The clinical history and histopathological features of this case support the diagnosis of NSF 10 years after exposure to gadolinium. Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease.
Pagetoid reticulosis is a rare variant of mycosis fungoides that presents with a large, usually single, erythematous, slowly growing scaly plaque containing an intraepidermal proliferation of neoplastic T lymphocytes. Histopathologically, this disease has distinctive attributes. In this report, we present two cases of pagetoid reticulosis, compare its microscopic features to those of ‘classical' mycosis fungoides, and provide a brief review of the pertinent literature.
Mammographic density (MD) is associated with increased breast cancer risk, yet limited data exist on an association between MD and breast cancer molecular subtypes. Women ages 18 years and older with breast cancer and available mammograms between 2003 and 2012 were enrolled in a larger study on MD. MD was classified by the Breast Imaging Reporting and Data System (BI-RADS) classification and by volumetric breast percent density (Volpara Solutions). Subtype was assigned by hormone receptor status, tumor grade, and mitotic score (MS). Subtypes included: Luminal-A (ER/PR and grade = 1; ER/PR and grade = 2 and MS = 1; ER/PR and grade = 1; = 233); Luminal-B (ER and grade = 3 or MS = 3; ER/PR and grade = 2; ER/PR and grade = 2 and MS = 2; = 79); Her-2-neu (H2P; = 59); triple-negative (ER/PR, Her-2; = 86). Precancer factors including age, race, body mass index (kg/m), family history of breast cancer, and history of lobular carcinoma in situ were analyzed. A total of 604 patients had invasive cancer; 457 had sufficient information for analysis. Women with H2P tumors were younger ( = 0.011) and had the highest volumetric percent density ( = 0.002) among subgroups. Multinomial logistic regression (LA = reference) demonstrated that although quantitative MD does not significantly differentiate between all subtypes ( = 0.123), the association between MD and H2P tumors is significant (OR = 1.06; confidence interval, 1.01-1.12). This association was not seen using BI-RADS classification in bivariable analysis but was statistically significant ( = 0.047) when controlling for other precancer factors. Increased MD is more strongly associated with H2P tumors when compared with LA. Delineating risk factors specific to breast cancer subtype may promote development of individualized risk prediction models and screening strategies. .
Hemophagocytic lymphohistiocytosis (HLH) is a rare, life-threatening hyperinflammatory syndrome characterized by uncontrolled activation and proliferation of proinflammatory cytokines. Initial presentation commonly includes fever, hepatosplenomegaly, and pancytopenia; 6 to 65% of cases also have a concurrent cutaneous eruption. We present the case of a 6-day-old premature infant boy with congenital severe thrombocytopenia, anemia, and hepatosplenomegaly who presented with several cutaneous violaceous papules and nodules and was found to have HLH.
Key Clinical MessageA 27‐year old male with Hodgkin's lymphoma was treated with combined chemotherapy that included bleomycin. He presented with pruritic erythematous, edematous linear lesions and was diagnosed to have flagellate hyperpigmentation, a rare side effect of bleomycin chemotherapy.
Mammographic density is not associated with an increased need for re-excision or resection of unnecessary margins at initial BCS.
Background: While mammographic density is linked to increased breast cancer risk, limited yet conflicting data exists on an association between density and developing specific molecular subtypes of breast cancer. Methods: Eligible patients were enrolled in a larger study on breast density, diagnosed with cancer between 2003-2013, and had pathology and films available for review. Density was classified qualitatively from existing radiology reports according to Breast Imaging Reporting and Data System (BIRADS) classification and quantitatively by volumetric breast density measurements using Volpara SolutionsTM software. Subtype was assigned by hormone receptor status, tumor grade and mitotic score (MS). Subtype categories included: Luminal A (ER/PR + & grade 1; ER/PR + & grade 2 & MS=1; ER+/PR- & grade 1); Luminal B (ER+ & grade 3 or MS=3; ER+/PR- & grade 2; ER/PR + & grade 2 & MS=2); Her-2 + (ER+ or ER - & Her-2 +); Triple Negative (ER/PR-, Her-2 -). Relevant pre-cancer factors including patient age, race, BMI, family history of breast cancer, and biopsy showing LCIS were included in analysis. Results: Of 604 patients with invasive cancer, 457 had sufficient information for analysis. Among these, 233 (51%) had Luminal A, 79 (17%) Luminal B, 59 (13%) Her-2 +, and 86 (19%) Triple Negative tumors. Younger women and those with denser breasts based on quantitative measurements were more likely to have Her-2+ tumors (Table 1); this association was not seen using the standard BIRADS classification. Triple Negative tumors were less common in patients with LCIS and more common in African Americans. A multinomial logistic regression model controlling for pre-cancer patient factors demonstrated that while quantitative breast density does not significantly differentiate between all molecular subtypes (p=0.140), the association between Her-2+ tumors and denser breasts using continuous quantitative measurements is significant (p=0.035). Conclusion: Women with denser breasts by continuous-scaled quantitative measurements are at higher risk for Her-2+ tumors; an association not delineated using standard BIRADS density classification. Delineating risk factors specific to molecular breast cancer subtype may promote individualized risk prediction models and prevention strategies. Table 1. Association between patient factors and molecular breast cancer subtype Molecular SubtypeVariableLuminal ALuminal BHer-2+Triple NegativeP value (n=233)(n=79)(n=59)(n=86) Age (median,IQR)61 (54,70)58 (50,67)54 (46,70)59 (48,67)0.006BMI (median,IQR)27.1 (22.9,30.5)25.7 (23.0,30.0)26.0 (22.7,32.6)28.1 (24.3,32.6)0.173Volpara density (median,IQR)7.18 (4.74,11.25)8.68 (5.68,14.34)10.25 (5.96,16.51)7.00 (4.97,11.89)0.002BIRADS density (n,%)0.183 Fatty42 (18.0%)15 (19.0%)5 (8.5%)16 (18.6%) Scattered103 (44.2%)27 (34.2%)20 (33.9%)36 (41.9%) Heterogeneous74 (31.8%)30 (38.0%)25 (42.4%)26 *30.2%) Extreme14 (6.0%)6 (7.6%)9 (15.2%)7 (8.1%) Unspecified01 (1.2%)01 (1.2%) Race (n,%)0.002 Caucasian202 (86.7%)65 (82.3%)51 (86.4%)61 (70.9%) African American23 (9.9%)13 (16.5%)6 (10.2%)23 (26.7%) Other2 (0.9%)02 (3.4%)0 Unspecified6 (2.6%)1 (1.2%)02 (2.3%) LCIS (n,%)48 (20.6%)8 (10.1%)8 (13.6%)5 (5.8%)0.004Family history of breast cancer (n,%)107 (45.9%)34 (43.0%)21 (35.6%)39 (45.35%)0.625 Citation Format: Brandy L Edwards, Kristen A Atkins, George J Stukenborg, Wendy M Novicoff, Krista N Larson, Wendy F Cohn, Jennifer A Harvey, Anneke T Schroen. Association of mammographic density and molecular breast cancer subtype [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P2-04-04.
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