Papilläre Tumoren der Mamma

The term papilloma applies to benign proliferative epithelial breast lesions with a papillary architecture. The papillae in such lesions contain an arborizing fibrovascular core, glandular surface epithelium and a basal myoepithelial layer. A basement membrane encloses these structures. Papilloma may occur at any site in the ductal lobular system and according to its localization is subdivided into two types: solitary (central) papilloma which are located in the major nipple/subareolar ducts or large segmental ducts and multiple (peripheral) papillomas in cystically dilated terminal ductal lobular units (TDLU). Stromal changes, epithelial metaplasia and/or proliferations and neoplasia may alter the prototypical architecture. In a significant number of papillomas atypia can be identified which have to be classified as atypical proliferates of the ductal type. These lesions must be distinguished from the papillary type of ductal carcinoma in situ. Some 17% of all papilloma are associated with (synchronous) intraductal or invasive carcinoma, but these also act as an indicator for subsequent (metachronous) carcinoma. As a consequence, in minimally invasive biopsy papilloma has to be classified as B3 and usually has to be followed by surgical excision.

[The significance of "normal tissue" in the development of breast cancer: new concepts of early carcinogenesis]

Only little information on the primary molecularbiological events involved in early breast is available. In particular, the definition of postulated precursor lesions of invasive breast cancer, such as ductal hyperplasia or ductal carcinoma in situ, is under an intense, controversial discussion in terms of pathogenesis and tumor biology. The most recent research on biological regulation mechanisms and genetic alterations in morphologically normally appearing breast tissue give rise for a reinterpretation for the most common progression models of breast cancer. The detection of genetic alterations within normal breast tissue in particular challenges the commonly postulated relationship between invasive and in situ breast carcinomas on the one hand, and benign, proliferative breast lesions on the other. The concerns about these relationship are further supported by the description of different cellular compartments within the normal female breast, including a "progenitor cell compartment" with different cytokeratin expression patterns, which can be transferred towards well known or suspected precursor lesions of invasive and in situ breast cancer. The aim of this manuscript is to provide an overview of the most recent results and developments in breast pathology, and to describe the consequences of our changing understanding of breast carcinogenesis.

Die avaskuläre Kapitatumnekrose bei Sportlern

The possibility of osteonecrosis of the carpal bones should always be considered when athletes present with pain of unknown origin in the hand and wrist, in particular, if they are participating in sports such as gymnastics or weight-lifting that involve extreme loading of the wrist with axial compression and microtrauma. This sort of extreme loading of the wrist combined with a constitutionally "weak" blood supply to the individual carpal bones may lead to the formation of osteo-necrotic zones. A treatment method that can produce excellent results, depending on the pathomorphology, is available in the form of vascularized bone grafting.

Expression of MAGE-A cancer/testis antigens in esophageal squamous cell carcinomas

BACKGROUND

Although the diagnosis and therapy of esophageal cancer have improved over the past decade, the prognosis remains dismal. Since MAGE-A cancer/testis antigens (CTA) are potential targets for immunotherapy, this study was aimed at evaluating their expression in these patients and its prognostic value.

MATERIALS AND METHODS

Using 57B monoclonal antibody, MAGE-A CTA expression was analyzed in paraffin-embedded tumor specimens of 98 patients with esophageal squamous cell carcinoma or adenocarcinomas who had undergone surgical resection. For all patients, a postoperative follow-up of at least 4 years was available. The expression was quantified using a scoring system considering intensity and homogeneity of the immunostaining. The prognostic relevance of MAGE-A expression was analyzed in univariate analyses as well as Cox proportional hazard regression analysis.

RESULTS

57B positivity could be detected in 38 tumors (38.8%). Positive staining was observed in five out of 32 adenocarcinomas (15.2%) and in 33 out of 66 (50%) squamous cell carcinomas. MAGE-A expression did not correlate with the TNM classification, grading or age of the patients. Both univariate (p=0.88) and multivariate analyses (p = 0.82) revealed that MAGE-A expression lacked prognostic significance in esophageal carcinomas.

CONCLUSION

MAGE-A was expressed in half of the squamous cell carcinomas of the esophagus, but rarely in adenocarcinomas. Although its immunodetection was insufficient for prognostic evaluation, the high expression rate suggests MAGE-A as a potential target for immunotherapy in the first group with the ability for pretherapeutic testing.

High resolution infrared spectra and rovibrational analysis of the coupled nu2/nu5 bands of D3Si35Cl. Equilibrium rotational constants

The Fourier transform infrared spectrum of monoisotopic D3Si35Cl in the region of the nu2/nu5 band system was recorded with a resolution of 2.4x10(-3) cm-1. More than 9000 lines of the strongly Coriolis x,y-coupled bands, (nu2)0=701.936, and (nu5)0=688.898 cm-1, have been assigned, among them 276 forbidden but perturbation allowed transitions around avoided crossings according to Delta(k-l)=+/-3 mechanisms. Three different models taking into account redundancies in the framework of unitary equivalent reductions of the rovibrational Hamiltonian have been employed to fit the data. All three models reproduced consistently the full data set employing 28 refined parameters with an rms deviation of 0.31x10(-3) cm-1. The equivalence of the parameter sets was established by the agreement of parameter sums obtained with the different models. The analysis of the avoided crossings, together with the fit of the forbidden lines, allowed an independent determination of the ground state parameters A0 and D(K)0. Combined with existing data for nu1, nu3, nu4, and nu6, the present results allowed the determination of experimental values, Ae=1.4371895(94) and Be=0.19823049(59) cm-1. The experimental results are compared with those of previous ab initio calculations of the anharmonic force field.

[Bootstrapping algorithm approach reveals inherent regulatory pattern in 550 invasive breast cancer cases: CK5/6/CK14 and CK8/18/CK19 builds an antagonistic set]

All the preliminary observations on a lot of marker sets defining different stages in the tumor development are building a framework of work hypothesis which can be verified in characterising large pools of histological uniform rated paraffin probes. We developed a bootstrapping algorithm based on correlation measures to uncover regulatory patterns of immunohistochemical characterized tissue arrays with 550 invasive breast cancer cases. The algorithm is implemented in 'S' a computer language used to model mathematical solutions. Focussing on the Cytokeratins versus a set of prominent markers in breast cancer differentiation it will be obvious that markers which are known to appear in early (progenitor) forms conform to CK5/6 and CK14 while others associated with late stages conform to CK8/18 and CK19. Markers examined are among others EGFR, EMA, erb-B2, Vimentin, p53, ER and PR. The developed approach is an elegant and complete procedure to reveal the real regulatory patterns which are enclosed in a certain experimental design. The statistical significance of the results calculated by our algorithm is generally high and in the presented experimental design smaller than 0.6 * 10E-6.

[Expression of early placenta insulin-like growth factor (EPIL) in breast cancer cells provides an autocrine loop with enhancement of predominantly HER-2-related invasivity]

AIMS

Recently, we were able to show that the expression of early placenta insulin like growth factor (EPIL) is expressed by highly motile HER-2-positive breast cancer cells in vitro (Brandt et al., Cancer Res. 2002) in Paget cells in vivo and indicates a poor clinical prognosis, irrespectively of other prognostic factors.

METHODS

In order to demonstrate the interplay between HER-2 and Epil we established a cellular model for high simultaneous Epil and HER-2 expression. The HER-2-positive breast cancer cell line SKBR3 was modified with an EPIL expression vector. In addition, an assay for the knockdown of EPIL-expression via siRNA was established. Erk1/2 expression was measured via Western Blot. The phenotype of the viable cells was determined by laser scan microscopy.

RESULTS

Epil overexpression in SKBR3 cells resulted in fast and frequent protrusion formation of the cells shown by laser scan microscopy. The cells were further characterized by a significantly increased invasiveness, which could be reversed by Epil specific siRNA treatment. Increased invasiveness and morphological changes were associated with a decreased erk1/2 phosphorylation.

CONCLUSIONS

These data further supports the assumption that EPIL might provide an autocrine loop in HER-2-positive breast cancer cells that enforce metastasis, conceivably escape from adjuvant therapy and in consequence poor clinical outcome. A tight interaction between HER-2 and EPIL in invasive breast cancer cells is therefore likely. The exact mechanims remain to be elucidated.

Ck5-positive cells are precursor cells of glandular and myoepithelial cell lineages in the human breast epithelium. A new cell concept as a basis for a better understanding of proliferative breast disease?

The question of whether stem cells exist in the human breast has never been satisfactorily resolved. Using a double immunofluorescence technique for simultaneous demonstration of cytokeratin subgroups 5, 8/18/19 and the differentiation marker smooth muscle actin, we provided direct evidence of the existence of a Ck5-positive cells that differentiate to either the glandular or myoepithelial cell lineage via intermediary cells. We postulate that the Ck5-positive cells are phenotypically and behaviourally committed adult stem cells. We further provide evidence that benign proliferative breast disease lesions resemble normal breast epithelium, whereas most breast carcinomas phenotypically consist of glandularly differentiated cells. The results were corroborated biochemically by Western blotting techniques. This cell biological model provides a new tool which helps to distinguish benign and malignant breast lesions. Furthermore this model provides a basis to unravel the regulatory mechanisms that govern normal and pathological cell growth.

Deciphering a subgroup of breast carcinomas with putative progression of grade during carcinogenesis revealed by comparative genomic hybridisation (CGH) and immunohistochemistry

Distinct parallel cytogenetic pathways in breast carcinogenesis could be identified in recent years. Nevertheless, it remained unclear as to which tumours may have progressed in grade or which patterns of cytogenetic alteration may define the switch from an in situ towards an invasive lesion. In order to gain more detailed insights into cytogenetic mechanisms of the pathogenesis of breast cancer, the chromosomal imbalances of 206 invasive breast cancer cases were characterised by means of comparative genomic hybridisation (CGH). CGH data were subjected to hierarchical cluster analysis and the results were further compared with immunohistochemical findings on tissue arrays from the same breast cancer cases. The combined analysis of immunohistochemical and cytogenetic data provided evidence that carcinomas with gains of 7p, and to a lesser extent losses of 9q and gains of 5p, are a distinct subgroup within the spectrum of ductal invasive grade 3 breast carcinomas. These aberrations were associated with a high degree of cytogenetic instability (16.6 alterations per case on average), 16q-losses in over 70% of these cases, strong oestrogen receptor expression and absence of strong expression of p53, c-erbB2 and Ck 5. These characteristics provide strong support for the hypothesis that these tumours may develop through stages of well- and perhaps intermediately differentiated breast cancers. Our results therefore underline the existence of several parallel and also stepwise progression pathways towards breast cancer.