Breast cancer is the most common malignancy in women, with an incidence that varies between 40 and 90 per 100 000 (standardized rate) worldwide. Breast cancer is the most frequent female tumour in Italy, representing about 25% of all female tumours as reported in Italian registries (Zanetti et al, 1997).A positive family history is known to be a high risk factor for developing the disease: 5-10% of all breast cancers arise in individuals carrying a germline mutation and are usually considered hereditary forms (Claus et al, 1991). Two major breast cancersusceptibility genes, BRCA1 and BRCA2, have been cloned (Miki et al, 1994;Wooster et al, 1995) and both are thought to account for 30-60% of hereditary breast cancer (Serova et al, 1997;Szabo et al, 1997;Vehmanen et al, 1997aVehmanen et al, , 1997b. However, large-scale mutation analyses conducted in several populations suggest the existence of additional breast cancer-susceptibility gene(s). BRCA1 mutations are responsible for the majority of familial breast cancer associated with ovarian carcinoma, for about 50% of cases with breast cancer alone and for very few male breast cancer cases (Easton et al, 1993;Stratton et al, 1994;Narod et al, 1995). It has been estimated that women carrying a germline mutation in BRCA1 have a risk ranging from 80 to 90% for developing breast cancer and from 44 to 63% for developing ovarian cancer (Easton et al, 1993(Easton et al, , 1995Ford et al, 1994; Miki et al, 1994;Wooster et al, 1994). BRCA2 mutations account for a similar proportion of inherited breast cancer and are frequently associated with male breast cancer (Wooster et al, 1995). Breast cancer risk in females carrying BRCA2 mutations is calculated to be similar to that conferred by BRCA1 mutations (Easton et al, 1993Ford et al, 1994; Miki et al, 1994;Wooster et al, 1994). BRCA1 and particularly BRCA2 families are often affected by other tumours such as prostate, liver, pancreas, lung, stomach and colorectum (Wooster et al, 1995;Gudmundsson et al, 1996;Phelan et al, 1996;Thorlacius et al, 1996;Vehmanen et al, 1997b;Tonin et al, 1998). Except for higher incidences of ovarian cancer in families with mutations in a 3.3-kb region of exon 11 of BRCA2 (the so-called ovarian cancer cluster region [OCCR]; Gayther et al, 1997), no other significant association between genotype and phenotype was described. BRCA1 and BRCA2 mutations are for the most part frame-shifts due to small deletions leading to premature translation termination (Wooster et al, 1995;Phelan et al, 1996;Tavtigian et al, 1996;Gayther et al, 1997).Some of these mutations are prevalent in genetically homogeneous populations as a consequence of a founder effect. A single BRCA2 mutation accounts for the majority of hereditary breast cancer in Iceland Thorlacius et al, 1996) and for 40% of male breast cancer cases , whereas three different founder mutations (185delAG and 5382insC in BRCA1, and 6174delT in BRCA2) have a high frequency in Ashkenazi Jews (Roa et al, 1996). Although at different rates, BRCA1 and BRCA2 f...

BACKGROUND.Factors that are predictive of carrying BRCA1 and BRCA2 germline

Identification of such features should address BC patients and their families to genetic counseling and BRCA1/2 mutational analysis. In addition, this is the first report of a detailed BRCA1/2 mutation screening in Sardinia, having immediate implications for the clinical management of BC families.

A case of angiotropic lymphoma involving renal glomeruli and interstitial vessels associated with nephrotic syndrome and with minor lesions in the glomerular basal membrane is reported. A 56-year-old woman had fever, weakness and clinical findings of a nephrotic syndrome with normal renal function. Renal biopsy revealed that the glomeruli were infiltrated by neoplastic lymphoid cells positive for CD20 and CD45; the glomerular basement membranes showed a pattern of minimal change disease. This case and our review of the literature suggest that the rare association of intravascular lymphoma and glomerular disease is more than coincidental.

No abstract

Purpose: Geometric uncertainties limit the accuracy of three-dimensional conformal radiotherapy treatments. This study aims to evaluate typical random and systematic set-up errors and analyse the impact of no action level (NAL) correction protocol on systematic set-up errors and clinical target volume (CTV)-planning target volume (PTV) margins. Materials and methods:A total 668 pairs of orthogonal electronic portal images were compared with digitally reconstructed radiographs from computed tomography planning scans for 100 patients consecutively treated during 2011. Patients were divided into groups depending on the treated anatomical region. Patient-specific and population random and systematic set-up errors were calculated. Impact of application of NAL correction protocol on systematic set-up errors and CTV-PTV expansions were evaluated.Results: Population set-up errors resulted from about 1 mm in head and neck to 2-3 mm in prostate, rectum, lung, breast and gynaecological districts. Patient-specific systematic set-up errors were higher for breast and gynaecological districts and application of NAL correction protocol gave significant reductions, even higher than 30%. Calculated CTV-PTV margins ranged from 10 mm on left-right direction for prostate to 20 mm on superior-inferior direction for lung.Conclusions: Set-up errors resulted reasonably controlled and application of NAL correction protocol could further improve the level of accuracy. However, the NAL application alone did not seem to add any substantial benefit on CTV-PTV total margins without the adoption of corrective strategies to reduce other important uncertainties limiting accuracy of three-dimensional conformal radiotherapy.

No abstract

Most non-small-cell lung cancer (NSCLC) patients are likely to develop brain metastases during the course of their illness. Currently, no consensus on NSCLC patients’ treatment with brain metastasis has been established. Although whole brain radiotherapy prolongs the median survival time of approximately 4 months, a cisplatin-pemetrexed combination may also represent a potential option in the treatment of asymptomatic NSCLC patients with brain metastases. Herein, we report the case of a non-smoker male patient with multiple, large and diffuse brain metastases from an “epidermal growth factor receptor (EGFR) wild-type” lung adenocarcinoma who underwent an overly aggressive chemo/radiation therapy. This approach led to a complete and durable remission of the disease and to a long survival of up to 58 months from diagnosis of primary tumor. The uncommon course of this metastatic disease induced us to describe its oncological management and to investigate the molecular features of the tumor.