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Metastases to the breast from extramammary tumors are rare. Several clinical, radiologic, and histologic signs can help to distinguish metastases from breast primary tumors. In the present study, we present a case of a left-sided breast metastasis from renal cancer in a 44-year-old woman whose clinical presentation was a mammary nodule in the upper internal quadrant. The patient underwent quadrantectomy with sentinel lymph node biopsy. The histology revealed a clear cell carcinoma. On computed tomography scan a 538-cm left renal mass with pulmonary, liver, and intrapericardial nodules was found. The patient underwent palliative care and died after 4 months. Metastasis to the breast is rare, but all of those clinical, radiologic, and histologic signs more typical of extramammary malignancies should always be considered in order to choose the best treatment strategy. Key words: Renal cell metastases -Clear cell carcinoma -Breast cancer -Metastases to the breastA 44-year-old woman with no significant medical history presented to the breast outpatient clinic after noticing a solitary, painless, left-sided breast mass.Physical examination revealed a focal, round, smooth, mobile mass at the 10-o'clock position of the left breast. She had no nipple discharge or skin changes, and no palpable axillary or supraclavicular lymphadenopathy. The right breast was normal to palpation. Mammography revealed a solid, smooth nodule in the upper internal quadrant of the left breast (Fig. 1). Ultrasound demonstrated an oval mass in the 10-o'clock position of the left breast measuring 15310 mm (Fig. 2). Fine-needle aspira-

SummaryA re-investigation of the use of the transketolase-TPP-effect for the assessment of the thiamine status of chronic alcoholics with various degrees of liver cirrhosis was carried out on 36 alcoholics. The extent of the liver damage in these patients was established by clinical examinations and biochemical tests. Fourteen persons showed no significant hepatic abnormalities, 5 patients had compensated liver cirrhosis, 7 slightly decompensated, and 10 patients suffered from severely decompensated liver cirrhosis. This investigation shows that the transketolase-TPP-effect is also present in patients even with severe liver cirrhosis and that a decrease of the TPP -effect can be observed after oral thiamine administration in these subjects. The TPP-effect of patients with compensated liver cirrhosis was markedly smaller than that of the subjects with slightly or severely decompensated cirrhosis. Accordingly a relationship exists between the TPP-effect and the degree of liver damage. No other correlations however could be established in this respect. Keywords TPP-effect, chronic alcoholics, liver cirrhosis, oral thiamine administration Chronic alcoholism is frequently associated with deficiencies of vitamins (1-5), mainly of thiamine (6-10). The clinical symptoms of thiamine deficiency are dependent upon the severity of the vitamin deprivation. A mild thiamine deficiency might exist without or with so-called subclinical symptoms. A reliable method for the assessment of the thiamine status is therefore of great importance.Several methods have been proposed, including: determination of blood pyruvate level (11, 12), thiamine excretion in urine (13, 14), microbiological assay of thiamine in blood (15) The enhancement of the enzyme activity resulting from the in vitro addition of thiamine pyrophosphate (TPP) to the hemolyzed blood, i.e., the determination of the TPP-effect gives better results in this respect (19,20). In our own investigations the determination of the TPP-effect before and after oral thiamine administration represents the more specific test (8,18). The determination of the TPP-effect is generally accepted for the assessment of the thiamine status with the exception of certain cases of alcoholics. Fennelly et al.(21) as well as Konttinen et al. (22) reported that the in vitro addition of TPP to hemolyzed blood from alcoholics with liver cirrhosis did not increase the transketolase activity, while the hemolysates from thiamine-deficient patients without liver disease a marked rise of enzyme activity was observed.As a consequence of these investigations the use of the TPP-effect for the assessment of the thiamine status of chronic alcoholics would in our opinion be rather limited since many of these patients suffer from liver cirrhosis.A re-investigation of this question seemed to be necessary in subjects in which the extent of the liver cirrhosis had been established by clinical examinations and biochemical tests (Quick, GOT, GPT, and y-globulin) by two of the co-authors (Filippini and Monnat). Simult...