Sternal or parasternal involvement from breast cancer: a misleading clinical sign

Sternal arch is a nonspecific clinical signs wich may arise during following of breast cancer, this sign reveals an involvement of internal mammary nodes secondary to breast cancer. To report a rare event such as a loco-regional sternal or parasternal invasion secondary to locally advanced cases of breast cancer [BC] about a Tunisian series. We collected retrospectively from 1988 to 2012, 11 cases of BC treated at the Institut Salah Azaiez [ISA] of Tunis, with presence during the disease evolution [initial or at relapse] of a sternal or parasternal swelling. We analyzed their clinical history, clinical and imaging data [CT-scan and/or MRI], stage, time of occurrence, treatment and evolution. All patients were females and their mean age was 46 years varying from 24 to 75 years. The sternal or parasternal swelling was found at diagnosis in 5 cases and on recurrence in 6 patients after a mean free interval of 24 months, > 12 months in 5 cases. The mean clinical tumor size of the primitive BC was 38 mm [24-75 mm] and lesions located in external quadrants in 3 cases and internal or central in 6 cases. Sternal involvement related to large Intrammmary Chain [IMC] adenopathies was diagnosed by CT-scan. 7 patients had synchronous metastases. 9 out of the 11 patients received a locoregional RT and two received chemotherapy [CT]. Sternal or parasternal swelling is a clinical apparent symptom of advanced internal mammary lymph nodes in breast cancer. The first etiologic diagnosis in this context is an advanced internal mammary chain [IMC] node involvement from breast cancer

[Atypical presentations of internal mammary chain involvement in breast cancer]

Breast cancer is the first cancer in women. Lymphatic involvement in breast cancer is common, especially in our patients because of the frequency of locally advanced forms. This contrast with a weak rate of diagnosed internal mammary chain invasion. To clarify the atypical presentations of internal mammary chain involvement in breast cancer. We present observations of patients presenting atypical forms of internal mammary chain involvement. The invasion of internal mammary chain is often underestimated. Indeed, this site of lymphatic spread is not accessible to the clinical exam and its radiological exploration is not systematic. Otherwise, different clinical, pathological and radiological presentations have to attract our attention to a potential internal mammary chain invasion. Our misrecognition of this site of spread and its different presentations can partly explain the lack of diagnosis

[Tumours of the pineal region: retrospective study about 40 cases]

The tumours of the pineal region are rare brain tumours, most common in children and characterized by a large clinical and histologic polymorphism. To assess the outcome and prognostic factors of 40 patients with primitive pineal region tumours treated at the department of radiotherapy of Salah Azaiz institute. Between January 19977 and December 2000, 40 patient received radiotherapy. There were 22 adults and 18 children [age <16 years]. The mean age was 20.4 years and sex ratio was 2.07. Histologic diagnosis was confirmed in 11 cases; 16 patients had a CT evaluation after 20 Gy radiotherapy and in 13 cases diagnosis was performed with CT aspects +/- germinal tumour markers. Target volume varied: 10 had craniospinal irradiation, 16 had local irradiation and 14 had whole brain irradiation with a boost at the tumour bed. Chemotherapy was proposed for metastases and recurrent diseases. Survival rates were 87% at 2 years and 74, 5% at 5 years. For children, survival rates were 88% at 2 and 4 years. Eight patients [20%] failed locally and 5 patients [12.5%] had metastasis. Age, performance status and large fields of radiotherapy seem to be associated with prognosis and survival. Pineal tumors and especially germinal tumours are chemosensitive and radiosensitive, care of these tumours is multidisciplinary involving surgery, chemotherapy and radiotherapy. From our study and a review of the literature, we tried to find a therapeutic strategy for tumours of the pineal region

[Internal mammary lymph node invasion in breast cancer: myth or reality]

The internal mammary nodes are often underestimated as breast cancer lymphatic pathway spread. It is yet the first site of lymphatic invasion in central or internal tumors and the second site in external tumors. The intra-thoracic situation of internal mammary nodes explains partly, the difficulty of its exploration. To evaluate the risk of internal mammary node invasion, some predictive factors are established [tumor size, internal or central tumor location, axillary node invasion and young age]. Prognostic and therapeutic impact of invasion justifies its systematic research. Without exploring internal mammary nodes status, TNM classification remains, incomplete. CT scanner, magnetic resonnance imaging, positron emission tomography scanner and sentinel node exploration technique are helpful to explore this region and to adapt its irradiation

[Total body irradiation: techniques and main indications]

The radiotherapy department at Salah Azaiz institute had started, in March 2000, a new sophisticated technique of irradiation consisting in total body irradiation [TBI]. TBI is used in many preparative regimens before bone marrow transplantation in the treatment of haematological malignancies. TBI aims to destroy immunocompetent tissues in order to avoid graft rejection and to eradicate residual tumor cells. In this article, we review different TBI techniques and its main indications. We also describe the acute and late effects of TBI