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An unusual case of isolated, serial metastases of gallbladder carcinoma involving the chest wall, axilla, breast and lung parenchyma  [cached]
Pamela Jeyaraj,Terence T. Sio,Matthew J. Iott
Rare Tumors , 2013, DOI: 10.4081/rt.2013.e7
Abstract: In the English literature, only 9 cases of adenocarcinoma of the gallbladder with cutaneous metastasis have been reported so far. One case of multiple cutaneous metastases along with deposits in the breast tissue has been reported. We present a case of incidental metastatic gallbladder carcinoma with no intra-abdominal disease presenting as a series of four isolated cutaneous right chest wall, axillary nodal, breast and pulmonary metastases following resection and adjuvant chemoradiation for her primary tumor. In spite of the metastatic disease coupled with the aggressive nature of the cancer, this patient reported that her energy level had returned to baseline with a good appetite and a stable weight indicating a good performance status and now is alive at 25 months since diagnosis. Her serially-presented, oligometastatic diseases were well-controlled by concurrent chemoradiation and stereotactic radiation therapy. We report this case study because of its rarity and for the purpose of complementing current literature with an additional example of cutaneous metastasis from adenocarcinoma of the gallbladder.
Bronchiolitis obliterans organizing pneumonia (BOOP) after thoracic radiotherapy for breast carcinoma
Robin Cornelissen, Suresh Senan, Imogeen E Antonisse, Hauw Liem, Youke KY Tan, Arjan Rudolphus, Joachim GJV Aerts
Radiation Oncology , 2007, DOI: 10.1186/1748-717x-2-2
Abstract: Radiation pneumonitis and fibrosis are well-recognized complications of thoracic radiotherapy, but less common complications include Bronchiolitis Obliterans Organizing Pneumonia (BOOP) and eosinophilic pneumonia [1]. It is also not commonly appreciated that these complications can manifest in patients receiving radiotherapy for breast cancer. We report two such patients who developed a BOOP following post-operative radiotherapy to the thoracic wall. The clinical features, diagnostic considerations, and treatment of interstitial lung disease following radiotherapy will serve to alert clinicians to this clinical entity and provide guidelines for diagnostic workup.A 59-year-old female who was a lifelong non-smoker underwent a modified radical mastectomy in August 2002 for an adenocarcinoma of her left breast, staged pT2N2M0. Adjuvant chemotherapy consisting of 4 cycles of doxorubicin (60 mg/m2) with cyclofosfamide (600 mg/m2) was administered from September to November 2002, followed by tamoxifen 20 mg daily. The patient was then referred for adjuvant radiotherapy on the left thoracic wall and the axillary lymph nodes. After CT planning, she received radiation from 6th February to 20th March 2003 to a total dose of 50 Gy in 25 fractions. The thoracic wall was irradiated using tangential 6 Mv photon fields, and regional lymph nodes using an anterior-posterior photon field (6 Mv) dosed at 3 cm, with a posterior top-up field to the axilla. The V20, i.e. volume of total lung receiving a dose of 20 Gy or more, was 32%.In April 2003, the patient complained of shortness of breath. Physical examination revealed a temperature of 38.0°C and pulmonary auscultation revealed inspiratory crackles and bronchial breathing sounds. Peripheral O2 saturation was 97% measured by a pulse-oxymeter during treatment with 2 litres of O2 a minute. Blood analysis revealed a CRP of 189 mg/L(0–10 mg/L) and a one-hour sedimentation rate of 105 mm/hour(0–30 mm/hour), haemoglobin was 5.4 mmol/L(7.5–1
Perforation of Axillary Vein by a Branch of the Axillary Artery: an Anatomical Study
Mahajan,Anita; Rana,K. K; Saha,S;
International Journal of Morphology , 2012, DOI: 10.4067/S0717-95022012000200036
Abstract: anatomical variations in the region of axilla and pectoral region are very common. these variations need attention to avoid complications arising during surgeries and diagnostic and interventional invasive procedures in this region such as surgeries for breast carcinoma, venous access during central venous line, pacemaker and cardiac defibrillator implantation etc. during routine cadaveric dissection we had noticed a rare variation of axillary vein and artery. in this case axillary vein, just deep to the inferior border of pectoralis minor was pierced by the lateral thoracic artery, a branch of axillary artery. perforation of the axillary vein by a branch of the axillary artery is extremely rare variation encountered till now. we report a variation wherein the lateral thoracic artery a branch of the second part of axillary artery was unusually long and perforated the axillary vein, just posterior to the inferior border of pectoralis minor muscle before supplying the structures in the anterolateral chest wall. histological findings revealed duplication of lumen at the site of perforation through which the lateral thoracic artery was passing and the surrounding area was sealed by the connective tissue. sound knowledge of anatomy of axillary and pectoral region may help in reducing complications while doing surgical and diagnostic procedure in these regions.
Accessory breast tissue in axilla masquerading as breast cancer recurrence  [cached]
Goyal Shikha,Puri Tarun,Gupta Ruchika,Julka Pramod
Journal of Cancer Research and Therapeutics , 2008,
Abstract: Ectopic or accessory breast tissue is most commonly located in the axilla, though it may be present anywhere along the milk line. Development is hormone dependent, similar to normal breast tissue. These lesions do not warrant any intervention unless they produce discomfort, thus their identification and distinction from other breast pathologies, both benign and malignant, is essential. We report a case with locally advanced breast cancer who presented with an ipsilateral axillary mass following surgery, radiotherapy, and chemotherapy. Subsequent evaluation with excision biopsy showed duct ectasia in axillary breast tissue and the patient was continued on hormone therapy with tamoxifen.
An accessory muscle of the thoracic wall
Hardy MA,Fabrizio PA
International Journal of Anatomical Variations , 2009,
Abstract: In addition to identifying a pectoralis quartus muscle variation, an additional variation of the anterior thoracic wall that has not been reported in the literature was found in a 60-year-old male cadaver. The accessory muscle originated from the aponeurosis of the external abdominal oblique and inserted on the fascia overlying the coracobrachialis muscle. Additionally, the co-existence of an accessory muscle and pectoralis quartus has not been previously described. The current findings and the clinical significance are discussed as a single muscle variation and as two muscle variations in combination.
Nirmala Jaget Lakkawar,Gayathri Maran,Suguna Srinivasan,Thirupurasundari Rangaswamy
Acta Medica Medianae , 2010,
Abstract: Ectopic or accessory breast tissue (EBT) is an uncommon residual tissue that persists from normal embryonic development, found in 2-6% of the female population. EBT may occur anywhere along the embryonic mammary streak, but is most commonly located in the axillary region. EBT can consist of any or all components of the breast and may be functional or non-functional. The development of this tissue is hormone- dependent, similar to normal breast tissue. EBT presents as asymptomatic mass and may prove to be a diagnostic challenge in the absence of areola and nipple. The identification and distinction of EBT from other breast pathologies occurring in the area, both benign and malignant, is essential for proper management. In most of the cases, these lesions are asymptomatic and do not warrant any intervention unless they produce discomfort. In this report, we present a case of an ectopic breast tissue in the left axilla of an 24-year-old Asian Indian primipara patient. The importance of FNAC as diagnostic tool in suspected cases of polymastia without nipple/areola and the conservative approach through regular follow-up for management of proven benign ectopic breast tissue are highlighted.
Thoracic Wall Schwannoma
Güven ?o??un,Sevin Ba?er,Gokhan Yuncu,Nevzat Karabulut
Respiratory Case Reports , 2013, DOI: 10.5505/respircase.2013.55264
Abstract: Schwannoma is a solitary, capsulated lesion and originates from the neural tissue. They are primarily located in the thorax in the costovertebral sulcus, but may rarely originate from peripheral intercostal nerves. Less than 10% of primary thoracic neurogenic tumors originate from the peripheral intercostal nerves. Radiological investigation is useful to differentiate the lesions of the chest wall and lung parenchyma. Schwannomas are generally asymptomatic lesions and diagnosis and treatment depend on the surgical excision of mass. Our case was a 31-yearold female with a cough and occasional chest pain. The chest X-ray revealed a smooth mass at right apical zone of the lung. It was treated with thoracoscopic surgery and diagnosed as intercostal schwannoma. This case was presented with radiological and pathological differential diagnosis and symptoms.
Dosimetric consequences of the shift towards computed tomography guided target definition and planning for breast conserving radiotherapy
Hans van der Laan, Wil V Dolsma, John H Maduro, Erik W Korevaar, Johannes A Langendijk
Radiation Oncology , 2008, DOI: 10.1186/1748-717x-3-6
Abstract: Twenty-five patients with left-sided breast cancer were subject of CT-guided target definition and 3D-conformal dose-planning, and conventionally defined target volumes and treatment plans were reconstructed on the planning CT. Accumulated dose-distributions were calculated for the conventional and 3D-conformal dose-plans, taking into account a prescribed dose of 50 Gy for the breast plans and 16 Gy for the boost plans.With conventional treatment plans, CT-based breast and boost PTVs received the intended dose in 78% and 32% of the patients, respectively, and smaller volumes received the prescribed breast and boost doses compared with 3D-conformal dose-planning. The mean lung dose, the volume of the lungs receiving > 20 Gy, the mean heart dose, and volume of the heart receiving > 30 Gy were significantly less with conventional treatment plans. Specific areas within the breast and boost PTVs systematically received a lower than intended dose with conventional treatment plans.The shift towards CT-guided target definition and planning as the golden standard for breast conserving radiotherapy has resulted in improved target coverage at the cost of larger irradiated volumes and an increased dose delivered to organs at risk. Tissue is now included into the breast and boost target volumes that was never explicitly defined or included with conventional treatment. Therefore, a coherent definition of the breast and boost target volumes is needed, based on clinical data confirming tumour control probability and normal tissue complication probability with the use of 3D-conformal radiotherapy.Ever since the early days of breast cancer radiotherapy, irradiation was performed by means of tangential beams directed to treat the whole breast or chest wall [1]. With the use of tangential beams, non-target thoracic structures were avoided as much as possible. To ensure that all breast parenchyma was included into the target volume, one relied upon visible or palpable anatomy as assesse
Male Breast Cancer Originating in an Accessory Mammary Gland in the Axilla: A Case Report  [PDF]
Jun Yamamura,Norikazu Masuda,Yoshinori Kodama,Hiroyuki Yasojima,Makiko Mizutani,Keiko Kuriyama,Masayuki Mano,Shoji Nakamori,Mitsugu Sekimoto
Case Reports in Medicine , 2012, DOI: 10.1155/2012/286210
Abstract: Carcinoma of an accessory mammary gland is an extremely rare tumor. A 61-year-old male patient presented with a hard mass measuring 85?mm × 51?mm in the left axilla. Incisional biopsy histopathologically showed an adenocarcinoma compatible with breast carcinoma originating in an accessory mammary gland. Systemic examinations revealed no evidence of malignant or occult primary lesion in the bilateral mammary glands or in other organs. Neoadjuvant chemotherapy was performed for the locally advanced axillary tumor and reduced the tumor to 55?mm in size, and, then, he could undergo complete resection with a negative surgical margin in combination with reconstructive surgery to fill the resulting skin defect with a local flap of the latissimus dorsi muscle. The patient has presented with no metastatic lesion in four years since the operation. This unusual case shows that neoadjuvant chemotherapy is an effective and tolerated therapy for advanced accessory breast cancer in the axilla. 1. Introduction Cases of adenocarcinoma in the axilla are uncommon and can be regarded as sebaceous or sweat gland cancer, mammary carcinoma arising in an accessory mammary gland, or metastatic lymph nodes from breast cancer or another primary cancer [1–3]. Herein, we describe a rare case of a male patient with an axillary malignant tumor which could be histopathologically compatible with breast cancer arising in an accessory mammary gland. 2. Case Report A 61-year-old man first noticed a small subcutaneous nodule in the left axillary area in 2005. The nodule gradually increased in size and he was referred to our hospital in November 2007. Clinical examination revealed an irregular immobile hard mass, measuring roughly 85?mm × 51?mm in the left axilla (Figure 1). Computed tomography (CT) showed an exposed and lobulated 77?mm soft tissue density mass with faint calcification in wide contact with skin (Figure 2(a)). Also, CT showed suspicious direct involvement of the left subclavian vein, enlarged lymph nodes in the left axilla, and small round lymph nodes less than 10?mm in the mediastinum. Magnetic resonance imaging (MRI) and ultrasonography (US) revealed no primary lesion in the ipsilateral breast tail and bilateral mammary gland. Additionally, positron emission tomography (PET)/CT demonstrated no evidence of any malignant or occult primary lesions, but the axillary tumor. Figure 1: An irregular, immobile, and hard mass, measuring roughly 85?mm × 51?mm, exposed in the left axilla with slight bleeding. Figure 2: (a) Computed tomography (CT) showed an exposed and lobulated 77?mm
"Accuracy Of 5 Node Sampling In Evaluating The Axilla In Operable Breast Cancer: A Pilot Study "
Omrani Poor R,Taheri AY,Mahmood Zadeh H,Arab Kheradmand A
Tehran University Medical Journal , 2005,
Abstract: Background: To evaluate the accuracy of 5node sampling as an alternative to classic axillary dissection in operable breast cancer(stage I and II ) Method and Material: 5 largest nodes of level one were sampled in 26 consecutive patient with breast cancer undergoing modified radical mastectomy and axillary clearance between june 2002 to march 2004. Result: False negative rate for 5 node sampling was 7.7%, of 14 cases with negative 5 node sampling 2 (7.7%) were found to have disease elsewhere in the axilla. Conclusion: Sampling of 5 largest nodes accurately (92%) identifies patients with metastatic nodes.
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