Circulating tumor cells (CTCs) are defined as tumor cells circulating in the peripheral blood of patients, shed from either the primary tumor or from its metastases. The detection of circulating tumor cells (CTCs) in the peripheral blood of breast cancer patients may account for the different steps in the biologic progression of the disease. The detection of microscopic disease in patients with breast cancer is imperative to prognosis and can predict the efficacy of targeted treatments. In general, there are two main methods for their detection. These are based on cytometric and nucleic acid manipulation. Both methods generally require an enrichment step to increase sensitivity of the assay. This step is based on either detection of specific surface markers using immuno-selection and/or on morphological features, such as cell size or density. We review the methods of detecting CTCs, their prognostic implications, and opportunities to exploit the properties of CTCs to develop personalized therapy.
Breast ; Breast Neoplasms ; Cell Size ; Humans ; Neoplasm Metastasis ; Neoplastic Cells, Circulating ; Nucleic Acids ; Prognosis

PURPOSE: The aims of our study were to assess the correlation between serum HER2 and clinicopathologic factors, the effect of serum HER2 on survival rate, and the effect of changes in serum HER2 levels between pre- and post-adjuvant chemotherapy on survival rate. METHODS: The study subjects, 200 women with breast cancer, were a subset of patients operated on between January 2005 and December 2006. We evaluated changes in serum HER2 levels between pre- and post-adjuvant chemotherapy. RESULTS: Being estrogen receptor (ER) negative was also correlated with high serum HER2 (p=0.017). The number of patients with changes in serum HER2 (>20% increased level during the follow-up period) was correlated with advanced T-stage (p=0.010), advanced American Joint Committee on Cancer (AJCC) stage (p=0.015) and poor histologic grade (p=0.001). Univariate analysis for prognostic factors associated with disease-free survival (DFS) revealed that the difference in DFS between those with serum HER2 level <15 ng/mL and those with levels > or =15 ng/mL was statistically significant (p=0.0129) and the changes in serum HER2 levels were also statistically significant (p=0.001). Prognostic factors associated with overall survival revealed that the changes in serum HER2 levels between pre- and post-adjuvant chemotherapy were statistically significant (p=0.0012). CONCLUSION: Serum HER2 level is associated with a more advanced degree of axillary lymph node involvement and associated with ER negativity. And Changes in serum HER2 levels are associated with more advanced AJCC staging and histologic tumor grade. There are significant associations between serum HER2 level, changes in serum HER2 levels and 5-year DFS.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Estrogens ; Female ; Follow-Up Studies ; Humans ; Joints ; Lymph Nodes ; Prognosis ; Survival Rate

OBJECTIVES: p53 is a tumor suppressor gene and plays an important role in the etiology of breast cancer. The aim of this study is to clarify clinical significance of p53 in Ductal Carcinoma in situ (DCIS), and discuss about survival effect. METHODS: The study subjects, 69 women with breast cancer, were a subset of patients operated from Jan 2005 to Dec 2006. We used a cutoff of 10% to distinguish between positive and negative p53 staining. The University of Southern California (USC)/Van Nuys Prognostic Index (VNPI) were compared with 2 categories of p53. RESULTS: The positivity of p53 was found in 20 patients (29.0%) in DCIS. And negativity of p53 was found in 49 patients (71.0%). And 15 patients (21.7%) had a low USC/VNPI score, 42 patients (60.9%) intermediate and 12 patients (17.4%) a high score. The positivity of p53 was correlated with high USC/VNPI (P = 0.001). The univariate analysis for prognostic factors associated with Disease Free Survival (DFS) revealed that patients with p53 positivity show shorter Disease Free Survival (DFS) than patients with p53 negativity (P = 0.013) and USC/VNPI was also statistically significant (P = 0.030). CONCLUSIONS: According to our study, p53 was associated with high USC/VNPI. These findings suggest that p53 can be used to classify DCIS into at least two subtypes with differing prognoses.
Breast Neoplasms ; California ; Carcinoma, Ductal ; Carcinoma, Intraductal, Noninfiltrating ; Disease-Free Survival ; Female ; Genes, Tumor Suppressor ; Humans ; Prognosis

PURPOSE: The genes p53 and B-cell lymphoma (bcl)-2 play an important role in regulating the mechanisms of apoptosis. In this paper, we retrospectively applied these factors to our series of triple negative breast cancer (TNBC) patients, in conjunction with an evaluation of the prognostic significance of these factors' influence on TNBC survival rate. Particular focus was placed on the role of bcl-2, p53, Ki-67. METHODS: The study subjects, 94 women with TNBC, were a subset of patients operated at Kosin University Gospel Hospital from January 2000 to December 2005. Chi-squared tests were used for statistical analysis. RESULTS: Positive staining for cytokeratin (CK)5/6 in 23 cases (24.5%), epidermal growth factor receptor in 15 cases (16.0%), bcl-2 in 26 cases (27.7%), p53 in 55 cases (58.5%) and Ki-67 in 74 cases (78.7%) was determined. Lymph node status, tumor size and expression of CK5/6 or Ki-67 were independent prognostic factors for patients with TNBC. CONCLUSION: Markers regulating cell cycle and cell death such as p53 and bcl-2 cannot be used to classify TNBCs into two subtypes with differing disease-free survival. But because our study is small in size, more abundant patient data will be needed to evaluate the factors' predictive role in regulating cell cycle and cell death.
Apoptosis ; Breast ; Breast Neoplasms ; Cell Cycle ; Cell Death ; Disease-Free Survival ; Female ; Humans ; Keratins ; Lymph Nodes ; Lymphoma, B-Cell ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Survival Rate

PURPOSE: Triple negative breast cancer (TNBC) has had poor prognosis compared with the luminal subtype. And there has been no benefit from doxorubicin. However, the addition of paclitaxel is known to improve both disease-free survival (DFS) and overall survival (OS). The aim of our study was to assess the effect of the addition of paclitaxel after adjuvant chemotherapy with doxorubicin plus cyclophosphamide in TNBC. METHODS: We randomly selected 87 women from 104 women with TNBC who had been randomly assigned to receive doxorubicin (60 mg per square meter of body-surface area) plus cyclophosphamide (600 mg per square meter) for four cycles, followed by four cycles of paclitaxel (175 mg per square meter) or two more cycles of doxorubicin plus cyclophosphamide. Due to predictions of clinical outcomes in women who receive adjuvant paclitaxel based chemotherapy, immunohistochemical analyses of these tissue specimens for CK5/6 were used. RESULTS: Among patients with TNBC, 24 patients (27.6%) were classified as CK5/6-positive triple negative type. Twelve patients were classified as paclitaxel chemotherapy group and 75 patients were classified as no paclitaxel group. No interaction was observed between DFS or OS and paclitaxel regimens. CK5/6 was, however, not associated with a significant benefit from paclitaxel in our study. CONCLUSION: In our study, the addition of paclitaxel after adjuvant treatment with doxorubicin (<60 mg per square meter) is not associated with DFS or OS in TNBC.
Breast ; Breast Neoplasms ; Chemotherapy, Adjuvant ; Cyclophosphamide ; Disease-Free Survival ; Doxorubicin ; Female ; Humans ; Paclitaxel ; Phenobarbital ; Prognosis

OBJECTIVES: Breast conserving surgery (BCS) for early breast cancer is now an accepted treatment, but there are controversies about its comparability with mastectomy. Thus, we investigated the survival outcomes who underwent BCS and modified radical mastectomy (MRM). METHODS: In this retrospective review, we analyzed the survival outcomes of 618 patients with early breast cancer who underwent two different surgery from January 2002 to December 2009. Postoperative pathologic difference, disease free survival period, overall survival period, recurrence pattern, recurrent rate and site were compared. In addition, preoperative patients data are also collected. RESULTS: Disease free survival period of MRM and BCS was 108.46 months and 80.82 months, respectively (P < 0.01). However, there was no significant correlation between overall survival period and operative methods (P = 0.67). In addition, recurrence pattern (P = 0.21), recurrent rate (P = 0.36) and site (P = 0.45, P = 0.09) were not associated with operative method. CONCLUSIONS: In this study, we can suggest that early breast cancer patients could improve their disease free survival if they underwent MRM. So, when we operate high risk breast cancer patients, MRM could be considered for their disease free life. Further studies may be required to establish appropriate strategy of surgery for early breast cancer.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Humans ; Mastectomy ; Mastectomy, Modified Radical* ; Mastectomy, Segmental* ; Methods ; Recurrence ; Retrospective Studies

This article provides an update on tinnitus for audiologists and other clinicians who provide tinnitus-specific services. Tinnitus can be attributable to hearing loss, somatosensory system dysfunction, or auditory cortex dysfunction, with hearing loss being the most common cause and serious underlying pathologies being rare. Hearing loss does not always lead to tinnitus, and patients with tinnitus do not always suffer from hearing loss. The first scenario is explained by a so-called inhibitory gating mechanism, whereas the second assumes that all tinnitus sufferers have some degree of hearing impairment, which might not be detected in standard audiological examinations. The treatments should aim at symptomatic relief and management of associated distress. Current treatment options include pharmacotherapy, education, counseling, cognitive behavioral therapy, and sound therapy.

A 49-year-old female presented with severe dyspnea. She was diagnosed with cardiac tamponade combined with ascending aortic pseudoaneurysm and rupture, which was caused by Klebsiella pneumoniae infection. This extremely rare condition was managed by an emergency pericardiostomy and two separate aortic operations. Antibiotics active for the K. pneumoniae isolate were used throughout. The patient was well for nine months after discharge and continues to be followed up for signs of possible reinfection.
Aneurysm, False ; Anti-Bacterial Agents ; Aortic Aneurysm ; Aortic Rupture* ; Cardiac Tamponade ; Dyspnea ; Emergencies ; Female ; Humans ; Klebsiella pneumoniae* ; Klebsiella* ; Middle Aged ; Pericardial Window Techniques ; Pericarditis* ; Pneumonia ; Rupture

PURPOSE: Phyllodes tumors of the breast are biphasic neoplasms. They are composed of epithelium and a spindle cell stroma. However, there is some controversy over its clinical behavior, pathologic characteristics, and local recurrence rates. Therefore we analyzed the clinicopathological characteristics of phyllodes tumor and the risk factor that influence a local recurrence after surgery were analyzed. METHODS: We retrospectively analyzed the medical records of 73 patients with a phyllodes tumor and who had undergone surgery at the Department of Surgery, Kosin University, from 1994 to 2005. The median follow up period was 73 months (range: 5-250 months). The microscopic slides were re-examined and the pathologic criteria we analyzed were cellular atypia, stromal cellularity, pleomorphism, necrosis, differentiation, the tumor margin, and the number of mitosis. The malignancy was reclassifed using the histological criteria reported by Pietruszka et at. (benign was 0-4 mitoses/10 highpower folds, borderline 5-9 mitoses, and malignant was more than 10 mitoses), The clinical features we evaluated included age, the preoperative diagnosis, the tumor size, surgical methods, and local recurrence. RESULTS: The mean age was 38.2 yr (range: 15-60 yr) and the mean tumor size was 4.3 cm (range: 1.6-18 cm), The most commonly performed surgical procedures were local or wide excision (60 cases, 82.2%), mastectomy in 10 cases (13.7%) and MRM in 3 cases (4.1%). Out of the 73 cases we reviewed, 49 (67.1%) were confirmed as being a benign, 3 (4.1%) were borderline, and 21 (28.7%) were malignant phyllodes tumor. Cellular atypia was minimal in 55 cases (75.3%) and it was prominent in 18 cases (24.6%). The stromal cellularity was minimal in 49 cases (67.1%) and it was prominent in 24 cases (32.8%). The tumor margin was infiltrating in 27 cases (36.9%) and pushing in 46 cases (63.0%). A local recurrence developed in 12 cases (16.4%). There were no dependable histopathological features to predict a local recurrence except for stromal cellularity, and an infiltrating margin. CONCLUSION: From the above results, the strong prognostic factors that can be used to predict a local recurrence appear to be stromal cellularity, and an infiltrating tumor margin.
Breast ; Diagnosis ; Epithelium ; Follow-Up Studies ; Humans ; Mastectomy ; Medical Records ; Mitosis ; Necrosis ; Phyllodes Tumor* ; Recurrence* ; Retrospective Studies ; Risk Factors*

Adiaspiromycosis is known as an infection that is due to Chrysosporium species which are filamentous soil saprophytes that cause pulmonary infection in rare cases but are classified mainly as a contaminant rather than a pathogen in dermatological areas. Deep fungal infections, commonly by Aspergillosis and Candida, are associated with patients who have an impaired skin barrier or immunosuppression and it takes a long time to identify the pathogen because it is hard to diagnosis it without clinical suspicion. In our case, a 56-year-old female living in a rural area who took immunosuppressants including cyclophosphamide, mycophenolate mefetil, and prednisolone due to pemphigus vulgaris presented at our clinic with an erythematous patch with pustular discharges on the left forearm for 2 months. She had been treated with antibiotics under the impression of cellulitis but was not responsive to it. A Chrysosporium species was identified by tissue culture and treatment was successful with an antifungal agent. We here report a case of deep fungal infection caused by Chrysosporium species without pulmonary infiltration which is a rare manifestation.
Anti-Bacterial Agents ; Aspergillosis ; Candida ; Cellulitis ; Chrysosporium ; Cyclophosphamide ; Female ; Forearm ; Humans ; Immunosuppression ; Immunosuppressive Agents ; Middle Aged ; Pemphigus ; Prednisolone ; Skin ; Soil