[Ossifying fibroma of the face and hyperparathyroidism in a chronic hemodialysis patient]. / Fibrome ossifiant de la face et hyperparathyroïdie chez une hémodialysée chronique.

The bony complications in secondary hyperparathyroidism in chronic renal failure are varied. The ossifying fibroma is a rare manifestation. We report a case of a 40 years old woman with indeterminate nephropathy undergoing hemodialysis since 1982. Since may 1995, the patient had a diffuse and intensive bone pain of the two inferior members inducing functional importance with apparition of endobuccal tumefaction in the hard palate with an important increase of the volume of the maxillo-mandibular complex six months later associated to disturbances of the deglutition and phonation. In december 1995, the serum parathyroid hormone level is measured at 1527.6 pg/ml and the serum alkaline phosphatase level at 1620 UI/l. The bony lesions are disseminated to all the skeleton in the form of a demineralization with an ossifying expansive process affecting the maxillo-mandibular complex. Calcemia was at 2.3 mmol/l and phosphoremia at 2.1 mmol/l. The surgical biopsy of this pseudotumor showed an aspect of ossifying fibroma. The cervical echography showed a left inferior parathyroid nodular. In june 1996, a subtotal parathyroidectomy was done. The 9th day after surgery, the serum parathyroid hormone level was at 103 pg/ml with normal calcemia and phosphoremia. Five years later, the volume of the tumor reduced moderately. This observation induces 3 commentaries: the bony manifestations associated to secondary hyperparathyroidism have sometimes a tumoral aspect, the ossifying fibroma may be for known as well as the brown tumor and the treatment of these tumors in complex justifying furthermore a rigorous prevention of the hyperparathyroidism in hemodialyzed patients.

Disappearance of the in situ component: a criterion predictive of metastasis in breast cancer after local relapse.

Local recurrence after conservative treatment of breast cancer is associated with a significant risk for metastasis. In order to identify criteria predictive of metastasis in this subset of women, we analyzed a series of 35 patients with local relapse among 512 consecutive patients treated with tumorectomy and radiotherapy. When relapse occurred within 2 years of initial treatment, overall 2-year survival from the time of local relapse was 39.5%. When local relapse occurred more than 2 years from initial therapy, 2-year survival was 80.5% (p < 0.001). Pathological slides of both initial and recurrent tumors were reviewed and compared. In 17 patients, local relapse and initial tumor had the same morphological features, with an in-situ component either absent or present in the same proportion. Metastasis occurred in two of these patients. In contrast, 9 of 12 patients in whom the proportion of non-invasive carcinoma had decreased at the time of local recurrence developed metastasis. Overall 2-year survival from the time of relapse was significantly better in the former group of patients (93.3% versus 52.5%, p < 0.05). We concluded that early relapses have a poor prognostic significance and that disappearance of the in-situ component or increase of the invasive component at the time of relapse is a feature predictive of tumor-related death and that more intensive therapy might benefit to this subset of women.

[Prognostic value of local recurrence after conservative treatment of cancers of the breast ]. / Valeur pronostique de la récidive locale après traitement conservateur des cancers du sein.

To determine the prognostic significance of local relapse after conservative treatment of an invasive carcinoma of the breast, we analysed the results obtained in a series of 512 patients. All patients had a lumpectomy with axillary dissection followed by irradiation. Adjuvant medical treatment was administered to 168 patients. The actuarial 5 years and 10 years overall survival rates were respectively 92.5% and 79.7%. Local relapses occurred in 35 patients (6.8%). The actuarial 5 and 10 years local control rates were respectively 91.2% and 83.6%. In these patients, risk of metastasis was significantly increased as compared with patients without a local relapse. Recurrence in the breast within 2 years of initial treatment several affected the risk of metastasis occurring as compared to later relapses. We conclude that the occurrence of a breast relapse after successful local conservative treatment is a bad prognostic factor, predictive of a high risk for the development of distant metastases.

[Predisposing factors for local recurrence after conservative treatment of breast cancer]. / Facteurs prédisposants aux récidives locales après traitement conservateur des cancers du sein.

The factors predisposing to local relapse after conservative treatment of early stage breast cancer are controversial. To determine these factors, we analysed the results obtained in a series of 512 patients consecutively treated for invasive breast carcinomas by conservative surgery and radiotherapy. All patients were treated by tumorectomy and axillary dissection, radiation therapy of 45 Gy to the whole breast with a boost of 15 Gy to the tumor area, and adjuvant medical treatment for 168 out of 187 patients. The overall 5-year and 10-year survival rates were respectively 92.5% and 79.9%. The actuarial 5-year and 10-year local control rates were respectively 91.2% and 83.6%. Local relapses occurred in 35 patients. Local relapse occurred more frequently in premenopausal patients, in patients less than 50 years-old as compared to older patients, in patients with low body-mass index (BMI), and in patients with small breast size. Local control was not significantly affected by tumor size or node involvement. With multivariate analysis, the only factor influencing local control was the body-mass index: the actuarial risk of local relapse was increased by 5.7 in patients with a BMI less than or equal to 22 as compared to patients with a BMI greater than 22 (p less than 0.02). We concluded that although certain clinical factors such as age, menopausal status, breast size and body-mass index have an influence on local control, these factors are not sufficiently discriminant to question the indication of conservative treatment. There is a need to individualize factors that could allow a better discrimination of patients with a high probability of local relapse.