Long-term results of hemipelvic allograft: Report of four cases

Reconstruction after the excision of pelvic tumors involving the pelvic ring implies difficult problems. Restoration of the function is difficult and an allograft can be one of the possible solutions. Pelvic allograft is recommended by many authors to reconstruct the pelvic ring following extensive resections of bone tumors. Between 1988 and 1989, we performed hemipelvic resection and allograft reconstruction in 4 patients with pelvic sarcomas. The mean age was 42.3 years (range 38–48), consists of 3 male and 1 female. One case developed an infection and one case showed recurrence, both responding to surgical treatment. Outcome in those cases in which surgery was curative to the primary tumor was satisfactory at 10 years follow-up, with a mean total Enneking score of 25.3 (range 24–27) and a good functional result in Merlé D'Aubigne functional score. Despite the limited number of cases presented, our results added to the reported results in the literature led us to consider that allografts are valuable in pelvic reconstructions after en-bloc resections for bone tumors. This revised version was published online in July 2006 with corrections to the Cover Date.     

Initiation of Metastatic Breast Carcinoma by Targeting of the Ductal Epithelium with Adenovirus-Cre: A Novel Transgenic Mouse Model of Breast Cancer

Breast cancer is a heterogeneous disease involving complex cellular interactions between the developing tumor and immune system, eventually resulting in exponential tumor growth and metastasis to distal tissues and the collapse of anti-tumor immunity. Many useful animal models exist to study breast cancer, but none completely recapitulate the disease progression that occurs in humans. In order to gain a better understanding of the cellular interactions that result in the formation of latent metastasis and decreased survival, we have generated an inducible transgenic mouse model of YFP-expressing ductal carcinoma that develops after sexual maturity in immune-competent mice and is driven by consistent, endocrine-independent oncogene expression. Activation of YFP, ablation of p53, and expression of an oncogenic form of K-ras was achieved by the delivery of an adenovirus expressing Cre-recombinase into the mammary duct of sexually mature, virgin female mice. Tumors begin to appear 6 weeks after the initiation of oncogenic events. After tumors become apparent, they progress slowly for approximately two weeks before they begin to grow exponentially. After 7-8 weeks post-adenovirus injection, vasculature is observed connecting the tumor mass to distal lymph nodes, with eventual lymphovascular invasion of YFP+ tumor cells to the distal axillary lymph nodes. Infiltrating leukocyte populations are similar to those found in human breast carcinomas, including the presence of αβ and γδ T cells, macrophages and MDSCs. This unique model will facilitate the study of cellular and immunological mechanisms involved in latent metastasis and dormancy in addition to being useful for designing novel immunotherapeutic interventions to treat invasive breast cancer.     

Pancreatic solitary and synchronous metastasis from breast cancer: a case report and systematic review of controversies in diagnosis and treatment

Background

Metastases from breast cancer cause the frequent involvement of lung, bone, liver, and brain, while the occurrence of metastases to the gastrointestinal tract is rare, and more frequently discovered after a primary diagnosis of breast cancer. Solitary pancreatic metastases from breast cancer, without widespread disease, are actually unusual, and only 19 cases have been previously described; truly exceptional is a solitary pancreatic metastasis becoming evident together with the primary breast cancer.

Case presentation

A 68-year-old woman reported general fatigue, lethargy, and jaundice. Abdominal ultrasound (US) and magnetic resonance imaging (MRI) showed an ampulloma of Vater’s papilla; moreover, a neoplastic nodule in the left breast was diagnosed. She underwent surgery for both breast cancer and ampulloma of Vater’s papilla. Pathological examination of pancreatic specimen, however, did not confirm primary carcinoma of the duodenal papilla, but showed a metastatic involvement of pancreas from lobular breast cancer. Immunohistochemistry has been essential to confirm the origin of the malignancy: hormone receptors and mammaglobin were expressed in both the primary breast tumor and the pancreatic metastasis.

Conclusions

This is one of the few reported cases in literature of an isolated and synchronous pancreatic metastasis from breast cancer, where the definitive diagnosis was obtained only after surgery. We discuss the controversies in this diagnosis and the choice of correct treatment. The surgical resection of solitary metastases can be performed in the absence of disseminated disease.     

Isolated jejunal metastasis in a patient with cervical cancer: A case report

Background

In approximately 8% of cervical carcinoma patients, gastrointestinal tract is involved, most commonly the rectosigmoid portion, because of local extension. Isolated metastases to small bowel are exceedingly rare.

Case report

We present a case of a 63-year-old woman with cervical cancer who developed isolated jejunal metastasis 8 months after postoperative chemoradiotherapy. The patient was alive with no evidence of disease 6 months after resection of metastasis. Very few cases have been reported concerning squamous cell carcinoma of the cervix with documented metastases to the small bowel. There is only one published case report of cervical cancer with multiple metastases to the small intestine and jejunum. To our knowledge, this is the first case of cervical cancer with isolated jejunal metastasis, which was initially demonstrated with positron emission tomography and confirmed histopathologically.

Conclusion

Although the exact mechanism underlying the isolated metastasis is unknown, hematogenous spread or tumor seeding during surgery may play a role.     

21例胫骨近端骨肉瘤保肢治疗临床分析

目的：探讨胫骨上端骨肉瘤保肢手术中使用人工关节重建的疗效和并发症。方法：回顾性分析2000年6月-2010年6月对21例胫骨上段骨肉瘤患者行根治性切除人工关节重建手术的临床资料,其中男性13例,女性8例,年龄21—62岁,平均34．1岁。依据Enneking分期：ⅡA期12例、ⅡB期9例。均采用广泛性边缘切除手术治疗。所有患者均接受术前、术后化疗。结果：1例患者发生术后胫前肌群坏死。所有患者均随访6—72个月,平均45．1个月。ⅡA期12例患者中,1例因肺转移死亡（占8．3％）,局部复发1例,行股骨下段截肢,10例无病生存;ⅡB期9例,4例死亡,5例存活;Enneking分期明显影响预后。结论：胫骨上段人工关节重建对胫骨上段骨肉瘤的保肢治疗具有良好的疗效。     

Breast metastasis from squamous cell carcinoma of the oropharynx: a case report

Background

Breast metastases from extramammary tumors are extremely rare, the most common primary tumors being contralateral breast carcinoma, followed by lung, gynecological, gastrointestinal, melanoma, and hematological cancers. Only a few cases deriving from head and neck squamous cell carcinoma have been reported in the literature to date.

Case presentation

We report a case of a 47-year-old Caucasian woman who presented to our hospital with a solitary breast lesion in the right upper external quadrant associated with multiple bone and visceral metastases. Two years before, she had undergone radical resection of a squamous cell carcinoma of the oropharynx (stage pT2, pN1), which was followed by adjuvant radiotherapy. Breast ultrasound showed a hypoechogenic tumor lesion of 4 cm in the right upper external quadrant that was associated with multiple axillary and infra-/supraclavicular adenopathies. A positron emission tomographic scan documented multiple visceral and bone metastases with a single hypermetabolic lesion of the right breast. The results of histology and immunohistochemistry were consistent with a metastasis from a squamous cell carcinoma. The patient died of acute respiratory insufficiency 1 month after her breast metastasis diagnosis and before starting any systemic antitumoral treatment.

Conclusions

Although breast metastases are extremely rare, they should be considered in any patient with a history of cancer and confirmed by histology and immunohistochemistry because they are very difficult to distinguish from other primary breast tumors based only on clinical and radiological features. There are no standardized treatment guidelines for breast metastasis management. Surgery and radiotherapy can play a role in symptom palliation, but they do not have any relevant impact on survival, the prognosis being poor, with an estimated overall survival less than 1 year from diagnosis.

     

Does extirpation of the primary breast tumor give boost to growth of metastases? Evidence revealed by mathematical modeling

A comprehensive mechanistic model of cancer natural history was utilized to obtain an explicit formula for the distribution of volumes of detectable metastases in a given secondary site at any time post-diagnosis. This model provided an excellent fit to the volumes of n = 31, 20 and 15 bone metastases observed in three breast cancer patients 8 years, 5.5 years and 9 months after primary diagnosis, respectively. The model with optimal parameters allowed us to reconstruct the individual natural history of cancer for the first patient. This gave definitive answers, for the patient in question, to the following three questions of major importance in clinical oncology: (1) How early an event is metastatic dissemination of breast cancer? (2) How long is the metastasis latency time? and (3) Does extirpation of the primary breast tumor accelerate the growth of metastases? Specifically, according to the model applied to the first patient, (1) inception of the first metastasis occurred 29.5 years prior to the primary diagnosis; (2) the expected metastasis latency time was about 79.5 years; and (3) resection of the primary tumor was followed by a 32-fold increase in the rate of metastasis growth. The model and our conclusions were validated by the results for the two other patients.     

Stabilization of Notch1 and β-catenin in response to ER- breast cancer-specific up-regulation of PSAT1 mediates distant metastasis

Breast cancer has the highest incidence in women worldwide, with a mortality rate second only to lung cancer. Distant metastasis is the major cause of breast cancer-induced death. While upregulation of phosphoserine aminotransferase 1 (PSAT1) has been reported in several cancer types, its specific roles in breast cancer and potential involvement in distant metastasis remain unclear. In our study, PSAT1 was upregulated in metastatic breast cancer and promoted distant metastasis both in vitro and in vivo. Data obtained from transwell and wound healing, colony, sphere assays and detection of various malignant phenotypic markers showed that PSAT1 mediates distant metastasis by promoting invasion, migration, proliferation, anti-apoptosis, stemness and angiogenesis in breast cancer cells. Mechanistically, PSAT1 activated Notch and β-catenin signaling pathways, leading to enhanced distant metastasis. The clinical relevance of PSAT1 in breast cancer was additionally investigated, which revealed associations of poorer patient prognosis with high PSAT1 mRNA and protein expression. In summary, PSAT1 is a critical molecular regulator of distant metastasis that may effectively serve as a marker of poor prognosis in breast cancer.     

改良带蒂胸大肌肌皮瓣修复口腔颌面肿瘤术后缺损的临床分析

目的:探讨只带血管蒂的改良胸大肌皮瓣转移修复口腔颌面部组织缺损的临床效果。方法:取胸大肌皮瓣时蒂部只保留血管,利用改良只带血管蒂的胸大肌皮瓣对6例不同口腔颌面部组织缺损进行修复,包括舌癌3例、舌咽癌1例、牙龈癌1例、颊癌1例。结果:术后皮瓣血供良好,完整成活,成活率100%;所有患者获得3~18个月随访,在随访期内均存活;重建的舌外形良好,虽然味觉功能无法恢复,运动功能随切除范围增加而降低,但均能满足发音、吞咽和咀嚼功能需要。结论:只带血管蒂的改良胸大肌皮瓣是修复口腔颌面部组织缺损有效而可靠的方法,为恶性肿瘤根治术后造成的缺损提供了有力修复保障。     

Internal auditory canal metastasis mimicking a vestibular schwannoma at presentation – a case report and review of the literature

Metastasis to the internal auditory canal from breast carcinoma is extremely rare and difficult to diagnose. It radiologically mimics vestibular schwannoma and can occur as a first manifestation of systemic relapse after a long disease-free interval in patients previously treated for early breast cancer. The diagnosis is usually made retrospectively and the optimal management of such metastasis following complete resection remains undefined.     

Métastase méningée révélatrice de cancer thyroïdien multimétastatique

We report the case of a 74-year-old patient who presented with cognitive disorders. Morphological imaging showed a tumor which was considered as a meningioma. Surgical resection of this tumor was performed and pathology indicated a meningeal metastasis of a thyroid cancer. The patient had previously a thyroidectomy with an initial benign pathology report. Meningeal metastases of thyroid cancer are rare, and a meningeal metastasis revealing a thyroid cancer is very rare.     

Tsukamurella tyrosinosolvens - An unusual case report of bacteremic pneumonia after lung transplantation

Intravesical administration of Bacillus Calmette-Guérin is used as a treatment method in superficial bladder cancer. While it is generally well tolerated, serious side effects may develop. Granulomatous hepatitis cases have been previously reported; however, only one case with tuberculous peritonitis exists in the current literature. We hereby present two cases, one of which is the second tubercular peritonitis case following Bacillus Calmette-Guérin treatment to be reported, and the other a case with granulomatous hepatitis. Complete cure was achieved in both cases with specific therapy. In the patient who developed peritonitis, intravesical Bacillus Calmette-Guérin therapy was recommenced after antituberculosis treatment, and completed without further complications.     

脂联素及其受体在乳腺癌中的表达及其与临床病理特征的相关性分析

目的:观察和分析脂联素(ADPN)及脂联素受体(adipo R)在乳腺癌中的表达及其与临床病理特征的相关性。方法:选取60例乳腺癌患者作为病例组,选取30例良性乳腺疾病患者作为对照组,对两组患者血清ADPN水平进行检测和比较。对病例组患者肿瘤组织及对照组患者病变组织中的ADPN、adipo R1、adipo R2表达水平进行检测和比较。对病例组患者的肿瘤原发部位、肿瘤结节数量、病理类型、肿瘤局部浸润情况、淋巴结转移情况、T分期、TNM分期情况及其与ADPN、adipo R1、adipo R2水平的关联性进行观察和分析。结果:病例组患者的血清ADPN水平及肿瘤乳腺组织中ADPN、adipo R1、adipo R2表达水平均显著低于对照组,两组之间的差异均有统计学意义(P0.05)。乳腺癌患者血清ADPN水平和乳腺组织中ADPN表达水平与肿瘤的局部浸润情况、T分期、淋巴结转移情况、TNM分期具有关联性(P0.05),乳腺癌患者乳腺组织中adipo R1和adipo R2表达水平与肿瘤的病理类型、局部浸润情况、T分期、淋巴结转移情况、TNM分期具有关联性(P0.05)。结论:乳腺癌患者外周血中的ADPN及肿瘤组织中的ADPN及其受体均呈现低表达,而且其表达水平与肿瘤的病理类型、浸润和转移情况及临床分期具有关联性,有望作为乳腺癌诊断和治疗的新型靶点。     

Reconstructive management of contralateral breast cancer in patients who previously underwent unilateral breast reconstruction

When a patient who has had unilateral breast reconstruction presents with a new cancer on the opposite side, the reconstructive management of the second breast can be unclear. This study was performed to determine whether reconstruction of the second breast is oncologically reasonable and to evaluate the reconstructive options available to these patients.Patients who had mastectomy with unilateral breast reconstruction between 1988 and 1994 and who had a minimal follow-up of 5 years from the initial breast cancer were reviewed. Of 469 patients reviewed, 18 patients (4 percent) were identified who developed contralateral breast cancer. Mean age at the initial breast cancer presentation was 43 years (range, 26 to 57 years), and mean age at presentation with contralateral breast cancer was 48 years (range, 36 to 67). The mean interval between the initial and contralateral breast cancer presentations was 5 years (range, 1 to 10 years). Mean follow-up from the time of contralateral breast cancer was 5 years (range, 1 to 9 years). In most cases, contralateral breast cancer presented at an early stage (13 of 18 patients; 72 percent), and a shift to an earlier stage at presentation of the contralateral cancer was evident compared with the initial breast cancer. Of the 18 patients who developed contralateral breast cancer, 16 (89 percent) had no evidence of disease, one was alive with disease, and one died. Reconstructive management after the initial mastectomy included 16 transverse rectus abdominis myocutaneous flaps (seven free and nine pedicled), one latissimus dorsi myocutaneous flap with implant, and one superior gluteal free flap. Surgical management of the second breast after contralateral breast cancer included breast conservation in two patients, mastectomy without reconstruction in four, and mastectomy with reconstruction in 12. Reconstruction of the second breast included one free transverse rectus abdominis myocutaneous flap, three extended latissimus dorsi flaps, two latissimus dorsi myocutaneous flaps with implants, three implants alone, two Rubens flaps, and one superior gluteal free flap. No major complications were noted after the reconstruction of the second breast. The best symmetry was obtained when similar methods and tissues were used on both sides.The incidence of contralateral breast cancer after mastectomy and unilateral breast reconstruction is low. In most cases, contralateral breast cancer presents at an earlier stage compared with the initial breast cancer, and the prognosis is good. In patients who develop a contralateral breast cancer after mastectomy and unilateral breast reconstruction, the reconstruction of the second breast after mastectomy is oncologically reasonable and should be offered to provide optimal breast symmetry and a better quality of life. The best result is obtained when similar methods and tissues are used on both sides.     

Métastase splénique isolée métachrone d’un adénocarcinome colique

Isolated splenic metastases of colorectal cancers are very rare but possible even after several years of remission. We report the case of a 74-year-old man who developed isolated metachronous splenic metastasis of left colon cancer 5 years after the treatment of the primary tumor. Splenic metastasis was found by imaging examinations. The patient underwent splenectomy and the histological examination confirmed the metastatic nature of the splenic lesion. 18F-FDG PET allows both staging and resectability of these isolated metachronous splenic metastasis because a long-term survival can be achieved by splenectomy.     

Reconstruction with bilateral pedicled TRAM flap for paraffinoma breast

Although autogenous tissue can be used to replace unsatisfactory prosthetic breast reconstructions in mastectomy patients, because of the magnitude, complexity, and many potential complications associated with the procedure, combined with a long-term recovery, the use of an implant to replace the mastectomy defect is still the most common method for paraffinoma breast treatment. Between July of 1996 and June of 2003, 21 paraffinoma breast patients underwent bilateral pedicle transverse rectus abdominis myocutaneous (TRAM) flap reconstruction. There were 10 primary cases that had never been treated before this visit, including a case of unilateral associated breast cancer. There were also 11 secondary cases that had prostheses implanted after removal of materials injected in other clinics. The diagnoses included unacceptable breast contour in 11 patients, breast hardening in 11 patients, palpable nodules in five patients, nipple malposition in four patients, prominent scarring in three patients, breast skin necrosis in one patient, and nipple necrosis in one patient. A 100 percent flap survival rate with no clinical fat necrosis was achieved. There were 11 of 21 abdominal hypertrophic scars, six of 21 prechest (anterior surface of the thorax) hypertrophic scars, and no abdominal hernia; the symmetry satisfaction rate was 100 percent among primary cases and nine of 11 in secondary cases. The breast softness satisfaction rate in primary cases was also 100 percent and nine of 11 for secondary cases. Excellent cosmetic results were achieved in all patients (42 breasts in total). The unfavorable results of the secondary cases (patients with previous treatments) indicate that it is impossible to completely remove all of the injected foreign body by resection. This also means that scar appearance can only be minimized if resection of the entire paraffinoma is performed through a periareolar incision. The excellent results of the primary cases show that immediate autogenous tissue reconstruction should be the first alternative and is the best option for treating foreign-body granuloma breast, given that autogenous tissue is available. Similarly, the results of the secondary cases also demonstrate that autogenous tissue reconstruction could be considered in reversing some unfavorable results of past treatments.     

Ankle ligament reconstruction after wide resection of the osteosarcoma of the distal fibula: a case report

Background

Restoration of the lateral ankle after distal fibulectomy is a difficult reconstructive procedure. Many surgical techniques have been proposed. This report shows another fibular reconstructive option with promising outcome.

Case presentation

We report the case of a 30-year-old woman who presented with a solitary mass located in the lateral aspect of the ankle. The mass had grown rapidly for 2 months and caused increasing pain. Physical examination showed a 3.0 cm diameter tender, nonmobile hard mass in the lateral malleolus. Radiographs showed an osteolytic lesion involving the lateral cortex at the distal fibula. After incisional biopsy, pathologic examination found a well-differentiated intramedullary osteosarcoma. Neoadjuvant chemotherapy with doxorubicin was provided for 3 months prior to definitive surgical treatment. Magnetic resonance imaging showed persistent tumor in the biopsy site. After distal fibulectomy and wide resection, split tibialis posterior tendon transfer to the remaining peroneus brevis restored the stability of the ankle. The pain resolved within 3 months. The ankle was stable and no recurrence of the cancer was found at a 7 year follow-up.

Conclusion

Reconstruction following distal fibulectomy and surrounding soft tissue resection responds favorably to split tibialis posterior transfer to the remaining peroneus brevis suggesting that this technique can provide a good and functional outcome.

     

Validity of an automatic measure protocol in distal femur for allograft selection from a three-dimensional virtual bone bank system

Osteoarticular allograft is one possible treatment in wide surgical resections with large defects. Performing best osteoarticular allograft selection is of great relevance for optimal exploitation of the bone databank, good surgery outcome and patient’s recovery. Current approaches are, however, very time consuming hindering these points in practice. We present a validation study of a software able to perform automatic bone measurements used to automatically assess the distal femur sizes across a databank. 170 distal femur surfaces were reconstructed from CT data and measured manually using a size measure protocol taking into account the transepicondyler distance (A), anterior-posterior distance in medial condyle (B) and anterior-posterior distance in lateral condyle (C). Intra- and inter-observer studies were conducted and regarded as ground truth measurements. Manual and automatic measures were compared. For the automatic measurements, the correlation coefficients between observer one and automatic method, were of 0.99 for A measure and 0.96 for B and C measures. The average time needed to perform the measurements was of 16 h for both manual measurements, and of 3 min for the automatic method. Results demonstrate the high reliability and, most importantly, high repeatability of the proposed approach, and considerable speed-up on the planning.     

Angiopoietin-2, an angiogenic regulator, promotes initial growth and survival of breast cancer metastases to the lung through the integrin-linked kinase (ILK)-AKT-B cell lymphoma 2 (Bcl-2) pathway

The early onsets of breast cancer metastasis involve cell retention, survival, and resistant to apoptosis and subsequent growth at target vascular beds and tissues in distant organs. We previously reported that angiopoietin-2 (Ang2), an angiogenic regulator stimulates MCF-7 breast tumor metastasis from their orthotopic sites to distant organs through the α(5)β(1) integrin/integrin-linked kinase (ILK)/Akt pathway. Here, by using an experimental tumor metastasis model and in vitro studies, we further dissect the underlying mechanism by which Ang2 promotes the initial growth and survival of MCF-7 breast cancer metastasis in the lung of animals. We show that Ang2 increases cell survival and suppresses cell apoptosis through ILK-induced phosphorylation of Akt1, Akt2, and up-regulation of Bcl-2 in breast cancer cells. Inhibition of ILK, Akt1, and Akt2, and their effector Bcl-2 diminishes Ang2-stimulated breast cancer cell survival and Ang2-attenuated apoptosis in vitro, and initial survival and growth of breast cancer metastasis in the lung of animals. Additionally, siRNA knockdown of endogenous Ang2 in three human metastatic breast cancer cell lines also inhibits phosphorylation of Akt, expression of Bcl-2, and tumor cell survival, migration, and increases cell apoptosis. Since increased expression of Ang2 correlates with elevated potential of human breast cancer metastasis in clinic, our data underscore the importance that up-regulated Ang2 not only stimulates breast cancer growth and metastasis at late stages of the process, but is also critical at the initiating stages of metastases onset, thereby suggesting Ang2 as a promising therapeutic target for treating patients with metastatic breast cancer.