A 47-year woman presented with an 8 cm breast mass.Histology and staging indicated a stage III breast cancer. She received eight cycles of neoadjuvant chemotherapy (Adriamycin and cyclophosphamide followed by paclitaxel) and then underwent a modified radical mastectomy. Upon recovery from surgery, she underwent a computed tomography scan of the chest as part of radiation therapy treatment planning. This study showed interval development of an anterior mediastinal mass ( Fig. 1) that was not present on a previous scan done as part of her initial staging (Fig. 2). To exclude progression of her malignancy, an excisional biopsy was done that revealed thymus hyperplasia (Fig. 3).Thymus hyperplasia associated with chemotherapy was first described in children and represents a form of "rebound phenomenon" occurring in a number of conditions, including recovery from severe stress situations and after administration of corticosteroids or chemotherapy. It is rarely seen in adults and therefore can be easily confused with cancer progression. The evaluation of a postchemotherapy anterior mediastinal mass ranges from close observation to excisional biopsy. If the diagnosis of thymus hyperplasia is entertained, administration of short-term steroids will reduce the size of the thymus and eliminate unnecessary surgery. Occasionally histologic confirmation may be required. Empiric antineoplastic therapy is not indicated. Figure 1. Computed tomography scan of the thorax shows thymic enlargement in the anterior mediastinum.Figure 2. Computed tomography scan of the thorax at initial staging shows no mass in the anterior mediastinum.
A case of acquired tracheoesophageal fistula (TEF) is presented in a 44-yearold female who presented with acute respiratory failure due to bilateral aspiration pneumonia. The patient had persistent air leak while on mechanical ventilation and underwent bronchoscopy which revealed the above etiology. Histopathology showed Barrett's esophagitis. The patient underwent primary closure followed by a short course of proton pump inhibitors. There are only two prior reported cases of acquired TEF associated with Barrett's esophagitis. This condition should be taken under consideration when investigating of an explained persistent air leak in a mechanically ventilated patient. ______________________________________________________________________________ 96 MJM 2007 10(2):96-98
A case of acquired tracheoesophageal fistula (TEF) is presented in a 44-year-old female who presented with acute respiratory failure due to bilateral aspiration pneumonia. The patient had persistent air leak while on mechanical ventilation and underwent bronchoscopy which revealed the above etiology. Histopathology showed Barrett's esophagitis. The patient underwent primary closure followed by a short course of proton pump inhibitors. There are only two prior reported cases of acquired TEF associated with Barrett's esophagitis. This condition should be taken under consideration when investigating of an explained persistent air leak in a mechanically ventilated patient.
2546 Background: Trastuzumab, a recombinant humanized anti-HER2 monoclonal antibody, has been found to have potent antiproliferative effects in HER2 overexpressing human breast tumors. Lovastatin, an HMG-CoA reductase inhibitor suppresses growth, and induces apoptosis in breast cancer cells. Both agents induce a G0/G1 arrest of cell cycle progression. The purpose of this study was to evaluate the antiproliferative effect of the novel combination of lovastatin and trastuzumab in human breast cancer cell lines. Methods: Increasing doses of lovastatin (0.16-40 μM) and trastuzumab (0.039-1 μg/ml) were tested alone and in combination. Three breast carcinoma cell lines were studied: two HER2 overexpressing lines (BT474 and SKBR3) and one cell line that expresses low levels of the receptor (MCF7). Inhibition of growth was assessed after 7 days of treatment by the MTT colorimetric assay, while apoptosis was detected using an in situ DNA Fragmentation Detection kit. Results: A dose-dependent growth inhibition was demonstrated in all three cell lines tested with lovastatin, while trastuzumab was only effective in the HER2 overexpressing cells. Trastuzumab (0.06 μg/ml) inhibited cell growth by 29.3% and 40.1%, while lovastatin (2.5 μM) caused an inhibition of 19.1% and 43% in the BT474 and SKBR3 cell lines, respectively. The combination of trastuzumab and lovastatin, at these doses, significantly inhibited growth in BT474 and SKBR3 cells by 45.4% and 68.9% (P < 0.001, oneway ANOVA) compared to either agent alone. Conclusions: Lovastatin plus trastuzumab treatment led to increased growth inhibition in HER2 positive breast cancer cell lines. Further studies in an animal model are warranted. This combination may also have important clinical therapeutic implications. No significant financial relationships to disclose.
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