Eccrine porocarcinoma.

Eccrine porocarcinoma, a malignancy of the eccrine sweat glands, is extremely rare. Our report and a review of the literature (70 cases) emphasize the features of this tumor. Age at time of treatment ranged from 19 to 94 years (mean 67 years). Duration of the lesion ranged from two months to 50 years; 31 (44%) had the lesion present > or = 5 years. Forty-four patients (62%) had tumors located on the extremities, 13 (19%) on the head and neck region and 12 (17%) on the trunk. All patients whose race is known were white. Primary treatment should consist of wide local excision and regional lymphadenectomy, if clinically indicated. Although there is a significant risk of cutaneous, regional lymph node, or visceral metastases, the value of elective or therapeutic regional lymphadenectomy is unknown, as is the role of adjunctive therapy.

The impact of mammography on breast biopsy.

To determine the efficacy of mammography in the detection of early breast carcinoma at an urban teaching hospital, the results of all breast biopsies performed between 1983 and 1987 that were preceded by mammographic examination were retrospectively reviewed. There were 503 women in this population. Malignancy was detected in 79 cases (15.7%); 21 were in situ and 58 were invasive. Among all nonpalpable malignancies, 53.0 per cent were in situ, while only 2.4 per cent of all palpable malignancies were in situ. An abnormality was found in 374 mammograms (74%), and 73 (19.5%) were malignant. The abnormality most likely to represent a malignancy (44% yield) was spiculated density, followed by clustered microcalcifications (25%), mass (22%), and asymmetric density (14%). Six malignancies were detected by biopsy for clinical indications, despite a negative mammogram (4.7% false- negative rate). The interpretation of mammograms by radiologists carried a 2.4 per cent false-negative rate. The mammographic features of mass, clustered microcalcifications, spiculations or asymmetric density should generally mandate breast biopsy, although the clinical examination should remain an important basis for management decisions. An aggressive approach toward screening mammography and breast biopsy based on mammographic criteria may enhance survival among women with breast carcinoma.

Gastroduodenal polyps in familial adenomatous polyposis.

A retrospective review of the medical records of 30 patients with familial adenomatous polyposis who underwent oesophagogastroduodenoscopy was performed to evaluate the spectrum of gastroduodenal polyps. Twenty-five patients (83%) had gastroduodenal polyps. Eighteen patients (60%) had gastric polyps and 21 patients (70%) had duodenal polyps. Five patients (17%) had gastric and 20 patients (67%) had duodenal adenomatous polyps. Three patients (10%) died from an upper gastrointestinal tract adenocarcinoma. Three of nine patients with periampullary adenomas had a normal-appearing papilla of Vater. Since gastroduodenal polyps are common in familial adenomatous polyposis, oesophagogastroduodenoscopy should be performed at the time of diagnosis. Biopsy of polyps as well as biopsy of a normal-appearing papilla of Vater should be performed. Due to their malignant potential, if identified, gastroduodenal adenomatous polyps should be destroyed.

Breast biopsy. Changing patterns during a five-year period.

The current emphasis on early detection of breast carcinoma prompted an analysis of all breast biopsies performed at an urban teaching hospital between January 1, 1983, and December 31, 1987. There were 1,342 biopsies during this interval in 933 patients with an overall mean age of 45.3 years. Malignancy was diagnosed in 197 patients (14.7%) with a mean age of 57.5 years, while the remaining patients with a benign diagnosis had a mean age of 43.2 years. There were 178 nonpalpable lesions (13.3%) and 22 malignancies were detected in this group (12.4%). Most (91%) of the nonpalpable malignancies were "early" (in situ and stage I), while 71 per cent of the palpable malignancies were "advanced" (stages II and III). Although the yearly number of biopsies remained constant, upward trends were demonstrated in the number of nonpalpable lesions biopsied, the proportion of malignancies detected among all biopsies, and in the yield of proliferative benign forms of breast disease, specifically those with atypia. These trends correlated with a sixfold increase in the yearly number of mammograms performed over the same time interval. These results suggest that a commitment to an expanded use of mammography and to an aggressive approach to breast biopsy can increase the detection of both early forms of breast carcinoma and those benign breast lesions that are known pathologic risk determinants for breast carcinoma. Such a commitment may influence the future survival of this population.

Chiari network entrapment of thromboemboli: congenital inferior vena cava filter.

Pulmonary emboli and a right atrial thrombus enmeshed in a Chiari network developed concurrently in a 69-year-old man. The network perhaps functioned as an inferior vena cava filter preventing massive pulmonary embolus. Chiari network should be considered in the differential diagnosis of a right atrial mass and the presence of pulmonary emboli should suggest surgical removal.