Pseudotumor of the omentum with a fishbone nucleus.

A 23-year-old Japanese man was admitted with a chief complaint of abdominal pain. He was previously healthy, and his past medical history was unremarkable. Local tenderness and rebound tenderness at McBurney's point were elicited. Abdominal roentgenography was non-diagnostic. Ultrasonography and computed tomography showed a tumor with a central core. Based on a diagnosis of appendicitis with omental inflammation or an omental tumor, laparotomy performed. Intraoperatively, no site of gastrointestinal perforation was detected; however, a 5-cm omental granuloma was identified that proved to have a fishbone nucleus on pathological examination. The postoperative course was uneventful, and upper gastrointestinal endoscopy and barium enema were unremarkable. A large solitary omental pseudotumor is rare, and the clinical course in this case was atypical compared with the usual course of intestinal perforation by a foreign body and formation of an intra-abdominal granuloma.

[Changing behavior of estrogen and progesterone receptors with metastasis or recurrence of breast cancer].

Changes in level of estrogen receptor (ER) and progesterone receptor (PgR) and their affecting factors were studied with metastasis or recurrence of breast cancer. Since 1983, from 177 patients, 443 specimens were obtained and 244 simultaneous and 122 sequential pairs were compared. The consistency rate was 81% for both ER and PgR with simultaneous comparison,and 69% for ER and 71% for PgR with sequential comparison, mainly due to positive-to-negative change, and less than 10% of negative-to-positive change. Positive-to-negative change was prominent with intervening endocrine treatment, and it was significant (p=0.015) for ER by multiple regression analysis of age, interval of sampling and from prior surgery, intervening chemotherapy, endocrine therapy and human epidermal growth factor receptor 2 (HER 2). Based on recent data of ER and PgR, feasible treatment seems to be planned, because about 30% of them are different from that of primary lesion.

[Postoperative changes in serum lipid levels of breast cancer and adjuvant chemotherapy].

Postoperative adjuvant drugs are usually given long-term for breast cancer to obtain various effects and their effects on serum lipid level changes were studied. Between June 1990 and May 2003, changes in serum levels of five serum lipids, cholesterol (CHO), triglyceride (TG), phospholipid (PL), free fatty acid (FFA), and high-density lipoprotein-cholesterol (HDL-C), were quantitated for 453 surgically-treated patients with breast cancer. Postoperative adjuvant settings were: 1. no drug; 2. Goserelin (G) of subcutaneous gradual release form; 3. tamoxifen; 4. oral fluoropyrimidines, i. e. tegafur, carmofur and doxyfluridine; and 5. oral alkylating agents, i. e. carboquone or cyclophosphamide. Preoperative levels of all five lipids correlated with age until 70, and postoperative levels of all five increased. The CHO level increased in patients treated with G, fluoropyrimidines and oral alkylating agents, decreased in patients treated with tamoxifen, and was stable in patients without adjuvant treatment. While the increase in the CHO level in G or decrease in tamoxifen was restored nearly to the preoperative level, the changes in patients with fluoropyrimidines or alkylating agents continued after five-year administration. Multiple regression analysis revealed significant effects of preoperative levels of all lipids, including T for CHO, G and oral fluoropyrimidines for TG, G for FFA, and oral fluoropyrimidines for PL. While postoperative adjuvant treatment for breast cancer affects changes in serum lipid levels as a function of preoperative level and age, it seems to be due to direct or indirect endocrine milieu.

[Estimation of level of enzyme induction of thymidine phosphorylase, dihydropyrimidine dehydrogenase, and thymidylate synthase in primary and recurrent breast cancer].

Several enzymes are closely related with the mechanism of action of fluoropyrimidine (FP). Dihydropyrimidine dehydrogenase (DPD) which catalyzes 5-fluorouracil (5-FU), thymidine phosphorylase (TP), responsible for catalyzing doxifluridine to 5-FU, and thymidylate synthase (TS) were estimated for breast cancer. TP level determined by enzyme-linked immunoabsorbant assay (ELISA), DPD level by ELISA and catalytic assay and TS level by fluorodeoxyuridine monophosphate (FdUMP) binding assay were estimated for 210 specimens from 125 consenting patients with primary or metastatic breast cancer who gave consent. TS level of T1 was higher than that of T2-4 (p < 0.05). A high positive correlation was observed between TP and DPD in the same specimen. The ratio of simultaneously resected metastasis/primary and postoperative recurrent/primary never exceeded two. Enzyme level, generally decreased with or without interventing FP therapy. Enzyme level increase was frequently observed in a series of no-drug, non-FP, and FP therapy regimens. For selection of chemotherapy or estimation of chemosensitivity, TS can be used, with either TP or DPD at first surgery, and also with intervening chemotherapy after recurrence.

A case of fat necrosis after breast quadrantectomy in which preoperative diagnosis was enabled by MRI with fat suppression technique.

A 63-year-old woman was found to have a left breast mass after quadrantectomy and radiation for bilateral breast cancer on postoperative cyclic examination. Intramammary recurrence could not be excluded by physical examination, mammography, or ultrasound examination. MR imaging with fat suppression technique revealed an oil-containing lesion, indicating fat necrosis. It was confirmed histologically that the mass-forming lesion included no cancer tissue. MR imaging with fat suppression technique appears to be a promising method for identification of postoperative mass lesions of the breast.

Postoperative adjuvant use of carmofur for early breast cancer.

OBJECTIVE: The efficacy of oral fluoropyrimidine carmofur was evaluated for adjuvant use for breast cancer. METHODS: 150 patients with breast cancer of T0N1, T1, N1, T2N0, and T2N1 were randomized to 100 for carmofur and 50 for carboquone. Both drugs were administered continuously for 28 days cyclically for 5 years with a cessation period of 28 days for carmofur and 56 days for carboquone. RESULTS: Overall survival excluding non-breast cancer death was 90% for the carmofur group and 88% for the carboquone group, adjusted by Cox's regression analysis. Difference in drug never affected survival. Leukocyte count was decreased in the carboquone group, but no change in serum transaminase was found in either group. Ten patients, 5 for carmofur and 5 for carboquone, suffered from second malignancy, more than expected in the normal population, but difference in the cumulative rate of each group was not significant. CONCLUSION: Adjuvant use of carmofur as well as carboquone is beneficial for early breast cancer.

Cytologic diagnosis of estrogen and progesterone receptors in breast imprints.

OBJECTIVE: To investigate estrogen receptor (ER) and progesterone receptor (PR) levels in imprint specimens obtained at breast surgery and to compare their correlation with that of standard methods. STUDY DESIGN: Imprint specimens for cytology were obtained from 101 mass-forming lesions in 66 patients, and specimens were frozen in liquid nitrogen for later assay. The imprint specimens were immunocytochemically (ICC) stained by monoclonal antibody to ER or PR; diaminobenzidine-stained cell nuclei in clusters were regarded as positive. Tissue specimens were assayed by the standard method of dextran-coated charcoal assay (DCC) and enzyme immunoassay. RESULTS: Forty-five primary breast cancer lesions, 2 contralateral breast cancer, 49 dissected nodes and 5 benign breast lesions were collected. The correlation between DCC and ICC was 81% (82/101) for ER and 74% (66/101) for PR. That between EIA and ICC was 88% (88/99) for ER and 80% (79/100) for PR, higher than that between DCC and ICC for ER and PR. CONCLUSION: ICC assessment of ER or PR on imprint cytology is a promising clinical test with an acceptable correlation.

[Inconsistency in quantitation of estrogen receptor and progesterone receptor with dextran charcoal method and enzyme immunoassay].

Six hundred and eighty-eight breast specimens including 442 breast cancers were studied to investigate the consistency and correlations between dextran charcoal assay (DCC) and enzyme immunoassay (EIA) for estrogen receptor (ER) and progesterone receptor (PgR). In DCC, ER was quantitated with competition of 16 alpha-125I-estradiol and diethyl stilbesterol, and PgR with 3H-R5020 and R5020. In EIA, kit from Abbott was used in ER and PgR quantitation. The mean age of the patients was 52 years and the mean age of patients with benign lesions was 39 years. The consistency rate was 95% for ER, and 83% for PgR, while the consistency coefficient kappa was 0.90 and 0.66, respectively. For the specimens in which the number of binding sites was calculated in both DCC (x) and EIA (y), the correlation coefficient was 0.787 and the linear regression formula was y = 0.5x + 58. For PgR, the correlation coefficient kappa was 0.612 and the regression formula was y = 2.6x + 91. In multiple regression analysis for consistency of DCC and EIA, for ER, there was an inconsistent trend for positive PgR and a consistent trend for patients in their fifties. For PgR, the trend was inconsistent for benign lesions and positive ER. In comparison with the efficacy of endocrine treatment, no responder was found in ER negative patients for both DCC and EIA. In PgR-negative patients a responder was found for both DCC and EIA. By Western blot analysis, anti-ER antibody provided in the ER.EIA kit showed affinity only for ER alpha and not for beta. In conclusion, in terms of the treatment efficacy for both ER and PgR, the current use of ER with EIA instead of DCC seems to give equivalent result, and old DCC data can be converted into the regression formula. However, PgR calculated by EIA was not equivalent with that of DCC.

Retrospective study of conservation surgery for breast cancer with or without axillary dissection.

BACKGROUND: It is already known that for breast cancer patients, an axillary dissection or locoregional radiation has no major effect on survival with a simple mastectomy. We analyzed whether axillary dissection improved the prognosis for breast conservation surgery. METHODS: From 1982 to 1995, 31 patients underwent axillary dissection and 33 did not in association with breast conservation surgery performed at our institution. Median follow up was at 55 months, ranging from 3 to 210. Survival rates of patients were analyzed retrospectively. RESULTS: In the dissection group, 8 patients had recurrence and 5 died within 3 years, yielding a relapse-free survival rate of 71%. In the non-dissection group, 7 patients had recurrence, 3 died within 3 years, with a relapse-free survival rate of 79%. Figures for overall survival, relapse-free except breast and relapse-free for breast at 5 years were 93%, 73%, and 96% for the dissection group, and 93%, 89%, and 89% for the non-dissection group, respectively. No difference was found in survival rates between the two groups. Adjusted by Cox's regression analysis, survival rates of overall, relapse-free, relapse-free except breast and relapse-free for breast, at 5 years were 86%, 71%, 77%, and 90% for the dissection group, and 100%, 78%, 85%, and 95% for the non-dissection group, respectively. No survival benefit was found in axillary dissection. The first site of recurrence was in the affected breast in 3 patients and in other sites in 5 patients for the dissection group, while for the non-dissection group it was in the affected axilla in 1 patient, the skin of the affected breast in 1 patient, the affected breast in 3 patients, and other sites in 2 patients. In the non-dissection group, a patient who had recurrence on the skin of the affected breast, subsequently had an axillary recurrence on the same side with plexus paresis. CONCLUSION: In breast conservation, prophylactic axillary dissection seems to be omitted, but the axilla of the affected side should be examined for metastasis while treatment is possible.

Levofloxacin for prophylaxis in breast cancer surgery compared with ofloxacin.

BACKGROUND: We found that once-daily use of ofloxacin is beneficial from the standpoints of economy and patient compliance. Levofloxacin, has twice the antimicrobial activity and same toxicity of ofloxacin. We investigated the clinical usefulness of levofloxacin compared with ofloxacin in breast surgery. METHOD: Between July, 1996 and April, 1999, 199 consecutive patients hospitalized in our department for treatment of breast cancer were enrolled in this study with their informed consent and 181 patients were evaluated. RESULTS: Four (4%) of the 99 patients in the levofloxacin group had wound infections, as did 5 (6%) of the 82 patients in the ofloxacin group. The median times needed for wound care, with 25th and 75th percentiles, were 13 [9, 16] days in the levofloxacin group and 11 [9, 16] days in the ofloxacin group. From infected wound three strains of Staphylococcus aureus were detected from the levofloxacin group and two strains were from ofloxacin group, but no methicillin-resistant strains were isolated. Multiple regression analysis showed that only wound dehiscence was a significant factor in the occurrence of wound infection and the period of wound care. No signs or symptoms suggesting levofloxacin or ofloxacin toxicity were observed. Laboratory test changes before and after treatment were similar in the two groups. CONCLUSION: It appears that levofloxacin is not superior to ofloxacin in prophylactic efficacy for postoperative wound infection after breast surgery.