The role of skin ulceration in breast carcinoma staging and outcome
Thaer KhouryCarmelo GaudiosoYisheng FangSouzan SanatiMateusz OpyrchalMohamed Mokhtar DesoukiRouzan G. KarabakhtsianZaibo LiDan WangLi YanRebecca Jacobson
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Abstract:
Breast carcinoma with skin ulceration (SU) is considered a locally advanced disease. The purpose of the study is to investigate if SU is an independent adverse factor. Breast carcinoma patients with SU (n=111) were included in the study. A subset (n=38, study cohort) was matched with cases that had no SU (n=38, matched cohort); the survival analyses were compared between these groups. Then, cases (n=80) were staged independent from SU into stage I, II or III. Disease free survival (DFS) and overall survival (OS) were analyzed. Patients with larger tumors tended to present with distant metastases more often than patients with smaller tumors (P=.004). In the matched cases, the 5-year DFS probability was 53% for the study cohort and 58% for the matched cohort; and for OS 75% for the study cohort and 84% for the matched cohort with no statistical significant difference. However, there was a trend towards worse DFS for the patients whose tumors had SU. When the cases were staged based on tumor size and node status (I, II or III), the OS was statistically significant (P=.047) but not the DFS (P=.195). Relatively small tumors with SU had an extent of disease similar to that observed in patients with early stages disease. The survival analysis suggests that SU may not be an adverse factor. However, more cases are needed to further examine this finding.Keywords:
Breast carcinoma
CTによる膀胱腫瘍浸潤度判定をより客観的なものとする目的で, 新たに理想膀胱外壁線および腫瘍根部径 (W)-縦径 (H) 比を設定して各浸潤度別に比較検討し, 以下の検討結果をえた. (1) CTによる形態診断で, 小乳頭状型, 乳頭状有茎性型, 乳頭状無茎性型を示したものはすべて Stage B1以下であつた. 広基結節型を示した23例中19例は, CTによる判定通り広基結節型 Stage B2以上であつたが, 残りの4例は摘出標本では乳頭状無茎性型 Stage B1であつた. (2) 体位変換時の腫瘍変位性は, 乳頭状有茎性型形態を示したもののみに認められ, そのすべてが Stage B1以下であつた. (3) 理想膀胱外壁線外への腫瘍突出は広基結節型を示した Stage C 以上の全例に認められた. また, 従来膀胱壁外には突出しないとされてきた Stage B2の6例中4例に認められた. 突出した腫瘍根部の外壁を比較すると Stage B2ではその突出部の性状は平滑であつたが, Stage C 以上の場合は不整であつた. (4) W/H比に関しては, 乳頭状型を呈した Stage B1以下と広基結節型を呈した Stage B2以上は1.2で明瞭に判別できた.以上より作成したCTによる膀胱腫瘍浸潤度判定基準により, Stage B1以下では37例中26例 (70%), Stage B2以上では19例中16例 (84%). 特に膀胱内注入物質として空気を用いた場合, Stage B2以上において15例中15例 (100%) と非常に高い一致率が得られた.本判定基準による膀胱腫瘍浸潤度のCT診断は, 従来は極めて困難であつた深層浸潤性腫瘍の各 Stage の判別診断を可能とし, 臨床上極めて有用なものと考える.
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Guru-shishya parampara (with due respect to its importance as an established form of knowledge-transfer system and its historical references) is in a way a register of a life-cycle of a trained (neo-classical) dancer. This system has a history of exchange for those specialists who claim the designation of a guru and all who register themselves as shishya under specific gurus. This chapter attempts a critical understanding of the so-called sacred duty of transmission of knowledge as a wat to ensure livelihood and survival. With the help of the case study of Amala Shankar (1919–2020) and her modern institution, the chapter looks at the Uday Shankar India Culture Centre as the alternate space for creating a value for the system of knowledge transfer beyond the traditional guru-shishya parampara.
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Objective To study diagnosis, treatment and prognosis of multiple primary breast carcinoma. Methods The data of 6 patients with multiple primary carcinomas correlated with breast carcinoma were summarized. First and second primary breast carcinoma were treated by radical operation or with radiotherapy and chemotherapy. Result 3 patients (50% ) happened recurrences of carcinoma were followed up. Conclusion The causes of genesis of second primary carcinoma and recurrence of primary carcinoma were related with suppression of immunological function and also biological property of carcinoma.
Breast carcinoma
Primary (astronomy)
Mammary carcinoma
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Carstens, Per Henrik Becher: Tubular carcinoma of the breast. A study of frequency. Am J Clin Pathol 70: 204–210, 1978. Tubular carcinoma of the breast is a recognizable histologic type of invasive mammary carcinoma, characterized by infrequent axillary lymph nodal metastases and an excellent prognosis. Of all carcinomas of the breast diagnosed in 1974 in the Louisville area, 42, or 10.3% were of the tubular variety. This is in contrast to the previously expressed opinion that tubular carcinoma is rare. Three histologic types of tubular carcinoma are described. Strict criteria for diagnosis of the mixed type are recommended.
Breast carcinoma
Axillary lymph nodes
Mammary carcinoma
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Third stage
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Of 282 patients, who had been treated for breast cancer between 1968 and 1973, bilateral carcinoma was diagnosed in 23 women. In these, a simultaneous second carcinoma was found seven times; in 16 cases, the second carcinoma developed during the further course of the disease, wherein the free intervals amounted to maximally 20 years. Attention is drawn to the relatively high risk of up to eight or ten per cent for the development of a carcinoma in the contralateral breast following the previous unilateral carcinoma. This reason calls for a half-yearly, clinical and radiological check-up examination of women having been treated for carcinoma of the breast. Finally, the problem of differentiation of a primary, autonomous second carcinoma from metastases of the first carcinoma on the contralateral side is considered and discussed with regard to the corresponding references in literature.
Breast carcinoma
Mammary carcinoma
Neoplasm
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地方性甲状腺腫は臨床, 病理学的に複雑な経過を示し, 疫学的, 病理学的発生論や治療の選択に多くの難題が残されている. 著者は本症の病期検討および妥当な病期分類がこれらの検索, 解明にきわめて有用であると着目し, 甲状腺剔出を行なった地方性甲状腺腫336例を臨床, 病理学的に精査し下記の結果をえた. 1) 地方性甲状腺腫は臨床的, 病理学的経過からStage 1;過形成期, Stage 2;腫大期, Stage 3;結節形成期と分類できた. 2) 本症は病期の進行に伴い病悩期間は長くなり, 甲状腺腫は増大し種々の局所圧迫症状をみるが, 合併症がなければ全身的, 臨床生化学的所見はほぼ正常である. 3) 臨床, 病理学的に本症はStage 1からStage 2さらにStage 3に進行し, Stage 3は終末期である. 4) 病変の占居部位はStage 1では両葉性, Stage 2では両葉性と単葉性がほぼ等しく, Stage 3では単葉性が多い点からもStageの進行度を裏付けられる. 5) 336例のうち男性39例, 女性297例, 男女比1:7.6で, 発生のピークは女性では20才から30才代, 男性は30才から40才代であった. 6) 手術適応例は若年者より成人に多く, 女性は男性より著しく多い. ヨード治療の効果が若年者ほど良好で, 男性は女性よりもヨード感受性が高いためである. 7) Stage 3の9.4%に甲状腺機能亢進症 (4.03%), 腺腫 (1.34%), 甲状腺癌 (4.03%) などの共存疾患がみられた. 8) ヨード治療はStage 1では効果的であるがStage 2では無効でStage 3に進行し, 種々の合併症を起こすこともあり, Stage 2における手術が望ましい.
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IN this paper, the term “inoperable carcinoma,” applying throughout to carcinoma of the breast, will include ulcerated carcinoma, carcinoma fixed to the thoracic wall, carcinoma with widespread cutaneous metastatis, carcinoma which could be extirpated surgically but accompanied by involvement of supraclavicular nodes, carcinoma with extensive involvement of axillary and supraclavicular nodes, carcinoma with osseous or visceral metastasis irrespective of nodal involvement, and carcinoma in the presence of such poor physical condition, due to complicating organic disease, that the risk of operation would be too great. The study concerns 41 patients treated in the Section on Therapeutic Radiology at the Mayo Clinic in the years 1925 to 1929, inclusive. Obviously, treatment in advanced stages of carcinoma of this type has little to offer in the way of cure. For this reason, radical surgical and radiologic treatments are not justified, even though they may give brilliant and unexpected results in a small percentage of cases. Treatment, therefore, is palliative only, and consists of measures to relieve discomfort from the tumor, to check its dissemination, to postpone or prevent fungation, to make fungation more tolerable if it already has taken place, and to maintain the patient in as good general physical condition as is possible until death ensues from visceral metastasis. Such treatment may consist of various measures, among which radiologic methods designed to hold the carcinoma in abeyance have a place. At the Mayo Clinic, such methods have produced results superior to those of all other methods investigated. Carcinoma of the breast may occur at any age and in persons of either sex. Of this group, three of the patients were between 20 and 30 years of age, five between 31 and 40, four between 41 and 50, eighteen between 51 and 60, seven between 61 and 70, and four were more than 70 years of age. In 19 cases the tumor was of the right breast; in 20, of the left breast and in two, bilateral. The group is too small to permit definite data to be obtained on the relationship of age to the virulence of the tumor, or to duration of the tumor. Three patients each had noticed a tumor in the breast from two to three months before they came to the Clinic; ten, from three to six months before; six, from six months to a year before; six, for thirteen months to one and one-half years before; five, for nineteen months to two years before; three, for two to three years before; five, for three to five years before, and three, for five to eight years before. With such wide variations in duration of carcinomas which had not received treatment, it is apparent that degrees of clinical malignancy varied widely, and that estimation of curative results or of degree of palliation, therefore, is difficult. However, since benefit from treatment and not cure was expected, the results of radiotherapy can, nevertheless.
Breast carcinoma
Metastatic carcinoma
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