Diabetic Mastopathy. Review of Diagnostic Methods and Therapeutic Options

Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, its diagnostic process is demanding, and treatment options are not clear and limited. Lesions in DM are usually multiple; therefore, surgical removal is not fully effective. A well-done anamnesis with core-needle biopsy is essential and definitive in most cases. In this review, we summarize up-to-date knowledge of diagnostic methods and therapeutic options for diabetic mastopathy treatment and present three cases of diabetic mastopathy-type lesions in ultrasound and radiological examinations.

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PARTICIPATION OF A PRIMARY PEDIATRICIAN IN THE EARLY DIAGNOSTICS AND TREATMENT OF TUBEROUS SCLEROSIS IN CHILDREN

Rossiyskiy Vestnik Perinatologii i Pediatrii (Russian Bulletin of Perinatology and Pediatrics) ◽

10.21508/1027-4065-2018-63-5-222-230 ◽

2018 ◽

Vol 63 (5) ◽

pp. 222-230

Author(s):

S. A. Volgina ◽

M. Yu. Dorofeeva

Keyword(s):

Tuberous Sclerosis ◽

Genetic Disorder ◽

Treatment Options ◽

Mtor Inhibitors ◽

Skin Lesions ◽

Diagnostic Process ◽

Surgical Removal ◽

Early Diagnostics ◽

Diagnostic Criterion

Tuberous sclerosis is a multisystem genetic disorder caused by unregulated activation of a mammalian rapamycin target (mTOR), leading to the growth of hamartomas in various organs. Skin lesions associated with tuberous sclerosis often develop at early age, which is an important diagnostic criterion. It is the pediatricians who can contribute to an early diagnostic process, to develop treatment strategy and create follow-up care for patients. Possible treatment options for skin lesions due tuberous sclerosis include pharmacological (e.g. local or systemic mTOR inhibitors) and non-pharmacological (surgical removal, laser therapy) methods.

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CONTEMPORARY TREATMENT APPROACH OF SQUAMOUS CELL SKIN CANCER: REVIEW

Problems in oncology ◽

10.37469/0507-3758-2019-65-1-7-15 ◽

2019 ◽

Vol 65 (1) ◽

pp. 7-15

Author(s):

Aleksey Belyaev ◽

Georgiy Prokhorov ◽

Zamira Radzhabova ◽

Olga Baykalova

Keyword(s):

Skin Cancer ◽

Squamous Cell ◽

New Technologies ◽

Treatment Options ◽

Epidermoid Carcinoma ◽

Surgical Removal ◽

Cochrane Central Register ◽

Epithelial Tumor ◽

Randomized Controlled Studies ◽

Skin Malignancy

The incidence of skin cancer is a steady increasing around the world. Tumors of epithelial origin occupy the first place in the structure of all skin malignancy. Epidermoid carcinoma is the most malignant epithelial tumor of the skin and mucous membranes with squamous differentiation. Generally, squamous cell carcinoma is successfully treated by surgical and radiological methods. Often a different kind of plastic defect reconstructions are required after surgical removal. The incidence of epidermoid carcinoma increases with age (average age of patients falls on 65 years) therefore variants of treatment options is limited by comorbidities. However, surgical oncologist do not have enough date and randomized controlled studies on this theme. Minimally invasive methods, especially cryothechnology are increasingly used, but unfortunately their advantage requires additional evidence. We suppose Inclusion in the conventional treatment of new technologies may possibly improve the results of treatment. We reviewed the literature, summarizing data on various methods of treating squamous cell skin cancer. Comprehensive and systematic search was based on MedLine, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Scopus and PubMed among original articles for the period from January 1974 to October 2018.

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The ‘wave sign’ in hip arthroscopy: a systematic review of epidemiological factors, current diagnostic methods and treatment options

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnaa058 ◽

2020 ◽

Author(s):

Jason Derry Onggo ◽

James Randolph Onggo ◽

Mithun Nambiar ◽

Andrew Duong ◽

Olufemi R Ayeni ◽

...

Keyword(s):

Risk Factors ◽

Systematic Review ◽

Protective Factor ◽

Treatment Options ◽

Arthroscopic Surgery ◽

Classification Systems ◽

Diagnostic Methods ◽

Suture Repair ◽

Significant Heterogeneity ◽

Epidemiological Factors

ABSTRACT This study aims to present a systematic review and synthesized evidence on the epidemiological factors, diagnostic methods and treatment options available for this phenomenon. A multi-database search (OVID Medline, EMBASE and PubMed) was performed according to PRISMA guidelines on 18 June 2019. All studies of any study design discussing on the epidemiological factors, diagnostic methods, classification systems and treatment options of the wave sign were included. The Newcastle–Ottawa quality assessment tool was used to appraise articles. No quantitative analysis could be performed due to heterogeneous data reported; 11 studies with a total of 501 patients with the wave sign were included. Three studies examined risk factors for wave sign and concluded that cam lesions were most common. Other risk factors include alpha angle >65° (OR=4.00, 95% CI: 1.26–12.71, P=0.02), male gender (OR 2.24, 95% CI: 1.09–4.62, P=0.03) and older age (OR=1.04, 95% CI: 1.01–1.07, P=0.03). Increased acetabular coverage in setting of concurrent cam lesions may be a protective factor. Wave signs most commonly occur at the anterior, superior and anterosuperior acetabulum. In terms of staging accuracy, the Haddad classification had the highest coefficients in intraclass correlation (k=0.81, 95% CI: 0.23–0.95, P=0.011), inter-observer reliability (k=0.88, 95% CI: 0.72–0.97, P<0.001) and internal validity (k=0.89). One study investigated the utility of quantitative magnetic imaging for wave sign, concluding that significant heterogeneity in T1ρ and T2 values (P<0.05) of acetabular cartilage is indicative of acetabular debonding. Four studies reported treatment techniques, including bridging suture repair, reverse microfracture with bubble decompression and microfracture with fibrin adhesive glue, with the latter reporting statistically significant improvements in modified Harris hip scores at 6-months (MD=19.2, P<0.05), 12-months (MD=22.0, P<0.05) and 28-months (MD=17.5, P<0.001). No clinical studies were available for other treatment options. There is a scarcity of literature on the wave sign. Identifying at risk symptomatic patients is important to provide prompt diagnosis and treatment. Diagnostic techniques and operative options are still in early developmental stages. More research is needed to understand the natural history of wave sign lesions after arthroscopic surgery and whether intervention can improve long-term outcomes. Level IV, Systematic review of non-homogeneous studies.

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Comparison of an oncology clinical decision-support system’s recommendations with actual treatment decisions

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa334 ◽

2021 ◽

Author(s):

Suthida Suwanvecho ◽

Harit Suwanrusme ◽

Tanawat Jirakulaporn ◽

Surasit Issarachai ◽

Nimit Taechakraichana ◽

...

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Treatment Options ◽

Stage Iv ◽

Clinical Decision ◽

Treatment Decisions ◽

Therapeutic Options ◽

Cancer Type ◽

The Us ◽

Rectal Cancers

Abstract Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.

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Differential Diagnosis of Calvarial Tumors: A Series of 8 Cases

Indian Journal of Neurosurgery ◽

10.1055/s-0041-1722828 ◽

2021 ◽

Author(s):

Jitesh Kumar Sharma ◽

Rashim Kataria ◽

Madhur Choudhary ◽

Devendra Kumar Purohit

Keyword(s):

Bone Tumors ◽

Primitive Neuroectodermal Tumor ◽

Treatment Options ◽

Follicular Carcinoma ◽

Brown Tumor ◽

Clinical Correlation ◽

Skull Bone ◽

Clinical Presentations ◽

Tumor Metastases ◽

Radiological Examinations

Abstract Introduction To present and discuss the clinical presentations, investigations, and treatment options for skull bone tumors. Materials and Methods This study was conducted from January 2019 to December 2019 at the Department of Neurosurgery. During this period, eight patients presented with skull bone tumor in the outpatient department. All patients were thoroughly investigated. Surgery was conducted on six patients and two patients had disseminated carcinoma; hence, surgery was not done. Patients were regularly followed-up after the surgery. Results In our study, out of eight cases, five were females and three were males. We had two cases of fibrous dysplasia, two cases of osteomas, and one case each of brown tumor, metastases from lung carcinoma, metastases from follicular carcinoma of thyroid, and Ewing sarcoma/primitive neuroectodermal tumor (PNET). Excision of tumor was performed where indicated and adjuvant chemo- and radiotherapy was suggested wherever required. Conclusion Bony tumors of the skull are uncommon diseases for the neurosurgeons. These tumors require a careful diagnosis with suitable radiological examinations and proper clinical correlation for proper management.

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The Emerging Factors and Treatment Options for NAFLD-Related Hepatocellular Carcinoma

Cancers ◽

10.3390/cancers13153740 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3740

Author(s):

Chunye Zhang ◽

Ming Yang

Keyword(s):

Hepatocellular Carcinoma ◽

Liver Cancer ◽

Fatty Liver ◽

Early Stage ◽

Primary Liver Cancer ◽

Treatment Options ◽

Underlying Mechanism ◽

Diagnostic Methods ◽

T Cell Therapy ◽

Nonalcoholic Fatty Liver

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer, followed by cholangiocarcinoma (CCA). HCC is the third most common cause of cancer death worldwide, and its incidence is rising, associated with an increased prevalence of obesity and nonalcoholic fatty liver disease (NAFLD). However, current treatment options are limited. Genetic factors and epigenetic factors, influenced by age and environment, significantly impact the initiation and progression of NAFLD-related HCC. In addition, both transcriptional factors and post-transcriptional modification are critically important for the development of HCC in the fatty liver under inflammatory and fibrotic conditions. The early diagnosis of liver cancer predicts curative treatment and longer survival. However, clinical HCC cases are commonly found in a very late stage due to the asymptomatic nature of the early stage of NAFLD-related HCC. The development of diagnostic methods and novel biomarkers, as well as the combined evaluation algorithm and artificial intelligence, support the early and precise diagnosis of NAFLD-related HCC, and timely monitoring during its progression. Treatment options for HCC and NAFLD-related HCC include immunotherapy, CAR T cell therapy, peptide treatment, bariatric surgery, anti-fibrotic treatment, and so on. Overall, the incidence of NAFLD-related HCC is increasing, and a better understanding of the underlying mechanism implicated in the progression of NAFLD-related HCC is essential for improving treatment and prognosis.

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Dermoscopic aspect of verrucous epidermal nevi: New findings

TURKISH JOURNAL OF MEDICAL SCIENCES ◽

10.3906/sag-1811-27 ◽

2019 ◽

Author(s):

ÖMER FARUK ELMAS ◽

NECMETTİN AKDENİZ

Keyword(s):

Polarized Light ◽

Diagnostic Methods ◽

The Other ◽

Diagnostic Process ◽

Fine Scale ◽

Epidermal Nevus ◽

Clinical Interpretation ◽

New Findings ◽

Clinical Variants ◽

Histopathological Investigation

Background and Aim: Verrucous epidermal nevi are cutaneous hamartomas having many clinical variants. Dermoscopic features of verrucous epidermal nevus have rarely been investigated. We aimed to identify dermoscopic findings of the entity which will facilitate the diagnostic process by reducing the use of invasive diagnostic methods. Material and Methods: The study included the patients with histopathologically approved verrucous epidermal nevus. Clinical, dermoscopic and histopathological features of the patients were retrospectively reviewed and the findings identified were recorded. Dermoscopic examination was performed with a polarized-light handheld dermoscope with 10-fold magnification. Results: The most common dermoscopic features were thick brown circles, thick brown branched lines and terminal hairs. The most common vessel pattern was dotted vessels. Branched thick brown lines, brown globules, brown dots forming lines, serpiginous brown dots, white and brown exophytic papillary structures, fine scale, thick adherent scale and cerebriform structures were the other findings. Conclusion: We observed many vascular and non-vascular dermoscopic findings which have not been described previously for the entity. Dermoscopic examination of the verrucous epidermal nevi may lead more reliable clinical interpretation and thus it may reduce the need for histopathological investigation. Keywords: dermoscopy, large brown circles, verrucous epidermal nevus

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Surgical Approach to Splenic Hydatid Cyst: Single Center Experience

International Surgery ◽

10.9738/intsurg-d-13-00138.1 ◽

2013 ◽

Vol 98 (4) ◽

pp. 346-353 ◽

Cited By ~ 10

Author(s):

Cengiz Eris ◽

Sami Akbulut ◽

Mehmet Kamil Yildiz ◽

Hasan Abuoglu ◽

Mehmet Odabasi ◽

...

Keyword(s):

Hydatid Cyst ◽

Surgical Approach ◽

Treatment Options ◽

Clinical Findings ◽

Partial Cystectomy ◽

Diagnostic Methods ◽

Septic Complications ◽

Single Center Experience ◽

Medicinal Treatment ◽

Splenic Hydatid Cyst

Abstract The benefits and risks of surgery for splenic hydatid cyst (SHC) remain controversial. We aimed to share our experience about a surgical approach for SHC. Sixteen consecutive patients with SHC disease who underwent open splenectomy at our hospital between January 2006 and July 2012 were retrospectively evaluated. Data on the patients' demographic features, clinical findings, radiological and serological diagnostic methods, and surgical and medicinal treatment options were collected and used to generate descriptive profiles of diagnosis, treatment course, and outcome. The patient population was composed of 6 females and 10 males, with an age range of 18 to 79 years (mean age: 47.0 ± 18.0). Radiological examinations detected hydatid cysts in spleen alone (n = 7) or both spleen and liver (n = 9). Preoperative serological testing identified 13 of the patients as IHA positive. All except 1 patient received a 10- to 21-day preoperative course of albendazole therapy and all patients received vaccination 1 week prior to surgery. Seven patients underwent splenectomy. The remaining patients underwent splenectomy with partial cystectomy and omentopexy (n = 6), partial cystectomy and unroofing (n = 1), pericystectomy (n = 1), or pericystectomy with partial nephrectomy (n = 1). All except one patient received a 10- to 45-day postoperative course of albendazole. No patients developed serious complications or signs of recurrence during the follow-up. The clinical profile of SHC disease at our hospital includes diagnosis by radiological methods, splenectomy treatment by simple or concomitant procedures according to the patient's symptoms, cyst size, number and localization, and compression of adjacent organs, and adjunct vaccination to decrease risk of postoperative septic complications. This profile is associated with low risk of complications and high therapeutic efficacy.

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Novel treatment options in advanced adenoid cystic carcinoma of the breast.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.e13071 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. e13071-e13071

Author(s):

Evan Wenig ◽

Reumu E. Birhiray

Keyword(s):

Disease Control ◽

Adenoid Cystic Carcinoma ◽

Metastatic Disease ◽

Triple Negative ◽

Treatment Options ◽

Locally Advanced ◽

Therapeutic Options ◽

Breast Mass ◽

Ongoing Research ◽

Adenoid Cystic

e13071 Background: Adenoid cystic carcinoma (ACC) accounts for less than 0.1% of all breast cancer cases. The disease typically remains localized and indolent, and frequently occurs with triple negative status. Methods: In patients with locally advanced or metastatic disease, chemotherapy for triple negative breast carcinoma is seldom effective. Thus new treatment paradigms are desired. Drug targeted analysis derived from next generation sequencing and identification of driver mutations may offer a bright future in treatment options in chemo-resistant malignancy. Results: A 53 year old woman presented with breast mass and mastectomy with stage pT3N0M0 triple negative ACC of the breast resulting in observation. She later relapsed with chest wall disease, resulting in resection and radiation therapy. Shortly thereafter, she relapsed with pulmonary metastatic disease. She was treated with carboplatin and doxorubicin which were discontinued due to disease progression. Liquid assay revealed an IDH2 mutation, prompting treatment with enasidenib with ongoing evidence of disease control at 4 months. Patient tolerated treatment well without grade 3 or 4 adverse reactions. A 48 year old woman presented with an increasing 9.5 cm unresectable breast mass without distant metastasis. Pathology showed triple negative ACC of the breast, resulting in chemotherapy with doxorubicin, cyclophosphamide, and paclitaxel with clinically progressive disease. She represented with necrotic and ulcerating changes of the breast. Foundational genomic testing showed an FGFR2 mutation. After four months of treatment with erdafitinib, she had resolution of pain and cessation of pain medication. Her therapy led to a grade 2 adverse event related to hyperphosphatemia. She underwent surgical resection with negative margins. Conclusions: These examples illustrate a potential treatment paradigm for a rare malignancy for which there is no standard of care. Here we present two desperate cases, one of which had a driver mutation of IDH2, and the other FGFR2 for which there are targeted therapies approved in other disease states. The use of these two agents resulted in clinical benefit. A patient with metastatic disease treated with enasidenib has ongoing disease control for over 4 months with minimal adverse reaction. A patient with advanced local disease requiring narcotics and gabapentin for pain control treated with erdafitinib had significant symptomatic control with successful cessation of pain medications and ability to undergo potentially curable mastectomy with negative margins despite progression on prior chemotherapy. In summary, ongoing research of ACC of the breast will be required. Alternative therapeutic options related to targeted treatment may offer promise to clinical outcomes in the future. For cases of locally advanced or metastatic disease, the use of targeted therapy may offer new therapeutic options.

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Recent advances in managing systemic sclerosis

F1000Research ◽

10.12688/f1000research.10022.1 ◽

2017 ◽

Vol 6 ◽

pp. 88

Author(s):

Martin Aringer ◽

Anne Erler

Keyword(s):

Systemic Sclerosis ◽

Treatment Options ◽

The Body ◽

Therapeutic Options ◽

Recent Advances ◽

Main Components ◽

Near Future

How the main components in systemic sclerosis—namely autoimmunity, vasculopathy, and fibrosis—fit together is still not sufficiently clear. However, vascular treatment options are well established, the body of evidence for the efficacy of immunomodulatory approaches is increasing, and now at least one hopeful substance that may directly interfere with fibrosis is being tested. Although we still wait for important breakthroughs, there is grounds for hope that better therapeutic options will be available in the near future.

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