RESUMEN
BACKGROUND AND OBJECTIVES: Occult primary breast carcinoma is uncommon. Most reported series encompass a large periods of time with great variability in diagnostic and treatment approaches. The objective of the present study was to review the recent experience with this type of presentation of breast cancer in the University of Alabama at Birmingham. METHODS: Retrospective review of clinicopathological data of female patients presenting with axillary metastasis of adenocarcinoma with unknown primary and normal clinical and mammographic breast exam seen at UAB between 1985 and 1998. RESULTS: Ten patients were identified. Mean age was 56 years. Sixty per cent were white and postmenopausal. All patients had biopsy proven adenocarcinoma consistent with breast primary. All but one patient underwent an axillary dissection. Nine out of ten patients received some type of local treatment to the breast. Three of them underwent mastectomy and no invasive carcinoma was demonstrated in the surgical specimens. Six patients received radiation therapy to the breast. All patients received chemotherapy. With mean follow-up time of 48 months, two patients developed local recurrence to the axilla and four developed distant metastasis and eventually died. At last follow-up six patients are alive with no evidence of disease. CONCLUSIONS: In presence of axillary metastasis from an unknown breast primary, an extensive work-up evaluation is not necessary. An axillary dissection is recommended to provide prognostic indicators as well as local control. A breast conservation approach seems to be feasible without affect the local control and survival.
Asunto(s)
Adenocarcinoma/secundario , Neoplasias de la Mama/diagnóstico , Metástasis Linfática/diagnóstico , Neoplasias Primarias Desconocidas/diagnóstico , Adenocarcinoma/diagnóstico , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/mortalidad , Adenocarcinoma/radioterapia , Adenocarcinoma/cirugía , Adulto , Anciano , Alabama/epidemiología , Axila , Biopsia , Neoplasias Óseas/secundario , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/mortalidad , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/cirugía , Terapia Combinada , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Pulmonares/secundario , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Mamografía , Menopausia , Persona de Mediana Edad , Neoplasias Primarias Desconocidas/mortalidad , Palpación , Estudios Retrospectivos , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
BACKGROUND AND OBJECTIVES: Occult primary breast carcinoma is uncommon. Most reported series encompass a large periods of time with great variability in diagnostic and treatment approaches. The objective of the present study was to review the recent experience with this type of presentation of breast cancer in the University of Alabama at Birmingham. METHODS: Retrospective review of clinicopathological data of female patients presenting with axillary metastasis of adenocarcinoma with unknown primary and normal clinical and mammographic breast exam seen at UAB between 1985 and 1998. RESULTS: Ten patients were identified. Mean age was 56 years. Sixty per cent were white and postmenopausal. All patients had biopsy proven adenocarcinoma consistent with breast primary. All but one patient underwent an axillary dissection. Nine out of ten patients received some type of local treatment to the breast. Three of them underwent mastectomy and no invasive carcinoma was demonstrated in the surgical specimens. Six patients received radiation therapy to the breast. All patients received chemotherapy. With mean follow-up time of 48 months, two patients developed local recurrence to the axilla and four developed distant metastasis and eventually died. At last follow-up six patients are alive with no evidence of disease. CONCLUSIONS: In presence of axillary metastasis from an unknown breast primary, an extensive work-up evaluation is not necessary. An axillary dissection is recommended to provide prognostic indicators as well as local control. A breast conservation approach seems to be feasible without affect the local control and survival.
Asunto(s)
Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Neoplasias de la Mama , Adenocarcinoma , Metástasis Linfática , Metástasis Linfática/diagnóstico , Neoplasias Primarias Desconocidas/diagnóstico , Axila , Biopsia , Neoplasias de la Mama , Menopausia , Mamografía , Adenocarcinoma , Tomografía Computarizada por Rayos X , Alabama , Estudios Retrospectivos , Estudios de Seguimiento , Resultado del Tratamiento , Terapia Combinada , Neoplasias Pulmonares , Ganglios Linfáticos , Escisión del Ganglio Linfático , Neoplasias Óseas/secundario , Neoplasias Primarias Desconocidas/mortalidad , PalpaciónRESUMEN
Adult T-cell leukemia/lymphoma (ATL) is frequently a very aggressive malignancy with a poor survival despite aggressive multiagent chemotherapy. The combination of the antiretroviral drug zidovudine (AZT) and interferon alpha (IFNalpha) has been reported to induce remissions in patients with ATL. The purpose of this study was to evaluate the clinical response and toxicity following administration of a combination of IFNalpha-2b and AZT in patients with human T-cell lymphotropic virus type I (HTLV-I)-associated ATL. Eighteen patients with ATL (chronic. crisis, acute or lymphoma type) were treated with the combination of AZT (50 - 200 mg orally 5 times a day) and IFNalpha-2b (2.5 - 10 million units subcutaneously daily). Three patients had objective responses lasting more than one month. One patient had a clinical complete remission, lasting 21.6 months and two patients had partial remissions lasting 3.7 and 26.5 months. Six patients were not considered evaluable for response due to short and/or interrupted periods of treatment. Seventeen patients have died with a median survival time after initiation of therapy of 6 months. Neutropenia and thrombocytopenia were the dose limiting toxicities. In conclusion, the response rate in this study was lower than noted in the two previous published series. This may be due to the amount and type of prior treatment our patients had received.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Interferón-alfa/administración & dosificación , Leucemia-Linfoma de Células T del Adulto/tratamiento farmacológico , Zidovudina/administración & dosificación , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/toxicidad , Supervivencia sin Enfermedad , Femenino , Humanos , Interferón alfa-2 , Interferón-alfa/toxicidad , Leucemia-Linfoma de Células T del Adulto/complicaciones , Leucemia-Linfoma de Células T del Adulto/mortalidad , Masculino , Dosis Máxima Tolerada , Persona de Mediana Edad , Neutropenia/inducido químicamente , Proteínas Recombinantes , Inducción de Remisión , Pruebas Cutáneas , Trombocitopenia/inducido químicamente , Resultado del Tratamiento , Zidovudina/toxicidadRESUMEN
Nasal, pharyngeal, cervical and vaginal swab specimens were obtained from 74 desert bighorn sheep for the purpose of investigating the normal aerobic bacterial flora of wild sheep. A total of 281 isolates was obtained and identified by standard microbiologic tests. One hundred seven of these isolates were gram positive and included Bacillus sp. (36%), Staphylococcus epidermidis (8%), S. aureus (4%), Corynebacterium sp. (diphtheroids, 4%), and Streptococcus sp. (48%). gram negative isolates totaled 174 and included Neisseria sp. (18%), Citrobacter sp. (3%), Enterobacter sp. (2%), Escherichia coli (2%), Proteus sp. (2%) and non-fermentative bacilli (NFB) (73%). Of the NFB isolates, Pseudomonas sp. (25%), Acinetobacter sp. (18%), Moraxella sp. (15%) were identified.