RESUMEN
We report the case of a 79-year-old woman with a longstanding lymphedema of the right arm who developed a skin lymphoma involving the right wrist area. Microscopically, the lesion was composed of numerous centroblasts infiltrating both the dermis and the subcutaneous tissue. Phenotypic investigations showed expression of CD20, CD79a, and bcl-2 protein by neoplastic cells. In addition, these cells were CD5 positive. No expression of anaplastic large cell lymphoma kinase (ALK), CD10, CD23, CD30, CD43, bcl-6, cyclin D1, p53 or p16INK4a could be seen. Polymerase chain reaction (PCR) analysis demonstrated a clonal rearrangement of the genes coding for the kappa light chain of the immunoglobulin (Ig). No rearrangement of the genes coding for the Ig heavy chain, t(14;18) or t(11;14) chromosome translocations, or Epstein-Barr virus (EBV) genomic sequences could be found. The tumor was classified as stage IE and was first cured by complete surgical excision. Nineteen months later, a recurrence was noted in the right elbow area. This study further illustrates that lymphoma of the skin may complicate chronic limb lymphedema. Like most of the previously reported cases, this neoplasm belonged to the category of diffuse large B-cell lymphoma. However, it showed CD5 expression as a singular feature.
Asunto(s)
Antígenos CD5/biosíntesis , Linfedema/complicaciones , Linfoma de Células B/complicaciones , Linfoma de Células B Grandes Difuso/complicaciones , Neoplasias Cutáneas/complicaciones , Anciano , Brazo , Enfermedad Crónica , Femenino , Humanos , Linfedema/inmunología , Linfedema/patología , Linfoma de Células B/inmunología , Linfoma de Células B/patología , Linfoma de Células B Grandes Difuso/inmunología , Linfoma de Células B Grandes Difuso/patología , Reacción en Cadena de la Polimerasa , Neoplasias Cutáneas/inmunología , Neoplasias Cutáneas/patologíaRESUMEN
Since 1989, superior pedicle vertical scar mammaplasty as described by Lejour has been used in the authors' department as the only technique for breast reduction. From 1991 through 1994, a series of 170 consecutive patients (330 breasts) underwent an operation. In these patients, minor complications were observed in 30 percent of the patients and major complications in 15 percent. Surgical revision for scar or volume corrections was necessary in 28 percent of the breasts, which seemed unacceptable. Therefore, the original technique was modified by decreasing the skin undermining and avoiding liposuction in the breast. Primary skin excision was performed in the submammary fold at the end of the operation if the skin could not be puckered adequately. This modified technique was used from 1996 through 1999 in 138 consecutive patients (227 breasts). In the second series, minor complications were observed in 15 percent of the patients and major complications in 5 percent. However, the technical modifications did not significantly change the rate of secondary scar and volume corrections, which were still necessary in 22 percent of the breasts. In large breasts, the addition of a horizontal scar at the end of the operation did not change the rate of secondary revision, which however compares favorably with the figures obtained with the inverted T, superior pedicle mammaplasty.
Asunto(s)
Cicatriz/etiología , Mamoplastia/métodos , Complicaciones Posoperatorias/etiología , Adolescente , Adulto , Anciano , Cicatriz/cirugía , Estética , Femenino , Humanos , Lipectomía/métodos , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud , Complicaciones Posoperatorias/cirugía , Reoperación/métodos , Técnicas de SuturaRESUMEN
AIMS AND BACKGROUND: Breast conserving treatment (BCT) should provide similar quality of local control as mastectomy and avoid psychological distress due to mutilation. Randomized trials have demonstrated the value of conservative surgery for small tumors. Several publications have indicated the possibility of improving the cosmetic result when quadrantectomy is combined with plastic surgery. These papers focused on two techniques involving reduction mammaplasty and latissimus dorsi flap procedures. At the European Institute of Oncology (EIO) we use various plastic procedures to reshape the breast and to improve symmetry. The choice of these techniques depends on tumor size and location, as well as on breast volume. METHODS AND STUDY DESIGN: In two years (1995 and 1996) 111 patients were treated at the EIO with quadrantectomy and concomitant plastic surgery. Preoperative tumor staging was as follows: T1 57.5%, T2 29%, T3 4.5%, Tis 8%, and sarcoma 1%. The tumor locations were upper quadrant 50%, lower quadrant 40%, and central quadrant 10%. The plastic surgery techniques used included local glandular flaps, areola transposition, mastopexy or classical reduction mastoplasty procedures, the round block technique, prosthesis insertion, and distal musculocutaneous flaps. Cosmetic evaluation on the basis of predefined cosmetic criteria was carried out on photographs after a mean follow-up of 21 months. In 48 cases the patients' own rating of breast cosmesis was asked. RESULTS: The global results were good in 77.5%, fair in 17%, and poor in 5.5% of the patients. No statistical difference was observed between different tumor locations, although the percentage of good cosmetic results, which was similar in the upper and lower quadrantectomy groups, was slightly lower for centrally located tumors. With regard to the different techniques, we obtained 100% good results with the round block technique and the Grisotti flap, 87% good results with the inferior pedicle, 74% good results with the Lejour and superior pedicle techniques, 67% good results with the latissimus dorsi flap, and 58% good results with prosthetic implants. The outcome was less satisfactory when no contralateral mastoplasty was performed (14 of the 111 cases): 72% good, 14% fair, and 14% poor results. These differences were not statistically significant. The median weight of the specimens was 157 g, which is almost three-fold the usual weight in regular tumorectomies. Six carcinomas were found in contralateral breasts (4 DCIS and 2 infiltrating). CONCLUSIONS: The double-team approach (plastic surgeons and oncologists) to BCT may improve the final cosmetic result following large tumor excisions. It can also extend the indications for breast preserving surgery. Moreover, it allows surgical and histological exploration of the contralateral breast when a surgical procedure for symmetry is required.