1/14. Anterolateral thigh flap for postmastectomy breast reconstruction.Most postmastectomy defects are reconstructed by use of lower abdominal-wall tissue either as a pedicled or free flap. However, there are some contraindications for using lower abdominal flaps in breast reconstruction, such as inadequate soft-tissue volume, previous abdominoplasty, lower paramedian or multiple abdominal scars, and plans for future pregnancy. In such situations, a gluteal flap has often been the second choice. However, the quality of the adipose tissue of gluteal flaps is inferior to that of lower abdominal flaps, the pedicle is short, and a two-team approach is not possible because creation of the gluteal flap requires that the patient's position be changed during the operation. In 2000, five cases of breast reconstructions were performed with anterolateral thigh flaps in the authors' institution. Two of them were secondary and three were immediate unilateral breast reconstructions. The mean weight of the specimen removed was 350 g in the three patients who underwent immediate reconstruction, and the mean weight of the entire anterolateral thigh flap was 410 g. skin islands ranged in size from 4 x 8 cm to 7 x 22 cm, with the underlying fat pad ranging in size from 10 x 12 cm to 14 x 22 cm. The mean pedicle length was 11 cm (range, 7 to 15 cm). All flaps were completely successful, except for one that involved some fat necrosis. The quality of the skin and underlying fat and the pliability of the anterolateral thigh flap are much superior to those of gluteal flaps and are similar to those of lower abdominal flaps. In thin patients, more subcutaneous fat can be harvested by extending the flap under the skin. Use of a thigh flap allows a two-team approach with the patient in a supine position, and no change of patient position is required during the operation. However, the position of the scar may not be acceptable to some patients. Therefore, when an abdominal flap is unavailable or contraindicated, the creation of an anterolateral thigh flap for primary and secondary breast reconstruction is an alternative to the use of lower abdominal and gluteal tissues.- - - - - - - - - - ranking = 1keywords = fat (Clic here for more details about this article) |
2/14. Radiofrequency ablation of a stereotactically localized nonpalpable breast carcinoma.A nonpalpable breast lesion was detected in a 71-year-old woman who had returned for her annual mammogram. Stereotactic core needle biopsy revealed an infiltrating ductal carcinoma. The patient agreed to stereotactic localization and radiofrequency ablation of the lesion followed after 4 weeks by open surgical biopsy. The breast lesion was localized and the radiofrequency ablation performed under local anesthesia in the outpatient/office setting. The lesion was ablated for a total of 20 minutes at a sustained mean temperature of 75 degrees C. After a 30-second cooldown the peripheral temperature of the four peripheral thermocouples ranged from 58 degrees C to 70 degrees C. A surgical clip was placed at the site of the ablated lesion. The postprocedure course was uneventful and the patient proceeded to open biopsy 4 weeks later. The open biopsy specimen, a left segmental mastectomy, underwent specimen radiography, which confirmed the surgical clip in the center of the lesion. There was extensive central necrosis and hemorrhage surrounded by fat necrosis. There was no definite viable residual tumor and the margins were clear. This is the first case in a clinical protocol designed to determine the efficacy of stereotactic localization and radiofrequency ablation of nonpalpable breast lesions. Additional ablations will be required to define the procedure but the results from this initial patient suggest that this is a promising minimally invasive curative approach for nonpalpable breast lesions.- - - - - - - - - - ranking = 0.25keywords = fat (Clic here for more details about this article) |
3/14. Obstructive jaundice in a metastatic tumor of the pancreas from breast cancer: a case report.Metastatic pancreas tumors from breast cancer are comparatively uncommon and patients with this tumor usually remain asymptomatic during their life. A 55-year-old woman presented with obstructive jaundice following mastectomy for invasive ductal carcinoma. We diagnosed obstructive jaundice due to a pancreatic tumor demonstrated on computed tomography and performed percutaneous transhepatic cholangio-drainage. Although the patient recovered from the jaundice, she had exacerbation of pneumonia from which she died. At autopsy, invasive ductal carcinoma was found in the pancreas tumor. Immunohistochemical staining was performed to confirm whether the pancreatic tumor was primary or secondary. Human milk fat globules 1 and 2 and gross cystic disease fluid protein-15, which characteristically exist in normal breast tissue or breast carcinoma, were expressed both in the primary breast tumor and the pancreatic tumor. In contrast, both the anti-estrogen receptor and anti-progesterone receptor antibodies stained positively in the primary breast cancer; however, neither of them was positive in the metastatic pancreatic tumor. We report a rare case of a patient who presented with obstructive jaundice from a pancreatic tumor metastasizing from breast cancer and in whom immunohistochemical staining using the antibodies unique to the mammary gland was effective for the diagnosis of this secondary tumor.- - - - - - - - - - ranking = 0.25keywords = fat (Clic here for more details about this article) |
4/14. A case study: prescriptive exercise intervention after bilateral mastectomies.exercise for cancer patients is gaining support. In the current case study, a female breast cancer patient was diagnosed with breast cancer at the age of 29 years; she underwent a left modified radical mastectomy. She developed cancer again in the opposite breast at the age of 57 years and had a right modified radical mastectomy. After the second mastectomy (the right breast), the patient received chemotherapy and radiation. Following her cancer treatments, she participated in an exercise intervention for 6 months at the University of Northern colorado's Rocky Mountain Cancer rehabilitation Institute. A 6-month reassessment showed that she increased her muscular strength and cardiovascular function in addition to attenuating her cancer-related fatigue and depression. It is recommended that health professionals work together to ensure that a collaborative effort is undertaken to increase functional work capacity that will significantly improve patients' quality of life.- - - - - - - - - - ranking = 0.25keywords = fat (Clic here for more details about this article) |
5/14. cisplatin plus vinorelbine (PVn) as a salvage regimen for refractory breast cancer.breast cancer is regarded as a systemic disease even when tumors are completely resected. In patients with advanced breast cancer the overall prognosis is poor, but the disease is not uniformly fatal. Vinorelbine has proved to be effective when given as a single agent in this setting. Since it has a moderate to severe myelotoxic effect, a combination of vinorelbine with cisplatin, which is a weak myelotoxic drug, is ideal for the treatment of patients with advanced disease. In this paper, we report on a patient with advanced breast cancer who attained complete response of 14 months duration to a cisplatin/vinorelbine combination after progression during treatment with paclitaxel and doxorubicin.- - - - - - - - - - ranking = 0.25keywords = fat (Clic here for more details about this article) |
6/14. Cancer presenting as fatal pulmonary tumour embolism.Rapidly fatal pulmonary tumour embolism is a rare complication of malignancy, and often presents as progressive dyspnea without obvious cause.We describe two cases presenting with a dramatic clinical picture of lactic acidosis and cardiopulmonary arrest soon after admission on ICU. The first patient was a 29-year old woman with a breast cancer seeming in remission who was admitted with rapidly increasing dyspnea since two weeks. The second patient was a 46-year old woman with hiv and no history of malignancy, who developed dyspnea and lactic acidosis over the course of a few days while she was investigated for an occipital brain lesion. Both patients died soon after admission and massive tumour emboli were found on autopsy. breast cancer was the origin of the emboli in both cases. Symptoms were out of proportion to the initial physical cardiopulmonary findings and radiographic features. Clinical signs of pulmonary tumour embolism are non-specific and subacute. prognosis is poor and definite diagnosis is usually made post-mortem. Solid malignancies such as breast cancer account for most of the cases. Pulmonary tumour embolism should be considered in critically ill patients with unexplained hypoxemia and lactic acidosis, mild or no radiological abnormalities and fast clinical deterioration. It may occur in young patients and in patients without history of malignancy.- - - - - - - - - - ranking = 1.25keywords = fat (Clic here for more details about this article) |
7/14. breast carcinoma metastatic to paranasal sinuses.BACKGROUND. breast cancer affects 150,000 women a year in the united states. breast carcinoma that is metastatic to the paranasal sinus (PNS) is rare. A patient with breast cancer treated recently at the University of texas M. D. Anderson Cancer Center developed bilateral metastasis to the ethmoid sinuses. This case prompted a review of the incidence of this disease, its treatment, and outcome. methods. A review of the published reports dating back to 1939 of breast carcinoma that was metastatic to the PNS was performed. In addition, autopsy series in the breast oncology literature were reviewed for cases of breast carcinoma that was metastatic to the PNS. RESULTS. From this review, we identified only eight cases of breast carcinoma that was metastatic to the PNS. All cases were unilateral and presented as mass lesions. Despite treatment, all patients died soon after diagnosis. CONCLUSIONS. We conclude that breast carcinoma metastatic to the PNS is rare and has been uniformly fatal because, as disseminated disease, it does not respond well to conventional systemic therapies.- - - - - - - - - - ranking = 0.25keywords = fat (Clic here for more details about this article) |
8/14. Fine needle aspiration cytology of renal and retroperitoneal angiomyolipoma. Report of two cases with cytologic findings and clinicopathologic pitfalls in diagnosis.BACKGROUND: angiomyolipoma is a benign soft tissue neoplasm that usually arises in the kidney, although rare extrarenal examples have been documented. CASES: Two cases of the neoplasm occurred in which fine needle aspiration (FNA) biopsies were performed. The first patient was a 73-year-old female with a history of breast carcinoma who presented with a large retroperitoneal mass. Transabdominal FNA biopsy revealed multiple fragments of spindle-shaped mesenchymal cells, a few of which showed marked cellular atypia with occasional cells containing fat vacuoles, producing a lipoblastlike appearance. However, the atypical spindle cells were immunohistochemically reactive for actin, raising the possibility of a smooth muscle tumor rather than a liposarcoma. The surgically resected specimen revealed an extrarenal, retroperitoneal angiomyolipoma. The second patient was a 71-year-old female who presented with a right renal mass and hepatomegaly. Computed tomography showed a mass in the upper pole of the kidney and multiple enhancing lesions in the liver. FNA biopsy was diagnostic of angiomyolipoma, which was confirmed histologically. CONCLUSION: angiomyolipoma should be considered in aspirates of both renal and extrarenal masses when an admixture of blood vessels, fat and smooth muscle cells is encountered. Pitfalls leading to an incorrect diagnosis include aspiration at unusual sites for angiomyolipoma and/or the presence of atypical spindle cells and lipoblastlike cells, which can be mistaken for leiomyosarcoma or liposarcoma cells. Ancillary studies, such as immunocytochemistry for smooth muscle markers, may be helpful in making the correct diagnosis.- - - - - - - - - - ranking = 0.5keywords = fat (Clic here for more details about this article) |
9/14. paclitaxel-induced cardiotoxicity. An ultrastructural study.The ultrastructural appearance of the myocardium in a fatal case of paclitaxel-induced cardiotoxicity is reported, which includes swelling of the sarcoplasmic reticulum, loss of myofibrils, and accumulation of lipofuscin as well as laminated myelinoid figures. Such changes are very similar to those seen in anthracycline-induced cardiotoxicity and may suggest a pathogenetic final common pathway. While endomyocardial biopsy is a recognized means of monitoring anthracycline-induced cardiotoxicity, whether more liberal use of endomyocardial biopsy can prevent fatal cases of paclitaxel-induced cardiotoxicity needs to be further assessed.- - - - - - - - - - ranking = 0.5keywords = fat (Clic here for more details about this article) |
10/14. Induction and subsequent rupture of aneurysms of the circle of willis after radiation therapy in ehlers-danlos syndrome: a plausible hypothesis.Multiple aneurysms of the circle of willis developed in a 62-year-old woman with ehlers-danlos syndrome (EDS) within 7 months of initiation of radiation therapy to the brain. A major response of the arterial wall to radiation damage is the formation of collagen. In patients with EDS, in whom there is a defect in collagen, this repair is incomplete. We propose that the incomplete repair of the arterial wall consequent to EDS resulted in weakness of these walls, formation of an aneurysm, and, ultimately, fatal subarachnoid hemorrhage.- - - - - - - - - - ranking = 0.25keywords = fat (Clic here for more details about this article) |
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