Peritoneal solitary fibrous tumour (SFT): long-term survival of recurrent and metastasised SFT treated with cytoreductive surgery and intraperitoneal chemotherapy.

This study reports a case of a SFT of the peritoneum in a 44-year-old white man that recurred 3 years after the initial surgical removal of the tumour. The patient recurred diffusely, developing a pattern of sarcomatosis and hepatic metastasis and was treated by surgical cytoreduction followed by intraoperative peritoneal hyperthermic chemotherapy (IPHC). Subsequently, he developed pulmonary metastases and was treated with palliative chemotherapy. The patient persisted with recurrent and distant disease, although it was reduced and stabilised, allowing his survival for the last 3 years since the extended surgery. New treatment strategies for a rare disease such as this one have first to be described in order to improve patient follow-up.

Medullary thyroid carcinoma: multivariate analysis of prognostic factors influencing survival.

BACKGROUND: Medullary thyroid carcinoma (MTC) is a rare development of thyroid cancer with a no negligible mortality rate. Our aim was to determine factors that predict outcome in patients with MTC. METHODS: We reviewed the records of all patients with MTC (n=56) who underwent treatment at our institution between January 1990 and December 2000. Univariate and multivariate analysis of clinicopathologic predictors of MTC outcome were performed to identify subsets of patients with different probabilities in terms of overall survival, local recurrence, and distant metastases. RESULTS: Multivariate analysis demonstrated that a statistically significant decrease in overall survival is associated with T4b tumours (p=0.06), the presence of distant metastases at the time of presentation (p=0.033), lymphatic invasion (p=0.099), and postoperative treatment (p=0.045). CONCLUSIONS: The analysis of survival curves of patients with MTC shows that the occurrence of locoregional and distant metastases occurs preferentially within the first 5 years, which identifies this as a crucial period for follow-up. In this series of patients with MTC, the tumours classified as T4b, metastases at presentation, the presence of lymphovascular invasion, and postoperative treatment were the most important prognostic features. At present, there is no available beneficial adjuvant therapy. However, as the development of molecular therapy progresses, it should be tested in clinical trials with the purpose of achievement of novel targeted therapies for selected MTC patients with risk factors.

Medullary thyroid carcinoma: multivariate analysis of prognostic factors influencing survival

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Background. Medullary thyroid carcinoma (MTC)is a rare development of thyroid cancer with a nonegligible mortality rate. Our aim was to determinefactors that predict outcome in patients with MTC.Methods. We reviewed the records of all patientswith MTC (n = 56) who underwent treatment at ourinstitution between January 1990 and December2000. Univariate and multivariate analysis of clinicopathologicpredictors of MTC outcome were performedto identify subsets of patients with differentprobabilities in terms of overall survival, local recurrence,and distant metastases.Results. Multivariate analysis demonstrated that astatistically significant decrease in overall survivalis associated with T4b tumours (p = 0.06), the presenceof distant metastases at the time of presentation(p = 0.033), lymphatic invasion (p = 0.099), andpostoperative treatment (p = 0.045).Conclusions. The analysis of survival curves of patientswith MTC shows that the occurrence of locoregionaland distant metastases occurs preferentiallywithin the first 5 years, which identifies this asa crucial period for follow-up. In this series of patientswith MTC, the tumours classified as T4b,metastases at presentation, the presence of lymphovascularinvasion, and postoperative treatment werethe most important prognostic features. At present,there is no available beneficial adjuvant therapy.However, as the development of molecular therapyprogresses, it should be tested in clinical trials withthe purpose of achievement of novel targeted therapiesfor selected MTC patients with risk factors

Predictors of positive axillary lymph nodes in breast cancer patients with metastatic sentinel lymph node

Introducción. El cáncer de mama con ganglio centinela (GC) metastásico podría estar asociado a factores clínico-patológicos relacionados con la presencia de ganglios linfáticos axilares no-centinela (GLANC) positivos. El objetivo de este trabajo es determinar los factores que predicen la implicación de los GLANC en los pacientes con cancer de mama con GC positivos. Material y métodos. Se procede a análisis retrospectivos de una base de datos que incluyen pacientes con carcinoma de mama invasivo sometidos a biopsia del ganglio centinela, correspondiente a enero de 1999 a agosto de 2002 (n=80). Los factores clínico-patológicos fueron analizados con el objetivo de determinar los factores predictivos de los ganglios axilares positivos adicionales. Resultados. En el análisis global de la población, se verificó que existían 23 pacientes con GC positivos, que fueron sometidos a disección ganglionar axilar convencional. El análisis estadístico reveló que la invasión linfovascular (p~0,00000), la dimensión de la metástasis mayor de 2 mm (p=0,002) y la presencia de extensión extranodal (p=0,002), correspondieron a factores predictivos positivos de desarrollo metastásico de los GLANC. Conclusiones. La probabilidad de la existencia de GLANC positivos se correlaciona con parámetros patológicos como la presencia de invasión linfovascular, el tamaño de metástasis de los GC, y la extensión extranodal. Estos datos podrán ser útiles en lo que concierne a la decisión terapéutica de efectuar la disección ganglionar axilar convencional en los pacientes con cáncer de mama con GC metastásico

Introduction. Breast cancer with metastatic sentinel lymph nodes (SLN) may have clinico-pathologic factors associated with the presence of positive non-sentinel axillary nodes (NSLN). The aim of the present study was to determine factors that predict involvement of NSLN in breast cancer patients with positive SLN. Material and methods. A prospective database search identified 80 patients who underwent SLN biopsy for invasive breast cancer between January 1999 and August 2002. Clinico-pathologic data was analyzed to determine factors that predicted additional positive axillary nodes. Results. A total of 23 patients had positive SLN and underwent conventional axillary lymph node dissection. Statistical analysis revealed that lympho-vascular invasion (p~0.00000), SLN metastasis >2 mm (p=0.002), and the presence of extra-nodal involvement (p=0.002), were positive predictors of the metastatic involvement of NSLN. Conclusions. The likelihood of positive NSLN correlates with pathologic parameters such as the presence of lympho-vascular invasion, size of the SLN metastasis, and extra-nodal involvement. These data may be helpful with the regard to the decision to undertake axillary dissection in breast cancer patients with metastatic sentinel lymph nodes