-
Annals of Surgical Oncology Oct 2023Breast-conserving surgery (BCS) is a mainstay for breast cancer management, and obtaining negative margins is critical. Some have advocated for the use of preoperative...
BACKGROUND
Breast-conserving surgery (BCS) is a mainstay for breast cancer management, and obtaining negative margins is critical. Some have advocated for the use of preoperative magnetic resonance imaging (MRI) in reducing positive margins after BCS. We sought to determine whether preoperative MRI was associated with reduced positive margins.
PATIENTS AND METHODS
The SHAVE/SHAVE2 trials were multicenter trials in ten US centers with patients with stage 0-3 breast cancer undergoing BCS. Use of preoperative MRI was at the discretion of the surgeon. We evaluated whether or not preoperative MRI was associated with margin status prior to randomization regarding resection of cavity with shave margins.
RESULTS
A total of 631 patients participated. Median age was 64 (range 29-94) years, with a median tumor size of 1.3 cm (range 0.1-9.3 cm). Patient factors included 26.1% of patients (165) had palpable tumors, and 6.5% (41) received neoadjuvant chemotherapy. Tumor factors were notable for invasive lobular histology in 7.0% (44) and extensive intraductal component (EIC) in 32.8% (207). A preoperative MRI was performed in 193 (30.6%) patients. Those who underwent preoperative MRI were less likely to have a positive margin (31.1% versus 38.8%), although this difference was not statistically significant (p = 0.073). On multivariate analysis, controlling for patient and tumor factors, utilization of preoperative MRI was not a significant factor in predicting margin status (p = 0.110). Rather, age (p = 0.032) and tumor size (p = 0.040) were the only factors associated with margin status.
CONCLUSION
These data suggest that preoperative MRI is not associated margin status; rather, patient age and tumor size are the associated factors.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Middle Aged; Breast Neoplasms; Carcinoma, Ductal, Breast; Magnetic Resonance Imaging; Margins of Excision; Mastectomy, Segmental
PubMed: 37505353
DOI: 10.1245/s10434-023-13884-8 -
Journal of Cosmetic and Laser Therapy :... May 2023to report a possibly novel complication of laser hair removal.
OBJECTIVE
to report a possibly novel complication of laser hair removal.
CASE REPORT
a white-skinned 18-year-old patient discovered an umbilical, brown, and raised lesion while shaving before his second diode laser hair removal session. He sought consultation before his fourth laser session since the lesion further thickened and darkened. Dermoscopy showed no pigmented network, but a few comedo-like openings within an erythematous-light brown scaly and fissured papule, "moth-eaten" borders, and a central crust due to manipulation, suggesting the diagnosis of seborrheic keratosis. We noted that the laser fluence was increased on the umbilical region where hair seemed resistant to treatment. The patient denied a recent history of local sun tanning, sunburns, inflammation, drainage, or manipulation. The lesion cleared, with no short-term relapse, after one session of cryotherapy.
CONCLUSION
the development of a seborrheic keratosis-like lesion on a densely haired non-sun-exposed umbilicus of a young patient, following pre-laser shaving and high-fluence hair removal diode laser sessions, could have implicated triggering irritation and/or keratinocyte stimulation by red light-engendered reactive oxygen species (ROS) in the skin with silent epidermal mosaicism.
Topics: Male; Humans; Keratosis, Seborrheic; Hair Removal; Lasers, Semiconductor; Umbilicus; Neoplasm Recurrence, Local
PubMed: 37503868
DOI: 10.1080/14764172.2023.2241690 -
Annals of Surgical Oncology Oct 2023The clinical significance of nonclassic, lobular carcinoma in situ (NC-LCIS) at the surgical margin of excisions for invasive cancer is unknown. We sought to determine...
BACKGROUND
The clinical significance of nonclassic, lobular carcinoma in situ (NC-LCIS) at the surgical margin of excisions for invasive cancer is unknown. We sought to determine whether NC-LCIS at or near the margin in the setting of a concurrent invasive carcinoma is associated with risk of ipsilateral breast tumor recurrence (IBTR) and locoregional recurrence (LRR).
METHODS
Patients with stage 0-III breast cancer and NC-LCIS who underwent lumpectomy between January 2010 and January 2022 at a single institution were retrospectively identified. NC-LCIS margins were stratified as <2 mm, ≥2 mm, or within shave margin. Rates of IBTR and LRR were examined.
RESULTS
A total of 511 female patients (median age 60 years [interquartile range (IQR) 52-69]) with NC-LCIS and an associated ipsilateral breast cancer with a median follow-up of 3.4 years (IQR 2.0-5.9) were identified. Final margins for NC-LCIS were ≥2 mm in 348 patients (68%), <2 mm in 37 (7.2%), and within shave margin in 126 (24.6%). Crude incidence of IBTR was 3.3% (n = 17) and that of LRR was 4.9% (n = 25). There was no difference in the crude rate of IBTR by NC-LCIS margin status (IBTR rate: 3.7% ≥2 mm, 0% <2 mm, 3.2% within shave margin, p = 0.8) nor in LRR (LRR rate: 4.9% ≥2 mm, 2.7% <2 mm, 5.6% within shave margin, p = 0.9).
CONCLUSIONS
For completely excised invasive breast cancers associated with NC-LCIS, extent of margin width for NC-LCIS was not associated with a difference in IBTR or LRR. These data suggest that the decision to perform reexcision of margin after lumpectomy should be driven by the invasive cancer, rather than the NC-LCIS margin.
Topics: Female; Humans; Middle Aged; Aged; Breast Carcinoma In Situ; Carcinoma, Lobular; Mastectomy, Segmental; Carcinoma in Situ; Retrospective Studies; Neoplasm Recurrence, Local; Breast Neoplasms
PubMed: 37493892
DOI: 10.1245/s10434-023-13899-1 -
HCA Healthcare Journal of Medicine 2022Description Pleomorphic dermal sarcoma (PDS) can clinically and histopathologically mimic atypical fibroxanthoma (AFX). However, it has a more aggressive clinical course...
Description Pleomorphic dermal sarcoma (PDS) can clinically and histopathologically mimic atypical fibroxanthoma (AFX). However, it has a more aggressive clinical course with a higher recurrence rate and metastatic potential. This case presentation aims to report a rapidly-growing, exophytic, 4 cm tumor following a non-diagnostic shave biopsy 2 months prior and to highlight distinctive features between PDS and AFX needed to make the correct diagnosis. Like AFX, PDS occurs on the sun-damaged skin of the elderly, usually on the head and neck. Also, like AFX, PDS histopathologically consists of sheets or fascicles of epithelioid and/or spindle-shaped cells, often with multinucleation, pleomorphism, and numerous mitotic figures. Immunohistochemistry cannot distinguish PDS from AFX but is used to exclude other malignancies. PDS can be distinguished from AFX by size (PDS is usually >2.0 cm) and by the presence of more aggressive histopathologic features, such as subcutaneous involvement, perineural and/or lymphovascular invasion, and necrosis. PDS is a rare entity not well documented in the literature with confusing, misleading, and changing nomenclature. PDS is a diagnosis of exclusion made after complete excision of the tumor with the aid of histopathology and immunohistochemistry.
PubMed: 37425251
DOI: 10.36518/2689-0216.1334 -
Microbial Pathogenesis Sep 2023Leptospira enters humans and animals through injured skin or mucous membranes by direct or indirect contact with urine excreted from infected reservoirs. Individuals...
Leptospira enters humans and animals through injured skin or mucous membranes by direct or indirect contact with urine excreted from infected reservoirs. Individuals with cut or scratched skin are at high risk of infection and are recommended to be protected from contact with Leptospira, but the risk of infection via skin without apparent wounds is unknown. We hypothesized that the stratum corneum of the epidermis might prevent percutaneous invasion of leptospires. We established a stratum corneum deficient model of hamsters using the tape stripping method. The mortality rate of hamsters lacking stratum corneum that were exposed to Leptospira was higher than that of controls with shaved skin, and was not significantly different from an epidermal wound group. These results indicated that the stratum corneum plays a critical role in protecting the host against leptospiral entry. We also examined the migration of leptospires through the monolayer of HaCaT cells (human keratinocyte cell line) using Transwell. The number of pathogenic leptospires penetrating the HaCaT cell monolayers was higher than that of non-pathogenic leptospires. Furthermore, scanning and transmission electron microscopic observations revealed that the bacteria penetrated the cell monolayers through both intracellular and intercellular routes. This suggested that pathogenic Leptospira can migrate easily through keratinocyte layers and is associated with virulence. Our study further highlights the importance of the stratum corneum as a critical barrier against the invasion of Leptospira found in contaminated soil and water. Hence, preventative measures against contact infection should be taken, even without visible skin wounds.
Topics: Cricetinae; Animals; Humans; Leptospira interrogans; Leptospirosis; Epidermis; Leptospira; Skin
PubMed: 37422175
DOI: 10.1016/j.micpath.2023.106243 -
The Journal of Obstetrics and... Sep 2023Minimally invasive surgery (MIS) has been introduced as an alternative to more radical surgical procedures. The Japan Society of Gynecologic and Obstetric Endoscopy and...
AIM
Minimally invasive surgery (MIS) has been introduced as an alternative to more radical surgical procedures. The Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy conducted a cross-sectional questionnaire survey to ascertain the status of MIS for endometrial cancer.
METHODS
The survey was conducted between May 10 and June 30, 2022. The questionnaire included information on personal attributes, academic affiliations, qualifications, hysterectomies, and intraoperative procedures performed.
RESULTS
The total number of questionnaire respondents was 436 (9.2% of the membership). The hysterectomy methods and percentage performed were as follows: simple total hysterectomy (equivalent to benign surgery), 3%; simple total hysterectomy with care to avoid shaving the cervix, 31%; extended total hysterectomy, 48%; and modified radical hysterectomy, 15%. An analysis of hysterectomies performed using MIS for endometrial cancer by qualified gynecologists of endoscopy or board-certified gynecologic oncologists showed a tendency not to choose simple total hysterectomy compared to the gynecologists who did not hold certification (p = 0.019, p = 0.045, and p = 0.010, respectively). Additionally, 67% of respondents did not use uterine manipulators, and 59% of the respondents did not perform lymph node dissection following the guidelines for treating endometrial cancer in Japan.
CONCLUSION
This study provided the current status of MIS for endometrial cancer in Japan. The hysterectomy method, use of uterine manipulators, and criteria for omitting lymph node dissection were generally in agreement with the guidelines. Currently, an extra-fascial simple hysterectomy, including at least not shaving the cervix, was a major method for early invasive endometrial cancer using MIS.
Topics: Female; Humans; Cross-Sectional Studies; Japan; Endometrial Neoplasms; Hysterectomy; Surveys and Questionnaires; Minimally Invasive Surgical Procedures; Retrospective Studies; Laparoscopy
PubMed: 37365774
DOI: 10.1111/jog.15728 -
Journal of Ethnopharmacology Dec 2023Liangxue Jiedu formula (LXJDF) is an effective traditional Chinese medicine (TCM) formula for treating psoriasis of blood-heat syndrome and has been used in clinics for...
Liangxue Jiedu formula improves imiquimod-induced psoriasiform dermatitis with circadian desynchrony by regulating Th17 cell differentiation based on network pharmacological analysis.
ETHNOPHARMACOLOGICAL RELEVANCE
Liangxue Jiedu formula (LXJDF) is an effective traditional Chinese medicine (TCM) formula for treating psoriasis of blood-heat syndrome and has been used in clinics for decades.
AIM OF THE STUDY
This study aimed to discover the mechanism of LXJDF in psoriasis and the circadian clock by network pharmacology and experimental studies.
MATERIALS AND METHODS
The compounds of LXJDF were obtained from the TCMSP and BATMAN-TCM databases. The genes related to psoriasis and circadian rhythm/clock were identified by the OMIM and GeneCards databases. Then, target genes were integrated by Venn and analyzed by the String, CytoNCA, DAVID (GO and KEGG) databases, and the network was constructed using Cytoscape. Mice were raised under light disturbance for fourteen days. On the eighth day, mouse dorsal skin was shaved and smeared with 62.5 mg 5% imiquimod at 8:00 (ZT0) for six successive days. Mice were randomly divided into the model, LXJDF-H (49.2 g/kg·bw), LXJDF-L (24.6 g/kg·bw), and positive drug (dexamethasone) groups. Other mice were smeared with Vaseline under the normal light cycle as the control. The drug of each group was administered at 10:00 (ZT2) and 22:00 (ZT14). The skin lesions were observed, and PASI was scored daily. HE and immunofluorescence were used to measure pathological morphology. Th17 cytokines in serum and skin were measured by flow cytometry and qPCR. Circadian clock gene and protein expression levels were determined by qPCR and Western blotting.
RESULTS
We found 34 potential targets of LXJDF in the treatment of psoriasis and circadian rhythm and confirmed their importance by topology analysis. KEGG pathway analysis revealed that the two major pathways were Th17 cell differentiation and the HIF-1 signaling pathway. At ZT2 and ZT14, LXJDF improved IMQ-induced light disturbance mouse skin lesions, including alleviating scales, erythema, and infiltration, reducing PASI, and inhibiting keratinocyte hyperproliferation and parakeratosis. LXJDF reduced IL-17A, IL-17F, TNF-α, and IL-6 in serum at ZT2 and increased IL-10 at ZT2 and ZT14. LXJDF downregulated the expression of IL-17A and IL-17F in skin. At ZT2, LXJDF significantly upregulated CLOCK and REV-ERBα expression and downregulated HIF-1α expression. At ZT14, LXJDF decreased HIF-1α and RORγt expression and significantly increased REV-ERBα expression.
CONCLUSION
LXJDF improves psoriasis dermatitis with circadian rhythm disorders by regulating Th17 cell differentiation.
Topics: Animals; Mice; Interleukin-17; Imiquimod; Skin; Psoriasis; Cell Differentiation; Dermatitis; Disease Models, Animal; Th17 Cells; Mice, Inbred BALB C
PubMed: 37331449
DOI: 10.1016/j.jep.2023.116807 -
Cureus May 2023Infections due to nontuberculous mycobacteria (NTM) are caused by mycobacterial species other than , , and . Patients who are immunocompromised have increased...
Infections due to nontuberculous mycobacteria (NTM) are caused by mycobacterial species other than , , and . Patients who are immunocompromised have increased susceptibility to pulmonary, lymphatic, and skin infections by these pathogens. We present a case of a 78-year-old male who presented to dermatology with a left dorsolateral hand infection after sustaining cat scratches in the setting of topical steroid therapy for suspected pyoderma gangrenosum. A shave biopsy of the lesion showed granulomatous dermatitis and associated acid-fast bacilli, while tissue culture grew . This case demonstrates cat scratches as an uncommon risk factor for cutaneous NTM disease. Although an association between cat scratches and human NTM infections has only been reported in two previous cases, it must be considered in cases of unusual and persistent cutaneous lesions, especially in immunocompromised patients, even those with only local immunosuppression from topical agents.
PubMed: 37313069
DOI: 10.7759/cureus.38901 -
Cureus May 2023Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates...
Introduction Breast-conserving surgery (BCS) followed by adjuvant radiotherapy has similar overall survival compared to mastectomy but is associated with higher rates of local recurrence. Positive surgical margins in BCS are the most important predictor of local recurrence. The aim of our study was to assess the risk factors associated with positive margins in women undergoing BCS for breast cancer in order to inform our clinical practice and minimize re-operation rates. Methods Patients with a diagnosis of breast cancer who underwent BCS from January 2013 to January 2021 were identified from our pathology database and included in the study. All patients underwent a lumpectomy with the removal of additional shaved cavity margins. Statistical analysis was used to assess the effect of patient clinical and pathological risk factors on the rate of positive margins. Results One hundred and twenty patients underwent BCS for breast cancer. Twenty-four percent of patients had positive margins. Of the 29 patients that underwent subsequent re-excisions, only 13 (45%) had residual disease in the re-excision specimen. In younger patients, tumors localized in lower quadrants and the presence of extensive intraductal component within invasive breast cancer increased the risk of positive margins. In addition, positive margins were encountered more significantly in patients with ductal carcinoma in situ (DCIS) compared to invasive tumors. Multivariate analysis showed that DCIS and young age were the only factors independently associated with positive margins. Conclusion DCIS and younger patients have a higher rate of positive margins during BCS than invasive breast cancer. For such patients at higher risk of positive margins, excision of cavity shave margins and intraoperative inking may be done to lower positive margin rates. Preoperative review of breast imaging, core biopsies, and counseling of patients about the likelihood of positive margins is important.
PubMed: 37265920
DOI: 10.7759/cureus.38399 -
ACS Nano Jun 2023Obesity is a major risk factor for multiple chronic diseases. Anthropometric and imaging approaches are primarily used to assess adiposity, and there is a dearth of...
Obesity is a major risk factor for multiple chronic diseases. Anthropometric and imaging approaches are primarily used to assess adiposity, and there is a dearth of techniques to determine the changes in adipose tissue (AT) at the molecular level. Extracellular vesicles (EVs) have emerged as a novel and less invasive source of biomarkers for various pathologies. Furthermore, the possibility of enriching cell or tissue-specific EVs from the biofluids based on their unique surface markers has led to classifying these vesicles as "liquid biopsies", offering valuable molecular information on hard-to-access tissues. Here, we isolated small EVs from AT (sEV) of lean and diet-induced obese (DIO) mice, identified unique surface proteins on sEV by surface shaving followed by mass spectrometry, and developed a signature of five unique proteins. Using this signature, we pulled out sEV from the blood of mice and validated the specificity of isolated sEV by measuring the expression of adiponectin, 38 adipokines on an array, and several adipose tissue-related miRNAs. Furthermore, we provided evidence of sEV applicability in disease prediction by characterizing sEV from the blood of lean and DIO mice. Interestingly, sEV cargo showed a stronger pro-inflammatory effect on THP1 monocytes compared to sEV and a significant increase in obesity-associated miRNA expression. Equally important, sEV cargo revealed an obesity-associated aberrant amino acid metabolism that was subsequently validated in the corresponding AT. Lastly, we show a significant increase in inflammation-related molecules in sEV isolated from the blood of nondiabetic obese (>30 kg/m) individuals. Overall, the present study offers a less-invasive approach to characterize AT.
Topics: Adipose Tissue; Liquid Biopsy; Extracellular Vesicles; Obesity; Humans; Animals; Mice; Biomarkers
PubMed: 37224410
DOI: 10.1021/acsnano.3c00422