Gastric metastases from breast cancer: A report of two cases and review of literature.

Though breast cancer is a common cancer it rarely metastasizes to stomach. Lobular carcinoma is the most common histological type which presents with gastric metastases. The most common presentation is linitis plastica. Here, we would like to report two cases of invasive ductal breast cancer who presented with gastric metastases. One case presented as linitis plastica and the other as nodular growth. Both were given palliative chemotherapy and both responded partially. One patient was succumbed to death in 6 months and the other patient is surviving 7 months after diagnosis of gastric metastases. In conclusion, gastric metastases from breast cancer are rare and are associated with poor prognosis. We would like to add these cases to the literature due to its rarity.

"Ovarian Metastases from Colorectal Cancer: Our Experience".

Ovarian metastases from colorectal cancer are uncommon and can present synchronously and metachronoulsy. Role of prophylactic oophorectomy for colorectal cancer is controversial and there is no definitive evidence to support it. A retrospective analysis of all the patients with colorectal cancer who had attended a single unit at our center have been analysed. Clinical presentation, Pathological features and image findings were analyzed. We had 7 patients with ovarian metastases who had presented synchronously or metachronously at our institute. Five patients presented synchronously at the time of primary surgery and 2 patients had presented metachronously after the treatment of primary. Three patients had malignancy in ascending colon and 2 had in sigmoid colon , one in rectosigmoid junction and one case in rectum. The mean overall survival rate was 12.4 months (range 6-20 months). All the patients received adjuvant chemotherapy. Ovarian metastases is rare in colorectal and occurs in younger patients.

Mesopancreas in pancreatic cancer: where do we stand - review of literature.

Pancreatic cancer is associated with poor prognosis and surgery remains the main modality of treatment. Negative resection margin is an important prognostic factor for survival. Retropancreatic margin or the medial margin is the most common site of positive resection margin. Mesopancreas was proposed in analogy with mesorectum, which is considered as a fusion fascia formed embryologically during the development of pancreas. This mesopancreas lies posterior to the pancreas and contains pancreaticoduodenal vessels, lymphatics, nerve plexus and loose areolar tissue. Various technical modifications were proposed for better dissection of mesopancreas like posterior approach and artery first approach. There is an increased rate of R0 resection by these technical modifications but whether this will turn to increase in survival rates is yet to be established.

Challenges in Diagnosis and Management of Paget's Disease of the Breast-a Retrospective Study.

Paget's disease of the breast is uncommon and patients may present with nipple discharge, eczema, plaque or nipple destruction with or without a lump. The aim of the present study was to evaluate the presentation, clinicopathological features and treatment given for patients presenting with Paget's disease of the breast. We performed a retrospective analysis of medical records of patients who were treated at our centre for Paget's disease of the breast from 2006-2011. Twenty patients were treated in this period. Twelve patients had associated lump and eight patients did not have a lump in the breast. Two patients did not have a lump or any detected abnormality in mammography. Multicentricity was present in five patients. Diagnosis of malignancy was made by fine-needle aspiration cytology for patients with palpable lump and nipple wedge biopsy for patients with no lump. Modified radical mastectomy was done in 10 patients: 2 patients underwent total mastectomy and sentinel lymph node biopsy and 8 patients underwent central quadrantectomy and sentinel lymph node biopsy. Eleven patients had invasive ductal carcinoma, one patient had ductal carcinoma in situ with foci of invasion and eight patients had ductal carcinoma in situ. Seven patients had lymph node metastases. Three patients had recurrence, one had local recurrence and two had distant recurrences. The mean follow up period was 28 months (range 15-64 months). Paget's disease of the breast is a rare entity and one needs imaging and biopsy to diagnose these patients as they have associated cancer. They can be considered for breast conservation surgery with good cosmetic and oncological results.

A Retrospective Study of Marjolin's Ulcer Over an Eleven Year Period.

BACKGROUND: Marjolin's ulcer is a rare aggressive cutaneous malignancy occurring in previously occurred wounds. The most common aetiology is a burn wound involving extremities and squamous cell carcinoma is the most common variant. MATERIALS AND METHODS: A retrospective analyses of medical records of patients treated in a single unit with a diagnosis of Marjolin's ulcer was performed. RESULTS: During the study period, 14 patients were treated. Four patients had lymph node metastases and one had pulmonary metastases at the time of presentation. Seven patients underwent wide excision with reconstruction and seven underwent amputation or disarticulation because of advanced malignancy. During the follow up two patients developed local recurrence and one developed pulmonary metastases. Both the patients with pulmonary metastases had Marjolin's ulcer of trunk. CONCLUSION: Marjolin's ulcer occurs more commonly in the extremities. Distant metastases occur commonly in patients with ulcers on the of trunk.

Constitutional mismatch repair deficiency syndrome: Do we know it?

Constitutional mismatch repair deficiency syndrome is a rare autosomal recessive syndrome caused by homozygous mutations in mismatch repair genes. This is characterized by the childhood onset of brain tumors, colorectal cancers, cutaneous manifestations of neurofibromatosis-1 like café au lait spots, hematological malignancies, and occasionally other rare malignancies. Here, we would like to present a family in which the sibling had glioblastoma, and the present case had acute lymphoblastic lymphoma and colorectal cancer. We would like to present this case because of its rarity and would add to literature.

Sarcomatoid carcinoma of penis with bilateral inguinal metastases-a case report and review of literature.

Sarcomatoid carcinoma or carcinosarcoma of the penis is a rare entity with 36 cases reported in the literature. A 61-year-old male presented with swelling in the glans and shaft of the penis with bilateral inguinal lymph node metastases. He underwent total penectomy with bilateral inguinal block dissection. Histopathology revealed sarcomatoid carcinoma of the Penis with bilateral inguinal lymph node metastases. The patient later developed bilateral lung metastases in 6 months and was succumbed to death. Sarcomatoid carcinoma or carcinosarcoma is a rare malignancy with poor prognosis.

Role of chemotherapy prior to orchiectomy in metastatic testicular cancer-is testis really a sanctuary site?

A germ-cell tumour (GCT) of the testis is a chemosensitive tumour with high cure rates even in advanced disease. Radical inguinal orchiectomy is the initial procedure used to diagnose it which helps to risk-stratify these patients. However, in patients with life-threatening metastases, primary chemotherapy was attempted in a few studies, followed by delayed orchiectomy. The aim of this review is to study the histopathological findings of delayed orchiectomy and the retroperitoneal lymph node dissection (RPLND) specimens, to assess difference and concordance in response rates in histological types of GCTs in pathological specimens. Overall, 352 patients received initial chemotherapy followed by orchiectomy, and 235 of them had undergone RPLND. Delayed orchiectomy specimens had viable tumour in 74 (21%) patients, scarring/necrosis in 171 patients (48.5%), and teratoma in 107 (30.3%) patients. RPLND specimens had residual disease in 36 (15.3%) patients, scarring/necrosis in 100 patients (42.5%), and teratoma in 99 patients (42.3%). Patients with seminoma who underwent delayed orchiectomy had complete disappearance of tumour in 81.3% of cases, and in non-seminomatous GCT, it was 43.4%. These results raise the question of the existence of a blood-testis barrier in patients with advanced GCT and argue against the testis as a sanctuary site.

Role of fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose positron emission tomography-computed tomography in the evaluation of axillary lymph node involvement in operable breast cancer in comparison with sentinel lymph node biopsy.

PURPOSE: Role of (18 [F] fluorine-18-labeled 2-fluoro-2-deoxy-D-glucose [FDG] positron emission tomography-computed tomography [PET-CT]) in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer and compare results with sentinel lymph node biopsy (SLNB). METHODS: A total of 37 patients of proven T1T2N0 breast cancer were included in the study. Patients with past history of breast surgery, T3T4 disease, uncontrolled diabetes mellitus and pregnant patients were excluded from the study. Pre-operative FDG PET-CT was performed followed by sentinel lymph node (SLN) biopsy with blue dye or combined technique. RESULTS: SLN was identified in 32 of 37 patients with an identification rate of 86.48% (32/37). With combined technique SLN identification rate was 100% (6/6) while with blue dye alone; it was 83.8% (26/31). Among 37 patients, 16 had axillary metastases of which 12 had macrometastases and four had micrometastases detected by immunohistochemistry (IHC). Of 12 patients with axillary macrometastases, skip metastases were present in two patients in whom SLN was negative and in two patients SLN was not identified, but axillary dissection showed metastases. PET-CT had shown sensitivity, specificity, negative predictive value and positive predictive value of 56%, 90%, 73%, and 81.8%, respectively. IHC of SLN detected four patients with micrometastases upstaging the disease by 11% (4/37). CONCLUSION: Because FDG PET-CT has a high specificity in the evaluation of axillary lymph node involvement in T1T2N0 breast cancer patients according to the results of this study if FDG PET-CT is positive in axillary lymph nodes, axillary lymph node dissection may be considered instead of SLNB.

Assessment of the clinical utility of the Gail model in estimating the risk of breast cancer in women from the Indian population.

INTRODUCTION: Breast cancer screening programmes are based on various risk models to assess the risk of breast cancer in the general population. The aim of the present study is to predict the efficacy of the Gail model (GM) in the Indian population. We did a retrospective calculation of the Gail score from the hospital records of patients with breast cancer and benign breast disease. MATERIALS AND METHODS: The Gail score was calculated in three groups. The three groups were made up of 104 patients with confirmed breast cancer (Group A), 100 patients with confirmed benign breast diseases (Group B), and 100 patient attendants (Group C). STATISTICAL ANALYSIS: The data analysis was done using SPSS 15.0, Medcal 9.0.1. RESULTS: The median Gail score in the three groups of patients was 7.5±3.04 in patients with breast cancer, 8.2±1.4 in patients with benign breast diseases, and 7.8±1.7 in normal people. The median Gail score was lower in patients with breast cancer when compared with normal people. CONCLUSION: The GM is not useful in identifying the risk of breast cancer in Indian women. There is a need for further studies to evaluate other genetic and environmental factors to create an appropriate model for the Indian population.

Cytological and Pathological Correlation of FNAC in Assessing Breast Lumps and Axillary Lymph Node Swellings in a Public Sector Hospital in India.

Background. Breast lumps have varied pathology, and there are different techniques to prove the diagnosis. The aim of the present study is to analyze the role of fine needle aspiration cytology (FNAC) of the breast lesions at our center. Methods. We had retrospectively analysed 854 patients who underwent FNAC for primary breast lumps and 190 patients who underwent FNAC for an axillary lymph node in the year 2010. Results. Of 854 patients, histological correlation was available in 723 patients. The analysis was done for 812 patients as medical records were not available for 42 patients. FNAC was false negative in seven cases; 2 cases of phyllodes were reported as fibroadenoma, and 5 cases of carcinoma were diagnosed as atypical hyperplasia. The sensitivity, specificity, and false negative value of FNAC in diagnosing breast lumps were 99% (715/723), 100%, and 1%, respectively. Of 190 patients for whom FNAC was performed for axilla, 170 had proven to have axillary lymph node metastases, and the rest had reactive hyperplasia or inflammatory cells. Conclusions. FNAC is rapid, accurate, outpatient based, and less complicated procedure and helps in diagnosis of breast cancer, benign diseases, and axillary involvement in experienced hands with less chance of false results.

Triple negative breast cancer - our experience and review.

Triple negative breast cancer (TNBC) constitutes 10-25% of patients with breast cancer. TNBC is an aggressive phenotype affecting younger age groups and has poor prognosis. We retrospectively analysed 50 triple negative breast cancer patients attending our outpatient department among 270 breast cancer patients. The incidence of TNBC was 18.5%, and most of them were premenopausal 56% (28/50) with mean age was 46.66 ± 13.87 (Range 28-72 years). Most of them had Invasive ductal cancer 94% (47/50) and were high grade (Grade 3-96%)(48/50). Five patients presented with metastatic disease (2 patients only Skeletal, 1 patient with Skeletal and Lung, 1 patient with Lung and 1 patient with Liver) and 7 patients developed recurrence (all 7 had chest wall recurrence, 3 had supraclavicular lymph node recurrence, 2 had skeletal metastases and 1 had developed brain metastases) during follow up. The mean disease free survival was 15 months (Range 3-58 months) and overall survival was 20.14 months (Range 5-70 months). Fifty six percent (28/50) of patients were premenopausal and mean age of presentation was 46.66 ± 13.87 years (Range 28-72 years). Ten percent (5/50) presented with metastatic disease and 15% (7/45) developed metastases during follow up. Five patients (10%) died during follow up. Hence, Triple negative breast cancer is aggressive, with rapid progression leading to mortality in younger patients.