scholarly journals Breast cancer-associated opsoclonus-myoclonus syndrome: a case report

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Aikaterini Kostoglou ◽  
Dimitrios Vlastos ◽  
Athanasios Bakalis ◽  
Debashis Ghosh
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Ct Scan ◽  
Axillary Lymph Node ◽  
Whole Body ◽  
Caucasian Woman ◽  
Axillary Lymph ◽  
Paraneoplastic Neurological Syndromes ◽  
Opsoclonus Myoclonus Syndrome

Abstract Background Paraneoplastic neurological syndromes constitute rare neurological complications of malignant disease, manifesting in <1% of patients with cancer. Opsoclonus-myoclonus syndrome (OMS) presents with chaotic ocular saccades (opsoclonus), spontaneous muscular jerking (myoclonus) that may be accompanied by ataxia, strabismus, aphasia, or mutism. Its paraneoplastic variant in the adult is most commonly associated with small-cell lung cancer, followed by breast cancer. Importantly, neurological symptoms usually precede the diagnosis of breast cancer and tend to recure after its treatment. Case presentation A 43-year-old premenopausal Caucasian woman with a medical history of hypertension was admitted following an episode of focal seizure. This progressed to generalised tonic-clonic seizures and she was subsequently loaded with phenytoin, valproate, and levetiracetam. Initial workup included whole body CT scan, viral and autoimmune serology. The CT scan revealed an enhancing right axillary lymph node, which in combination with Anti-Ri antibody positivity raised the spectre of paraneoplastic OMS. MRI of the head revealed subtle nonspecific white matter signal change within the centrum semiovale without any mass lesions, while MRI of the spine was unremarkable. An uncomplicated right mastectomy and axillary lymph node clearance was performed: histopathology revealed a 9-mm, grade 2, oestrogen receptor-positive, progesterone receptor-negative (ER8, PR0), Her2-negative invasive ductal carcinoma, and 4/6 positive lymph nodes (T1b N2 M0). Two months later, she was readmitted with vertigo, diplopia, facial weakness, and ataxia, setting the diagnosis anti-Ri syndrome recurrence. MDT recommended mammogram and ultrasound of the left breast, which were normal. Subsequently, four months after initial discharge, she suffered another neurological recurrence; due to concomitant abdominal pain, PET-CT was performed demonstrating a hypermetabolic right ovarian focus. Bilateral salpingo-oophorectomy was performed as per gynaecology MDT and final histology showed normal tubes and ovaries. She has remained on remission since then, with a negative annual mammogram follow-up. Conclusions In conclusion, we report a case of OMS associated with breast cancer anti-Ri onconeural antibody. Its manifestations preceded the diagnosis of malignancy and it persisted after cancer treatment, underlining the importance for high clinical suspicion in cases of classical paraneoplastic neurological syndromes as well as the need for long-term clinical follow-up.

The prognostic value of nodal ratios in node-positive breast cancer: AUBMC experience

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21072-21072
Author(s):  
A. Shamseddine ◽  
H. Hatoum ◽  
Z. Salem ◽  
Z. Abdel Khalek ◽  
N. El Saghir ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Lymph Nodes ◽  
Axillary Lymph Node ◽  
Disease Free Survival ◽  
Axillary Lymph ◽  
Node Positive ◽  
The Impact ◽  
Positive Breast Cancer

21072 Background: Axillary lymph node metastasis has proven to be the most important factor affecting overall survival (OS) and disease free survival (DFS) in patients with breast cancer. Recent evidence suggests that axillary lymph node ratio (LNR) may be at least as important as absolute number of involved lymph nodes in predicting OS and DFS. The aim of this retrospective study is to evaluate the impact of axillary nodal ratios in node-positive breast cancer as a prognostic factor for survival. Methods: Data from 1181 patients with stage I, II and III breast cancer diagnosed at AUBMC between 1990 and 2001 were studied. The median age at diagnosis was 50 years (23 - 88); the median number of lymph nodes dissected was 17 (0 - 49). Survival was compared in 737 patients with node-positive disease according to a LNR below or more than 0.25 (defined as number of involved lymph nodes divided by total dissected axillary lymph nodes). Results: Patients with LNR = 0.25 had a median follow-up of 30 months (1.2–156) and a median DFS of 26 months (1–156). The 5-year survival was 26.2% (94/358) and the 5-year DFS was 22.9% (82/358). Patients with LNR <0.25 had a median follow-up of 36 months (1.2–157) and a median DFS of 36 months (1–157). The 5-year survival of 33.2% (245/737) and the 5-year DFS was 29.8 % (220/737). LNR showed significance as a continuous variable and a categorical variable (0, < 0.25, and = 0.25) with a p < 0.001 Conclusions: LNR significantly predicts OS and DFS in node-positive primary breast cancer. No significant financial relationships to disclose.

scholarly journals 17-Year Follow-Up of Comparing Mastoscopic and Conventional Axillary Dissection in Breast Cancer: A Multicentres, Randomized Controlled Trial

2021 ◽  
Author(s):  
Chengyu Luo， ◽  
Guang Cao ◽  
Wenbin Guo ◽  
Jie Yang ◽  
Qiuru Sun ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Axillary Lymph Node Dissection ◽  
Lymph Node Dissection ◽  
Axillary Lymph Node ◽  
Cancer Surgery ◽  
Breast Cancer Surgery ◽  
Axillary Lymph ◽  
Node Dissection

Abstract Background: Longer follow-up was necessary to testify the exact value of mastoscopic axillary lymph node dissection (MALND).Methods：From January 1, 2003 to December 31, 2005, 1027 patients with breast cancer were randomly assigned to two groups: MALND and CALND (conventional axillary lymph node dissection). 996 eligible patients were enrolled.Results：The final cohort of 996 patients was followed for an average of 198 months. The events other than death differed significantly between the two cohorts（p=0.0311） (46.3% in MALND and 53.2% in CALND, respectively). The sum of the events other than death and deaths from other causes was much more in CALND （59.6%）than in MALND (53.4%）（p=0.0494）. The 17-year DFS rates were 36.7 percent for MALND group and 33.6 percent for CALND group，respectively. There was a significant difference between the groups (p=.0306). The OS rates were 53.2 percent after MALND and 46.0 percent after CALND ( p= .0119). The MALND patients had much less axillary pain (p =. 0000), numbness or paresthesia (p = .0000) ，arm mobility (p =. 0000), and arm swelling on operated side (p = .0000). The aesthetic appearance of axilla in MALND group was much better than that in CALND group (p =. 0000) at an average follow-up of 17-year.Conclusions：The use of MALND in breast cancer surgery not only decreases the relapse and arm complications but also improves long-term survival of patients. Therefore, MALND should be one of the preferred approaches for breast cancer surgery when ALND is needed.

Adherence to post-surgery follow-up assessment and its association with sociodemographic and disease characteristics in patients with breast cancer in China.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19232-e19232
Author(s):  
Ran Feng ◽  
Jingfeng Jing ◽  
Haibo Yang ◽  
Xiaojun Zhang ◽  
Ming Li ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Cancer Patients ◽  
Axillary Lymph Node ◽  
Insurance Coverage ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Node Dissection ◽  
Post Surgery

e19232 Background: The incidence of breast cancer has increased more than 30% in the past decades in China. Epidemiological studies based on international and Chinese data have showed that breast cancer is the most common in female malignant tumors. Breast cancer patients with early breast cancer have better survival, lower recurrence and metastasis rate due to early diagnosis and improved treatment. As an important element in the comprehensive management of breast cancer patients, follow-up can eliminate treatment-related complications, detect recurrence and metastasis as early as possible, and improve mental health and quality of life. It is increasingly recognized as a distinct phase of cancer care. However, follow-up adherence after breast surgery has not been studied in China. The aim of this study is to investigate the loss of follow-up after breast cancer surgery and its association with patients', tumor and treatment characteristics. Methods: A total of 711 patients underwent surgical treatment in Shanxi Bethune Hospital from March 2012 to May 2018 were included in this study. Baseline socio-demographic, tumor, and treatment characteristics were obtained from the hospital electronic medical records. The post-surgery follow-up was reviewed and assessed from the patients’ follow-up examination record. Factors associated with the first three-year follow-up was evaluated using logistic regression analysis. Results: The annual follow-up rate after surgery decreased gradually from 67.1% at the 1st year, 60.2% at the 3rd year to 51.9% at the 4th year, and 43.5% at the 5th year. Loss of follow-up during the first three years after surgery was significantly associated with older age >65 years(OR=2.34, 95% CI:1.14-4.82), lower medical insurance coverage(OR=4.26, 95%CI:1.77-10.25), axillary lymph node dissection(OR=2.52, 95%CI:1.39-4.55), no chemotherapy(OR=3.55, 95% CI:1.87-6.75) and no radiotherapy(OR=3.85, 95%CI:2.11-7.03). Conclusions: This study indicated that the annual follow-up rate after curative surgery for breast cancer survivors decreased significantly within five years, and that the risk of poor adherence to follow-up examinations was significantly increased in patients aged over 65 years with lower medical insurance coverage, having extensive axillary lymph node dissection, and lack of systematic treatments. These results suggest potential for improving adherence to follow-up in higher-risk subgroups and help clinicians to develop tailored patient management.

scholarly journals Aldehyde dehydrogenase 1 (ALDH1) immunostaining in axillary lymph node metastases is an independent prognostic factor in ALDH1-positive breast cancer

2021 ◽  
Vol 49 (10) ◽  
pp. 030006052110472
Author(s):  
Xin Guan ◽  
Yi Dong ◽  
Zhimin Fan ◽  
Yue Zhan ◽  
Xinpeng Xie ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Lymph Node ◽  
Aldehyde Dehydrogenase ◽  
Lymph Node Metastases ◽  
Axillary Lymph Node ◽  
Poor Prognosis ◽  
Axillary Lymph ◽  
Axillary Lymph Node Metastases ◽  
Node Metastases

Objective To determine whether aldehyde dehydrogenase 1 (ALDH1) immunostaining in axillary lymph node metastases in patients with breast cancer is associated with poor clinical prognosis. Methods This retrospective study reviewed data from the medical records of patients with immunohistochemistry-confirmed invasive ductal carcinoma (IDC) and 1–3 metastatic lymph nodes in the ipsilateral axilla between December 2012 and July 2015. The association between ALDH1 immunostaining in axillary lymph node metastases and clinical parameters and prognosis was analysed using χ2-test, Kaplan–Meier survival analysis, univariate and multivariate Cox regression analyses. Results A total of 229 patients with IDC were enrolled in the study. The median follow-up was 61 months (range, 20–89 months). Patients with ALDH1-positive axillary lymph node metastases had significantly shorter relapse-free survival and overall survival compared with those with ALDH1-negative axillary lymph node metastases. ALDH1 immunostaining in axillary lymph node metastases was a significant predictor of poor prognosis in univariate and multivariate analyses. Conclusion This large study with long-term follow-up suggests that ALDH1 immunostaining in axillary lymph node metastases is an independent predictor of poor prognosis in patients with breast cancer. The clinical relevance of this finding should be confirmed in further well-designed prospective studies.

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