Anterolateral thigh flap for abdominal wall reconstruction. A case report.

Abdominal wall reconstruction aims at restoring the anatomical, functional and aesthetic integrity of this region, while providing protection of abdominal viscera and prevent herniation. There are various techniques used for abdominal wall reconstruction. We present a difficult case of abdominal wall reconstruction performed with a pedicled antero-lateral thigh (ALT] flap with good postoperative results.

Signet ring cell gastric carcinoma with breast and leptomeningeal metastases: a case report.

Gastric cancer is the 5th most common malignancy worldwide. Signet ring cell histology represents an aggressive subtype of gastric cancer, presenting at a younger age. Both breast and leptomeningeal metastases are rare locations of tumor dissemination, requiring correct and immediate diagnosis and treatment. We present a case of a 45-year old female with signet ring cell gastric carcinoma who developed both left breast and leptomeningeal metastases, requiring multiple chemotherapy lines. As far as we know, this is the first published case in literature following multiple lines of treatment for both breast and leptomeningeal metastases from signet ring cell gastric carcinoma.

Immediate Breast Reconstruction in Large Ptotic Breasts Using the Inferior Based Dermal Flap. Indications and Technique.

Introduction: Achieving good aesthetic outcomes during immediate reconstruction in women with large ptotic breast presents a unique challenge for the reconstructive surgeon. We present our paradigm regarding immediate reconstruction in patients with large ptotic breasts, using the inferiorly based dermal flap. Materials and Methods: Ten patients with large ptotic breasts underwent mastectomy and immediate implant reconstruction at the "Prof. Dr. I. Chiricuta" Institute of Oncology. The mastectomy was carried out using a Wise pattern skin resection with preservation of a dermal flap at the lower pole of the breast. The flap was sutured to the pectoralis major muscle and completed the subpectoral pocket created for the implant. Results: The reconstruction was done bilaterally in three cases with a total number of 13 reconstructed breasts. Of these 11 required dermal flaps. All reconstructions were completed successfully and there were no implant losses. Four breasts (36%) developed superficial necrosis of the tip of the mastectomy flaps at the T junction. Conclusion: The dermal flap technique is safe, versatile and reliable. It is used in a wide array of reconstructive scenarios as it provides the surgeon with an excellent alternative to more costly and unreliable methods.

Clinical outcomes and cost-effectiveness of primary treatment of ovarian cancer in North-Western Romania.

PURPOSE: Ovarian cancer has the poorest survival rate among gynaecological malignancies. Besides the comparison of different therapeutic strategies aimed to improve outcomes, studies have also begun to focus on aspects of cost-effectiveness of these strategies. In this context, we proposed to evaluate the survival impact, costs and cost-effectiveness of two primary treatment options, primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT), in patients with advanced ovarian cancer treated in a tertiary cancer center of the North-Western Romania. METHODS: The study included patients with stages IIIC and IV ovarian cancer treated at the "Prof. Dr. Ion Chiricuta" Institute of Oncology, Cluj-Napoca, between 2008-2011, by either PDS or NACT. Survival was the measure of the effectiveness of the two treatments. A cost-effectiveness analysis was carried out by estimating the incremental cost-effectiveness ratio (ICER) and the average cost-effectiveness ratio (ACER). RESULTS: There was no significant difference in overall survival between the two treatment groups. The median costs for the NACT subgroup were 3580.41 € compared to 2990.19 € for the PDS subgroup, with an incremental cost of 590.22 €. The effectiveness measured in years of survival was 3.34 years for NACT and 3.57 years for PDS. The corresponding median ICER was -2566.17 €/year of survival. ACER was higher for NACT compared to PDS (1071.98 vs. 837.59 €/year of survival). CONCLUSIONS: Despite the higher costs, NACT did not prove to be a more effective therapeutic strategy in terms of survival of patients with stage IIIC/IV ovarian cancer. Altogether, our results state that NACT might be less cost-effective than PDS.

Transient leukemia of Down syndrome.

Childhood leukemia is mostly a "developmental accident" during fetal hematopoiesis and may require multiple prenatal and postnatal "hits". The World Health Organization defines transient leukemia of Down syndrome (DS) as increased peripheral blood blasts in neonates with DS and classifies this type of leukemia as a separate entity. Although it was shown that DS predisposes children to myeloid leukemia, neither the nature of the predisposition nor the associated genetic lesions have been defined. Acute myeloid leukemia of DS is a unique disease characterized by a long pre-leukemic, myelodysplastic phase, unusual chromosomal findings and a high cure rate. In the present manuscript, we present a comprehensive review of the literature about clinical and biological findings of transient leukemia of DS (TL-DS) and link them with the genetic discoveries in the field. We address the manuscript to the pediatric generalist and especially to the next generation of pediatric hematologists.

Developing a needs assessment questionnaire for women of reproductive age following breast cancer treatment: a cross-sectional pilot study in a Romanian sample.

PURPOSE: Studies addressing the needs of cancer patients highlight the necessity to identify what types of informational and support needs are specific to women of reproductive age after primary treatment for breast cancer. We developed a questionnaire for evaluating informational and treatment decision, psychological and socio-familial needs in young breast cancer patients following treatment. METHODS: 101 patients of reproductive age, treated for breast cancer at the Oncology Institute "Prof. Dr. Ion Chiricuta", Cluj-Napoca, between 2006 and 2013 were included. They all had completed surgery, chemo-radiotherapy, and were receiving hormone therapy. The questionnaire named Breast Cancer following Treatment Needs Assessment Scale (BCTNAS) consisted of 21 6-point Likert items. The validation procedures used were: construct validity performed by exploratory factor analysis (EFA), reliability and internal consistency analysis using ordinal Cronbach's alpha (α) and ordinal Omega (ω) correlation coefficients. RESULTS: According to EFA, the questionnaire evidenced four factors: needs concerning medical information and treatment decisions (PA1), needs for psycho-spiritual support (PA2), needs for socio-familial support (PA3), needs concerning medical support/assistance (PA4). The items of BCTNAS reported factor loadings (λi) greater than 0.40 for PA1 factor, λi ≥0.31 for PA2, λi ≥0.53 for PA3 and λi ≥0.33 for PA4, respectively. Reliability analysis demonstrated that BCTNAS is reliable: ordinal Cronbach's alpha of 0.81 (95% IC: 0.75-0.86) and ordinal omega of 0.85 (95% IC: 0.68-0.82) for the total scale score, with very good internal consistency. CONCLUSIONS: The BCTNAS questionnaire provides a potential instrument to identify and assess the needs of breast cancer patients in the post-treatment period, having a positive impact on the quality of patient care.

Quality control of ion torrent sequencing library.

Next-generation sequencing (NSG) is an important method for gathering large amounts of sequencing data for different types of applications regarding the diagnosis and response to treatment of different diseases. An important step in the NGS process is the quality control of sequencing libraries, which can influence the yield and efficiency of the sequencing run. This study evaluated two different methods for library quality control, Agilent Bioanalyzer and qPCR, and showed that both methods can be used. However, as is the case with any analytical method, they have their limitations. The Agilent Bioanalyzer quantifies only the high quality libraries, but it underestimates their concentration, while qPCR also quantifies lower quality libraries, but it overestimates their concentration.

Breast tumor bank: an important resource for developing translational cancer research in Romania.

The development of a breast tumor bank facilitates translational research. Easy access to biological specimens allows scientists to translate the outcomes of basic science into clinically useful knowledge. The breast tumor bank is particularly useful for triple negative breast cancer (TNBC) that is sporadic but exhibits the worst prognosis. It serves as a national resource that includes biological samples of paraffin-embedded and frozen tumor tissue with corresponding pathological and clinical data. During the first two years, the bank has accrued data and samples from more than 254 breast cancer cases. Based on this information, we observed a higher number of samples with ER (estrogen receptor) and PR (progesterone receptor) positive and negative for Her2. Also, 30% of the total number of cases was defined as TNBC. The use of tumor banks in research and diagnosis allows for the design of different studies that can bring reliable results that may improve the lives of patients, especially those diagnosed with TNBC.

Case report of primary small cell neuroendocrine breast cancer.

UNLABELLED: Primary neuroendocrine cancer of the breast (NECB) is an extremely rare tumor. In 2003, the World Health Organization (WHO) recognized this category with three well-described subtypes: small cell, large cell, and carcinoid-like carcinoma; very few peer-review publications based on the WHO definition were encountered in the literature, and we conducted a literature search to investigate the reported incidence, diagnosis, prognosis, hormone receptor status, and treatment options for this rare tumor. Confirming the breast as an origin of neuroendocrine tumor represents a challenge. The diagnosis is mainly dependent on the exclusion of other extra-mammary organs based on clinical, radiological, and pathological data. Primary neuroendocrine carcinoma of the breast is rare - only about 30 cases have been reported in literature. Immunohistochemical examination showing expression of chromogranin and/or synaptophysin confirms evidence of neuroendocrine differentiation. Usually foci of neuroendocrine differentiation can be seen in breast carcinoma and are reported to be present in about 2-5% of breast cancer cases. Here, we report a case of breast carcinoma in which most of the areas studied on the tissue section showed neuroendocrine differentiation. Primary neuroendocrine carcinoma of the breast is a group that exhibits morphological features similar to those of neuroendocrine tumors of both the gastrointestinal tract and the lung. CASE PRESENTATION: We report the case of a 50-year-old Caucasian woman with primary small cell neuroendocrine cancer of the breast, which we characterized with immunohistochemical techniques. A palpable and mobile 3.0 cm tumor was located in the upper-outer quadrant of her right breast. After pathological confirmation the patient underwent 8 cycles of chemotherapy, and subsequent radical mastectomy with axillary lymph node resection were performed. Microscopically, the tumor consisted predominantly of a diffuse proliferation of small oat cells. The tumor cells were positive for neuroendocrine markers; 21 of 30 lymph nodes were metastatic. Local recurrence with multiple lung metastases developed only 5 weeks after surgery, despite of the transient tumor regression achieved by chemotherapy. This case reinforces the importance of an early correct diagnosis and the standardization of a treatment regimen for this very rare tumor. A correct treatment needs to be chosen.

Multiple primary malignancies--epidemiological analysis at a single tertiary institution.

BACKGROUND: A literature review on 1,104 269 cancer patients concluded that the prevalence of multiple primary malignancies (MPM) is between 0.73% and 11.7%. MPMs seem to have higher incidence than that influenced by hazard only. AIM: The purpose of this study was to investigate clinically useful information for effective screening for synchronous and metachronous second primary cancers and to identify a potential surveillance protocol. METHODS: Using statistical and epidemiological indicators we evaluated the patients with MPMs (double locations) admitted to the Institute of Oncology "Prof. Dr. Ion Chiricuta", Cluj-Napoca between 2001 and 2004. RESULTS: Out of the 63 cases, 22 cases (34.9%) were synchronous tumors while 41 cases (65.1%) were metachronous tumors, the occurrence interval ranging from 6.2 to 254 months, with an average of 34.6 months for the entire group. Almost half of the metachronous tumors (20 cases) occurred between 6.2 and 24 months while 14 cases (20%) were detected after a 5-year interval. The most frequent malignant associations were ovary-colon, ovary-breast, breast-breast. Both primary and secondary tumors tended to be in an advanced stage explained by the low compliance of the patients to follow-up. CONCLUSIONS: The possibility that MPMs exist must always be considered during pretreatment evaluation. Screening procedures are especially useful for the early detection of associated tumors, whereas careful monitoring of patients treated for primary cancer and a good communication between patients and medical care team would ensure an early detection for secondary tumors, and, subsequently, an appropriate management.