Implications of extracapsular nodal metastases for treatment and prognosis of breast cancer.

BACKGROUND: Extracapsular extension of nodal metastases from cancer of the breast is a frequent histologic finding, but its significance for prognosis and treatment is unclear. METHODS: One hundred forty-three patients with breast cancer who had metastases to axillary lymph nodes were identified and divided into two groups: those with entirely intracapsular metastases (ICM), and those with extracapsular metastases (ECM). RESULTS: ECM was found in 58.7% of patients. A direct correlation was found between ECM and both the number of metastases and their size. Overall survival was significantly lower in patients with ECM, but an influence on survival independent of node count could be demonstrated only in patients with one to three involved nodes. ECM did not influence the pattern (i.e., locoregional versus distant) of recurrence and was not associated with increased recurrence in the axilla. Radiation therapy reduced locoregional failures in both ICM and ECM groups, but it did not improve survival. CONCLUSIONS: It is concluded that ECM has limited influence on prognosis independent of the number of positive nodes and is not an indication for radiation therapy of the axilla after a complete axillary dissection.

An investigation of colon cancer associated with urinary diversion.

The mechanism by which ureterocolic anastomoses promote cancer of the colon is uncertain. To investigate the role of anastomotic healing, rats were exposed to the colon carcinogen azoxymethane after which they had either 1) a sham operation, 2) colotomy with suture, or 3) colovesical anastomosis, performed randomly. The first two groups had an equally low frequency of colon cancers, whereas rats with colovesical fistulas had a significantly higher frequency, and cancers were concentrated at the anastomotic site. It was concluded that prompt healing does not promote cancer in this model. It is probably not responsible for suture-line recurrences seen clinically, nor for the increased frequency of cancer at the site of urinary diversion into the colon.

Propionibacterium avidum as the etiologic agent of splenic abscess.

Propionibacterium avidum was isolated from an intrasplenic abscess in a patient recovering from coronary artery bypass surgery. This organism has not previously been reported as an etiologic agent of splenic abscess nor has splenic abscess been described as a complication of coronary bypass surgery. This report emphasizes the potential pathogenicity of normal microbial flora following surgical manipulation.