Ultrasound characteristics of breast fibroadenomas are related to clinical and histological parameters.

PURPOSE: We hypothesized that ultrasound characteristics of breast fibroadenomas (FA) vary in relation to the clinical and histological parameters: patient age, tumor size and histological classification. MATERIALS AND METHODS: Eleven ultrasound characteristics frequently observed in breast tumors were defined before the onset of our study. These characteristics, as well as a semi-quantitative score for vascularization on color-coded Doppler ultrasound, were analyzed in a retrospective study. Histology revealed adult type differentiation in all FA. They were divided into florid, regressive and mixed subtypes. The examiner was blinded for the histological classification during image analysis. RESULTS: Histological type: florid FA: more frequent in younger women (age group < 30 years; p < 0.001), and bigger than regressive FA (larger than 16 mm: p = 0.007). Statistically significant differences between florid and regressive FA regarding the ultrasound features: enhanced posterior ultrasound transmission (p < 0.001), homogenous echo pattern (p = 0.003) and lobulated margin contour (p = 0.042). Tumor size: patients with larger tumors (> 16 mm) were younger (mean age 35 vs. 43 years, p < 0.001). More often in bigger FA: enhanced dorsal ultrasound transmission (p < 0.001), hyperechoic spots (p < 0.001), strong vascularization (p < 0.001), inhomogeneous echo pattern (p = 0.001), horizontal axis (p = 0.009), lobulated margin contour (p = 0.009), lateral shadowing (p = 0.047). Age: more often in older patients (age group > 30 years): dorsal ultrasound shadowing (p = 0.008), irregular margin contour (p = 0.038), homogenous echo pattern (p = 0.047). CONCLUSION: Histological type, tumor size and patient age significantly influence ultrasound characteristics of breast FA. This might be helpful to consider when breast lesions are classified and decisions for biopsies are made.

[Achievements of tumor surgery in tumors of the breast]. / Leistungen der Tumorchirurgie bei Tumoren der Brustdrüse.

Radical mastectomy (Rotter-Halsted) lowered the local and regional recurrence rate from 60% to 6%. Prospective randomized trials showed that there are no differences in overall survival or disease-free survival when a combination of simple mastectomy and lymph node dissection is used; the axillary recurrence rate was 1.8%. Adjuvant radiotherapy is superfluous. Conservative therapy should be reserved for stage I carcinomas in breast cancer.

Acute renal failure following hyperthermic isolation perfusion of the left leg.

This is the case report of a 37-year-old female who underwent primary excision of a malignant melanoma on the left foot as well as an inguinal lymphnode dissection in May 1983. In January 1984 a satellitosis on the same foot was treated with an isolation perfusion which had to be repeated in December of the same year due to secondary satellitosis. For the first perfusion, Alkeran 80 mg was used with a temperature of up to 41.4 degrees C, whereas Cis-Platinum 20 mg/l and Eldesine 0.3 mg/l were used for the second perfusion, with a maximum temperature in the tumor area of 39.0 degrees C. On the first postoperative day, significant edema of the left leg accompanied by severe pain was noticed. This was followed by an increase of the serum creatinine to 2.2 mg % two days later. Despite the immediate inducement of a forced diuresis, renal function deteriorated during the following days with serum creatinine going up to 4.8 % and CK to 14800 U/L. After a forced diuresis of two weeks' duration, the laboratory parameters slowly went back to normal. As a consequence of this complication we analyzed the influence of hyperthermic isolation perfusion on five patients with regard to muscular damage and its influence on renal failure. During perfusion we observed myoglobinemia which subsided within 36 hours. This slope was paralleled by CK values. A discrete myoglobinuria which was observed in two patients disappeared within 36 hours after perfusion. No rise of creatinine could be found. The changes described above were not influenced by cytostatic medication (Alkeran versus Cis-Platinum and Eldesine). In addition, none of the cases showed a leakage of over 16%. The case of acute renal failure was apparently caused by increased rhabdomyolysis as a consequence of the second hyperthermic perfusion.

Mastectomy stimulates prolactin release in breast cancer patients.

Hyperprolactinaemia has been described to occur after mastectomy in breast cancer patients, but whether it may be the result of surgery or breast cancer is particularly unknown. Plasma prolactin levels were measured in 51 patients one day before, and 1, 7, 30, and 180 days after mastectomy (23 primary breast cancer patients), tumourectomy (10 patients with benign or malignant breast lesions), and cholecystectomy (18 patients with cholelithiasis). Elevated prolactin levels were found on the 7th and 30th postoperative day in mastectomized and laparotomized patients, but not in patients who underwent tumourectomy of benign or malignant breast lesions (p less than 0.01). The prolactin levels were in the normal range one day before and again 180 days after surgery in all patients. We conclude, therefore, that postoperative hyperprolactinaemia in breast cancer patients is a result of surgery rather than the disease.

The stimulatory effect of corticotrophin on testicular testosterone release in male rabbits.

Intravenous injection of 1-24 ACTH synthetic analogue (10 micrograms/kg body weight 1-24 ACTH) via permanent indwelling jugular catheters to intact male rabbits, resulted in a rapid rise of plasma corticosteroid (C) and plasma testosterone (T) levels. Mean C levels were significantly elevated during the period between 10 and 100 min after ACTH administration whereas mean T concentrations showed a significant rise at 20 min after the 1-24 ACTH administration. On the other hand a significant suppression of plasma T levels was observed 120 min p.i., indicating a biphasic effect of 1-24 ACTH on plasma T levels. Castrated animals reacted to 1-24 ACTH with mean C levels, comparable to concentrations in intact rabbits, whereas their lowered plasma T concentrations showed no changes. When 1-24 ACTH was administered to intact animals 96 h after pretreatment with HCG, plasma T levels were significantly elevated at 20 min after 1-24 ACTH injection whereas a second HCG injection was ineffective in modifying T concentrations. From these results we concluded, that exogenously applied 1-24 ACTH can effectively stimulate the testicular T release in adult male rabbits and that such release is independent of the LH receptors in Leydig cells.