Aggressive treatment for hepatic metastases from breast cancer: results from a single center.

BACKGROUND: Breast cancer (BC) is the most common cancer among women worldwide. It has been estimated that approximately 12-20 % of patients will develop liver metastases from breast cancer (BCLM) and that in approximately 5 % of cases the liver is the only metastatic site. Patients with isolated BCLM have the poorest prognosis with a median survival ranging from 19 to 26 months. METHODS: A total of 26 women with isolated BCLM and without any sign of disease progression after a cycle of chemotherapy were retrospectively reviewed. Women were treated with hepatic resection (HR) for unilobar disease or surgical "open" RFA for bilobar disease. Data were collected on either original BC or BCLM and from patients follow-up. RESULTS: Overall survival from BC diagnosis was 47.69 ± 22.25 months (range 33-84, median 45.5 months); it was 52.25 ± 14.57 months (range 33-84, median 48.5 months) for the HR patients and 43.79 ± 27.14 months (range 9-101, median 39 months) for the RFA patients. Overall survival from BCLM treatment was 21.12 ± 12.78 months (range 9-64, median 15.5 months); in detail it was 29.42 ± 14.53 months (range 12-64, median 29.5 months) for the resected patients and 14 ± 4.45 months (range 9-24, median 13.5 months) for patients treated by RFA with a strongly significant survival difference for operated patients (p = 0.001). Overall disease-free survival from BCLM was 15.96 ± 13.16 months (range 3-64, median 12 months), disease-free survival for resected patients was 23.22 ± 16.2 months (range 8-64, median 18.5 months), and for patients treated by RFA was 9.64 ± 4.22 months (range 3-18, median 9 months; Fig. 1). Overall 1, 2, and 5 years (actuarial) survival was respectively 80.7, 57, and 31 %. Given in details for the two groups, they were respectively 100, 66.6 and 34 % (actuarial) for the resected group patients and 64.2, 21.4, and 11.5 % (actuarial) for the RFA patients. Fig. 1 Kaplan-Meier analysis of survival after BC and BCLM treatment. GROUP 1 = resection; GROUP 2 = RFA. Overall survival from breast cancer treatment (months) p = 0.082 ns. Overall survival from BCLM treatment (months) p = 0.001 CONCLUSIONS: Aggressive treatment on isolated BCLM may improve survival for these patients.

Sporadic, nontrauma-related, desmoid tumor of the pancreas: a rare disease-case report and literature review.

Desmoid tumors (DTs) are neoplasms of fibroblastic origin characterized by lack of a capsule. They are nonmetastatic and locally aggressive. Intraabdominal DTs are often observed in familial adenomatous polyposis and Gardner syndrome or subsequent to localized traumatic injury. Sporadic forms are defined as nontrauma- or nongenetic-related DTs. Isolated, sporadic pancreatic DTs have been considered anecdotal, with only 9 cases described in the literature. We report the case of a 68-year-old man with a case of sporadic cystic DT localized to the pancreatic tail. The tumor was discovered incidentally during computerized tomography performed for an unrelated condition. The patient was asymptomatic; however, biopsy was performed on the clinical suspicion of cystic cancer of the pancreas. Pathology analysis showed fibroblastic proliferation, and the diagnosis of DT was confirmed by immunohistochemical staining for beta-catenin. The patient underwent resection with no further treatment and remain disease-free 60 months after surgery.

Liver transplantation. A summary of our surgical practice.

At the turn of the new century, liver transplant procedures can finally be considered an efficient treatment option. Technology has helped transplant intervention become a preferred treatment for patients with progressive and irreversible liver failure. New immuno-suppressive drugs have been introduced which reduce the patient's immunological reaction to the implanted organ, entail minimal side effects and improve practical applications of liver transplantation. As a result of these technological advanced and proper disease management, liver transplant procedures are no longer thought of as an elite therapy, reserved for selected patients with end stage liver disease. In our opinion, it is now a sound and valid surgical option with strictly defined characteristics, indications and well-understood limits. Throughout the past decade, we have studied and applied this type of intervention and have come to terms with its rapid expansion at both the theoretical and practical levels. The most significant obstacle remaining today is the discrepancy between the ever increasing demand and limited supply of organs. The future of liver transplant lies in overcoming this obstacle. Liver transplant practice began at our Institute on 23 November 1990 with the first surgical intervention to replace an organ. In the past 10 years, we have exceeded 200 liver transplant procedures.

[Echo-guided fine-needle biopsy for the diagnosis of hepatic angioma. A report on 114 cases]. / La biopsia ecoguidata con ago sottile per la diagnosi di angioma epatico. Rapporto su 114 casi.

METHODS: Personal experience with fine-needle aspiration biopsy (FNAB) performed in 114 patients (42 males and 72 females) with hepatic angiomas, in whom imaging techniques did not allow a definite diagnosis, is reported. FNAB was made on 57.9% of the cases for atypical US pattern of the nodule, on 52.6% for a previous cancer history, with both conditions on 10.5%. The procedure was carried out by cyto-assistance for collecting material and a rapid stain diagnosis with an average of 2 biopsies per patient. Diagnostic accuracy was evaluated with following laparoscopy in 25 cases; surgery in 4 cases; angiography in 6 cases and US follow-up for 1 year at least in 78 cases (1 drop-out). RESULTS: One false-negative and 4 false-positives were detected with an overall accuracy of 96%. Two minor accidents were observed, due to a profuse bleeding of giant angiomas and resolved with medical care. CONCLUSIONS: Therefore, in case of angiomas larger than 5 cm, the use of laparoscopy after FNAB to control the bleeding and to confirm the diagnosis is suggested.

Ultrasound-guided fine needle biopsy and laparoscopy in the study of pancreatic masses: report on 136 cases.

The authors report their experience from 136 fine needle ultrasound (FN-US)-guided biopsies and laparoscopies. The pancreatic diseases considered by these methods were as follows: 9 cases of Pancreatitis, 11 cases of Pancreatic cysts, 5 cases of endocrine cancer, 109 cases of Exocrine cancer and 2 not conclusive cases. Diagnostic accuracy of FNB and laparoscopy was evaluated for each group and, in particular, for cancer patients. In the latter group, FNB helped to detect abdominal diffusion in 25 cases (33%) while laparoscopy, including laparoscopic washing, revealed a micro-diffusion in 31 cases (55%), the latter not shown previously by CT, RNM and US. The combination of these methods allows us to confirm the advanced stage of the majority of pancreatic cancers at onset. Furthermore, this seems to be a very reliable method to select resectable patients, thus avoiding useless, sometimes hazardous and expensive further investigation.

Intraoperative cytology of pancreatic masses. A 10-year experience.

The results of intraoperative fine needle aspiration biopsy (FNAB) of 92 pancreatic masses (1982-1992) are reported. The high sensitivity (1.00) and specificity (1.00) values are believed to be due to the presence of a cytopathologist in the operating room. The cytopathologist assesses the adequacy of the sampled material and, using rapid staining, can make a cytologic intraoperative diagnosis. This procedure led to the diagnosis of inflammatory lesions and of common and rare pancreatic neoplasms in a few minutes. Emphasis is laid on the characteristics of pancreatic FNAB vs. the more invasive procedures (e.g., wedge biopsies).

[Comparison between nuclear DNA and histologic grade of prostatic carcinoma]. / Comparaison entre ADN nucléaire et grade histologique du carcinome prostatique.

DNA nuclear ploidy determined by flow cytometry was evaluated from prostate tissue in 51 patients with prostatic cancer who had undergone radical prostatectomy. DNA ploidy pattern was diploid in 46% and aneuploid in 54% of tumors. DNA ploidy was compared to histological tumor grading. 92 Aneuploidy was found in 0% of the tumors with Gleason score between 2 and 4 in 62% between 5 and 7 and in 50% between 8 and 10. Our results suggest there is no relationship between the two parameters.

"Cyto-assisted", ultrasound-guided biopsy in the diagnosis of focal disease of the abdomen.

From May 1988 to June 1990, 260 patients with abdominal focal disease underwent ultrasonically guided percutaneous fine needle biopsy. The technique of so-called "FNAB-CYT" is described. The procedure entailed very few complications: the mortality rate was 0% and the morbidity rate was 1.5%. The specificity of the technique was 100%, and sensitivity was 93.43%. False-negative diagnoses were made in 8 cases, and in 5 patients the cytologic diagnoses were uncertain. There were no false-positives. The possibility of an immediate control of the collected material by the pathologist avoids the risk of inadequate samples and reduces the number of biopsies for the patient. Comparison among diagnoses on rapid and definitive preparations and histologic ones was carried out to evaluate the diagnostic efficiency of the cytologic procedure. In our experience, a rapid staining of the smears allowed a correct cytologic diagnosis in 87.7% of the cases within approximately 5 min of the biopsy. On the basis of our experience, the authors recommend FNAB-CYT as a routine first-level (less invasive) procedure for diagnosis of abdominal focal disease.

Cytology in the diagnosis of pancreatic cancer.

The study of cytology in duodenal and/or pure pancreatic juice has been proposed in the differential diagnosis of pancreatic cancer. In our experience the sensitivity of cytology in duodenal juice, collected during Secretin-Cholecystokinin test, in diagnosing pancreatic cancer was 66.6%. False positive results were obtained only rarely (1.4%) in patients with chronic pancreatitis and benign diseases of the gastrointestinal tract. The cytological evaluation of pure pancreatic juice, obtained by ERCP, increases sensitivity up to 80-90%, especially when the combination of the results of ERCP and cytology is performed. Cytological examination of duodenal and/or pure pancreatic juice is a useful tool in detecting pancreatic malignancy and in differential diagnosis with chronic pancreatitis.

Grading of the prostate carcinoma: cyto-histological correlations on 100 cases.

From January 1980 to December 1983, 154 patients underwent prostatic FNAB and histological control. The sensitivity of cytology was 85%, the specificity 68% and the predictive value of positive cases 83%. The cyto-histological correlation of the grading of the 100 prostatic carcinomas histologically confirmed (85 cytologically positive for carcinoma and 15 negative or uncertain) showed a predictive value of positive results of 58%, ranging from 42% for G3, 50% for G1 and 69% for G2. The usefulness of cytological grading is stressed to monitor the follow-up of those patients treated for prostatic carcinoma who, because of the advanced stage or age, were not surgically treated.

Transrectal thin-needle aspiration biopsy of prostate: four years' experience.

Fine-needle aspiration biopsy of the prostate is of great advantage in the diagnosis of prostatic disease. The procedure is quick, safe, and reliable. Several aspirations can be done even in outpatients with minimum trauma. Complications are rare. In this study cytologic diagnosis was obtained in 511 consecutive patients. To evaluate the cytologic accuracy, 195 cytologic diagnoses were compared with histologic findings obtained from transperineal biopsy on the same patients. Correlation was achieved in 96.42 per cent of these cases. The findings in 127 histologically graded prostatic cancers were compared with the cytologic differentiation observed in aspiration smears of the same patients. Cytologic grading of prostatic carcinoma corresponded to the histologic grading in 85.8 per cent of the cases.

CEA concentration and cytology in duodenal fluid collected during the Secretin-Pancreozymin test. Attempt at an early diagnosis of pancreatic carcinoma by means of simple procedure.

CEA concentration in juice collected during the Secretin-Pancreozymin test, and cytology were evaluated in order to establish whether they may be used as an aid in the diagnosis of pancreatic carcinoma before resorting to x-ray examinations. Thirty-three subjects were studied: 6 normal subjects, 12 with chronic pancreatitis, 3 after recovery from acute pancreatitis, 8 with gall-stones, 3 with carcinoma of the pancreas and 1 with cancer of the biliary tract. Three duodenal juice samples (at 30, 60 and 90 mins of hormonal infusion) were taken in each subject for CEA, cytology, bicarbonate and trypsin determinations. Although a significant statistical difference was noted between normal subjects and patients with carcinoma of the pancreas in the 30-min-juice sample, CEA concentration in the duodenal juice did not seem a reliable index in the diagnosis of pancreatic carcinoma. The information provided by cytology was also very scanty and sometimes misleading. The clinical picture and radiological investigation still remain the surest basis for the diagnosis of pancreatic cancer.

[Value and limitations of exfoliative cytological study of the pancreatico-duodenal juice collected during the secretin and pancreozymin test in the diagnosis of pancreatic carcinoma]. / Validità e limiti dello studio della citologia esfoliativa sul succo pancreatico-duodenale raccolto durante test alla secretina e pancreozimina nella diagnosi di carcinoma pancreatico.

Studies on exfoliative cytology of the pancreatic-duodenal juice in the diagnosis of pancreas neoplasia are not numerous and the data reported are not uniform. The present study examines 176 patients, 18 of them suffering from carcinoma of the pancreas. In these latter patients there were no advanced signs of the disease. Cytology gave a correctly negative result in 46.8% of the normal subjects and in those with non-neoplastic pancreatic or digestive conditions, correctly positive in 66.6% of the pancreas neoplasias, falsely negative in 2,2% of the total series and in 33.3% of the pancreatic cancers, and falsely positive in 1,1% of the series. In 47.7% of cases, the study proved useless owing to the absence of material in the collected juice.