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190-533 - DOMINO.DOC SYSTEM ADMINISTRATION 3.0 - Dump Information

Vendor : Lotus
Exam Code : 190-533
Exam Name : DOMINO.DOC SYSTEM ADMINISTRATION 3.0
Questions and Answers : 90 Q & A
Updated On : January 19, 2018
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190-533 Questions and Answers

190-533 Lotus DOMINO.DOC SYSTEM ADMINISTRATION 3.0 http://killexams.com/pass4sure/exam-detail/190-533 QUESTION:81 In a standard installation, in which one of the following templates can Lisa find the script library where custom code can be added to run when a document or binder is checked out? A. DDM.NTF B. DOMDOC.NTF C. FILECAB.NTF D. DOCSTAT.NTF Answer:C QUESTION:82 Which of the following actions can both a Domino.Doc administrator and a file cabinet creator carry out? A. Delete a file cabinet. B. Create a document type. C. Change the System Profile. D. Manage security for all file cabinets. Answer:B QUESTION:83 Which one of the following is the size limit for a single Domino.Doc file cabinet? A. 5000 documents B. Unlimited, up to the limitations of the storage medium C. Any number of documents, as long as their combined size is less than 1 GB D. Any number of documents, as long as their combined size is less than 4 GB Answer:B QUESTION:84 Dale, a system administrator, wants to enable searching on document content within the Project X file cabinet. Which one of the following actions will accomplish this? A. Nothing. Full-text indexing is enabled by default. B. Set up full-text indexing (with the index attachments option selected) on the file cabinet. C. Set up full-text indexing (with the index attachments option selected) on the binder database associated with the file cabinet. D. Set up full-text indexing (with the index attachments option selected) on the file cabinet template. Then, run the design process on the server. Answer:B QUESTION:85 Which one of the following actions can be selected to happen automatically when the last approver approves a document? A. Check the document in as a new draft. B. Check the document in as a new version. C. Check the document in at a specified date/time in the future. D. Return the document to the initiator of the approval for a final revision, and then check the document in as a new version. Answer:B QUESTION:86 At which one of the following times can one determine whether a document can have a life cycle? A. When the file room is created. B. When the document is checked out. C. When the document type is defined. D. When the document is approved for review. Answer:C QUESTION:87 Which one of the following can be created through the Domino.Doc API? A. Binder B. Library C. File cabinet D. Document type Answer:A QUESTION:88 Terry wants to place a document into a Life Cycle process (review and approval). In which one of the following definition forms is the Life Cycle process defined? A. Binder Type B. File Cabinet C. Document Type D. All documents can be placed into the Life Cycle process. Answer:C QUESTION:89 Terry, a system administrator, is checking the NOTES.INI file. Which one of the following server tasks would NEVER be needed by Domino.Doc? A. HTTP B. Calconn C. Replica D. DDMTran Answer:B QUESTION:90 Which one of the following lists describes the order of the Domino.Doc storage hierarchy from highest to lowest? A. File room, library, file cabinet, binder, document B. Document, binder, file cabinet, library, file room C. Library, file cabinet, category, file room, binder, document D. Library, file room, file cabinet, category, binder, document Answer:D For More exams visit http://killexams.com Kill your exam at First Attempt....Guaranteed!

Lotus 190-533 Exam (DOMINO.DOC SYSTEM ADMINISTRATION 3.0) Detailed Information

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    Who became treated? vitamin D medicine makes most sense in those with low vitamin D fame. In analogy, regular and powerful drugs such as insulin, antibiotics, or beta blockers are most effective constructive in selected, no longer all, intensive care unit sufferers. in this analyze, low vitamin D popularity was no longer a prerequisite for examine inclusion, and despite the fact a median 25-hydroxyvitamin D [25(OH)D] stage of 16.5 ng/ml at baseline is said within the intervention neighborhood, it's uncertain what share of the analyze cohort changed into diet D deficient. it will had been unique to analyze even if sufferers with very low 25(OH)D levels (i.e., under median degrees) replied more suitable to calcitriol than those with larger ranges, regardless of the quandary of sample measurement. it's also price noting that the reported liquid chromatography–mass spectrometry interassay coefficients of model for 25(OH)D (17.5%) and calcitriol (14.5%) are relatively excessive and, as such, were a trigger for some situation related to the conclusions drawn on this information.

    2.

    How were the sufferers handled? Calcitriol is the herbal active diet D metabolite and has a half-lifetime of handiest a few hours, in distinction to the plenty longer half-life of the native vitamin D metabolite cholecalciferol (2–3 weeks). The authors opted for a single dose of calcitriol and at the same time favored the reason why local 25(OH)D should be would becould very well be extra vital for immunomodulatory results than circulating calcitriol degrees (2). They eventually justified their choice to use calcitriol by suggesting impaired conversion of 25(OH)D to 1,25(OH)2nd in vital disease in keeping with two experiences (three, four). One look at investigated 30 sufferers who developed acute kidney harm (three), and the 2d looked at peritoneal dialysate monocytes from patients with conclusion-stage renal sickness (four). The latest examine design, despite the fact, excluded the most effective affected person cohort that was more likely to income most from calcitriol remedy; specifically, patients with conclusion-stage renal sickness. There is very restrained proof that 1α-hydroxylase recreation may certainly be reduced in important ailment. basically, circulating tiers of calcitriol and 25(OH)D had been shown to boost more than twofold inside days of excessive-dose cholecalciferol supplementation in critically ill patients (5). an identical raises in 1,25(OH)second tiers have been present in a examine during which 25(OH)D became given to intensive care unit sufferers, and the relative enhance was even greater than in the group receiving a 2-μg calcitriol dose every second day (6).

    We strongly consider that native nutrition D, and in particular cholecalciferol (diet D3), remains the foremost and most physiologic vitamin D metabolite to correct low 25(OH)D tiers in severely sick patients with or without sepsis. lively diet D analogs may well be constructive as adjunctive agents within the small subgroup of patients with superior acute or persistent renal failure. concerning the question posed by using Leaf and colleagues of whether calcitriol raises circulating hCAP-18 levels in humans with extreme sepsis, it looks the facts from this analyze are unable to give adequate solutions, as a result of we doubt that both the chosen target population or the single calcitriol remedy routine turned into most effective. To accurately investigate whether diet D may play a advisable function in the medication of septic sufferers, future reports are necessary, carefully choosing the target population, category of vitamin D supplementation, route/frequency/dose of administration, and techniques used to quantify pertinent biomarkers.

    1. Leaf DE, Raed A, Donnino MW, Ginde AA, Waikar SS. Randomized controlled trial of calcitriol in severe sepsis. Am J Respir Crit Care Med 2014;one hundred ninety:533–541. 2. Hewison M. Antibacterial effects of nutrition D. Nat Rev Endocrinol 2011;7:337–345. three. Leaf DE, Wolf M, Waikar SS, Chase H, Christov M, Cremers S, Stern L. FGF-23 levels in patients with AKI and risk of opposed effects. Clin J Am Soc Nephrol 2012;7:1217–1223. four. Bacchetta J, Sea JL, Chun RF, Lisse TS, Wesseling-Perry k, Gales B, Adams JS, Salusky IB, Hewison M. Fibroblast increase ingredient 23 inhibits extrarenal synthesis of 1,25-dihydroxyvitamin D in human monocytes. J Bone Miner Res 2013;28:46–fifty five. 5. Amrein okay, Sourij H, Wagner G, Holl A, Pieber TR, Smolle KH, Stojakovic T, Schnedl C, Dobnig H. brief-term consequences of excessive-dose oral diet D3 in severely sick nutrition D poor patients: a randomized, double-blind, placebo-managed pilot study 190-533. Crit Care 2011;15:R104. 6. Mata-Granados JM, Vargas-Vasserot J, Ferreiro-Vera C, Luque de Castro MD, Pavón RG, Quesada Gómez JM. comparison of vitamin D endocrine system (VDES) reputation and response to remedy of patients in intensive care instruments (ICUs) using an on line SPE-LC-MS/MS method. J Steroid Biochem Mol Biol 2010;121:452–455.
    Our facts File..txt - Vernier layout 2 LabQuest information.txt...

    Vernier structure 2 LabQuest facts.txt 3/5/116 16:6:33 Run 1 Wavelength Abs W A nm 380.30 0.229 381.10 0.228 381.90 0.228 382.80 0.227 383.60 0.230 384.forty 0.231 385.20 0.231 386.10 0.229 386.ninety 0.229 387.70 0.229 388.60 0.227 389.forty 0.224 390.20 0.220 391.00 0.217 391.ninety 0.215 392.70 0.214 393.50 0.212 394.30 0.211 395.20 0.211 396.00 0.212 396.80 0.214 397.60 0.216 398.50 0.220 399.30 0.224 four hundred.10 0.227 401.00 0.230 401.80 0.234 402.60 0.238 403.40 0.242 404.30 0.248 405.10 0.253 405.ninety 0.259 406.70 0.264 407.60 0.271 408.forty 0.276 409.20 0.281 410.00 0.286 410.ninety 0.292 411.70 0.297 412.50 0.303 413.30 0.308 414.20 0.313 415.00 0.318 415.eighty 0.323 416.70 0.328 417.50 0.333 418.30 0.338 419.10 0.343 420.00 0.348 420.eighty 0.352 421.60 0.358 422.40 0.362 423.30 0.366 424.10 0.370 424.90 0.373 425.70 0.377 426.60 0.382

    427.40 0.386 428.20 0.390 429.10 0.393 429.90 0.397 430.70 0.401 431.50 0.405 432.40 0.408 433.20 0.411 434.00 0.414 434.80 0.416 435.70 0.419 436.50 0.422 437.30 0.425 438.10 0.427 439.00 0.428 439.80 0.430 440.60 0.433 441.50 0.436 442.30 0.439 443.10 0.439 443.90 0.441 444.80 0.443 445.60 0.445 446.40 0.447 447.20 0.448 448.10 0.451 448.90 0.451 449.70 0.452 450.50 0.452 451.forty 0.453 452.20 0.454 453.00 0.455 453.ninety 0.454 454.70 0.454 455.50 0.453 456.30 0.455 457.20 0.455 458.00 0.456 458.eighty 0.454 459.60 0.454 460.50 0.453 461.30 0.453 462.10 0.452 462.90 0.450 463.80 0.449 464.60 0.448 465.40 0.447 466.30 0.446 467.10 0.445 467.90 0.445 468.70 0.444 469.60 0.442 470.forty 0.440 471.20 0.438 472.00 0.436 472.ninety 0.434 473.70 0.431 474.50 0.429 475.30 0.427 476.20 0.425 477.00 0.422 477.eighty 0.420 478.70 0.416 479.50 0.413

    480.30 0.410 481.10 0.407 482.00 0.405 482.80 0.402 483.60 0.399 484.40 0.396 485.30 0.393 486.10 0.391 486.ninety 0.387 487.70 0.384 488.60 0.380 489.40 0.377 490.20 0.373 491.00 0.370 491.ninety 0.368 492.70 0.364 493.50 0.359 494.40 0.356 495.20 0.352 496.00 0.350 496.80 0.346 497.70 0.344 498.50 0.341 499.30 0.338 500.10 0.335 501.00 0.331 501.eighty 0.326 502.60 0.322 503.forty 0.319 504.30 0.315 505.10 0.312 505.90 0.308 506.80 0.305 507.60 0.300 508.40 0.295 509.20 0.291 510.10 0.287 510.ninety 0.284 511.70 0.281 512.50 0.278 513.30 0.274 514.10 0.271 514.ninety 0.267 515.70 0.263 516.50 0.261 517.30 0.258 518.10 0.255 518.90 0.250 519.70 0.246 520.50 0.242 521.20 0.239 522.00 0.236 522.eighty 0.233 523.60 0.230 524.40 0.226 525.20 0.223 526.00 0.220 526.80 0.217 527.60 0.213 528.40 0.210 529.20 0.207 530.00 0.203 530.70 0.200 531.50 0.197

    532.30 0.193 533.10 0.a hundred ninety 533.ninety 0.187 534.70 0.185 535.50 0.182 536.30 0.179 537.10 0.a hundred seventy five 537.ninety 0.172 538.70 0.169 539.50 0.168 540.20 0.one hundred sixty five 541.00 0.162 541.eighty 0.159 542.60 0.157 543.forty 0.154 544.20 0.151 545.00 0.149 545.eighty 0.147 546.60 0.a hundred forty five 547.forty 0.142 548.20 0.138 549.00 0.136 549.70 0.133 550.50 0.131 551.30 0.129 552.10 0.127 552.90 0.124 553.70 0.121 554.50 0.120 555.30 0.118 556.10 0.116 556.ninety 0.114 557.70 0.112 558.50 0.109 559.20 0.108 560.00 0.106 560.eighty 0.103 561.60 0.one zero one 562.40 0.099 563.20 0.097 564.00 0.096 564.80 0.095 565.60 0.093 566.40 0.092 567.20 0.090 568.00 0.088 568.70 0.086 569.50 0.085 570.30 0.084 571.10 0.084 571.ninety 0.082 572.70 0.079 573.50 0.077 574.30 0.075 575.10 0.073 575.ninety 0.072 576.70 0.070 577.50 0.069 578.20 0.068 579.00 0.067 579.80 0.065 580.60 0.064 581.forty 0.063 582.20 0.062

    583.00 0.061 583.80 0.060 584.60 0.058 585.forty 0.057 586.20 0.056 587.00 0.055 587.70 0.055 588.50 0.054 589.20 0.052 590.00 0.051 590.70 0.050 591.50 0.050 592.20 0.049 592.ninety 0.047 593.70 0.046 594.forty 0.046 595.20 0.045 595.ninety 0.044 596.60 0.043 597.40 0.041 598.10 0.041 598.90 0.040 599.60 0.039 600.30 0.038 601.10 0.038 601.eighty 0.037 602.60 0.036 603.30 0.035 604.00 0.035 604.80 0.034 605.50 0.035 606.30 0.033 607.00 0.033 607.70 0.032 608.50 0.032 609.20 0.031 610.00 0.030 610.70 0.029 611.forty 0.028 612.20 0.028 612.90 0.027 613.70 0.027 614.40 0.026 615.20 0.026 615.ninety 0.025 616.60 0.025 617.40 0.024 618.10 0.023 618.90 0.023 619.60 0.023 620.30 0.022 621.10 0.021 621.eighty 0.021 622.60 0.021 623.30 0.021 624.00 0.021 624.80 0.020 625.50 0.020 626.30 0.019 627.00 0.019 627.70 0.019 628.50 0.018 629.20 0.017 630.00 0.017

    630.70 0.016 631.forty 0.017 632.20 0.017 632.90 0.017 633.70 0.016 634.40 0.016 635.10 0.016 635.ninety 0.015 636.60 0.015 637.forty 0.014 638.10 0.015 638.90 0.015 639.60 0.015 640.30 0.014 641.10 0.014 641.eighty 0.014 642.60 0.014 643.30 0.013 644.00 0.013 644.80 0.012 645.50 0.012 646.30 0.012 647.00 0.012 647.70 0.011 648.50 0.011 649.20 0.011 650.00 0.011 650.70 0.010 651.40 0.011 652.20 0.010 652.ninety 0.011 653.70 0.011 654.forty 0.011 655.10 0.010 655.90 0.009 656.60 0.009 657.forty 0.009 658.10 0.009 658.eighty 0.009 659.60 0.009 660.30 0.009 661.10 0.008 661.80 0.008 662.60 0.007 663.30 0.007 664.00 0.007 664.eighty 0.006 665.50 0.006 666.30 0.006 667.00 0.006 667.eighty 0.006 668.50 0.005 669.30 0.005 670.00 0.005 670.eighty 0.005 671.50 0.004 672.30 0.004 673.10 0.004 673.80 0.003 674.60 0.003 675.30 0.003 676.10 0.004 676.80 0.004 677.60 0.004

    678.forty 0.004 679.10 0.004 679.90 0.004 680.60 0.004 681.forty 0.004 682.10 0.004 682.ninety 0.004 683.70 0.004 684.forty 0.003 685.20 0.002 685.90 0.003 686.70 0.003 687.forty 0.003 688.20 0.003 689.00 0.003 689.70 0.003 690.50 0.002 691.20 0.002 692.00 0.002 692.70 0.002 693.50 0.002 694.30 0.002 695.00 0.002 695.80 0.002 696.50 0.002 697.30 0.003 698.00 0.003 698.80 0.003 699.60 0.002 seven-hundred.30 0.002 701.10 0.002 701.eighty 0.002 702.60 0.002 703.30 0.002 704.10 0.002 704.ninety 0.002 705.60 0.002 706.forty 0.002 707.20 0.002 708.00 0.002 708.80 0.002 709.60 0.002 710.40 0.002 711.20 0.002 712.00 0.002 712.80 0.001 713.60 0.002 714.40 0.002 715.20 0.003 716.00 0.003 716.80 0.002 717.60 0.002 718.forty 0.002 719.20 0.002 720.00 0.003 720.eighty 0.002 721.60 0.003 722.40 0.002 723.20 0.003 724.00 0.002 724.eighty 0.001 725.60 0.000 726.40 0.001 727.20 0.001

    728.00 0.001 728.eighty 0.001 729.60 0.000 730.40 0.000 731.20 -0.001 732.00 -0.001 732.eighty 0.000 733.60 0.001 734.forty 0.001 735.20 0.001 736.00 0.001 736.eighty 0.002 737.60 0.002 738.forty 0.004 739.20 0.004 740.00 0.004 740.eighty 0.003 741.60 0.003 742.40 0.003 743.20 0.003 744.00 0.003 744.eighty 0.003 745.60 0.003 746.40 0.003 747.20 0.002 748.00 0.002 748.80 0.003 749.60 0.004 750.forty 0.004 751.20 0.004 752.00 0.004 752.80 0.004 753.60 0.003 754.40 0.003 755.20 0.004 756.00 0.004 756.80 0.005 757.60 0.006 758.40 0.006 759.20 0.006 760.00 0.006 760.80 0.006 761.60 0.006 762.forty 0.007 763.20 0.007 764.00 0.008 764.80 0.009 765.60 0.009 766.forty 0.009 767.20 0.008 768.00 0.008 768.eighty 0.008 769.60 0.009 770.40 0.009 771.20 0.010 772.00 0.010 772.80 0.011 773.60 0.011 774.50 0.010 775.30 0.010 776.10 0.010 776.ninety 0.011 777.70 0.012 778.50 0.012

    779.30 0.012 780.10 0.013 780.90 0.013 781.70 0.014 782.50 0.013 783.30 0.013 784.10 0.013 784.ninety 0.014 785.70 0.015 786.50 0.015 787.30 0.014 788.10 0.015 788.90 0.015 789.70 0.015 790.50 0.015 791.30 0.015 792.10 0.016 792.90 0.016 793.70 0.016 794.50 0.017 795.30 0.017 796.10 0.018 796.ninety 0.019 797.70 0.020 798.50 0.020 799.30 0.020 800.10 0.021 800.90 0.022 801.70 0.022 802.50 0.022 803.30 0.022 804.10 0.022 804.90 0.022 805.70 0.023 806.50 0.023 807.30 0.024 808.10 0.025 808.90 0.025 809.70 0.025 810.50 0.024 811.30 0.025 812.10 0.025 812.90 0.026 813.70 0.027 814.50 0.027 815.30 0.027 816.10 0.028 816.90 0.028 817.70 0.028 818.50 0.028 819.30 0.028 820.10 0.028 820.90 0.029 821.70 0.030 822.50 0.030 823.30 0.030 824.10 0.031 824.ninety 0.031 825.70 0.031 826.50 0.031 827.30 0.031 828.10 0.031 828.ninety 0.032 829.70 0.033

    830.50 0.035 831.30 0.035 832.20 0.036 833.00 0.036 833.80 0.036 834.60 0.035 835.50 0.035 836.30 0.036 837.10 0.036 838.00 0.036 838.eighty 0.036 839.60 0.036 840.50 0.037 841.30 0.037 842.10 0.037 842.ninety 0.037 843.eighty 0.038 844.60 0.038 845.forty 0.038 846.30 0.039 847.10 0.039 847.ninety 0.039 848.eighty 0.039 849.60 0.039 850.40 0.039 851.30 0.039 852.10 0.038 852.90 0.038 853.70 0.038 854.60 0.039 855.40 0.039 856.20 0.038 857.10 0.038 857.90 0.038 858.70 0.039 859.60 0.039 860.40 0.039 861.20 0.039 862.10 0.039 862.ninety 0.039 863.70 0.039 864.50 0.039 865.forty 0.038 866.20 0.037 867.00 0.037 867.ninety 0.037 868.70 0.038 869.50 0.038 870.40 0.037 871.20 0.036 872.00 0.035 872.80 0.034 873.70 0.033 874.50 0.032 875.30 0.032 876.20 0.032 877.00 0.033 877.80 0.033 878.70 0.032 879.50 0.032 880.30 0.033 881.20 0.032 882.00 0.032 882.80 0.031

    883.60 0.030 884.50 0.029 885.30 0.029 886.10 0.028 887.00 0.027 887.80 0.026 888.60 0.027 889.50 0.027 890.30 0.027 891.10 0.028 892.00 0.027 892.80 0.027 893.60 0.026 894.40 0.026 895.30 0.026 896.10 0.026 896.90 0.025 897.eighty 0.026 898.60 0.026 899.40 0.027

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    Rab5 and sophistication III Phosphoinositide three-Kinase Vps34 Are involved in Hepatitis C Virus NS4B-precipitated Autophagy

    tophagy, vastly abolished HCV replication (10); this find-

    ing favors the first chance. ultimately, we validated that

    NS4B may affiliate with Rab5 and the Vps34-Beclin1 com-

    plex (Fig. 7), strengthening the finding that each Rab5 and

    Vps34 are concerned in NS4B-caused autophagy. The results of

    our reviews confirmed that the molecular pathways worried in

    NS4B- or HCV-caused autophagy are similar; as a result, we seasoned-

    pose that NS4B can recruit the Rab5 and Vps34 complex to

    set off autophagy and make a contribution to induction of autophagy by

    HCV.

    ACKNOWLEDGMENTS

    We thank IMB Electron Microscope Facility for technical assis-

    tance. We thank Andrea Tseng Lai for correcting the grammar. The

    shRNA constructs have been received from the country wide RNAi Core Fa-

    cility, Academia Sinica, Taiwan.

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    A Case of Secondary Angiosarcoma of the Breast after Breast-conserving surgery and Radiation: review of Radiologic and Pathologic Findings

    J Clin Imaging Sci. 2015; 5: 45.

    PMCID: PMC4584439

    branch of Radiology, Mount Sinai Beth Israel, big apple, country

    1Department of surgical procedure, Mount Sinai Beth Israel, new york, united states

    2Department of Pathology, Mount Sinai Beth Israel, ny, united states of america

    handle for correspondence: Dr. Christine N Eppelheimer, branch of Radiology, Mount Sinai Beth Israel, 10 Nathan D Perlman vicinity, long island - 10003, country. electronic mail: moc.liamg@remiehleppe.enitsirhc

    obtained 2015 Jun 4; authorized 2015 Aug 12.

    Copyright : © 2015 Journal of medical Imaging Science

    here's an open entry article distributed under the phrases of the inventive Commons Attribution-NonCommercial-ShareAlike 3.0 License, which permits others to remix, tweak, and build upon the work non-commercially, provided that the author is credited and the brand new creations are licensed under the identical terms.

    this article has been stated via different articles in PMC. summary

    Angiosarcoma of the breast is a rare and potentially existence-threatening disorder. it might latest as a palpable mass or subtle erythematous lesion, depending on the predisposing scientific components. Erythematous epidermis lesions could be at a loss for words for a benign system, which might also lead to a delay in prognosis. We present a case of an 80-12 months-ancient lady who developed secondary angiosarcoma after undergoing breast-conserving remedy for Stage IA breast cancer. in this article, we overview our experience with a case of secondary angiosarcoma of the breast and talk about the presentation, evaluation, and treatment of this ailment. This case demonstrates the magnitude of vigilance concerning erythematous or papular breast lesions in the surroundings of prior native radiation.

    key words: Breast-conserving surgical procedure, cutaneous angiosarcoma, radiation, secondary angiosarcoma

    INTRODUCTION

    Angiosarcoma of the breast is a infrequent disease accounting for 0.04% of malignant neoplasms of the breast.[1] Angiosarcomas are a subtype of soft-tissue sarcomas with vascular or endothelial starting place. The tumor is composed of complex anastomosing vascular channels which lack a true epithelial component, with the most average histologic look described as a vasoformative sample of growth.[2]

    There are two sorts of this sickness: fundamental angiosarcoma and secondary angiosarcoma. simple angiosarcoma tends to take place in younger sufferers and is more prone to latest as a palpable mass.[3] Secondary angiosarcoma may turn up after local radiation or in the atmosphere of continual post-operative lymphedema (Stewart–Treves syndrome).[4] With the creation of breast-conserving therapy (lumpectomy plus radiation), the incidence of Stewart–Treves syndrome has decreased while that of publish-irradiation angiosarcoma has extended.[2] In women with a history of prior breast radiation, the adjusted odds ratio for the building of angiosarcoma changed into estimated to be 11.6 (ninety five% CI = 4.3–26.1).[5]

    Secondary angiosarcoma is additionally commonly called cutaneous angiosarcoma because it tends to involve the subcutaneous tissues of the breast, whereas sparing the underlying breast parenchyma. due to this fact, secondary angiosarcoma most commonly items as a violaceous or erythematous lesion. besides the fact that children, a small percentage (7%) of sufferers with secondary angiosarcoma will existing with the manager criticism of a palpable mass.[3]

    RADIOLOGIC facets

    Our patient become an eighty-yr-historic lady with a historical past of Stage IA invasive ductal carcinoma of the appropriate breast diagnosed in 2008, which turned into estrogen receptor advantageous, progesterone receptor poor, and Her2neu poor. She underwent right partial mastectomy and sentinel lymph node biopsy, and received adjuvant whole breast exterior beam radiation with a typical dose of 5040 cGy and hormonal therapy. 4 years after surgery, she introduced with a small erythematous lesion on the correct breast. The mammogram at that time confirmed strong put up-surgical adjustments and clean epidermis thickening, according to prior radiation. A punch biopsy turned into carried out by way of a dermatologist at one other establishment and said it as eczematous dermatitis. The erythematous epidermis lesion enlarged over the next 2 years to 14 cm []. A repeat punch biopsy then published excessive-grade angiosarcoma.

    80-12 months-historical girl with an erythematous lesion with irregular borders clinically determined with secondary angiosarcoma.

    Concurrent mammogram showed extended skin thickening with new irregularity and dimpling of the epidermis surface []. epidermis thickening alone is expected in patients with a heritage of prior native radiation, however should be clean and uniform. Breast sonography verified irregular epidermis thickening and not using a discrete underlying breast mass []. Breast magnetic resonance imaging (MRI) also revealed dermis thickening with nonspecific foci of enhancement predominantly in the medial and inferior breast []. There turned into no suspicious improving mass or abnormal parenchymal enhancement preferred on MRI. Our patient then underwent a long appropriate total mastectomy, with broad resection (5 cm gross margins), and transverse rectus abdominus myocutaneous (TRAM) flap reconstruction []. She has been carefully adopted with physical exam and has shown no proof of recurrence at 8 months.

    80-12 months-historic lady with an erythematous lesion with irregular borders diagnosed with secondary angiosarcoma. (a) Craniocaudal (CC) and (b) mediolateral indirect (MLO) views of the appropriate breast from a mammogram taken 2 years just before diagnosis of angiosarcoma ...

    eighty-yr-ancient woman with an erythematous lesion with irregular borders diagnosed with secondary angiosarcoma. Ultrasound picture with colour Doppler of the correct breast displays epidermis thickening of the internal critical right breast (crimson bracket) as neatly as the ...

    80-year-old lady with an erythematous lesion with irregular borders clinically determined with secondary angiosarcoma. (a) MRI subtraction axial graphic of the right breast demonstrates foci of enhancement medially (arrow). (b) Delayed distinction-enhanced T1-weighted ...

    eighty-yr-old girl with an erythematous lesion with irregular borders diagnosed with secondary angiosarcoma. Intraoperative photo indicates the extent of angiosarcoma and the define of deliberate gross resection margins.

    PATHOLOGIC facets

    The whole appropriate breast changed into excised and sent for pathologic examination. A 14.5 × 11.four × 0.5 cm, irregular, thickened, mildly extended pink epidermis lesion turned into identified surrounding the nipple []. The lesion was observed three.6 cm from the closest resection margin. On sectioning, the discolored lesion was focally hemorrhagic and thickened (up to 0.5 cm in thickness in comparison to the average-looking tan skin which measured 0.2 cm in thickness). The remaining breast parenchyma turned into composed of predominantly delicate, yellow tissue admixed with delicate, red tissue.

    80-yr-old girl with an erythematous lesion with irregular borders clinically determined with secondary angiosarcoma. Gross pathology photograph shows a 14.5 × 11.4 × 0.5 cm, irregular, blue/pink dermis lesion surrounding the nipple.

    Microscopically, examination of the lesion with hematoxylin and eosin (H and E) staining revealed subcutaneous lesion inclusive of aggregates of solid spindle phone areas admixed with irregular, variably sized interconnecting vascular channels []. The irregular, interconnecting vascular channels were lined via an identical pleomorphic cells with hyperchromic nuclei and a high nuclear to cytoplasm ratio []. The strong, nodular areas had been composed of pleomorphic spindle cells with typical mitotic figures.

    80-12 months-old woman with an erythematous lesion with irregular borders diagnosed with secondary angiosarcoma. Hematoxylin and eosin stained biopsy tissue at low magnification indicates subcutaneous aggregates of solid spindle telephone areas (white arrows) admixed ...

    eighty-12 months-historic lady with an erythematous lesion with irregular borders diagnosed with secondary angiosarcoma. Hematoxylin and eosin stained biopsy tissue at larger magnification suggests irregular, variably sized interconnecting vascular channels lined by way of ...

    discussion

    The usual age of presentation for patients with secondary angiosarcoma of the breast is 73 years versus 43 years of age for sufferers with simple angiosarcoma. moreover, secondary angiosarcoma of the breast is extra likely to be high grade, in comparison to primary angiosarcoma. In a sequence of patients published by way of Scow et al., handiest 33% of patients with basic angiosarcoma of the breast had excessive-grade features in comparison to eighty two% of patients with secondary angiosarcoma.[3] The latency duration from radiation to construction of angiosarcoma is a median of seven years (range 3–19 years).[5] Our patient at the start offered four years after breast-conserving surgery and local radiation, with a small erythematous lesion. She became misdiagnosed at the moment with eczematous dermatitis. The clinical presentation may range tremendously, with erythematous or violaceous skin lesions being probably the most usual. subsequently, a delay in diagnosis is, regrettably, general.[6]

    The imaging features of secondary angiosarcoma can even be variable. commonly, the mammogram will reveal most effective post-surgical adjustments and nonspecific dermis thickening. This may be flawed for the regular epidermis adjustments regarding previous radiation. youngsters, radiation alterations would no longer be expected to boost at a later date, but somewhat lessen in prominence over time.[7] comparison with sequential mammograms, now not simply the patient's most contemporary study 190-533, may reveal delicate establishing alterations in epidermis irregularity or dimpling. also, if epidermis thickening is irregular, additional investigation and a question involving an linked dermal lesion can be warranted. within the subset of sufferers who have an linked parenchymal mass, the mammogram can also demonstrate an ill-described, uneven mass.[4]

    Sonography may additionally also reveal nonspecific findings corresponding to epidermis thickening. If an associated mass is considered on ultrasound, it may be circumscribed or unwell-defined with associated hypervascularity. Ultrasound can also additionally exhibit a blended hyperechoic and hypoechoic location with out a discrete mass.[1] Breast MRI with gadolinium, although no longer indispensable just before remedy, can also show foci of enhancement inside the thickened epidermis and can exhibit either plateau or washout kinetic curve.[8] These foci may well be small (below 1 cm) in measurement.

    We stress that the prognosis of secondary angiosarcoma of the breast is made with scientific exam and punch biopsy, and imaging plays a complementary function in analysis. youngsters, in infrequent instances, where the affected person has been misplaced to observe-up with interval breast tests by way of a surgeon or oncologists, irregular, worsening dermis thickening noted on movements mammogram and sonogram can also instantaneous a clinician to evaluate the affected person extra absolutely. once the prognosis is made, imaging performs an important function preoperatively to rule out the infrequent incidence of an underlying mass or a co-current ailment in advance of surgery.

    overall, secondary angiosarcoma of the breast has a negative prognosis, with a median sickness-free survival of two.41 years.[9] The 5-12 months disease-particular survival is forty seven%.[5] at the time of recurrence, forty one% of patients can have distant metastases, most generally to lymph nodes, lungs/pleura, and bone.[5]

    medicine of secondary angiosarcoma contains vast resection with mastectomy. The addition of adjuvant chemotherapy with doxorubicin or paclitaxel-primarily based agents can be regarded in patients with superior-stage or metastatic sickness.[10] prospective reviews are necessary to verify if adjuvant chemotherapy has an have an effect on on local recurrence or sickness-certain survival.

    CONCLUSION

    Secondary angiosarcoma of the breast is unusual; despite the fact, its incidence is expanding as the use of breast-conserving therapy has expanded. Clinically, patients will frequently current with a papular, erythematous dermis lesion. Imaging aspects, similar to modern skin alterations featuring a long time after radiation, are crucial diagnostic clues. cautious attention must receive to new skin lesions in patients with a historical past of prior breast irradiation, and diagnosis with a punch biopsy or excisional biopsy need to be carried out urgently. Early focus can assure that remedy is instituted with the intention to, hopefully, increase patient outcomes.

    fiscal guide and sponsorship

    Nil.

    Conflicts of pastime

    There are not any conflicts of activity.

    REFERENCES 1. Yang WT, Hennessy BT, Dryden MJ, Valero V, Hunt KK, Krishnamurthy S. Mammary angiosarcomas: Imaging findings in 24 patients. Radiology. 2007;242:725–34. [PubMed] 2. Billings SD, McKenney JK, Folpe AL, Hardacre MC, Weiss SW. Cutaneous angiosarcoma following breast-conserving surgical procedure and radiation: An analysis of 27 cases. Am J Surg Pathol. 2004;28:781–8. [PubMed] three. Scow JS, Reynolds CA, Degnim AC, Petersen IA, Jakub JW, Boughey JC. primary and secondary angiosarcoma of the breast: The mayo sanatorium journey. J Surg Oncol. 2010;one zero one:401–7. [PubMed] 4. Glazebrook KN, Magut MJ, Reynolds C. Angiosarcoma of the breast. AJR Am J Roentgenol. 2008;a hundred ninety:533–eight. [PubMed] 5. D’Angelo SP, Antonescu CR, Kuk D, Qin L, Moraco N, Carvajal RC, et al. excessive-risk facets in radiation-associated breast angiosarcomas. Br J melanoma. 2013;109:2340–6. [PMC free article] [PubMed] 6. Monroe AT, Feigenberg SJ, Mendenhall NP. Angiosarcoma after breast-conserving therapy. melanoma. 2003;ninety seven:1832–forty. [PubMed] 7. Moore A, Hendon A, Hester M, Samayoa L. Secondary angiosarcoma of the breast: Can imaging findings aid in the diagnosis? Breast J. 2008;14:293–eight. [PubMed] 8. Sanders LM, Groves AC, Schaefer S. Cutaneous angiosarcoma of the breast on MRI. AJR Am J Roentgenol. 2006;187:W143–6. [PubMed] 9. Vorburger SA, Xing Y, Hunt KK, Lakin GE, Benjamin RS, Feig BW, et al. Angiosarcoma of the breast. melanoma. 2005;104:2682–8. [PubMed] 10. Singla S, Papavasiliou P, Powers B, Gaughan J, von Mehren M, Watson JC, et al. Challenges within the medicine of angiosarcoma: A single establishment journey. Am J Surg. 2014;208:254–9. [PubMed]

    Articles from Journal of clinical Imaging Science are supplied here courtesy of Medknow Publications




    References:


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