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Skin Metastasis in Breast Cancer Patients; a Case Series. 乳腺癌患者皮肤转移的研究a案例系列。
Pub Date : 2020-01-01 DOI: 10.37029/jcas.v6i1.307
Sara Rehman, Muhammad Atif Naveed

Introduction: Breast cancer is the most common malignancy in women. It frequently metastasizes to bones, lungs and liver. Although rare, skin metastasis may also take place. It may also be the presenting feature of initial or recurrent breast cancer. The assessment of recurrent metastatic disease involving skin after mastectomy can be challenging because of the benign-appearing clinical presentation. The purpose of this case series was to explore the clinical and radiological presentation of skin metastasis in patients of breast cancer.

Materials and methods: This is a retrospective case series of breast cancer patients with skin lesions on chest and abdomen at the time of initial presentation, or post-treatment such as, after mastectomy or breast conservation therapy; who underwent various radiological investigations including mammography, ultrasound scan, computed tomography (CT) scan and magnetic resonance imaging from 1 May 2018 to 30 September 2019 at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan.

Results: A total of eight cases were identified, out of which seven were females. The most common presentation consisted of the presence of metastatic nodules which were seen in 62.5% (five out of eight) of the patients. Other features consisted of erythematous or plaque-like skin thickening on clinical examination, increased density with indistinct margins seen on a mammogram and diffuse oedematous changes in the skin with small irregular mass or infiltration into subcutaneous tissues were visualised on ultrasound and CT studies.

Conclusion: Skin metastasis from breast cancer most commonly presents as nodules, although rarely they may present as plaques or diffuse skin thickening. Awareness of diverse manifestations of skin metastasis is of utmost importance in early diagnosis and management.

乳腺癌是女性中最常见的恶性肿瘤。它经常转移到骨骼、肺和肝脏。虽然罕见,但也可能发生皮肤转移。它也可能是原发性或复发性乳腺癌的表现特征。乳房切除术后复发性皮肤转移性疾病的评估可能具有挑战性,因为临床表现良好。本病例系列的目的是探讨乳腺癌患者皮肤转移的临床和放射学表现。材料和方法:这是一个回顾性的病例系列,乳腺癌患者在首次就诊时,或治疗后,如乳房切除术或保乳治疗后,胸部和腹部皮肤病变;于2018年5月1日至2019年9月30日在巴基斯坦Shaukat Khanum纪念癌症医院和研究中心接受了各种放射检查,包括乳房x光检查、超声扫描、计算机断层扫描(CT)和磁共振成像。结果:共发现8例,其中7例为女性。最常见的表现包括转移性结节的存在,在62.5%(8名患者中有5名)的患者中可见。其他特征包括临床检查时的红斑或斑块样皮肤增厚,乳房x光检查时密度增加,边缘不清,超声和CT检查时可见皮肤弥漫性水肿改变,伴有小不规则肿块或渗入皮下组织。结论:乳腺癌的皮肤转移最常表现为结节,尽管很少表现为斑块或弥漫性皮肤增厚。了解皮肤转移的各种表现对早期诊断和治疗至关重要。
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引用次数: 0
THE ROLE OF INTRAOPERATIVE FROZEN SECTION OF SENTINEL LYMPH NODES IN UPFRONT BREAST CONSERVATION CANCER SURGERY 术中前哨淋巴结冷冻切片在前期乳腺癌保乳手术中的作用
Pub Date : 2019-06-30 DOI: 10.37029/JCAS.V5I2.227
R. Khan, A. Malik, S. Mohtasham, A. Khan, M. Parvaiz, A. Loya
Objective: Sentinel lymph node biopsy is the standard of care in clinically negative axilla in breast cancer patients for which frozen section (FS) is routinely performed intraoperatively. The objective of this study was to justify the use of FS in terms of number of tests performed and their impact on decision-making and cost saving. Materials and Methods: We retrospectively reviewed our prospectively maintained data from January 2014 to January 2018 for intraoperative FS in upfront breast conservation surgery patients. Results: A total of 357 patients were studied. All were female. Median age was 50 years (24–84). Mean tumour size was 29.11 mm. Numbers of sentinel lymph nodes identified were 1 in 50 (14.2%) patients, 2 in 121 (33.89%) patients and ≥3 in 186 (52%) patients. Number of positive sentinel lymph nodes was 0 in 264 (73.9%) patients, 1 in 62 (17.4%) patients, 2 in 20 (5.6%) patients and ≥3 in 11 (3.08%) patients. Axillary lymph node dissection (ALND) was offered to 30 (8.4%) patients as per the American College of Surgeons Oncology Group Z0011. The results for ALND showed that only 8 (2.3%) out of 30 patients had positive nodes identified in the additional axillary nodes dissected. Sensitivity of FS was 97% and specificity was 98.86%. False-negative rate was 3.22%. Conclusion: Intraoperative FS can be safely omitted in early breast cancer patients undergoing upfront breast conservation cancer surgery due to high sensitivity and specificity leading to low false-negative rates. ALND can be performed as a second operation as warranted only in a minority of patients. Key words: American College of Surgeons Oncology Group Z0011 trial, axillary lymph node dissection, intraoperative frozen section, sentinel lymph node biopsy
目的:前哨淋巴结活检是临床阴性乳腺癌患者腋窝的标准护理,术中常规进行冷冻切片(FS)。本研究的目的是根据所进行的测试数量及其对决策和成本节约的影响来证明FS的使用是合理的。材料和方法:我们回顾性地回顾了2014年1月至2018年1月前期保乳手术患者术中FS的前瞻性数据。结果:共纳入357例患者。都是女性。中位年龄为50岁(24-84岁)。肿瘤平均大小为29.11 mm。前哨淋巴结的检出率为50例中有1例(14.2%),121例中有2例(33.89%),186例中≥3例(52%)。前哨淋巴结阳性264例(73.9%)为0个,62例(17.4%)为1个,20例(5.6%)为2个,≥3个(3.08%)为11例。根据美国外科医师学会肿瘤组Z0011,为30例(8.4%)患者提供腋窝淋巴结清扫(ALND)。ALND的结果显示,30例患者中只有8例(2.3%)在额外的腋窝淋巴结中发现阳性淋巴结。FS的敏感性为97%,特异性为98.86%。假阴性率为3.22%。结论:早期乳腺癌患者术前保乳手术术中可安全省略术中FS,其敏感性和特异性高,假阴性率低。ALND仅在少数患者中可作为第二次手术。关键词:美国外科学会肿瘤组Z0011试验,腋窝淋巴结清扫术,术中冷冻切片,前哨淋巴结活检
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引用次数: 0
SOLITARY FIBROUS TUMOR OF BREAST 乳腺孤立性纤维性肿瘤
Pub Date : 2019-06-30 DOI: 10.37029/JCAS.V5I2.231
S. Noor, N. Akhtar, Usman Hassan, M. Hameed
Solitary fibrous tumours (SFTs) are fibroblastic mesenchymal tumour primarily identified in the pleura but are now being reported in other anatomic sites as well. SFT is generally characterised as a radiologically confined neoplasm composed of a proliferated spindle cells arranged in patternless manner. Intervening tissue shows prominent haemangiopericytoma-like vessels. Stroma is usually fibrous. Tumour is positive for CD34. SFT has a specific translocation representing fusion NAB2 with STAT6 genes. This translocation can be highlighted with very good specificity and sensitivity using STAT6 immunohistochemical stain. Some cases of SFTs have also been described in the breast. Rarely, SFT can show aggressive behaviour. SFT enters the differential diagnoses of benign and malignant spindle cell tumours of breast and it is, therefore, important that its clinical, radiological and pathological features are known to clinicians and diagnosticians. Key words: CD34, myofibroblastoma, NAB2-STAT6, solitary fibrous tumour
孤立纤维性肿瘤(SFTs)是一种纤维母细胞间充质肿瘤,主要在胸膜中发现,但现在也报道了其他解剖部位。SFT通常表现为放射学局限的肿瘤,由无模式排列的增殖梭形细胞组成。中间组织可见明显的血管外皮细胞瘤样血管。基质通常是纤维状的。肿瘤CD34阳性。SFT具有特异的易位,代表NAB2与STAT6基因融合。使用STAT6免疫组织化学染色可以突出这种易位,具有非常好的特异性和敏感性。一些SFTs病例也被描述为发生在乳房。SFT很少会表现出攻击性行为。SFT进入乳腺良性和恶性梭形细胞肿瘤的鉴别诊断,因此,重要的是临床医生和诊断人员了解其临床、放射学和病理特征。关键词:CD34,肌成纤维细胞瘤,NAB2-STAT6,孤立性纤维性肿瘤
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引用次数: 0
RUPTURED INTRACRANIAL DERMOID CYST 破裂的颅内皮样囊肿
Pub Date : 2019-06-30 DOI: 10.37029/JCAS.V5I2.223
Taimoor Ali Tariq, Pir Abdul Ahad Aziz Qureshi, Muhammad Talha Yaseen Kaimkhani
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引用次数: 0
EWING’S SARCOMA: APPROACHING CENTURY SINCE THIS BONE CANCER MADE NEWS 尤文氏肉瘤:近一个世纪以来,这种骨癌成为新闻
Pub Date : 2019-06-30 DOI: 10.37029/JCAS.V5I2.263
Z. Fadoo, Mir Ibrahim Sajid
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引用次数: 0
CENTRAL NERVOUS SYSTEM RELAPSE OF MULTIPLE MYELOMA 中枢神经系统多发性骨髓瘤复发
Pub Date : 2019-03-31 DOI: 10.37029/JCAS.V5I1.199
M. Qubtia, M. Nasir, Memoona Mian, A. Hameed
Multiple myeloma (MM) is a plasma cell disorder primarily involving bone marrow. Extramedullary involvement is less common, with central nervous system (CNS) myelomatosis being a rare entity and such presentation carries extremely dismal prognosis. We present case of a 40 years old male with MM who was initially treated with 6 cycles of Cyclophosphamide, Thalidomide and Dexamethasone resulting in complete response. 2 years later he presented with CNS myelomatosis and scrotal involvement and was initially treated with Bortezomib and dexamethasone, cranial irradiation and intrathecal Methorexate, Cytarabine, Hydrocortisone (TRIO IT), along with radical orchiectomy and testicular radiation during the course of treatment. However, after initial response his disease showed clinical and radiological progression after 4 months of therapy. He was switched to high dose Methotrexate (HD-MTX) with TRIOITand later Lenalidamide and dexamethasone (Len/dex) was added to the above regimen. He continued to show good clinical response but his cytology remained persistently positive, therefore, HD-MTX was discontinued in the later course of treatment. Subsequently he was started on best supportive care only, when his neurological status deteriorated further. He survived almost 9 months after a diagnosis of CNS myelomatosis. Patients with multiple myeloma, presenting with neurological symptoms should always be investigated for the possibility of CNS MM. CNS relapse is a fatal disease with poor prognosis. Recommended treatment must include a systemic anti-MM regimen that crosses the BBB (ideally Immunomodulatory drugs (IMiDs) IMiDs-dexamethasone based therapy), CNS irradiation and intrathecal chemotherapy.Key words: Multiple myeloma, central nervous system myelomatosis, therapy
多发性骨髓瘤(MM)是一种主要累及骨髓的浆细胞疾病。髓外受累不常见,中枢神经系统(CNS)骨髓瘤病是一种罕见的实体,这种表现预后非常差。我们报告了一例40岁男性MM患者,他最初接受了6个周期的环磷酰胺、沙利度胺和地塞米松治疗,完全缓解。2年后,他出现中枢神经系统骨髓瘤病和阴囊受累,最初接受硼替佐米和地塞米松、颅照射和鞘内甲氨喋呤、阿糖胞苷、氢化可的松(TRIO IT)治疗,同时在治疗过程中进行根治性睾丸切除术和睾丸放射治疗。然而,在最初的反应后,他的疾病在治疗4个月后表现出临床和放射学进展。患者改用高剂量甲氨蝶呤(HD-MTX)联合trioitd治疗,后在上述方案中加入来那胺和地塞米松(Len/dex)。他继续表现出良好的临床反应,但他的细胞学仍然持续呈阳性,因此,在治疗的后期停止了HD-MTX。随后,当他的神经系统状况进一步恶化时,他开始接受最好的支持治疗。在被诊断为中枢神经系统骨髓瘤病后,他活了近9个月。出现神经系统症状的多发性骨髓瘤患者应经常检查中枢神经系统MM的可能性,中枢神经系统复发是一种预后不良的致命疾病。推荐的治疗方案必须包括通过血脑屏障的全身抗mm方案(理想情况下是免疫调节药物(IMiDs), IMiDs-地塞米松为基础的治疗),中枢神经系统照射和鞘内化疗。关键词:多发性骨髓瘤,中枢神经系统骨髓瘤,治疗
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引用次数: 0
HEAD AND NECK CANCER STEM CELL PROTEOMICS 头颈癌干细胞蛋白质组学
Pub Date : 2019-03-31 DOI: 10.37029/JCAS.V5I1.182
S. Saleem, Sahrish Tariq
It is critical to identify the cell of origin of cancer and the genes/proteins/transcriptional/epigenetic factors of that cell. Here, we review studies on head and neck cancer stem cells (CSC) in the hope of developing better understanding of their role highlighting their importance as novel drug targets. CSC model has introduced a hierarchical conceptual framework for the interpretation of intratumour heterogeneity within tumour. This, in turn, has culminated in a major paradigm shift in terms of how different types of cancers can be targeted for treatment. Several malignancies conform to the CSC model of tumour growth yet identification of CSC markers remains a profound challenge.Key words: Chemo- and radio-resistance, head and neck cancer stem cells, proteomics, treatment modalities
确定癌症的起源细胞和该细胞的基因/蛋白质/转录/表观遗传因子是至关重要的。在这里,我们回顾了头颈癌干细胞(CSC)的研究,希望能更好地了解它们的作用,强调它们作为新型药物靶点的重要性。CSC模型引入了一个层次概念框架来解释肿瘤内的肿瘤异质性。反过来,就如何针对不同类型的癌症进行治疗而言,这最终导致了重大的范式转变。一些恶性肿瘤符合肿瘤生长的CSC模型,但CSC标记物的鉴定仍然是一个深刻的挑战。关键词:化疗和放疗耐药,头颈癌干细胞,蛋白质组学,治疗方式
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引用次数: 0
PERSISTENT LEFT SUPERIOR VENA CAVA: A DECEPTIVE ANOMALY 持续性左上腔静脉:欺骗性异常
Pub Date : 2019-03-31 DOI: 10.37029/JCAS.V5I1.207
J. Aleem, W. Ahmad
Persistent left superior vena cava (SVC) is a rare but vital congenital anomaly of the thoracic venous system. It is the persistence of vessel that normally regresses during early foetal life. It has utmost importance in intervention radiology, cardiothoracic procedures and insertion of the central venous line as well as in trauma. The vessel can drain into the right atrium through the coronary sinus, directly into left atrium or through pulmonary veins. It is usually detected during routine investigations and requires surgical treatment. In our case, SVC persists on both right and left sides with enlarged coronary sinus incidentally detected during follow-up for breast cancer.Key words: Persistent left superior vena cava, superior vena cava, vascular variant
持续性左上腔静脉(SVC)是一种罕见但重要的先天性胸静脉系统异常。在胎儿早期,血管的持久性通常会退化。它在介入放射学,心胸外科手术和中心静脉线的插入以及创伤中具有极其重要的意义。血管可经冠状窦流入右心房,直接流入左心房或经肺静脉。通常在常规检查中发现,需要手术治疗。在我们的病例中,右、左侧的SVC持续存在,在乳腺癌随访期间偶然发现冠状动脉窦增大。关键词:持续性左上腔静脉,上腔静脉,血管变异
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引用次数: 0
THE PREVALENCE OF DYSPLASIA IN COLORECTAL SERRATED/HYPERPLASTIC POLYPS IN OMANI POPULATION 阿曼人群中结直肠锯齿状/增生性息肉发育不良的患病率
Pub Date : 2019-03-31 DOI: 10.37029/JCAS.V5I1.210
A. Qureshi, Nawras Al Hadi, A. Shalaby
Purpose: Serrated/hyperplastic polyps (SPs) are characterised histologically by sawtooth architecture. Historically, these polyps were considered benign, without malignant potential and thus clinically unimportant. At present, the WHO defines serrated/hyperplastic lesions as heterogeneous group, which include hyperplastic polyps (HP), sessile serrated adenoma (SSA)/polyp and traditional serrated adenoma (TSA). These can have malignant potential. The aim of this study was to evaluate the prevalence of dysplastic changes in SP of colon and rectum of Omani population reported at a tertiary care centre.Methods: The study was conducted in the pathology department of a tertiary care centre including endoscopic polypectomies from colon and rectum of Omani patients presenting to gastroenterology clinic reported between 2014 and 2016, and these were analysed retrospectively for dysplastic changes and their association with different clinical parameters.Results: Dysplasia was seen in 32 of 146 cases (21.9%) and 114 (78.1%) were without dysplasia. Of these dysplastic, biopsies’ only two cases (1.4%) showed high-grade dysplasia and rest 30 (20.5%) low-grade dysplasia. According to the type of polyp, dysplasia was found in TSA 8/21 cases (46.7%) and SSA 9/17 cases (53.3%). Association of dysplasia was more common in the age group of > 50 (15.07%) and male patients (62.5%).Conclusion: SPs are now common findings that a gastroenterologist faces in their daily practice. In our study of Omani population, the prevalence of dysplasia is associated with older age group, male gender, SSA/polyp and traditional serrated adenoma.Key words: Dysplasia. colorectal, polyps
目的:锯齿状/增生性息肉(SPs)在组织学上以锯齿状结构为特征。历史上,这些息肉被认为是良性的,没有恶性的可能性,因此临床上不重要。目前WHO将锯齿状/增生性病变定义为异质组,包括增生性息肉(HP)、无根锯齿状腺瘤(SSA)/息肉和传统锯齿状腺瘤(TSA)。这些可能有恶性的潜在危险。本研究的目的是评估阿曼人口在三级保健中心报告的结肠和直肠SP发育不良改变的患病率。方法:该研究在一家三级保健中心的病理学部门进行,包括2014年至2016年在胃肠病学诊所报告的阿曼患者的结肠和直肠内镜息肉切除术,回顾性分析这些发育不良改变及其与不同临床参数的关系。结果:146例患者中32例(21.9%)出现异常增生,114例(78.1%)未见异常增生。在这些发育不良中,活检显示只有2例(1.4%)为高级别发育不良,其余30例(20.5%)为低级别发育不良。根据息肉类型不同,TSA 8/21例(46.7%)和SSA 9/17例(53.3%)存在异常增生。不典型增生多见于> 50岁年龄组(15.07%)和男性患者(62.5%)。结论:SPs现在是常见的发现,胃肠病学家面临在他们的日常实践。在我们对阿曼人口的研究中,不典型增生的患病率与年龄较大、男性、SSA/息肉和传统的锯齿状腺瘤有关。关键词:发育不良;结直肠息肉,
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引用次数: 0
MOST CANCERS ARE CAUSED BY BAD LUCK MUTATIONS: SCIENTIFIC EXPLANATION? 大多数癌症是由运气不好的突变引起的:科学解释?
Pub Date : 2019-03-31 DOI: 10.37029/JCAS.V5I1.229
S. Pervez
-
-
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引用次数: 1
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Journal of cancer & allied specialties
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