Intra-arterial chemotherapy for palliation of fungating breast cancer. A case report and review of the literature.

The infusion of chemotherapy into arteries that feed locally advanced tumors has theoretical appeal, since the tumor mass may be exposed to high drug concentrations with administration of reduced or conventional doses of chemotherapy. Experience in applying this technique to patients with breast cancer in the United States is limited. Locally advanced, fungating breast cancers pose particularly difficult management problems for which intra-arterial drug delivery may be appropriate in carefully, selected cases. Disseminated cancer, physical deformity, foul odor, bleeding, and infection, as well as associated psychosocial factors, contribute to the complexity of caring for these patients. We report the case of a patient with a massive fungating breast cancer who was effectively palliated with intra-arterial administration of mitomycin, fluorouracil, cisplatin, and mitozantrone. The rapidity of our patient's response using this approach supports the observations of other investigators. We offer a review of the literature reporting the application of this technique for patients with locally advanced breast cancer. Further study of intra-arterial chemotherapy in carefully selected patients with locally advanced and fungating breast cancers is warranted.

Predictive value of the fluorescent cytoprint assay (FCA): a retrospective correlation study of in vitro chemosensitivity and individual responses to chemotherapy.

The potential clinical usefulness of the fluorescent cytoprint assay (FCA) was assessed retrospectively in 73 cancer patients by correlating individual tumor chemosensitivity in vitro with responses to chemotherapy. The data show that the FCA has a sensitivity of 98%, specificity of 81%, and predictive accuracies of 85% and 97% for positive and negative clinical responses, respectively.

Inflammatory breast cancer.

Of all malignancies in women, perhaps none is as lethal or as frustrating to the surgeon as inflammatory breast cancer. No significant progress in curing or controlling inflammatory breast cancer was made until the last decade, when investigators, noting the futility of local therapies, applied systemic therapies with some significant improvement in survival. This article outlines the epidemiology, clinical signs, differential diagnosis, pathology, and treatment of this disease.

The problem of liver metastasis.

The detection and management of tumors metastatic to the liver is still unsettled. The uniformly poor prognosis only underlines the need to diagnose and treat the primary malignant lesion earlier, before systemic metastases lodge in the liver, lung or brain. Serologic markers are not specific or sensitive enough although when used serially they may follow the course of some tumors. The exciting advances in radiologic diagnosis have allowed a more accurate and pictorial representation of disease, exciting cross-sectional views but not earlier diagnosis. The use of scans and ultrasound as a screening measure is investigational only as there is not good evidence to support this as a routine screening test. The treatment of hepatic metastases is also insoluble. For primary lesions that are controlled surgically and whose natural history is measured in years (not months) a more aggressive approach is justified. Lesions confined to one lobe, particularly single lesions, lend themselves to resection. Segmental or wedge resection is the equal of formal hepatic lobectomy and is safer for patients and surgeons. For most patients (70 to 85 percent) operation is not a reasonable choice. How does one select from no therapy, intravenous chemotherapy, intraarterial chemotherapy (implantable pumps, infusion plus embolization) or hepatic artery embolization? These decisions are not easily reached. Institutional enthusiasm is as much a reflection of local expertise and biases as are meaningful data. There are responders to all of these methods, but few long-term survivors. Side effects that limit life style and activity detract from some of the remaining days. Today patients share in the decision-making process. Their own biases are frequently in discord with the treating physician's. When this exists and data do not support one treatment method we acquiesce to the patient's wishes and use his or her experience to increase our data base. Intraarterial chemotherapy is making a strong impact, objective information not withstanding. Unless an implantable pump is covered by third party payments we prefer a "test trial" of several monthly intraarterial injections of chemotherapy to see if a positive effect occurs. Intravenous chemotherapy remains our therapeutic choice particularly if part of a trial. If there is no response and side effects are severe, we prefer to withdraw treatment.

Aorticopulmonary paraganglioma and gastric leiomyoblastoma in a young woman.

The 16th report of a patient with "Carney's triad" is presented. The triad consists of an extra-adrenal paraganglioma, gastric leiomyoblastomas and a pulmonary chondroma. The diagnosis is made by discovery of the presence of at least two of these individually rare tumors. The patient described as 15 year old girl who presented with a pericardial effusion caused by an invasive mediastinal paraganglioma. She was subsequently found to have multiple gastric leiomyoblastomas. The leiomyoblastomas have been resected. The paraganglioma was unresectable, and the patient underwent sequential radiation therapy and chemotherapy without response. Concomitant 5-fluorouracil chemotherapy with radiation resulted in an objective regression of tumor mass.

IgE antipolymyxin B antibody formation in a T cell-depleted bone marrow transplant patient.

The production of IgE-class antibody specific for polymyxin B is documented in an 18-year-old white female acute myelocytic leukemic patient in relapse. The patient was rendered T cell-deficient by total body X-irradiation and antihuman thymocyte globulin for the purpose of bone marrow transplatation. Thereafter, symptoms of nasal congestion, rhinorrhea, and perinasal urtication produced by topical application of a polymyxin solution were noted. Reaginic activity mediated by an IgE antibody against polymyxin is documented by Prausnbitz-Küstner-type passive transfer reactions and by an indirect hemagglutination technique developed for these studies. The occurrence of type I hypersensitivity to this topical antibiotic is rare. It is speculated that pharmaceuticals normally having a low sensitizing potential might demonstrate increased reaginic immunogenicity in a spontaneously or iatrogenically T cell-depleted patient.

Demonstration of a blocking factor in the plasma and spinal fluid of patients with subacute sclerosing panencephalitis. I. Partial characterization.

Conflicting reports on the immune responsiveness of patients with subacute sclerosing panencephalitis (SSPE) have been reported. This report shows that the leucocytes from four SSPE patients exhibited strong sensitivity to both measles and SSPE virus preparations as measured by the macrophage migration inhibition test, mixed lymphocyte virus infected cell culture test, and the lymphotoxin assay. Earlier suggestions that a factor may be operating to suppress cellular reactivity are confirmed by the demonstration that the response of lymphocytes from SSPE patients could be blocked by the addition of SSPE spinal fluid or plasma. It was determined that the blocking factor was stable at -20 degrees C, heat labile at 56 degrees C for 30 minutes, trypsin and neuraminadase sensitive, and had a mol wt greater than 150,000 as determined by Sephadex G-200 gel chromatography. The blocking factor appeared to be specific for SSPE virus and did not block the response of lymphocytes to nonspecific mitogenic agents and other viral and bacterial agents.

Lymphocyte activation in subacute sclerosing panencephalitis virus and cytomegalovirus infections. In vitro stimulation in response to viral-infected cell lines.

Efforts to stimulate lymphocytes from measles seropositive and two patients with subacute sclerosing panencephalitis (SSPE) with either commercially available measles virus or virus isolated from a known case of SSPE failed to show any significant data using a microculture assay. Similar results were obtained using lymphocytes from two patients with active cytomegalovirus (CMV) infections and CMV seropositive individuals using CMV suspensions. On the other hand, lymphocytes from the patients with subacute sclerosing panencephalitis exhibited in vitro blastogenesis in culture with SSPE virus-infected HeLa cells. Similarly, lymphocytes from the CMV-infected patients demonstrated blastogenesis when cocultivated with CMV-infected WI-38 cells. This affords a new method for determining the cell-mediated immune capacity of patients with "slow" virus diseases.