Clinico-pathological study of intra-mammary lymph nodes in breast cancer

Axillary lymph node status considered the most significant factor for breast cancer outcome and treatment decision are based on the presence or absence of nodal disease. Intramammary lymph nodes [IMLNs] can be a site of regional spread. Is this a marker for more aggressive disease. This prospective study has been completed on 30 patients with [IMLNS] of breast cancer at the surgical oncology unit Al-Azhar University from February 2000 to February 2008. Their age ranged from 27 to 90 years with an average of 55 years in positive intramammary lymph nodes and their age ranged from 38 to 92 years with an average of 62 years in negative intramammary lymph node. Intramammary lymph nodes were identified in 30 breast cancer patients, with metastatic spread in 10 patients and benign IMLNs described in 20 patients. Patients without intramammary lymph nodes were excluded in this study. Positive intramammary lymph nodes were associated with more aggressive disease, including higher rates of invasive versus non invasive cancer [10% ductal carcinoma - in - situ [DCIS] with positive IMLNs versus 25% with negative IMLNs]. Lymphovascular invasion [60% vs 10%] and a higher rate of axillary lymph node involvement [75% vs. Patient with positive IMLNs were also more likely to undergo mastectomy [80% vs. 55%]. IMLNs metastasis is a marker for disease severity, recognition of this may influence choice of adjuvant therapy. The presence of metastatic disease in an IMLNs is associated with a high rate of axillary nodal involvement, and should mandate axillary dissection-preoperative mammography and lymphoscientigraphy help identified these extra-axillary metastases

Recnet management of non metastatic limb osteosarcoma

Osteosarcoma is the most common primary malignant bone tumor in children and adolescents. The specific aims of this study were to assess the response of the neoadjuvant chemotherapy [DOX/DDP] with non metastatic high grade limb osteosarcoma by MRI and correlate the results with histopathologic analysis. Twenty one patients with non metastatic high grade limb osteosarcoma, were entered between April 2003 and November 2006. Study of patients consist of 13 males and 8 females, age ranged from 10 to 23 years. All patients were treated in Surgical Oncology Unit and Clinical Oncology Department, Al-Azhar University hospitals with 3 cycles of Doxorubicjn and cisplatin [DOX/DDP] regimen followed by surgical resection. Limb sparing surgical resection was performed in 15 patients [71%] and amputation in 6 patients. The histologic response to chemotherapy was good [> 90% tumour necrosis] in 7 patients [33.3%], the response was complete [100% tumor necrosis] in two cases. The histologic response was related to tumor size and type as five patients out of 11 [45.5%] who had small tumour size achieved good histologic response versus only 18% of those who had large tumor size. MR imaging, provides an accurate study of the tumours volume than other imaging techniques and the clinical examination. All patients who had increased tumour volume in their MR images achieved poor histologic response [10 cases]. Seven out of 11 [66.7%] patients who had stable or reduction in tumour volume got good histologic response after 3 cycles of preoperative chemotherapy. In conclusion the combination of DOX/DDP in the neoadjuvant setting in patients with non metastatic primary limb osteosarcoma seems to be an effective and applicable regimen with an acceptable toxicity profile. The utilization of MRI especially dynamic study can be an important, non invasive tool to predict for histologic response early in the course of chemotherapy

Results of management in multimodality of rectal cancer

Colorectal cancer is the second most common cause of cancer death in men and women. Our goals were to examine the impact of neoadjuvant chemoradiation for rectal cancer on surgical outcomes and to determine prognostic factors predicting improved survival. This prospective study has been completed on 50 patients with cancer rectum 28 male and 22 female. The mean age of all patients 61 years ranged from 24-86 years. The most common symptoms were rectal bleeding 84% followed by change in bowel habits 56% and weight loss 16% more than 50% of patients had more than one symptom. Tumour location was lower rectum 64% middle rectum 32% and upper rectum 4% after preoperative chemoradiation 73% of patients had sphincter-preserving surgery, the 3 year disease free survival [DFS] and over all survival were 77% and 81% respectively. Twenty-four percent of patients showed a complete pathologic response. T-level down staging and pathologic T-stage did not correlate with recurrence or survival rates. Pathologic nodal stage was associated with a significant differences in recurrence rates [No 19% N1 20%, N2 75% =p 0.038] and DFS [No/N1 vs. N2, 79% vs. 25% p=0.002]. Neoadjuvant chemoradiation resulted in a high rate of sphincter preservation. Complete pathologic responses after surgery were frequent and although pathologic T-stage after surgery did not affect recurrence rates. Pathologic nodal response was associated with improved recurrence and survival rates

Comparative study between supraomohyoid neck dissection and radical neck dissection for squamous cell carcinoma cavity

Supraomohyoid neck dissection [SOHND] has been identified as an appropriate staging procedure to provide valuable pathologic information of the neck for patients with oral squamous cell carcinoma. However the role of SOHND as therapeutic procedure compared with the oncologic results of radical neck dissection, remains controversial for lack of adequate data in current literature. This prospective study has been completed on 50 patients with squamous cell carcinoma of oral cavity 35 male and 15 female. 25 patients who underwent SOHND with the mean age of patient 56 years ranged from 21-77 years and 25 patients who underwent RND with the mean age of patient 54 year ranged from 19-78 years. Tumor location was tongue 27 cases, floor of mouth 17 cases, gingiva 2 cases, buccal mucosa 2 cases and retromolar 2 cases. The occult metastatic rate was found to increase according to T-stage of primary tumour and had significant difference. Patients with oral squamous cell carcinoma who underwent elective SOHND and radical neck dissection [RND] between January 2002 and February 2007 Surgical Oncology Unit, Al Azhar University, were retrospectively reviewed the 2 types of treatment were analyzed for incidence of neck recurrence and survival probabilities. No significant difference were found between patients treated with SOHND versus RND. Occult metastasis rate, regional disease free survival, overall and disease free survival, and distant metastasis-free survival rates were found to be comparable. Supraomohyoid neck dissection compares favorably with RND for the staging and treatment of patients with oral squamous cell carcinoma

Clinico pathological study of pelvic lymph node dissection in radical hysterectomy for the treatment of early cervical cancer [TI and TII]

To determine if the number of removed lymph nodes in radical hysterectomy with lymphadenectomy [RHL] influences survival of patients with early stage cervical cancer and to analyze the relation of different factors like patient age, tumour size and infiltration depth with the number of nodes examined in node- negative early stage cervical cancer patients. The mean age at the time of operation among the patients with negative nodes [group A] was 43.3 year [SD 11.5] [range 21-g2 years] in contrast to the patients with positive lymph nodes [group B] who had mean age of 47.0 year [SD 13.6] [range 25-80 years]. In this study the patients who underwent RHL between April 2002- and January 2007, 33 patients had negative nodes [group A] without adjuvant therapy and 13 had positive nodes [group B]. The Kaplan-Meier method and Cox regression model were used to detect statistical significance factors associated with excision of nodes were confirmed with linear regression models, The median number of removed nodes was 19 and 18 for group A and group B respectively. There was no significant relationship between the number of removed nodes and the cancer specific survival [CSS] or disease free survival [DFS] for patients of group A [p=0.25 and p 0.77 respectively] the number of removed nodes in group B was not significantly associated with CSS [P = 0.084] but it was for the DFS [p = 0.014] factors like patient age, tumour size and infiltration depth were not associated with the number of nodes. No relation was found between the number of negative nodes examined after RHL for the treatment of early stage cervical cancer and CSS or DFS. However, higher amount of removed lymph nodes leaded to better DFS for patient with positive nodes. It is suggested that patients with positive nodes benefit from a complete pelvic lymphadenectomy and a sufficient yield of removed nodes

Management and prognosis of primary and recurrent retroperitoneal soft tissue sarcoma

Retroperitoneal sarcomas are rare tumor accounting for appn3xinately 15% of all soft tissue sarcomas. Surgical resection of localized tumors with gross and microscopically negative margins remains the standard of care. However, because retroperitoneal soft tissue sarcoma are frequently large and locally advanced, resections are often incomplete resulting in local recurrence, investigators are evaluating combined modality therapies to improve local control and disease specific survival. The aim in this study is to evaluate the result of surgical treatment and long-term outcome of patients with retroperitoneal soft tissue sarcoma [RSTS]. Between April 2002 and January 2007, 34 patients [15 males and 19 females; mean age 56 years, range 25-77 years], were evaluated complete resection was defined as removal of gross tumor with histologically confirmed clear resection margins. Twenty-eight out of 34 patients [82%] [15 were affected by primary retroperitoneal soft tissue sarcoma and 13 by recurrent retroperitoneal soft tissue sarcoma] underwent surgical exploration, twenty-three patients had grossly and microscopically complete resection [3 having grossly incomplete resection and the two patients with grossly complete resection have histologically involved resection margin]. Twenty-one out of 28 patients [75%] underwent removal of contiguous intra-abdominal organs. Peroperative mortality was nil, and morbidity occurred in six cases only [21%]. High tumor grade results a significant variable for worse suryival in all 28patients [100% 3 years survival for low grade versus 0% for high grade, P = 0.004]. Amongst completely resected patients only histologic grade and peroperative blood transfusion affected disease free survival [P= 0.04 and P = 0.05 respectively5. In conclusion, an aggressive surgical approach in both primary and recurrent RPS is associated with long-term survival