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Seminars in Cancer Biology Jul 2021Many breast lesions are associated with microcalcifications that are detectable by mammography. In most cases, radiologists are able to distinguish calcifications... (Review)
Review
Many breast lesions are associated with microcalcifications that are detectable by mammography. In most cases, radiologists are able to distinguish calcifications usually associated with benign diseases from those associated with malignancy. In addition to their value in the early detection of breast carcinoma and accurate radiological diagnosis, the presence of microcalcifications often affects the extent of surgical intervention. Certain types of microcalcifications are associated with negative genetic and molecular characteristics of the tumor and unfavorable prognosis. Microcalcifications localized in the larger ducts (duct-centric, casting-type microcalcifications) represent an independent negative prognostic marker compared to lesions containing other types of microcalcifications and to non-calcified lesions. In this review, we summarize the theoretical and methodological background for understanding the clinical impact and discuss the diagnostic and prognostic value of microcalcifications detected in the breast by mammography.
Topics: Breast Neoplasms; Calcinosis; Female; Humans; Mammography; Prognosis
PubMed: 31733292
DOI: 10.1016/j.semcancer.2019.10.024 -
Frontiers in Immunology 2021Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis, a rare subtype of autoimmune encephalitis, was first reported by Lai et al.... (Meta-Analysis)
Meta-Analysis Review
Anti-alpha-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptor (AMPAR) encephalitis, a rare subtype of autoimmune encephalitis, was first reported by Lai et al. The AMPAR antibodies target against extracellular epitopes of the GluA1 or GluA2 subunits of the receptor. AMPARs are expressed throughout the central nervous system, especially in the hippocampus and other limbic regions. Anti-AMPAR encephalitis was more common in middle-aged women and most patients had an acute or subacute onset. Limbic encephalitis, a classic syndrome of anti-AMPAR encephalitis, was clinically characterized by a subacute disturbance of short-term memory loss, confusion, abnormal behavior and seizure. Magnetic resonance imaging often showed T2/fluid-attenuated inversion-recovery hyperintensities in the bilateral medial temporal lobe. For suspected patients, paired serum and cerebrospinal fluid (CSF) testing with cell-based assay were recommended. CSF specimen was preferred given its higher sensitivity. Most patients with anti-AMPAR encephalitis were complicated with tumors, such as thymoma, small cell lung cancer, breast cancer, and ovarian cancer. First-line treatments included high-dose steroids, intravenous immunoglobulin and plasma exchange. Second-line treatments, including rituximab and cyclophosphamide, can be initiated in patients who were non-reactive to first-line treatment. Most patients with anti-AMPAR encephalitis showed a partial neurologic response to immunotherapy.
Topics: Animals; Autoantibodies; Autoantigens; Autoimmune Diseases; Autoimmunity; Biomarkers; Combined Modality Therapy; Diagnosis, Differential; Diagnostic Imaging; Disease Management; Encephalitis; Humans; Phenotype; Prognosis; Receptors, Glutamate; Symptom Assessment; Treatment Outcome
PubMed: 34093540
DOI: 10.3389/fimmu.2021.652820 -
Gland Surgery Dec 2018Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick... (Review)
Review
Understanding the ductal anatomy of the breast provides insights into tumorigenesis, which in turn offers guidance on therapeutic decisions. In this regard, the sick lobe hypothesis, which states that cancer arises from genetically unstable cells through mutations acquired in utero, forms the basis of malignant transformation. These 'at risk' cells line the mammary ductal-lobular system of a single 'sick' lobe and when exposed to noxious events in the surrounding microenvironment, further genetic changes occur which completes conversion to malignancy, in certain defined patterns. This review explores how anatomy, pathology and genomics can merge, not only to guide optimum surgery, but also to provide a more comprehensive portal for precision medicine.
PubMed: 30687632
DOI: 10.21037/gs.2018.09.08 -
Cureus Feb 2022Thyroid Hemiagenesis (THA) is an uncommon, congenital anomaly defined by the absence of one thyroid lobe with or without the isthmus. Reports suggest it may be found... (Review)
Review
Thyroid Hemiagenesis (THA) is an uncommon, congenital anomaly defined by the absence of one thyroid lobe with or without the isthmus. Reports suggest it may be found more often in regions endemic for hypothyroidism. Genetic abnormalities are thought to have a role based on findings in monozygotic twins. Most cases are sporadic, however familiar clusters have also been documented. It is found more frequently in females. A majority of patients report no symptoms and THA is found incidentally during investigations or intraoperatively. THA is usually associated with normal thyroid function, but it can present with thyroid hypofunction. Since a majority of patients are asymptomatic, there are no specific recommendations for management. Ultrasound imaging and thyroid scintigraphy using technetium or iodine are useful in diagnosis. Its clinical importance occurs when the remnant thyroid lobe requires excision leading to the lifelong requirement for thyroxine supplementation. Published English literature (Medline, PubMed, and Embase databases) was searched. Medical subject headings (MeSH) terms used were "thyroid hemiagenesis," "one thyroid lobe," and "thyroid aplasia". Case reports, case series, and original articles were selected to provide a framework for this review. Articles reviewed were published in the past 20 years. The association of THA with thyroid cancer was explored. In this group, the F:M ratio was 3.25:1. Left THA constituted 53% of cases, right THA in 29.4%, and isthmus absence in 17.6% of cases. Also, the authors investigated the link between THA and hyperparathyroidism, both left and right THA are seen in an equal number of cases in the hyperparathyroidism subgroup. In patients with THA and Grave's disease, left THA was seen in a majority of cases (86.7%), while an equal number of left and right THA was observed in patients with Hashimoto's thyroiditis. In addition, congenital abnormalities associated with THA were observed, the left THA was seen in 60% and right THA in 40% of cases of this subgroup. The summative review provided a detailed insight into the epidemiology, aetiopathogenesis, genetics, symptomatology, diagnosis, and treatment for THA by combining findings and results from almost a hundred research papers from around the world. THA remains a poorly understood, often incidentally detected, abnormality in euthyroid patients undergoing investigations and treatment for other thyroid disorders.
PubMed: 35371763
DOI: 10.7759/cureus.22401 -
Gland Surgery Apr 2023In the past, it was conventionally thought that multiple ipsilateral breast cancer (MIBC) was a contraindication to breast conservation surgery, especially if... (Review)
Review
BACKGROUND AND OBJECTIVE
In the past, it was conventionally thought that multiple ipsilateral breast cancer (MIBC) was a contraindication to breast conservation surgery, especially if multicentric foci in different quadrants of the breast were present. However, over time, there has been a growing body of evidence in the literature demonstrating no survival detriment or poorer local control with breast conservation for MIBC. There is, however, a paucity of information integrating anatomy, pathology with surgical treatment of MIBC. Understanding mammary anatomy, pathology of the sick lobe hypothesis and molecular impact of field cancerisation contributes significantly to the understanding of the role of surgical treatment of MIBC. The purpose of this narrative overview is to review the paradigm shifts over time in the use of breast conservation treatment (BCT) for MIBC, and how the concepts of the sick lobe hypothesis and field cancerisation interact with this therapeutic strategy. A secondary objective is to explore the feasibility of surgical de-escalation for BCT in the presence of MIBC.
METHODS
A PubMed search was performed for articles relating to BCT, multifocal, multicentric and MIBC. A separate literature search was performed for sick lobe hypothesis and field cancerisation and their interaction for surgical treatment for breast cancer. The available data was then analysed and synergised into a coherent summary of how the molecular and histologic aspects of MIBC interact with surgical therapy.
KEY CONTENT AND FINDINGS
There is a growing body of evidence supporting the use of BCT for MIBC. However, there is scant data connecting the basic science aspects of breast cancer in terms of pathology and genetics to adequacy of surgical extirpation of breast malignancies. This review bridges this gap by demonstrating how information on basic sciences available in contemporary literature can be extrapolated for use in artificial intelligence (AI) systems to assist in BCT for MIBC.
CONCLUSIONS
This narrative review connects several aspects of the surgical treatment for MIBC: historical perspectives of therapy compared with contemporary philosophy based on clinical evidence, anatomy/pathology (sick lobe hypothesis) and molecular findings (field cancerisation) as potential indicators of adequate surgical resection, and how current technology can be used to forge future AI applications in breast cancer surgery. These form the foundation for future research to safely de-escalate surgery for women with MIBC.
PubMed: 37200923
DOI: 10.21037/gs-22-609 -
Cancers Sep 2022Long-term memory disturbances are amongst the most common and disruptive cognitive symptoms experienced by breast cancer survivors following chemotherapy. To date, most... (Review)
Review
Long-term memory disturbances are amongst the most common and disruptive cognitive symptoms experienced by breast cancer survivors following chemotherapy. To date, most clinical assessments of long-term memory dysfunction in breast cancer survivors have utilized basic verbal and visual memory tasks that do not capture the complexities of everyday event memories. Complex event memories, including episodic memory and autobiographical memory, critically rely on hippocampal processing for encoding and retrieval. Systemic chemotherapy treatments used in breast cancer commonly cause neurotoxicity within the hippocampus, thereby creating a vulnerability to memory impairment. We review structural and functional neuroimaging studies that have identified disruptions in the recollection network and related episodic memory impairments in chemotherapy-treated breast cancer survivors, and argue for the need to better characterize hippocampally mediated memory dysfunction following chemotherapy treatments. Given the importance of autobiographical memory for a person's sense of identity, ability to plan for the future, and general functioning, under-appreciation of how this type of memory is impacted by cancer treatment can lead to overlooking or minimizing the negative experiences of breast cancer survivors, and neglecting a cognitive domain that may benefit from intervention strategies.
PubMed: 36230678
DOI: 10.3390/cancers14194752 -
Internal Medicine (Tokyo, Japan) Nov 2017Cases of drug-induced lung injury caused by tamoxifen are rare. A 74-year-old man underwent surgery for the treatment of right breast cancer; tamoxifen was administered...
Cases of drug-induced lung injury caused by tamoxifen are rare. A 74-year-old man underwent surgery for the treatment of right breast cancer; tamoxifen was administered as an adjuvant therapy after surgery. The patient developed cough and dyspnea and chest computed tomography showed ground glass opacification in the lower lobe of the right lung. He was diagnosed with tamoxifen-induced lung injury. The diagnosis was made based on the exclusion of other causes and recurrence with the re-administration of tamoxifen. Physicians should therefore be aware of the potential for the development of tamoxifen-induced lung injury.
Topics: Aged; Antineoplastic Agents, Hormonal; Breast Neoplasms, Male; Chemotherapy, Adjuvant; Humans; Lung Injury; Male; Tamoxifen; Tomography, X-Ray Computed
PubMed: 28943550
DOI: 10.2169/internalmedicine.8649-16 -
Journal of Biomedical Physics &... Feb 2021Breast cancer is the most common cancer among women. Considering the fact that a high dose is delivered in a single fraction of IORT, the evaluation of the dose at...
BACKGROUND
Breast cancer is the most common cancer among women. Considering the fact that a high dose is delivered in a single fraction of IORT, the evaluation of the dose at sensitive organs like thyroid is necessary.
OBJECTIVE
The current study has aimed to evaluate the received dose to thyroid lobes in the breast IORT technique.
MATERIAL AND METHODS
A total of 49 women with breast cancer undergoing IORT were enrolled in this cross-sectional study with census sampling. Immediately after tumor resection, a single dose of 20 Gray at the applicator surface was delivered using 50KV X-ray by an Intrabeam machine. The thyroid dose was detected using thermoluminescent detectors (TLD) 100 at the mid-thyroid line, left and right lobes.
RESULTS
The dose at the right and left lobes of the thyroid gland as well as the mid-thyroid line was found to be 40.18±35.44 mGy, 35.50±27.32 mGy, and 40.61±32.47 mGy, respectively. The right lobe received a significantly higher absorbed dose compared to the left lobe when the right breast was under IORT treatment. The same trend was seen with the left lobe and left breast under IORT treatment (P=0.0001 and P=0.018, respectively). The applicator size showed non-significant effects on the absorbed dose at the thyroid gland. Also, the applicator depth had a non-significant inverse effect on thyroid dose.
CONCLUSION
According to our findings, the absorbed dose at each thyroid lobe depends on the under-treatment side as well as the applicator size and depth (applicator upper surface distance from the skin).
PubMed: 33564640
DOI: 10.31661/jbpe.v0i0.2001-1046 -
Clinical EEG and Neuroscience Jul 2021Survivors of breast and other cancers often report protracted difficulty in performing tasks involving concentration and memory, even years after the completion of...
Survivors of breast and other cancers often report protracted difficulty in performing tasks involving concentration and memory, even years after the completion of treatment. The current study investigated whether cancer and treatment history is associated with deficits in sensory filtering (gating out) and sensory memory (gating in), early processes in stimulus processing that may contribute to difficulties in later remembering. A group of breast cancer survivors and age-matched healthy control participants (mean age 54 years) underwent testing with paired-click and oddball tasks while electroencephalographic (EEG) signals were recorded. The survivors showed relatively poor inhibition of redundant sensory stimulation (P50 suppression). Dipole source analysis localized the survivors' impairment to the hippocampus, with preservation of function in gating mechanisms of the frontal lobe and auditory cortex. Survivors also showed disruption to sensory memory processes needed to register novel information in an otherwise uniform auditory environment (mismatch negativity). The findings suggest that survivors experience deficits in early, automatic mechanisms of sensory gating, which may trigger a cascade of later perceived attentional and memory deficits. If our account is accurate, ideal therapies might aim to restore early inhibitory processes, such as those gauged by P50 suppression.
Topics: Acoustic Stimulation; Breast Neoplasms; Cancer Survivors; Electroencephalography; Evoked Potentials, Auditory; Humans; Middle Aged; Sensory Gating; Survivors
PubMed: 33167713
DOI: 10.1177/1550059420971120