Objectives: The purpose of this study was to determine the prevalence, clinical signs and radiological features of breast lymphoma. Methods: This is a retrospective review of 36 patients with breast lymphoma (22 primary and 14 secondary). 35 patients were female and 1 was male; their median age was 65 years (range 24-88 years). In all patients, the diagnosis was confirmed histopathologically. Results: The prevalence of breast lymphoma was 1.6% of all identified cases with non-Hodgkin lymphoma and 0.5% of cases with breast cancer. B-cell lymphoma was found in 94% and T-cell lymphoma in 6%. 96 lesions were identified (2.7 per patient). The mean size was 15.8¡8.3 mm. The number of intramammary lesions was higher in secondary than in primary lymphoma. The size of the identified intramammary lesions was larger in primary than in secondary lymphoma. Clinically, 86% of the patients presented with solitary or multiple breast lumps. In 14%, breast involvement was diagnosed incidentally during staging examinations. Conclusion: On mammography, intramammary masses were the most commonly seen (27 patients, 82%). Architectural distortion occurred in three patients (9%). In three patients (9%), no abnormalities were found on mammography. On ultrasound, the identified lesions were homogeneously hypoechoic or heterogeneously mixed hypo-to hyperechoic. On MRI, the morphology of the lesions was variable. After intravenous administration of contrast medium, a marked inhomogeneous contrast enhancement was seen in most cases. On CT, most lesions presented as circumscribed round or oval masses with moderate or high enhancement.

Self-renewal is considered as a common property of stem cells. Dysregulation of stem cell self-renewal is likely a requirement for the development of cancer. Hiwi, the human Piwi gene, encodes a protein responsible for stem cell self-renewal. In this study, we investigated the expression of Hiwi at the RNA level by real-time quantitative PCR in 65 primary soft-tissue sarcomas (STS) and ascertained its impact on prognosis for STS patients. In a multivariate Cox's proportional hazards regression model, we found that an increased expression of Hiwi mRNA is a significant negative prognostic factor for patients with STS (P ¼ 0.017; relative risk 4.6, 95% confidence interval (CI) 1.3-16.1) compared to medium expression of Hiwi transcript. However, a low expression of Hiwi transcript is correlated with a 2.4-fold (CI 0.7-8.0) increased risk, but this effect was not significant (P ¼ 0.17). Altogether, high-level expression of Hiwi mRNA identifies STS patients at high risk of tumourrelated death. This is the first report showing a correlation between expression of a gene involved in stem cell selfrenewal and prognosis of cancer patients.

Cancer stem cells can play an important role in tumorigenesis and tumor progression. However, it is still difficult to detect and isolate cancer stem cells. An alternative approach is to analyse stem cell-associated gene expression. We investigated the coexpression of three stem cell-associated genes, Hiwi, hTERT and survivin, by quantitative real-time-PCR in 104 primary soft-tissue sarcomas (STS). Multivariate Cox's proportional hazards regression analyses allowed correlating gene expression with overall survival for STS patients. Coexpression of all three stem cell-associated genes resulted in a significantly increased risk of tumor-related death. Importantly, tumors of patients with the poorest prognosis were of all four tumor stages, suggesting that their risk is based upon coexpression of stem cell-associated genes rather than on tumor stage.

Zusammenfassung 5 Anamnese und klinischer Befund: Ein 57-jähriger Mann stellte sich zur Abklärung hämorrhagischer Papeln palmar sowie nekrotisierender Knötchen an beiden Ellenbogen und an den Oberschenkeln vor. Zudem bestanden rezidivierende Arthralgien. Untersuchungen: Eine Hautbiopsie ergab das Bild einer kutanen nekrotisierenden Vaskulitis. Auffällig waren erhöhte Werte für antineutrophile zytoplasmatische Antikörper (c-ANCA) sowie Proteinase-3-Antikörper (PR3), eine mäßige Leukozytose und eine milde Proteinurie. Diagnose, Therapie und Verlauf: Eine frühe systemische Wegener-Granulomatose wurde anhand des PR3-Befundes sowie der kutanen His-tologien mit histiozytären Granulomen und einer nekrotisierenden Vaskulitis diagnostiziert. Unter einer ausschleichenden Prednisolontherapie und anschließender Remissionserhaltung mit Methotrexat (MTX) gingen die Hautveränderungen und Arthralgien vollständig zurück. Drei Monate später entwickelte sich eine zunehmende MTX-Toxizität, die auf eine Glomerulonephritis zurückgeführt wurde. Folgerung: Bei einer kutanen nekrotisierenden Vaskulitis unklarer Genese sollte auch an eine Wegener-Granulomatose gedacht werden. Eine Hautmanifestation kommt als Erstsymptom in Betracht. Bei mildem Verlauf ohne Nierenbeteiligung kann eine MTX-Therapie erwogen werden. Einleitung 5 Konsequenz für Klinik und Praxis 3In seltenen Fällen kommen Erstmanifestationen der Wegener-Granulomatose an der Haut vor.3Das Erscheinungsbild kann u.a. mit Papeln, Pusteln, Petechien, Ulzera, subkutanen Knoten und Bullae sehr variabel beginnen.3Hochspezifisch ist die Erhöhung von c-ANCA gegen PR3-Antigen.3Bei Hinweisen auf eine Nierenbeteiligung sollte die im Vergleich zu Cyclophosphamid nebenwirkungsärmere MTX-Therapie kritisch betrachtet werden.

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