)。80.6%的患者LMR高,且与TILs显著相关(p值=0.003)。病理CR与高TILs、低NLR和高LMR相关。在我们的研究中,我们评估了新辅助前全身和局部炎症标志物作为预后标志物,我们发现在多变量分析中,淋巴细胞单核细胞比例与总生存率保持统计学意义。肿瘤浸润淋巴细胞作为预后因素对总生存期和无病生存期的影响具有统计学意义。结论:全身性炎症标志物可作为局部晚期三阴性乳腺癌新辅助化疗病理完全缓解的标志。
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引用次数: 2
Nusap1, Melk and L1cam Expression in Cervical Cancer Tissues; Prognostic and Clinicopathological Implications Nusap1、Melk和L1cam在宫颈癌组织中的表达预后和临床病理意义
Pub Date : 2020-04-01 DOI: 10.1177/0300891620914149
O. Harb, M. Elfeky, Basant Sh Elshafaay, A. Obaya, Amr A. Awd, Mohamed M. Alkilany, L. Gertallah
Background: It is important to identify of novel therapeutic targets for cervical carcinoma. Nucleolar and spindle associated protein 1 (NUSAP1) could be able to bind microtubules, and has important role in spindle formation and mitotic progression. Maternal embryonic leucine zipper kinase (MELK) is a cell cycle related conserved protein kinase that is involved in control and regulation of the cell cycle, apoptosis, and carcinogenesis. The L1 cell adhesion molecule (L1-CAM) was discovered as a protein which has an essential role in cell migration and axon guidance in the nervous system. The Aim of This Study Is to investigate the tissue protein expression of NUSAP1, MELK and L1CAM in tissues of cervical carcinoma and to detect their prognostic roles. Methods: Expression of NUSAP1, MELK and L1CAM was evaluated in sections from 62 cases of cervical carcinoma using immunohistochemistry we followed our patients for 3 years correlate their expression with clinicopathological parameters and patients outcome. Results: High levels of NUSAP1, MELK and L1CAM expression was positively related to older age of the patients, high grade of the tumor, lympho-vascular invasion, advanced FIGO stage, poor survival rates and higher recurrence rate after successful therapy (p<0.001). L.N metastases (p=0.002), distant metastases (p=0.003). There are statistically significant positive association between NUSAP1, MELK and L1CAM Phi correlation coefficient= + 0.87 and + 0.721 respectively (p<0.001). Conclusion: NUSAP1, MELK and L1CAM are considered markers of poor prognosis in cervical carcinoma cells.
背景:寻找新的宫颈癌治疗靶点具有重要意义。核仁和纺锤体相关蛋白1 (NUSAP1)可以结合微管,在纺锤体形成和有丝分裂过程中起重要作用。母胚胎亮氨酸拉链激酶(MELK)是一种与细胞周期相关的保守蛋白激酶,参与细胞周期、细胞凋亡和癌变的控制和调节。L1细胞粘附分子(L1- cam)是一种在神经系统中对细胞迁移和轴突引导起重要作用的蛋白。本研究旨在探讨NUSAP1、MELK和L1CAM在宫颈癌组织中的组织蛋白表达及其在预后中的作用。方法:应用免疫组化技术检测62例宫颈癌组织中NUSAP1、MELK和L1CAM的表达,随访3年,并将其表达与临床病理参数和患者预后进行比较。结果:NUSAP1、MELK、L1CAM高表达与患者年龄大、肿瘤分级高、淋巴血管浸润、FIGO分期晚期、生存率低、治疗成功后复发率高呈正相关(p<0.001)。淋巴结转移(p=0.002),远处转移(p=0.003)。NUSAP1、MELK与L1CAM之间存在显著正相关,相关系数分别为+ 0.87、+ 0.721 (p<0.001)。结论:NUSAP1、MELK、L1CAM可作为宫颈癌细胞预后不良的标志物。
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引用次数: 0
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