-
[show abstract]
[hide abstract]
ABSTRACT: Although it is generally accepted that axillary dissection provides no survival advantage in patients with breast cancer,
it is commonly regarded as a reliable method of assessing nodal status and treating regional disease. However, it is time
to consider eliminating routine axillary dissection in patients who are clinically node-negative. A sentinel lymph node biopsy
may assess axillary nodal status while obviating a full axillary dissection. At present, axillary dissection remains the standard
approach for the surgical management of all patients with invasive carcinoma of the breast, regardless of tumor size or patient
age, though it is unnecessary for patients with small intraductal carcinomas.
Breast Cancer 04/1997; 4(3):143-153. · 1.36 Impact Factor
-
Masakuni Noguchi,
Masahide Minami,
Mitsuharu Earashi,
Takao Taniya,
Itsuo Miyazaki,
Hiroshi Nishijima,
Tsuyoshi Takanaka,
Hiroko Kawashima,
Yasuo Saito, Shinobu Nakamura,
Yuji Mizukami,
Akitaka Nonomura,
Takatoshi Michigishi,
Kunihiko Yokoyama
[show abstract]
[hide abstract]
ABSTRACT: We evaluated the oncologic and cosmetic outcome in patients with breast cancer treated with wide excision, transposition of adipose tissue with latissimus dorsi muscle (LDM), and axillary dissection followed by radiotherapy. In this study, a wide excision of breast tissue was performed to obtain tumor-free margins. The subsequent breast deformity was not corrected in six patients in the early phase of the study (Group 1), and in 16 patients in the late phase (Group 2) in which the breast deformity was not remarkable at the time of operation. Breast deformity was corrected by transposing adipose tissue with LDM on a vascular pedicle in the remaining 51 patients (Group 3). Five year survival was 100%. Two patients developed distant metastases. None were found to have local recurrence. Fifty percent of the Group 1 patients, 69% of the Group 2 patients, and 67% of the Group 3 patients had an excellent or good cosmetic result. However, when the cosmetic results were evaluated in patients who underwent transposition and had small breasts, the results were excellent or good in 76%, compared to 38% in the patients who had reconstructions who had large breasts. The difference was statistically significant (p = 0.0309). Therefore, it was confirmed that wide excision and axillary dissection followed by breast radiation could provide adequate local control, but frequently resulted in breast deformity. However, transposition of adipose tissue may be useful to correct the breast deformity, especially in women with small breasts.
Breast Cancer Research and Treatment 07/1995; 35(2):163-171. · 4.43 Impact Factor
-
Masakuni Noguchi,
Masahide Minami,
Mitsuharu Earashi,
Takao Taniya,
Itsuo Miyazaki,
Yuji Mizukami,
Akitaka Nonomura,
Hiroshi Nishijima,
Tsuyoshi Takanaka,
Hiroko Kawashima,
Yasuo Saito,
Chikara Takashima, Shinobu Nakamura,
Takatoshi Michigishi,
Kunihiko Yokoyama
[show abstract]
[hide abstract]
ABSTRACT: The diagnostic value of frozen section was evaluated in the histologic assessment of surgical margins obtained by wide excision
of breast tumors. There were 87 patients with unilateral breast cancer, and 5 with bilateral breast cancers. The periphery
of the excised breast tissue was peeled like an orange and histologically examined by frozen and permanent section. If eitherin situ or infiltrating microscopic tumor was found at the margin, it was considered positive. Using frozen sections, the margin
was judged histologically positive or suspicious in 30 tumors (31%) and negative in 67 (69%) tumors. Positive surgical margins
were histologically confirmed by permanent section in 20 (67%) of the 30 tumors diagnosed as positive or suspicious on frozen
section. Another 10 tumors had negative margins. In 4 tumors, however, while the initial or re-excised margin was negative
on frozen section, the margins were positive by permanent section. These surgical margins were positive due exclusively to
the presence of ductal carcinomain situ (DCIS). Evaluation of surgical margins in breast cancer by frozen section, thus exhibited a diagnostic accuracy of 86%, a
sensitivity of 83%, and a specificity of 86%. It is concluded that frozen sections are useful in the determination of involvement
of surgical margins after the wide excision of breast cancer. It must be pointed out that frozen sections will often overestimate
involvement of the surgical margins.
Breast Cancer 04/1995; 2(1):27-33. · 1.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We report herein the unusual case of a 60-year-old woman with an anaplastic thyroid carcinoma which produced granulocyte colony stimulating factor (G-CSF). She presented with large neck masses, respiratory difficulty, and a high fever. Laboratory examinations revealed marked leukocytosis of 43,200/mm3 with 85% granulocytes and an elevated G-CSF level of 67 pg/dl. Total thyroidectomy with bilateral node dissection and tracheostomy was performed, and a histological diagnosis of large-cell anaplastic thyroid carcinoma was confirmed. Immunohistochemical examination with a polyclonal antibody against G-CSF stained the tumor cells. Although the respiratory difficulty, fever, and marked granulocytosis subsequently improved, she died 1 month after undergoing surgery due to metastatic mediastinal disease.
Surgery Today 01/1995; 25(2):158-160. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The p53 expression in invasive breast cancers from 106 patients was correlated with clinicopathological variables to ascertain its usefulness for estimating prognosis. The p53 expression was significantly associated with the number of axillary lymph node metastases and the presence of internal mammary lymph node metastases; however, it was not associated with age, menopausal status, histologic type, or tumor size. Although p53 expression was a significant prognostic factor according to univariate analysis, it did not appear to be an independent prognostic factor according to multivariate analysis. Thus, the prognostic power of p53 expression is likely to be weak and therefore probably of limited clinical value. Nevertheless, the number of patients in our study was small, and we believe that an investigation of a larger series of patients is indicated.
Surgery Today 05/1994; 24(6):512-517. · 1.22 Impact Factor
-
Masakuni Noguchi,
Yasuo Saito,
Hiroshi Nishijima,
Masayo Koyanagi,
Akitaka Nonomura,
Yuji Mizukami, Shinobu Nakamura,
Takatoshi Michigishi,
Nagayoshi Ohta,
Hirohisa Kitagawa,
Mitsuharu Earashi,
Michael Thomas,
Itsuo Miyazaki
[show abstract]
[hide abstract]
ABSTRACT: An evaluation of the psychological and cosmetic morbidity of 31 patients who had undergone breast conserving treatment (BCT group) and 71 patients who had undergone radical mastectomy (RM group) revealed that 85% and 73%, respectively, were satisfied with their operative results. BCT appeared superior to RM in relation to body image, with 93% of the BCT group indicating BCT as a future choice of treatment, whereas only 35% of the RM group indicated RM as a future choice of treatment. For 59% of the BCT patients, the results were considered excellent or good by a physician, but fear of recurrence was frequently expressed by both groups even though an early stage of breast cancer had been significantly more common in the BCT group than the RM group. Sexual adjustment was the same in both groups. Body image was thus concluded to have been improved by BCT rather than RM, but psychological morbidity was essentially the same in both groups.
Surgery Today 06/1993; 23(7):598-602. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A rare case of non-Hodgkin's malignant T-cell lymphoma of the thyroid in a 79-y-ear-old woman is reported. Light microscopically, the tumor showed diffuse proliferation of lymphoid cells, revealing prominent nuclear irregularity and occasional multilobulated nuclei, and was diagnosed as a diffuse lymphoma of medium-sized cell type. Electron microscopically, the tumor cells were seen to possess irregularly indented nuclei. Immunologic surface marker studies showed that the lymphoma cells were positive for T-lytnphocyte-lineage antigens, OKT4 and OKT11, and did not react with B-lymphocyte-associated antigens. These findings indicated that the lymphoma had a T-cell phenotype.
Pathology International 11/1987; 37(12):1987 - 1995. · 1.62 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A rare case of columnar cell carcinoma of the thyroid gland is reported. The tumor was characterized by a predominantly papillary proliferation of tall columnar cells with marked nuclear stratification with associated focal areas showing solid or microfollicular growth. The nuclei of the tumor cells did not have the ground-glass appearance that characterizes papillary thyroid carcinoma; rather their nuclear features resembled follicular carcinoma. The tumor was found in an advanced stage and the patient died of lung metastases 2.5 years after surgery. The unique histopathological features and highly aggressive nature of columnar cell carcinoma require that this variant be differentiated from common papillary carcinoma of the thyroid. We also reviewed the literature emphasizing the lethal biological nature of this variant.
Human Pathology.
-
[show abstract]
[hide abstract]
ABSTRACT: We treated a case of primary Sjören's syndrome with progressive central nervous systems manifestations. Central nervous system involvement in such patients is difficult to diagnose and rarely described. A 71-year-old man presenting with vertigo and vomiting was admitted to our hospital. Intension tremor developed in the left extremities and gradually spread to the right extremities, while an articulation disorder also appeared. Results of T2-weighted cranial magnetic resonance imaging on admission showed abnormally high intensity areas in the pons, medulla oblongata, and cerebellum, nearly all of which were on the left side. Laboratory findings showed a high level of serum γ-globulin, and were positive antinuclear antibodies, anti-Ro antibodies, and anti-La antibodies, while histological findings of a minor salivary gland biopsy revealed focal sialadenitis with marked lymphocytic infiltration. These serological and histopathological findings confirmed that the patient had primary Sjören's syndrome. The patient underwent pulsed intravenous methylprednisolone therapy, and blepharoptosis, miosis, kinetic tremors improved with the therapy. In addition, the intensities in T2-weighted cranial MR images in the pons and medulla oblongata disappeared, and cerebellar intensity improved. In view of the underlying autoimmune disorder, it seemed likely that the etiology of the CNS symptoms was related to inflammatory brain changes, such as from autoimmune-related vasculitis.
-
[show abstract]
[hide abstract]
ABSTRACT: Autoimmune thrombocytopenia (AT) occurs after not only allogeneic but also autologous SCT following high-dose myeloablative chemotherapy against malignant tumors. A 50-year-old woman was diagnosed with metastatic breast cancer (MBC) and received myeloablative chemotherapy followed by autologous peripheral blood stem cell transplantation. Purpura developed on day +40 after transplantation, and a diagnosis of AT was made based on her bone marrow picture and elevation of serum PA-IgG level. Her thrombocytopenia was refractory to treatment with high-dose intravenous immune globulin (IVIG) and steroids. Although her platelet count recovered to within the normal range after splenectomy, 14 months after receiving SCT she died of disseminated intravascular coagulation syndrome caused by progression of cancer metastasis. There have been 10 reported cases of AT developing after high-dose myeloablative chemotherapy against malignant tumors followed by autologous SCT. We suggest that the thrombocytopenia after engraftment was caused by activation of dormant auto-immunity, which our patient potentially had, in conjunction with an insufficient quantity and quality of suppressor T-cells before complete reconstruction of the immune system after myeloablative conditioning. The clinical course of our patient was specific and different from previously reported cases since a splenectomy was necessary due to her thrombocytopenia being refractory to both steroid and IVIG therapy.
