ABSTRACT
Inflammatory local recurrence [ILR] after breast-conserving surgery for noninflammatory breast cancer [BC] is associated with dismal prognosis. Risk factors for ILR are not well defined
Methods: Between 2001 and 2010, twelve patients at our hospital developed ILR after breast-conserving surgery, adjuvant chemotherapy, and radiotherapy for BC. We compared their clinico-pathological characteristics to those of 24 patients with noninflammatory local recurrence [non-ILR], 24 patients with distant metastases, and 48 disease-free controls, matched for age and observation period
Results: The median time to ILR was 10 months. In univariate analysis, extent of lymph node involvement [p < 0.05], multifocality [p < 0.05], c-erbB2 overexpression [p < 0.05], and lymphovascular invasion [LVI] [p < 0.001] affected the risk of ILR. Conditional logistic regression analysis showed a significant association between ILR and combined LVI and high histopathological grade. The odds ratio [OR] for ILR versus non-ILR was 6.14 [95% confidence interval [CI] 1.48-25.38] and for ILR versus distant metastases it was 3.05 [95% CI 0.09-97.83] when both LVI and high histopathological grade were present. Patients with family history of BC were more likely to present with ILR than non-ILR [OR 5.47; 95% CI 1.55-19.31] or distant relapse [OR 5.62; 95% CI 0.26-119.95]
Conclusions: Pre- and postmenopausal women with high-grade BC and LVI are at increased risk to develop ILR, especially in the presence of family history of BC. Identification of risk factors for this lethal form of recurrent BC may lead to more effective preventive treatment strategies in properly selected patients
ABSTRACT
Hematological disorders, especially single lineage abnormalities, have been described in hyperthyroidism. Pancytopenia has been reported, without myelodysplastic syndrome or megaloblastic anemia. We studied the peripheral blood smear and the bone marrow aspiration and biopsy of a 65-year-old lady, who presented with pancytopenia and thyrotoxicosis due to multinodular goiter. She denied ingesting any toxic medication. At diagnosis: WBC: 2500/ul, platelets count: 58,000/ul, hemoglobin level: 6.5 g/dl. The bone marrow was moderately hyper cellular with moderate myelofibrosis and arrested hematopoiesis. The TSH level was: 0.02 mIU/l (N: 0.25-4), the fT3: 18 pmol/l (N: 4-10), the routine serum immunologic tests were negative. After treatment with single agent neomercazole (carbimazole), complete recovery of the blood cell counts was obtained within one month. The bone marrow aspiration, performed three months after starting therapy, showed normal hematopoiesis. The thyroid function tests returned to normal and no autoimmune reaction was detected on routine serum testing. Persistent response was observed six months later under medical treatment. The patient has refused surgical treatment. Reversible myelodysplastic syndrome may also be part of the changes in blood picture of patients with hyperthyroidism, probably due to direct toxic mechanism.