Circulating Tumor DNA in the Management of Early-Stage Breast Cancer.

Liquid biopsies refer to the isolation and analysis of tumor-derived biological material from body fluids, most commonly blood, in order to provide clinically valuable information for the management of cancer patients. Their non-invasive nature allows to overcome the limitations of tissue biopsy and complement the latter in guiding therapeutic decision-making. In the past years, several studies have demonstrated that circulating tumor DNA (ctDNA) detection can be used in the clinical setting to improve patient prognosis and monitor therapy response, especially in metastatic cancers. With the advent of significant technological advances in assay development, ctDNA can now be accurately and reliably identified in early-stage cancers despite its low levels in the bloodstream. In this review, we discuss the most important studies that highlight the potential clinical utility of ctDNA in early-stage breast cancer focusing on early diagnosis, detection of minimal residual disease and prediction of metastatic relapse. We also offer a concise description of the most sensitive techniques that are deemed appropriate for ctDNA detection in early-stage cancer and we examine their advantages and disadvantages, as they have been employed in various studies. Finally, we discuss future perspectives on how ctDNA could be better integrated into the everyday oncology practice.

Axillary lymph node dissection vs sentinel biopsy only among women with early-stage breast cancer and sentinel node metastasis: A systematic review and meta-analysis.

Axillary lymph node dissection (ALND) in early-stage breast cancer with limited sentinel node metastasis may not be superior to sentinel lymph node dissection (SLND). We performed a meta-analysis comparing SLND/Radiotherapy (RT) with ALND. All data were analyzed using Review Manager Software 5.3. Five randomized controlled trials (RCTs) were included. Overall survival, death, and disease-free survival were estimated higher in the SLND group compared to the ALND group. Statistically significant differences in axillary recurrence were observed in favor of ALND. Omission of ALND in patients with <3 positive SLNs is indicated.

The Histone Demethylase LSD1/ΚDM1A Mediates Chemoresistance in Breast Cancer via Regulation of a Stem Cell Program.

Breast cancer is the leading cause of cancer death in the female population, despite advances in diagnosis and treatment. The highly heterogeneous nature of the disease represents a major obstacle to successful therapy and results in a significant number of patients developing drug resistance and, eventually, suffering from tumor relapse. Cancer stem cells (CSCs) are a small subset of tumor cells characterized by self-renewal, increased tumor-initiation capacity, and resistance to conventional therapies. As such, they have been implicated in the etiology of tumor recurrence and have emerged as promising targets for the development of novel therapies. Here, we show that the histone demethylase lysine-specific demethylase 1 (LSD1) plays an important role in the chemoresistance of breast cancer cells. Our data, from a series of in vitro and in vivo assays, advocate for LSD1 being critical in maintaining a pool of tumor-initiating cells that may contribute to the development of drug resistance. Combinatory administration of LSD1 inhibitors and anti-cancer drugs is more efficacious than monotherapy alone in eliminating all tumor cells in a 3D spheroid system. In conclusion, we provide compelling evidence that LSD1 is a key regulator of breast cancer stemness and a potential target for the design of future combination therapies.

Breast cancer in young women: an overview.

Despite dramatic advances in cancer research setting, breast cancer remains a major health problem and represents currently a top biomedical research priority. Worldwide, breast cancer is the most common cancer affecting women, and its incidence and mortality rates are expected to increase significantly the next years. Recently the researchers' interest has been attracted by breast cancer arising in young women. Current evidence suggests that in women aged <45 years, breast cancer is unquestionably the leading cause of cancer-related deaths. This type of cancer seems to be highly heterogeneous and has potentially aggressive and complex biological features. However, management strategies, recommendations and options are not age based and the 'complex' biology of this type of cancer remains uncertain and unexplored. In this review, we summarize the latest scientific information on breast cancer arising in young women highlighting the heterogeneity and the complex nature of this type of cancer.

Surgical management of hydatid liver disease.

BACKGROUND: large retrospective clinical study describing the long-term experience of a single center in the surgical management of liver echinococcosis in an endemic area. METHODS: 232 patients were operated for liver hydatid disease between 1978 and 2012. Seventy-three patients (Group A) underwent a radical procedure (total pericystectomy or hepatectomy), while 145 (Group B) were treated with a more conservative method (partial cystectomy, with external drainage, omentoplasty or capitonnage) and 14 (Group C) received a combination of total and partial cystectomies. Morbidity, mortality, post-operative complications and recurrence rates in the long-term setting were retrospectively evaluated. RESULTS: Group A patients were treated with zero mortality and a morbidity rate of 10.95%. No recurrence was documented. In Group B, mortality reached 2.76%, (p = 0.153 compared to Group A) morbidity 24.13% (p = 0.021) and there were 10 cases of relapse (6.9%) at three-year complete follow-up (p = 0.989). Extrahepatic sites of disease were not uncommon. DISCUSSION: radical surgical procedures were better tolerated by patients and yielded better results in terms of recurrence rates.

Unusual locations of hydatid disease: a 33 year's experience analysis on 233 patients.

Hydatid disease is caused by the tapeworm Echinococcus granulosus and it is an endemic parasitic disease of the Mediterranean countries. Although the liver is the most involved organ by this disease, hydatidosis can be found anywhere in the human body. Rare forms of location may pose diagnostic and therapeutic dilemmas. Herein we report our experience with unusual located hydatid disease diagnosed and treated at our center the last 33 years. A total of 233 patients were treated for echinococcosis (91 males: 39% and 142 females: 61%) between 1980 and 2013 at our center. 18 of them (7, 8%) with uncommon located hydatid disease, were analyzed retrospectively. 18 patients (8 males and 10 females) were presented with unusual location of hydatid disease in our series. Two of them had only extrahepatic cysts (0, 9%). A total of 64 hydatid cysts with unusual location were analyzed. The most prevalent extrahepatic sites were peritoneal cavity and spleen. Total cystectomy with or without tube drainage or omentopexy was performed for hydatid cysts of the peritoneal cavity in our series. Splenectomy was performed in all cases of splenic hydatidosis. The mean time of post operative stay was 16, 3 days (range 7-35 days), morbidity 11% and mortality 5, 4%. Although echinococcosis is found most often in the liver and lungs, it seems that any organ can be involved by this zoonotic disease. The operating surgeon must always consider the possibility of unusual location of echinococcal cyst when dealing with patients with cystic mass in endemic areas, because any misinterpretation may result in unfavorable outcomes.

A bittersweet story: the true nature of the laurel of the Oracle of Delphi.

It is known from ancient sources that "laurel," identified with sweet bay, was used at the ancient Greek oracle of Delphi. The Pythia, the priestess who spoke the prophecies, purportedly used laurel as a means to inspire her divine frenzy. However, the clinical symptoms of the Pythia, as described in ancient sources, cannot be attributed to the use of sweet bay, which is harmless. A review of contemporary toxicological literature indicates that it is oleander that causes symptoms similar to those of the Pythia, while a closer examination of ancient literary texts indicates that oleander was often included under the generic term laurel. It is therefore likely that it was oleander, not sweet bay, that the Pythia used before the oracular procedure. This explanation could also shed light on other ancient accounts regarding the alleged spirit and chasm of Delphi, accounts that have been the subject of intense debate and interdisciplinary research for the last hundred years.

A case of encapsulating peritoneal sclerosis presented shortly after renal transplantation.

Encapsulating peritoneal sclerosis (EPS) is a rare but serious complication of peritoneal dialysis (PD), characterized by extensive intraperitoneal fibrosis and encasement of bowel loops. It typically associates with long-term PD and progressive loss of ultrafiltration. The management of EPS has evolved substantially from the original report of this entity and now includes immunosuppressive agents, antifibrotic agents, nutritional support, and surgical intervention. Although the exact cause of this condition remains obscure and despite the possible positive effect of immunosuppression on EPS, it has been described in the post-transplant setting upon the discontinuation of PD. We report such a case of a former PD patient who presented with EPS a month after renal transplantation. This article will highlight the current views regarding the management of post-transplant EPS and introduce the problem of long-term PD patients on the deceased-donor transplant waiting list.

A new simplified one port laparoscopic technique of peritoneal dialysis catheter placement with intra-abdominal fixation.

BACKGROUND: Various laparoscopic techniques have been described for the insertion of peritoneal dialysis catheters. However, most use 3 to 4 ports, thus multiplying the potential risk for abdominal wall complications (hemorrhage, hernia, leaking). METHODS: A Tenckhoff catheter was placed laparoscopically, using just 1 port, in 13 consecutive patients with end-stage renal failure. All catheters were fixed in the abdominal cavity with no additional ports for this purpose. RESULTS: After a follow-up of 76 patient-months, all catheters are working properly. There were no postoperative wall hemorrhages, early leaking, or hernias. There was 1 case of catheter migration and 2 cases of late leaking in 2 patients in total, due to severe constipation. There were no exit site or tunnel infections. One episode of peritonitis was successfully treated with antibiotics. CONCLUSION: The simplicity and the rapidity of the method justifies serious consideration for its use as the standard Tenckhoff catheter placement.