The coexistence of breast cancer and scleroderma is a rare entity. A close temporal relationship between both diseases onset implies a possible etiopathogenetic correlation. We present the case of a 60-yearold woman with breast cancer that occurred three months after diagnosis of scleroderma. A review of the literature is also reported.

A rare case of a patient with a ruptured abdominal aortic aneurysm (AAA) and an incidentally found left renal artery aneurysm (RAA) is presented. Successful repair of both aneurysms was simultaneously performed. The indications for such a surgical approach are also discussed.

Expression of the hormone-related proteins hsp27, pS2, and also of cathepsin D (CD) and metallothionein (MT) was studied by immunohistochemistry and analyzed against clinical data in breast cancer. Archived material of paraffin-embedded breast carcinoma tissues from a cohort of 134 patients with primary invasive breast cancer was used. Hsp27 and pS2 (>10% of tumor cells stained) were found to be expressed in 63.6% and 37.6% of cases, respectively, and were correlated negatively with grading (P=0.006 and 0.01) and positively with estrogen receptors (ER) (P=0.04 and 0.04). pS2 expression was correlated with lymph node status (P=0.02), tumor size (P=0.01), progesterone receptor (PR) content (P=0.02), hsp27 (P=0.015) and bcl-2 protein (P=0.001). An inverse relationship between pS2 expression and the expression of p53 protein (P=0.005) and proliferation-associated index MIB1 (P<0.0001) was noted. Stromal cathepsin D was positively correlated with tumor grade (P=0.01), PCNA (P=0.007), MIB1 (P=0.001) and p53 (P=0.01), and negatively with ER (P=0.04) and bcl-2 (P<0.0001). MT was correlated positively with stromal CD (P=0.007) and inversely with PgR (P=0.04). Univariate analysis showed CD expression to be a positive prognostic factor for survival (P=0.035), with borderline significance, while MT was more strongly positive (P=0.01). However, none of the proteins studied was found to be related to disease outcome in univariate analysis. Our data show that hsp27, pS2 and stromal CD expression may reflect tumor differentiation and the functional status of ER in breast cancer, but stromal CD and tumor MT expression were the only factors found that may be of limited prognostic value.

Mesenteric Venous Thrombosis (MVT), though uncommon, is an important cause of intestinal ischemia or infraction. Defects of the coagulation mechanism have been reported as predisposing factors for venous thrombosis development. We present our experience with 3 cases of MVT, all due to congenital defects of anticoagulant mechanism. A 25-year-old woman presented with an acute abdomen due to MVT and underwent small bowel resection. Laboratory investigation revealed a protein S deficiency (10%). A male, aged 42, suffering form non-specific, generalized abdominal pain, due to MVT, and was treated with anticoagulants. Laboratory investigation found an activated protein C resistance ratio below normal and the presence of a factor V Leiden was established. A 56-year-old male presented with symptoms of an obstructive ileus due to MVT and underwent small bowel resection. Laboratory investigation revealed, both, a double mutation of the methylenetetrahydrofolate reductase gene and a heterozygous factor V Leiden mutation. We concluded that when MVT is present, hypercoagulability, should be considered. In such a case, along with other possible deficiencies (protein C, S, ATIII), resistance to activated protein C should also be examined, as the factor V Leiden mutation is the most common prothrombotic genetic defect predisposing the development of thromboembolic disease.

We report the clinicopathological findings of two patients with ectopic gastric mucosa within the gall ladder. The first patient, a 78 year old man, was asymptomatic. He was admitted to hospital for a colon adenocarcinoma. Intraoperatively, a firm nodule was palpable in the gall bladder. Histological examination of the resected specimen revealed a body type gastric mucosa in the submucosa, adjacent to which were extensive pyloric gland and intestinal metaplasia with mild to moderate dysplasia. The remaining gall bladder mucosa demonstrated changes of chronic cholecystitis. The second patient was a 62 year old woman with symptoms of chronic cholecystitis. The preoperative diagnosis was consistent with this diagnosis with a “polyp” at the junction of the neck and cystic duct. Cholecystectomy was performed and the histological examination of the resected specimen showed that the “polyp” consisted of heterotopic gastric mucosa with glands of body and fundus type. In the remaining mucosa, chronic cholecystitis was evident. To the best of our knowledge, this is the first report of a clinicopathological presentation of heterotopic gastric mucosa, pyloric gland type, and intestinal metaplasia with dysplastic changes in the gall bladder. As heterotopic tissue may promote carcinogenesis of the gall bladder, close attention should be paid to any occurrence of such lesions in this anatomical region.

UICC classification accurately predicts overall survival but not recurrence-risk. We report here data of overall and first site-specific recurrence following curative surgery useful for the development of recurrence-oriented preventive target therapies. Patients who underwent resection for gastric cancer were stratified according to curability of surgery [curative (R0) vs non-curative resection], extent of surgery [limited (D1) vs extended (D2) node dissection] and pathological nodal/serosal status. The intent-to-treat principle, log-rank test and Cox regression analysis were used for statistical analysis of time-to-event (recurrence, death) endpoints. Curative resection only produced a chance of cure whereas survival was very poor following non-curative resection ( P < 0.0001). For D2 R0 subgroup of patients, a pathological serosa and a node state-based classification into three groups, proved to be of clinical implication. Risk of recurrence after a median follow-up of 92 months was low among patients with both serosa and node-negative cancer (first group; 11%), moderate among those with either serosa or node-positive cancer (second group; 53%) and very high among those with both serosa and node-positive cancer (third group; 83%). In multivariate analysis, the relative risks of recurrence and death from gastric cancer among patients in the second and third groups, as compared to those in the first, were 7.07 (95% CI, 2.36–21.17; P = 0.0002) and 16.19 (95% CI, 5.76–45.54; P < 0.0001) respectively. First site-specific recurrence analysis revealed: low rate of loco-regional recurrence alone (12%), serosa state determinant factor of the site-recurrence (peritoneal for serosa-positive and haematogenous for serosa-negative cancers) and dramatic increase of all types of recurrence by the presence of nodal metastases. Our findings demonstrate that a pathological serosa- and node-based classification is very simple and predicts accurately site-specific recurrence-risks. Furthermore they reveal that risk of recurrence following curative D2 surgery alone is low for serosa- and node-negative cancers, but very high in serosa- and node-positive cancers suggesting the need for new therapeutic strategies in this subgroup of patients. © 2001 Cancer Research Campaign http://www.bjcancer.com

Just a few years ago, resistance to activated protein C (APCR) was reported to be of high significance representing a strong predisposing factor in the development of venous thrombosis (VT). A little while later, APCR was established to be the result of a point mutation of the factor V gene (factor V Leiden: a G-to-A transition at position 1691). Up to today, it is not certain whether factor V Leiden is in itself able to lead to VT, or whether it acts in synergy with other factors. Nevertheless, heterozygous subjects have a tenfold increase in the risk of VT when compared to general population, whereas the risk is 80 times greater in homozygous individuals. In 1996, a prothrombin gene mutation (prothrombin G20210A allele), which is a single-nucleotide G-to-A transition at position 20210 in the sequence of the 3'-untranslated region (3'UTR) on chromosome 11, was discovered. The presence of this mutant gene results in elevated plasma prothrombin concentrations, increasing the possibility for the development of VT. However, the coexistence of these two abnormalities? as well. as the clinical consequence, have not yet been studied. So far, only a few reports are found in the literature describing the coexistence of both mutations. The authors present a 25-year-old patient with a simultaneous double mutation of the FV and F II gene. The patient was homozygous for the factor V Leiden and heterozygous for the prothrombin G20210A allele. It is unclear whether the coexistence of the two predisposes more to the development of VT than the summation of the two as independent factors.

problems of hypoestrogenia in view of her non-acceptance of add-back therapy. She then requested hysterectomy with bilateral salpingo-oophorectomy as a cure for her menstrual problems. She was adamant on the refusal to use add-back therapy with GnRH analogue but promised to use hormone replacement therapy after surgery. She was listed for surgery after counselling. At surgery (January 1998) there was no evidence of active endometriosis but the uterus was ® xed in retroversion. Both uterosacral ligaments were scarred and the pouch of Douglas was obliterated by scar tissue. Recovery from surgery was uneventful. Before discharge she started on tibolone 2 ́5 mg daily to relieve menopausal symptoms. On review at 3 months she was well, had not suffered any further recurrence and continued using tibolone for hormone replacement therapy. The histology of the uterus, fallopian tubes and ovaries was unremarkable. Two years on she remains well.

BACKGROUNDSmall intestinal canine submucosa has been used in previous studies as a large diameter arterial graft and has shown acceptable patency rates. The aim of our experimental study was to assess its effectiveness when it is used as an autogenous medium-sized diameter arterial graft (5-7 mm).METHODSFifteen mongrel dogs were included and underwent laparotomy under general anaesthesia. The mucosa, tunica muscularis and serosa were removed from a resected intestinal segment. The remaining tube, which consisted of the submucosa and the basilar tunica mucosa, represented the experimental graft which was used to replace a proportional gap of the canine infrarenal aorta. Ascertainment of peripheral pulses, measurement of the intra-aortic pressures, aortography and in vivo/in situ observation before the sacrifice of the animals, were the procedures used for verification of the graft's patency.RESULTSThe resistance to thrombogenicity of the graft was considered satisfactory: nine out of 10 grafts remained patent for postoperative intervals ranging from one day to one year; one graft showed partial obstruction due to a technical perioperative error. The grafts showed also excellent physical characteristics (ease of handling and suturing, blood impermeability and durability), resistance to infection and showed no tendency to develop myointimal hyperplasia.CONCLUSIONSSmall intestinal canine submucosa showed satisfactory haemodynamic properties, long-term patency and resistance to infection, when used as a medium-diameter arterial substitute.

Controversial is the optimal treatment of primary gastric lymphoma (pGL) Surgery, chemotherapy (CTx), radiotherapy (RTx) and H. Pylori eradication are proposed for the treatment of pGL We evaluated the clinicopathologic data and treatment results in patients with a primary GL. Between 1978 and 1997, 30 patients with a pGL; stage I-E (n=10), II1E (n=7) or II2E (n=13), were treated with surgery plus CTx/RTx. Eight patients with an advanced stage IIIE/IV were excluded from this study. The follow-up rate was 86% with a median observation time of 70 (4-170) months. A Resection with curative intent (R-0) was performed in 82% of patients with a stage I-E or II1E Hospital mortality was related to the type of resection. There were no operative deaths after a R-0-resection, while mortality was 18% for patients with unresectable tumors or with non-curative resections. survival was strongly correlated to the type of resection (curative vs non-curative, p<0.01). Surgical resection followed by CTx remains the best front-line therapy for pGL (stage I-E/II1E) It is unclear whether patients with advanced stage II2E benefit from primary surgery or from primary chemotherapy.