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Contains fulltext : 53248.pdf (Publisher’s version ) (Closed access) A 37-year-old woman was examined because of temporary diarrhoea. On CT scan, there was an abnormality of the liver. MRI showed a tumour that was suspicious for adenoma. Biopsy confirmed the diagnosis of hepatocellular adenoma. The patient then discontinued the use of oral contraceptives. The tumour regressed and was resected after two years. A 22-year-old woman presented with abdominal pain. A tumour was found in the upper right quadrant of the abdomen. In the laboratory, liver function tests were abnormal. Ultrasound and a CT scan of the liver showed an adenoma. After withdrawal of oral contraceptives, abdominal complaints lessened, but no regression of the tumour was detected. Surgical resection was uncomplicated. Hepatocellular adenoma is a rare, benign tumour of the liver, most often seen in young healthy women. Its incidence is rising due to the prolonged use of oral contraceptives. Not rarely, benign liver tumours are incidental findings on echography. If symptomatic, the presentation usually consists of vague abdominal complaints. Spontaneous rupture and malignant degeneration have been reported for adenoma. A reliable diagnosis is mandatory for the decision whether to apply surgery or continue observation. Radiological investigations play a key role in the detection and diagnosis of hepatocellular adenoma. Due to the risk of bleeding and malignant degeneration, elective surgical resection is indicated in symptomatic adenomas, asymptomatic adenomas larger than 5 cm in diameter, and smaller adenomas without regression after discontinuation of oral contraceptives.

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Contains fulltext : 49703.pdf (Publisher’s version ) (Closed access)

Item does not contain fulltext The aim of the study was to clarify the factors causing and/or influence morbidity following axillary dissection in patients treated for breast cancer by either lumpectomy or mastectomy. The records of 106 women with invasive breast cancer treated between 1996 and 1997 were retrospectively reviewed. Objective assessment included measurement of lymphoedema, shoulder mobility and axillary sensation. A questionnaire was used for subjective assessment of arm morbidity and pain. Lymphoedema was present in 13% of patients, a restriction in shoulder function in 24%, while 93% of patients had an impaired sensation in the axillary region. Lymphoedema and restriction in shoulder function were common in patients after adjuvant axillary radiation. Morbidity following axillary lymph node dissection is high and confirms the potentially severe effects of a staging procedure on a relatively young population. Adjuvant radiotherapy increases morbidity significantly and therefore indications for adjuvant axillary radiotherapy should be revised with scrutiny for each patient individually, bearing in mind the disastrous consequences of the combination of radiotherapy and surgery on the axilla.

PURPOSE: To assess prospectively the value of fluor-18-deoxyglucose (FDG) positron emission tomography (PET), in addition to conventional diagnostic methods (CDM), as a staging modality in candidates for resection of colorectal liver metastases. PATIENTS AND METHODS: In 51 patients analyzed for resection of colorectal liver metastases, clinical management decisions were recorded after a complete work-up with CDM. Afterward, FDG-PET scans were performed and any change of clinical management according to FDG-PET results was carefully documented. Discordances between FDG-PET and CDM results were identified and related to the final diagnosis by histopathology, intraoperative findings, and follow-up. RESULTS: In 10 (20%) out of 51 patients, clinical management decisions based on CDM were changed after FDG-PET findings were known. FDG-PET detected unresectable pulmonary (n = 5) and hepatic metastases (n = 1) and ruled out extrahepatic (n = 2) and hepatic disease (n = 2). Due to FDG-PET, eight patients were spared unwarranted liver resection or laparotomy and two other patients were identified as candidates for liver resection. When the results of FDG-PET were regarded as decisive in a retrospective analysis, potential change of management was 29% (15 patients). FDG-PET and CDM showed discordant extrahepatic results in 11 patients (22%) and discordant hepatic results in eight patients (16%). Compared with CDM, FDG-PET resulted in true upstaging (n = 11), true downstaging (n = 5), false upstaging (n = 1), and false downstaging (n = 2). The detection rate of liver metastases on a lesion basis was generally better for computed tomography than for FDG-PET (80% v 65%); this was related to tumor size. CONCLUSION: FDG-PET as a complementary staging method improves the therapeutic management of patients with colorectal liver metastases, especially by detecting unsuspected extrahepatic disease.

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Contains fulltext : 69356.pdf (Publisher’s version ) (Closed access) A decade of sentinel lymph node biopsy for breast cancer has taught us that old assumptions on contraindications (prior surgery, clinical positive axilla, multicentricity/multifocality, and neoadjuvant chemotherapy) should be discarded. Many clinical evaluation studies have shown that a new sentinel lymph node procedure after previous surgery of the breast and the axilla is feasible. It allows specialists to determine more precisely the biological activity of local recurrences and to re-conserve the axilla. In order to save as many axillas as possible, clinically suspect axillary lymph nodes should only be considered tumour positive if this is proven by biopsy. Also, in cases of multicentricity or multifocality a sentinel lymph node procedure should be performed. With the objective of conserving the axilla in as many patients as possible, a sentinel lymph node biopsy should be performed after neoadjuvant chemotherapy.

Contains fulltext : 49640.pdf (Publisher’s version ) (Closed access) There is increasing evidence that local recurrence after breast-conserving surgery may lead to an increase in distant metastases and disease-specific mortality. The most important factor responsible for recurrence is the margin status after excision. The treatment of patients with breast cancer should be decided upon by a multidisciplinary treatment group so that the candidates for a breast-conserving procedure can be adequately selected with emphasis on achieving maximum local control.

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Contains fulltext : 118052.pdf (Publisher’s version ) (Closed access) Barrett's esophagus, with gastroesophageal reflux disease and obesity as risk factors, predisposes to esophageal adenocarcinoma (EAC). Recently a British genome wide association study identified two Barrett's esophagus susceptibility loci mapping within the major histocompatibility complex (MHC; rs9257809) and closely to the Forkhead-F1 (FOXF1; rs9936833) coding gene. An interesting issue is whether polymorphisms associated with Barrett's esophagus, are also implicated in esophageal carcinoma (EC), and more specifically EAC genesis. Assessing the individual genetic susceptibility can help identify high risk patients more prone to benefit from surveillance programs. Our hypothesis: Barrett associated MHC and FOXF1 variants modify EC risk in Caucasians. In a Dutch case-control study, 431 patients with EC and 605 healthy controls were included. Polymorphisms at chromosomes 6p21 (MHC) and 16q24 (FOXF1) were determined by means of real-time polymerase chain reaction (RT-PCR). Logistic regression analysis was used to calculate odds ratios with 95% confidence intervals. The FOXF1 rs9936833 variant C allele was associated with an increased EAC susceptibility; OR, [95% CI]; 1.21, [0.99-1.47]. A sex-stratified analysis revealed a similar association in males; 1.24 [1.00-1.55]. The variant MHC rs9257809 G allele as well as the MHC heterozygous AG genotype significantly increased ESCC risk; 1.76 [1.16-2.66] and 1.74 [1.08-2.80], respectively. Sex-stratification showed that the variant G allele was especially present in female patients; 2.32 [1.04-5.20]. In conclusion, this study provides evidence that MHC rs9257809 and FOXF1 rs9936833 variants, associated with Barrett's esophagus, also increase ESCC and EAC susceptibility in Caucasians. FOX proteins are transcription factors involved in organogenesis of the GI tract, while MHC haplotypes are strongly associated with smoking behavior, a crucial risk factor for ESCC. Assessing the individual genetic susceptibility can help identify high risk patients more prone to benefit from (Barrett) surveillance programs.

Contains fulltext : 24078___.PDF (Publisher’s version ) (Open Access)

Item does not contain fulltext The new guideline is an adaptation to recent developments in the genetics of breast cancer. Hereditary and familial breast cancer may give rise to many questions in women coping with family members with the disease. Recommendations are given in a clear and succinct way. It is regrettable that breast self examination is not recommended anymore as it is not considered to be of evidence-based value. This may be true, but, particularly in young women, it is often the only way to detect breast cancer. In case of suspicion of a malignancy the patient should be referred to a surgeon who is dedicated to the diagnosis and treatment of breast cancer, and who is part of a multidisciplinary breast cancer group.