Prognostic factors for breast cancer and their use in the clinical setting

Breast cancer is the second leading cause of cancer deaths in US women today. This year, approximately 216,000 US women will be diagnosed with invasive breast cancer and another 60,000 with in situ disease. Numerous factors can quantify individual risks for breast cancer, guide therapy and predict outcome. This review focuses on the clinical, pathologic, molecular and genetic prognostic tools available for use in patients with breast cancer, and their impact on clinical decisions and treatment selection.

Clinicopathological profile of female Sudanese patients with locally advanced breast cancer

BACKGROUND

In Sudan, breast cancer is one of the most common malignancy affecting women and the incidence rates appear to be rising. Unfortunately, most of the patients presented in advanced stage.

OBJECTIVE

To obtain information on demographic characteristics, clinicopathological profile and factors related to late presentation.

MATERIALS AND METHODS

Descriptive study. 144 patients who presented from April 2009 through May 2011 with locally advanced breast cancer were included in this study.

RESULTS

144 patients ranging in age from 25-71 years (mean 47 years) were included in the study. Of these 62.5% were premenopausal women. More than 60% of the patients presented after > 1 year following onset of symptoms. 68% of patients attributed their late presentation for lack of education and financial aspects.

CONCLUSION

Our study shows that locally advanced breast cancer patients presented at a younger age. Lack of education, financial issues and dependency on traditional medicine are encountered for this late presentation. We suggest that the attitude of Sudanese females towards breast cancer has to change through continuous but targeted public education.

[Breast cancer classification is evolving]

Diagnostic strategy of breast cancer has changed enormously during the last thirty years. To classical obligatory morphological data on the macroscopical and microscopical levels are now added imunocytochemistry, which is capable of detecting therapeutic targets such hormonal receptors and HER2 (Human Epidermal growth factor Receptor2), and molecular biology, which yields the molecular profile of tumors and their multigenic properties. By leaning on up-to-date classifications (TNM system and UICC grades), the pathologist is able to evaluate not only diagnostic but also pronostic criteria, leading to personalized and predictive treatments.

[Fallopian tube carcinoma: clinical and morphological features, analysis of 69 cases]

Primary fallopian tube carcinoma (PFTC) is a rare gynecological malignancy accounting 0.14-1.8% cases. The purpose of the study was to assess clinical, morphological and immunohistochemical features of PFTC. All the cases of PFTC were detected during 1980-2005. 31 cases of PFTC were analyzed as to Ki-67, HER-2 expression, estrogen receptors (ER), progesterone receptors (PR), grade and stage. 69 cases of PFTC were detected with an average age of 55, 6 years (range 21-73 years). Stage I detected in 34.2% cases, Stages II and III--32.8%, Ca in situ--10%. Among 31 patients ER were positive in 75% (n = 23), PR were positive in 46% (n = 14): ER+PR+ in 12 (38%) cases, ER+PR- in 11 (36%) cases, ER-PR+ in 2 (6%) cases, ER-PR- in 6 (19.4%) cases. Only 2 cases were HER-2 positive with ER+PR+ and ER-PR- status. Ki-67 labeling index (LI, %) values ranged from 15 to 95% (median 60) with average rate 58.03% +/- 4.08. Ki-67 LI values > or = 60% were graded as high and < 60% as low. We did not find any significant differences in Ki-67 LI values among tumors of various Receptor Status. However Ki-67 L1 > 60% was associated with poor 5-year survival (14%), vs 75% in Ki-67 L1 < 60%. Primary fallopian tube carcinoma is mainly HER-2 negative, receptor positive in 79.6%. Ki-67 rate is irrespective of ER PR status. However the level of Ki-67 (> 60%) was a significant survival prognostic factor.

Outcome of fertility-sparing treatment with medroxyprogesterone acetate for atypical hyperplasia and endometrial carcinoma in young Japanese women

PURPOSE

To review the outcome in patients with atypical endometrial hyperplasia (AEH) and endometrial cancer (EC) who received MPA treatment in the present hospital.

MATERIALS AND METHODS

Patients with AEH or EC were administered MPA for 12 weeks followed by endometrial curettage. The rates of effect, recurrence, pregnancy, and complications were evaluated. The changes in progesterone receptors and FOXO-1, known as a target of MPA treatment, were examined by immunostaining.

RESULTS

Four of seven patients with endometrial cancer and three of three patients with AH had complete response. Four of seven patients had recurred within one year after the treatment and had to undergo hysterectomy. None of the patients showed changes in progesterone receptors. Although six of seven patients were negative for FOXO-1 before and after treatment, all the patients showed increased developments of FOXO-1 during MPA treatment.

CONCLUSION

Progestin as a fertility-preserving treatment is expected to be effective for endometrial cancer, but judicious use might be required because it shows high rate of recurrence. Further studies regarding the mechanism may be necessary to achieve high efficacy.

The role of immunohistochemical tests in multimodal treatment of the aggressive forms of breast cancer

Aggressive breast cancer is an invasive form with a differentiation degree G3/G4, the absence of estrogen receptor and progesterone and the absence or presence of the gene HER 2(+ or 3+). The immunohistochemical tests have an important role in establishing the diagnosis and the therapy.

MATERIAL AND METHOD

It was shown that the aggressive breast cancers, 97 out of 316 cases were operated in the period October 2011 - February 2014. The criteria of inclusion/ exclusion in the study groups and the treatment schemes were exposed.

RESULTS

For the study group (group A=43/ group B=45/ group C=9 cases), the distribution according to the age group and immunohistochemical classification, were shown and, histologically, the type of surgical intervention, postoperative staging, postoperative complications were highlighted.

CONCLUSIONS

The treatment of the aggressive forms of breast cancer, neoadjuvant and adjuvant can both be set only by IHC tests.

Male breast cancer: clinical features and multimodal treatment in a retrospective survey analysis at Italian centers

AIMS AND BACKGROUND

We report a collection of data about early breast cancer in male patients from 13 Italian institutions.

METHODS AND STUDY DESIGN

We obtained data from patient charts and performed statistical analysis. The primary end points were overall survival and disease-free survival.

RESULTS

A total of 205 men with invasive breast cancer was identified, with a median age of 66 years. Pathological characteristics were heterogeneous for T stage, N stage and HER2 status. Histological subtype was predominantly ductal infiltrating carcinoma. Most of them were hormone receptor positive. Mastectomy was the most common strategy. Postsurgical treatment was not standardized. Patients with large tumors were more likely to be treated with chemotherapy. Disease recurrence was associated with an ER+ and PR+ status.

CONCLUSIONS

We identified a correlation between relapse and hormone receptor expression, as is the case in female breast cancer.

Evaluation of the progesterone receptor status in breast cancer using three different antibodies: a comparison by Allred score system

Breast cancer (BC) hormonal receptors status is assessed by immunohistochemistry (IHC), a specific, sensitive, and accessible method that guide breast cancer treatment. In this study, we evaluated progesterone receptor (PR) expression in 53 BC cases using 3 anti-PgR antibodies (AB): monoclonal (SP42 and PgR636) and polyclonal ab62621. Primary BC cases (with signed informed consent) were used to generate tissue microarray platforms, where PR expression was accessed by IHC and evaluated by the Allred score. Categorical and quantitative data are shown in percentage and mean, respectively. Concordance (CON) and correlation among ABs were analyzed by Kappa factor (Κ), Spearman's correlation coefficient (ρ) or intraclass correlation coefficient. Staining patterns of each AB were compared by paired T-Test. We noted poor CON and Κ between ab62621 vs SP42 (CON=64.1%; Κ=0.247), and ab62621 vs PgR636 (CON=62.3%; Κ=0.204), but higher CON between SP42 vs PgR636 (CON 90.6%; Κ=0.738). Data were corroborated by Mc Nemar statistical test (p=0.019, p=0.014 and p>0.05, respectively). Regarding staining intensity (SI) among PgR+ samples, we found higher proportion of weak staining and lower SI for ab62621 (48.3%; mean IS=1.6), when compared to SP42 (20.0%, mean IS=2.1, T-test p<0.01) and PgR636 (2.3, 21.9%, T-test p<0.01). Within the entire sample, similar results were observed following ρ: SP42 vs PgR636 (ρ=0.8103); ab62621 vs SP42 (ρ=0.3524); ab62621 vs PgR636 (ρ=0.4075). As for proportion of stained cells and proportion score (PS), among PgR+ samples, the mean values for ab62621 (75.4%; 4.8) were significantly higher than those of SP42 (56.3%, 4.3; T-test p<0.01) and RPG636 (60.1%; 4.2; T-test p<0.01). Similar data were found after analyzing PS for the entire sample: SP42 vs PgR636 (ρ=0.8588); SP42 vs ab62621 (ρ=0.4832); RPG636 vs ab62621 (ρ=0.4050). Our data indicate that anti-PgR monoclonal ABs, PgR636 and SP42, are, unlike ab62621, equally suitable to test BC PgR status by IHC due to their higher accuracy. Therefore, we suggest their clinical use during BC diagnosis; thus, enabling more precise therapeutic decisions to treat BC.

Differential sensitivity of Pak5, Pak6, and Pak5/Pak6 double-knockout mice to the stimulant effects of amphetamine and exercise-induced alterations in body weight

OBJECTIVES

PAK5 and PAK6 are protein kinases highly expressed in the brain. Previously, we observed that Pak6 knockout mice gained significantly more weight during development than Pak5 knockout mice as well as wild-type controls and double-knockout mice lacking both Pak5 and Pak6. In this study, we assessed the effects of exercise on food intake and weight gain of these mice as well as their sensitivity to the stimulant effects of amphetamine.

METHODS

Mice of each genotype were placed in cages with free access to run wheel exercise or in cages without run wheels for a total of 74 days. Food and fluid intake as well as body weight of each mouse were measured on a weekly basis. Finally, mice were given a high dose of amphetamine and activity levels were observed immediately thereafter for 90 minutes. Brains and testes of mice were assayed for protein levels of the estrogen alpha and progesterone receptors.

RESULTS

While run wheel mice consumed significantly more food, they weighed less than non-run wheel mice. In addition, although Pak6 knockout mice consumed the same amount of food as wild-type mice, they were significantly heavier regardless of run wheel condition. Pak5 knockout mice were found to be more active than other genotypes after amphetamine treatment. Finally, protein levels of the progesterone and estrogen alpha receptors were altered in brain and testes of the Pak6 knockout mice.

DISCUSSION

Collectively, these data suggest that PAK6 play a role in weight gain unrelated to exercise and caloric intake and that Pak5 knockout mice are more sensitive to the stimulant effects of amphetamine.

Estrogen and Progesterone Receptors Expression in Uterine Malignant Smooth Muscle Tumors: Correlation with Clinical Outcome

Uterine leiomyosarcomas are associated with a poor prognosis, although a considerable diversity in behavior may be found, and prolonged survival may occur. The aim of this study was to analyze the expression of estrogen (ER) and progesterone (PR) receptors in tumor specimens from uterine leiomyosarcomas, and to test their correlation with disease-free interval and cause-specific survival. This additional information may help the clinician differentiate between patients who have minimal risk of recurrence and those at greater risk of developing progressive disease. We examined specimens from 31 uterine leiomyosarcoma patients with clinical history and known follow-up. Disease-free interval and cause-specific survival rates were calculated according to the Kaplan-Meier method. According to univariate analysis, with Cox proportional hazards models, the ER expression (P=0.006 and P=0.016, respectively), PR expression (P=0.005 and P=0.016, respectively), and FIGO stage disease (P=0.011 and P=0.007, respectively) were independent predictors of the risk of recurrence and death from disease.

The diagnostic efficiency of fine needle aspiration biopsy in breast cancers - review

The introduction of fine needle aspiration biopsy (FNAB) into diagnostics set new standards for less invasive morphological diagnostics research. This diagnostic method is better in many ways than core biopsy. In some researchers' view, FNAB is not an infallible method for assessing breast lesions, because it requires highly trained radiologists and cytologists in order to correlate the cytological findings with a radiological examination. Some researchers argue that FNAB is characterized by high diagnostic sensitivity and specificity; others that it has a greater advantage when it comes to costs in relation to conventional lymph node biopsy. Using ultrasound to guide FNAB decreases the number of false negative results and increases the sensitivity and specificity of FNAB. Fine needle aspiration biopsy plays an important role in the initial determination of the staging of breast lesions and of the character of the lesions (benign or malignant).

[A case of incidentally diagnosed retroperitoneal lymphangioleiomyomatosis with no respiratory symptoms]

A 39-year-old woman presented with a large retroperitoneal tumor found incidentally in a routine examination. The 138×37×26 mm mass was located in the left paraaortic region. Blood tests and urinalyses including endocrinological examinations revealed no abnormalities. A chest computed tomography revealed multiple thin-walled pulmonary cysts, which is a characteristic of lymphangioleiomyomatosis (LAM). Because the findings strongly suggested that the retroperitoneal tumor was an extrapulmonary manifestion of LAM, we performed laparoscopic resection of the tumor for diagnosis and treatment. The pathological diagnosis was LAM. The tumor cells were immunohistochemically positive for α -smooth muscle actin and weakly positive for HMB45, which is consistent with LAM. The cells were also positive for estrogen receptor (ER) and progesterone receptor (PgR). LAM is a rare progressive disease that affects mainly the lung, and leads to chronic respiratory failure. Extrapulmonary LAM without respiratory symptoms, is extremely rare. In the past, the prognosis of LAM was poor, with a median survival of 8-10 years, but now 85% survive more than 10 years. In the present case, deterioration of pulmonary lesions was not observed during the 10 months follow-up. Because ERand PgRfindings were positive, we will consider hormonal therapy as a treatment option, when the pulmonary lesions progress in the present case.

Clinical implications of CSN6 protein expression and correlation with mutant-type P53 protein in breast cancer

OBJECTIVE

Constitutive photomorphogenesis 9 subunit 6, as one subunit of the constitutive photomorphogenesis 9, plays an important role in tumor development. The aim of the study was to investigate the clinical and prognostic implications of constitutive photomorphogenesis 9 subunit 6 protein in breast cancer.

METHODS

We examined mastectomy specimens from 92 invasive breast cancers and matched with 20 adjacent non-cancerous tissues using immunohistochemistry.

RESULTS

The positive expressions of constitutive photomorphogenesis 9 subunit 6 protein in invasive breast cancer and adjacent non-cancerous tissue were 32.61% (30 of 92) and 10% (2 of 20), respectively. The positive expression of constitutive photomorphogenesis 9 subunit 6 protein was related to tumor size, histological type and lymph node metastasis (P = 0.015, 0.009 and 0.009, respectively). After univariate analysis, constitutive photomorphogenesis 9 subunit 6-positive expression was only found to be significantly related to mutant-type P53 expression (P < 0.001). Spearman's correlation analysis was used to demonstrate negative correlations between constitutive photomorphogenesis 9 subunit 6 and mutant-type P53 (r = -0.417). Constitutive photomorphogenesis 9 subunit 6 positive was associated with both poorer breast cancer-specific survival in 92 cases and in the lymph node-positive group (P = 0.007 and 0.024, respectively). In the Cox regression test, constitutive photomorphogenesis 9 subunit 6 protein was not shown to be an independent prognostic factor for breast cancer.

CONCLUSION

Constitutive photomorphogenesis 9 subunit 6 might be a new potential biomarker for breast cancer. However, the underlying mechanisms of constitutive photomorphogenesis 9 subunit 6's involvement are still unclear.

Treatment effect of capecitabine and docetaxel or docetaxel alone by oestrogen receptor status in patients with metastatic breast cancer: results of an exploratory analysis

We investigated treatment effects by oestrogen receptor (ER) status among women with metastatic breast cancer (MBC) receiving capecitabine (C) plus docetaxel (D) or D alone in a randomised phase III trial. Data were retrospectively analysed from patients whose disease had recurred following (neo)adjuvant anthracyclines. ER status was identified in 356/506 patients. In patients with ER-positive tumours, median overall survival from enrolment was 17.7 months with CD versus 12.5 months with D (hazard ratio [HR] 0.65, 95% confidence interval [CI]: 0.47-0.89; P = 0.007) and median time to progression (TTP) was 6.8 and 5.4 months, respectively (HR 0.62, 95% CI: 0.46-0.84; P = 0.002). For patients with ER-negative tumours, significantly longer TTP was seen with CD (5.2 versus 3.5 months; HR 0.73, 95% CI: 0.53-0.98; P = 0.038). Whether there is an additional C to D treatment benefit in ER-positive versus ER-negative MBC requires further evaluation.

The prognostic role of interleukin-8 (IL-8) and matrix metalloproteinases -2 and -9 in lymph node-negative untreated breast cancer patients

PURPOSE

To investigate the relationships, if any, between interleukin (IL) -8/matrix metalloproteinase (MMP)-2/ MMP-9 and other prognostic variables in lymph node-negative untreated breast cancer patients, and to determine the prognostic value of these potential biomarkers.

METHODS

The study included 135 patients with known clinicopathological parameters. IL-8, MMP-2 and MMP-9 levels were determined by ELISA in primary tumor tissue lysates.

RESULTS

There were no significant relationships between IL-8/MMP-2/MMP-9 expression and available clinicopathological parameters (patient age, menopausal status, tumor size and tumor grade). Estrogen receptor (ER)- patients had higher levels of both IL-8 and MMP-9 (p=0.006 and p=0.04, respectively) compared to ER+ patients; there was a significant negative correlation between ER and IL-8 (p=0.02). MMP-9 expression was significantly higher in patients with higher levels of IL-8 (p<0.001) and there was a significant positive correlation between IL-8 and MMP-9, as well as between progesterone receptor (PR) and MMP-2 (p<0.001 and p=0.05, respectively). PR+ patients had higher levels of MMP-2 than PR- patients (p=0.03). Among the investigated biomarkers, only IL-8 had a statistically significant prognostic value in terms of relapse free survival (RFS) (p<0.001). Patients with higher levels of IL-8 had worse prognosis.

CONCLUSIONS

Expression of IL-8 and consequently expression of MMP-9 could be hormonally regulated in breast cancer. IL-8 could be a marker of more aggressive, ER- breast cancer phenotype. Different expression of MMP-2 and MMP-9 regarding differential hormonal receptor expression could indicate distinct mechanisms of their regulation. It seems that IL-8 is a strong and independent unfavorable prognostic parameter in node-negative breast cancer. Node-negative patients with higher levels of IL-8 should be treated with adjuvant, especially IL-8 targeted therapy.

Prognostic factors for longer disease free survival and overall survival after surgical resection of isolated liver metastasis from breast cancer

PURPOSE

Isolated liver metastases (LMs) from breast cancer (BC) occur in only 1-3% of the cases. Resection of isolated LMs improves survival. We examined the prognostic factors for time to LM development, disease free survival (DFS) and overall survival (OS) after BCLM resection.

METHODS

From 2006 to 2009, 32 patients underwent LM resection. All of them had breast cancer surgery for their primary tumor and developed resectable LMs as the first and only site of disease progression.

RESULTS

LMs developed after a median of 25 months. With a median follow up of 37 months (range 7-66) after metastases resection, median DFS and OS (with 95% CI) were 22.5 (12-40) and 37 (≥23) months, respectively. Tumor size ≥3 vs <3 cm and adjuvant chemotherapy vs no adjuvant chemotherapy correlated with shorter time to LM development (p<0.01 for both parameters). These parameters and BC negative estrogen (ER)/ progesterone receptors (PR) (ER?/PR? vs other) were related with shorter DFS. Positive (vs negative) axillary lymph nodes and BC negative ER/ PR (ER?/PR? vs other) status correlated with shorter OS (p<0.01 for both parameters). A period to metastases development ≥ 24 months (vs ≤24) and single (vs multiple) metastases were related with longer DFS and OS (p<0.01 for both conditions).

CONCLUSION

Despite the relatively small number of patients in this study, we believe that positive ER/PR status for both BC and LMs, negative axillary lymph nodes, time to liver metastases development >24 months and single liver metastases predict longer DFS and OS after LM resection.

Capecitabine/cisplatin doublet in anthracycline and taxane pretreated and HER-2 negative metastatic breast carcinoma patients

PURPOSE

To evaluate the activity and toxicity of the combination of capecitabine and cisplatin (CapCisp) in anthracycline- and taxane-pretreated HER-2 negative metastatic breast carcinoma (MBC) female patients.

METHODS

Patients with HER-2 negative MBC pretreated with anthracycline and taxane and who were then treated with CapCisp combination were retrospectively evaluated. All patients received Cap 1000 mg/m(2) on days 1-14, and Cisp 60 mg/m(2) on day 1, repeated every 3 weeks. In case of disease control without severe toxicity, single agent Cap was continued until progression or unacceptable toxicities after Cisp cessation.

RESULTS

Sixty-four MBC patients with median age 43 years (range 20-66) were included the study. Infiltrative ductal carcinoma prevailed (85.9%). Ten percent of the patients had grade I, 42% grade II, and 48.0% grade III tumors. Estrogen receptor (ER) and progesterone receptor (PR) were positive in 48.4 and 51.6% of the patients, respectively. Twenty-eight percent of the patients had triple negative tumors. Almost the entire patient group had this regimen as a third-line treatment. The median combination chemotherapy cycles were 6 (range 2-8). Twenty-seven non-progressive patients continued treatment with single-agent Cap. Median single-agent Cap cycles after the combination chemotherapy were 4 (range 1-38). Disease control rate was 81.3% (complete response 6.3%; partial response 48.4%, stable disease 26.6%, progressive disease 18.8%). Median follow-up time was 10.6 months. Median time to disease progression was 7 months, median overall survival (OS) was 17 months (95% CI, 6.9-16.1) measured from the start of CapCisp chemotherapy. There were no treatment-related deaths. The most frequent grade 3-4 toxicities were neutropenia (8.1%), nausea - vomiting (7.8%) and thrombocytopenia (6.3%).

CONCLUSION

CapCisp doublet has an encouraging antitumor activity with acceptable and manageable toxicity in anthracycline- and taxane-pretreated HER-2 negative metastatic breast carcinoma patients.

Age related influence of triple receptor status on metastatic breast cancer post relapse survival

PURPOSE

Prognostic factors in metastatic breast cancer (MBC) differ from those of primary breast cancer. The aim of this study was to identify the clinical significance of combined estrogen and progesterone receptors (ER,PR) and human epidermal growth factor receptor-2 (HER2) status on MBC post relapse survival.

METHODS

The survival of 109 MBC patients was analyzed according to clinical characteristics and ER/PR status (tested by ligand binding assay) and HER2 status (tested by chromogenic in situ hybridization/CISH).

RESULTS

Proper parameters for follow up of MBC patients were patient age, duration of disease free interval (DFI), dominant site of metastasis, number of metastatic sites and ER, PR status. Follow up of MBC patients showed the statistically significant difference in post relapse survival between patients with extreme phenotypes ER+PR+ and ER-PR-. Addition of HER2 status confirmed negative effect of HER2 amplification on MBC post relapse survival resulting in worse prognosis of ER-PR-HER2+ patients. The corresponding triple receptor (ER,PR,HER2) combination repeated the same pattern. In combination with patient age it was shown that difference in post relapse survival between extreme phenotypes (ER+PR+HER2- and ER-PRHER2+) was age related i.e. patients older than 50 years, with ER-PR-HER2+ phenotype, had mortality rate 100% and median survival time 14 months.

CONCLUSION

There is a strong indication for use of combined triple receptor status for follow-up of MBC patients. Based on our results, the worst phenotype was neither triple positive nor triple negative, but the one that most likely reflects the biological background of these biomarkers (ERPR- HER2+). Double and triple receptor status showed repeated pattern of influence on prognosis, but the finding that ER-PR-HER2+ phenotype in an age-restricted subgroup of patients means extremely poor prognosis and a highest mortality rate deserves further consideration regarding therapy efficiency.

Comparative efficacy study of 5-year letrozole or anastrozole in postmenopausal hormone receptor-positive early breast cancer

PURPOSE

To compare the efficacy of adjuvant anastrozole and letrozole in hormone receptor-positive postmenopausal patients with early breast cancer.

METHODS

A total of 569 hormone receptor-positive postmenopausal early breast cancer patients were included and analyzed in this study. Of them 238 were taking adjuvant anastrozole and 331 adjuvant letrozole. Demographic and medical data including age, menopausal status, weight, height, treatment history and comorbid diseases were collected from their medical charts.

RESULTS

In both anastrozole and letrozole users, the baseline clinicopathologic characteristics and the treatment history with radiotherapy and chemotherapy were similar. The median patient follow-up was 26.4 months. In the anastrozole arm disease free survival (DFS) was 94.9, 81.3 and 66.0%, whereas in the letrozole arm DFS was 90.6, 78.7 and 68.5% in the first, third and fifth years, respectively (p=0.25). Median overall survival (OS) could not be reached due to the low number of events in both arms. Three-year survival rate in the anastrozole arm was 98.8%, whereas in the letrozole arm it was 96.7% (p = 0.20).

CONCLUSION

This study showed that both letrozole and anastrozole have similar effects on DFS and OS in the adjuvant hormonal treatment of postmenopausal hormone receptor-positive breast cancer. We believe that this retrospective study is the first to directly compare the efficacy of letrozole and anastrozole.

Endometrial carcinoma metastatic to the retromolar pad

Metastatic carcinoma from the female genitalia to the oral mucosa is exceptionally rare, with only 11 such cases having been previously reported in the English-language literature. We describe a new case in a 65-year-old woman with a history of endometrial carcinoma who presented with swelling of the retromolar pad. Radiographic examination showed slight opacities and irregular trabecular bone in the left posterior mandible. Following an incisional biopsy, histologic examination and immunohistochemical studies revealed glandular adenocarcinoma with positivity for progesterone receptor, estrogen receptor, and cytokeratin 7. The patient was referred to her primary care physician for comprehensive treatment. This case illustrates the value of considering cancer metastasis in the differential diagnosis of an oral swelling, particularly in a patient with a history of cancer.

Overexpression of CARM1 in breast cancer is correlated with poorly characterized clinicopathologic parameters and molecular subtypes

BACKGROUND

Coactivator-associated arginine methyltransferase 1 (CARM1) belongs to the protein arginine methyltransferase family. CARM1 has been reported to be associated with high grade tumors in breast cancer. It still remains unknown the expression pattern of CARM1 in breast cancer and its relationships with clinicopathological characteristics and molecular subtypes.

METHODS

Two hundred forty-seven invasive breast cancer cases were collected and prepared for tissue array. There were thirty-seven tumors with benign glandular epithelium adjacent to the tumors among these cases. Molecular subtype and CARM1 expression were investigated using immunohistochemistry.

RESULTS

Cell staining was observed in the cytoplasm and/or nucleus. Staining for CARM1 was significantly stronger in adenocarcinoma compared with adjacent benign epithelium. There is a significant correlation between CARM1 overexpression with young age, high grade, estrogen receptor (ER) and progesterone receptor (PR) negative, increased p53 expression, and high Ki-67 index. Our study demonstrated CARM1 overexpression was associated with an increase in the protein expression of HER2. Furthermore, our data indicated CARM1-overexpression rate were remarkably higher in HER2 subtype (69.6%), luminal B subtype (59.6%) and TN subtype (57.1%) compared with luminal A subtype (41.3%).

CONCLUSIONS

CARM1 expression was increased in invasive breast cancer. CARM1 overexpression was associated with poorly characterized clinicopathologic parameters and HER2 overexpression. There were significant differences between different molecular subtypes in their relationship to CARM1 overexpression. Our results support the value of using CARM1 in prognostic stratification of breast cancer patients and its potential therapeutic implications in targeting treatment.

VIRTUAL SLIDES

The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/4116338491022965.

Treatment outcomes of occult breast carcinoma and prognostic analyses

BACKGROUND

The surgical management of occult breast cancer is controversial. We compared the outcomes of different treatments of occult breast cancer and evaluated the potential prognostic factors for overall survival and recurrence.

METHODS

We retrospectively reviewed 77 patients who presented to our hospital from 1968 to 2011 with a diagnosis of occult breast cancer. Patients were divided into three groups: 42 patients (63%) were treated with modified radical mastectomy+axillary lymph node dissection (ALND), 16 patients (24%) were treated with ALND + postoperative radiotherapy, and 9 patients (13%) with only ALND. Survival analyses were undertaken to compare the efficacy of these three treatments.

RESULTS

Of the 77 patients with occult breast cancer, 2 patients were lost to follow-up and 8 patients refused surgical treatment: 67 patients (90.4%) were included in this analysis. The median follow-up was 62.2 (0.6-328.0) months. Kaplan-Meier analyses showed no significant difference in overall survival and recurrence-free survival between the three groups (P = 0.494 and 0.397, respectively). The prevalence of local recurrence was 11.9% for the mastectomy + ALND, 18.8% for ALND + radiotherapy, and 11.1% for ALND-only groups, and those for distant recurrence were 2.4%, 12.5%, and 11.1%, respectively. Compared with progesterone receptor-negative subjects, progesterone receptor-positive patients had better overall survival and lower recurrence rates (P = 0.057 and 0.062, respectively).

CONCLUSIONS

There was no significant difference in outcomes between mastectomy and breast-preserving surgery. Expression of the progesterone receptor should be taken into account when evaluating the prognosis of occult breast cancer.

Prediction of late disease recurrence and extended adjuvant letrozole benefit by the HOXB13/IL17BR biomarker

BACKGROUND

Biomarkers to optimize extended adjuvant endocrine therapy for women with estrogen receptor (ER)-positive breast cancer are limited. The HOXB13/IL17BR (H/I) biomarker predicts recurrence risk in ER-positive, lymph node-negative breast cancer patients. H/I was evaluated in MA.17 trial for prognostic performance for late recurrence and treatment benefit from extended adjuvant letrozole.

METHODS

A prospective-retrospective, nested case-control design of 83 recurrences matched to 166 nonrecurrences from letrozole- and placebo-treated patients within MA.17 was conducted. Expression of H/I within primary tumors was determined by reverse-transcription polymerase chain reaction with a prespecified cutpoint. The predictive ability of H/I for ascertaining benefit from letrozole was determined using multivariable conditional logistic regression including standard clinicopathological factors as covariates. All statistical tests were two-sided.

RESULTS

High H/I was statistically significantly associated with a decrease in late recurrence in patients receiving extended letrozole therapy (odds ratio [OR] = 0.35; 95% confidence interval [CI] = 0.16 to 0.75; P = .007). In an adjusted model with standard clinicopathological factors, high H/I remained statistically significantly associated with patient benefit from letrozole (OR = 0.33; 95% CI = 0.15 to 0.73; P = .006). Reduction in the absolute risk of recurrence at 5 years was 16.5% for patients with high H/I (P = .007). The interaction between H/I and letrozole treatment was statistically significant (P = .03).

CONCLUSIONS

In the absence of extended letrozole therapy, high H/I identifies a subgroup of ER-positive patients disease-free after 5 years of tamoxifen who are at risk for late recurrence. When extended endocrine therapy with letrozole is prescribed, high H/I predicts benefit from therapy and a decreased probability of late disease recurrence.

[Case report. Aggressive angiomyxoma of vagina. A rare tumor diagnosed]

The case of a female patient of 35 years of age, with a pedunculated tumor dependent of the vagina, of approximately 25 x 12 x 8 cm, who had a wide resection. The report was consistent with myxoid aggressive angiomyxoma. This is a myxoid mesenchymal neoplasm of slow growth, which mainly appears in deep soft tissues of the pelvic, genital or perineal areas of adult women. It is usually diagnosed after surgical resection by histopathologic examination. Routine evaluation includes: complete physical examination, imaging and pathology report of diagnostic confirmation.

Distribution and prognosis of molecular breast cancer subtypes defined by immunohistochemical biomarkers in a Spanish population-based study

BACKGROUND

The objective of this study is to analyze the distribution, clinicopathological features, relative survival rate and excess risk of death among females diagnosed with invasive breast cancer and classified by molecular subtype from ten Spanish cancer registries.

METHOD

Three thousand four hundred and eighty incident cases of women - mostly diagnosed in 2005 - were classified into five molecular subtypes according to immunohistochemical status of hormonal receptors and HER2 (human epidermal growth factor receptor 2): estrogen receptor (ER) and/or progesterone receptor (PR)+ and HER2-, ER+ and/or PR+ and HER2+, HER2-overexpressed (ER-, PR- and HER2+), triple negative (ER, PR and HER2-) and unclassified (hormonal receptor or/and HER2 unknown). Relative survival rates at 1, 3 and 5years and relative excess risks (RER) of death adjusting for molecular subtype, age, stage and histological grade were estimated.

RESULTS

Marked differences in clinicopathological characteristics and relative survival rate were observed between molecular subtypes. Compared with women with ER+ and/or PR+ and HER2-, ER+ and/or PR+ and HER2+ cases had an RER of 1.00 (95% CI: 0.66 to 1.52) after adjusting for age, stage and histological grade, whereas HER2-overexpressed, triple negative and women with unclassified subtypes presented an RER of 1.72 (95% CI: 1.15 to 2.57), 3.16 (95% CI: 2.26 to 4.41) and 2.55 (95% CI: 1.96 to 3.32), respectively.

CONCLUSION

The prognostic value of molecular subtype persists when adjusting for age, stage and histological grade. Hormone receptor-positive tumors were associated with a better prognosis when compared with HER2-overexpressed and triple negative subtypes. Further research is required to improve triple negative prognosis.

Metaplastic mammary carcinoma with discrepant hormone receptor results by IHC and RT-PCR

This is a young premenopausal woman with a T1cN0 metaplastic breast cancer that is ER/PR Allred score 3, but negative by mRNA. Our recommendations are: adjuvant chemotherapy with TAC x 6 or dose-dense doxorubicin and cyclophosphamide followed by paclitaxel (ddAC-T). Whole-breast radiation therapy would follow. The patient could try tamoxifen, although the likelihood of benefit is very small.

Prognostic factors in early-stage triple-negative breast cancer: lessons and limits from clinical practice

AIM

Triple-negative breast cancer has a poor prognosis due to its aggressive behaviour and lack of effective targeted therapies. We aimed to verify whether clinical and/or pathological features may help us identify triple-negative breast cancer with a different outcome.

PATIENTS AND METHODS

Patients diagnosed with stage I-III triple-negative breast cancer at our Institution were included in the analysis. The impact of various factors (age, menopausal status, tumor characteristics, adjuvant treatment, etc.) on survival was evaluated. Univariate and multivariate analyses were performed.

RESULTS

A total of 149 patients were included in this retrospective analysis. At univariate analysis, a better disease-free survival was related to smaller tumour size and absence of lymphovascular involvement or necrosis. At multivariate analysis, tumour size and lympho-vascular invasion were independent prognostic factors.

CONCLUSION

Triple-negative breast cancer represents a heterogeneous disease with different biology and clinical behaviour. These results re-inforce the wide use of adjuvant chemotherapy for all types of triple-negative breast cancer, regardless of tumour size or lymphovascular invasion. New biomarkers are mandatory for a better stratification of this heterogeneous population.

Neural crest transcription factor Sox10 is preferentially expressed in triple-negative and metaplastic breast carcinomas

The transcription factor Sox10 mediates the differentiation of neural crest-derived cells, and Sox10 labeling by immunohistochemistry (IHC) is used clinically primarily to support the diagnosis of melanoma. Sox10 expression by IHC has been previously documented in benign breast myoepithelial cells but not in breast carcinomas. Here, we report the first systematic study of Sox10 expression in invasive ductal carcinomas subclassified by IHC-defined molecular subtype (100 cases), as well as in 24 cases of ductal carcinoma in situ and 44 mammary fibroepithelial neoplasms. Tissue microarrays containing 168 primary breast tumors were subjected to IHC for Sox10. The extent of nuclear Sox10 labeling was scored by percentage labeling as follows: 0 (0%), 1+ (1%-25%), 2+ (25%-50%), 3+ (50%-75%), and 4+ (>75%). Overall, 40 (40%) of 100 invasive breast carcinomas demonstrated Sox10 immunoreactivity, which was seen primarily in the basal-like, unclassified triple-negative, and metaplastic carcinomas. Sox10 labeling was seen in 66% (38/58) of the basal-like, unclassified triple-negative, and metaplastic carcinomas as compared with 5% (2/42) of the luminal A, luminal B, and Her-2 carcinomas (P < .00001). Sox10 labeling was seen in 1 (4%) of 24 cases of ductal carcinoma in situ, which was negative for estrogen receptor/progesterone receptor. No labeling was seen in the stromal component of phyllodes tumors or fibroadenomas. These findings show that breast carcinoma must be considered in the differential diagnosis of melanoma for an S100-positive, Sox10-positive metastatic malignant neoplasm. Sox10 expression in the basal-like, unclassified triple-negative, and metaplastic carcinomas types supports the concept that these neoplasms show myoepithelial differentiation.

The expression of histone deacetylase 1, but not other class I histone deacetylases, is significantly increased in endometriosis

Class I histone deacetylases (HDACs-1-3) play an important role in steroid hormone-dependent gene expression and in modulating cell survival and proliferation. We analyzed their expression in a tissue microarray including 74 endometriosis samples and 30 normal endometrium controls. The mean HDAC-1 immunoreactivity score (IRS ± standard deviation) was 7.6 ± 2.5 in endometriosis and 5.3 ± 2.3 in normal endometrium (P < .001). In contrast, the IRSs of HDAC-2 and -3 were 11.7 ± 0.7 and 11.8 ± 1.1 in endometriosis and 11.6 ± 1.0 and 11.9 ± 0.4 in normal endometrium (P = .7 and P = .2), respectively. Significant correlations were found between HDAC-1 and estrogen (-alpha/-beta) and progesterone receptor expression. In conclusion, HDAC-1, but not HDAC-2/-3, was significantly increased in endometriosis and associated with steroid hormone receptor expression that may reflect interdependence. In context with the literature, specific inhibitors of HDAC-1 may have inhibitory activities similar to those of broad-spectrum HDAC inhibitors and may be clinically tolerated, which would increase their chance as an option in the treatment of endometriosis.

Sexually dimorphic neurons in the ventromedial hypothalamus govern mating in both sexes and aggression in males

Sexual dimorphisms in the brain underlie behavioral sex differences, but the function of individual sexually dimorphic neuronal populations is poorly understood. Neuronal sexual dimorphisms typically represent quantitative differences in cell number, gene expression, or other features, and it is unknown whether these dimorphisms control sex-typical behavior exclusively in one sex or in both sexes. The progesterone receptor (PR) controls female sexual behavior, and we find many sex differences in number, distribution, or projections of PR-expressing neurons in the adult mouse brain. Using a genetic strategy we developed, we have ablated one such dimorphic PR-expressing neuronal population located in the ventromedial hypothalamus (VMH). Ablation of these neurons in females greatly diminishes sexual receptivity. Strikingly, the corresponding ablation in males reduces mating and aggression. Our findings reveal the functions of a molecularly defined, sexually dimorphic neuronal population in the brain. Moreover, we show that sexually dimorphic neurons can control distinct sex-typical behaviors in both sexes.

The prognostic role of preoperative and (early) postoperatively change in CA15.3 serum levels in a single hospital cohort of primary operable breast cancers

Measuring CA15.3 serum levels in the early breast cancer setting is not recommended by current ASCO guidelines. In this large single center study, we assess the prognostic value of preoperative (n = 3746), postoperative (n = 4049) and change in (n = 3252) CA15.3, also across different breast cancer phenotypes. Preoperative, postoperative and change in CA15.3 were all significant (p = 0.0348, p < 0.0001, p < 0.0001 respectively in multivariate analysis) predictors of distant metastasis free survival. For breast cancer specific survival, only postoperative and change in CA15.3 were significant predictors (p < 0.0001 both). Multivariate prognostic models did not improve by incorporating information on preoperative CA15.3, but did improve when introducing information on postoperative CA15.3 for distant metastasis (p = 0.0365) and on change in CA15.3 for breast cancer specific survival (p = 0.0291). Change in CA15.3 impacts on prognosis (distant metastasis) differently in different breast cancer phenotypes. A decrease in CA15.3 may be informative of improved prognosis in basal like and HER2 like breast cancer.

Prognostic significance of estrogen receptor, progesterone receptor, HER2/neu, Ki-67, and nm23 expression in patients with invasive breast cancer

PURPOSE

To determine the prognostic significance of estrogen receptor (ER), progesterone receptor (PR), HER2/neu, Ki-67, and nm23 immunohistochemical expression with respect to progression free survival (PFS) and overall survival (OS) in Turkish patients with invasive breast cancer (IBC).

METHODS

Patients with IBC (n = 81; mean age = 51.9 ± 11.1 years) were prospectively enrolled at the Department of Oncology, Uludag University Medical Center, Bursa, Turkey. Immunohistochemistry was performed on formalin- fixed, paraffin-embedded tissue sections.

RESULTS

We did not find any significant association between immunohistochemical expression of ER, PR, HER2/ neu, Ki-67, and nm23 and the baseline characteristics of IBC patients. The median patient PFS was 30 months (range 22-45), and the median OS was 32 months (range 23-46). Stratification of the patient population according to nm23 immunohistochemical expression revealed a statistically significant difference in terms of both OS (p < 0.05) and DFS (p < 0.05). Multivariate Cox regression analysis indicated that tumor grade, axillary lymph node status, and nm23 immunohistochemical expression were the 3 main independent prognostic factors for PFS and OS in IBC patients.

CONCLUSION

Reduced nm23 immunohistochemical expression is an independent negative prognostic factor for OS and PFS. Patients with negative nm23 expression may require a more intensive follow-up.

Expression of hPEBP4 negatively correlates with estrogen and progesterone receptors in endometrial carcinoma

PURPOSE

To investigate the expression of human phosphatidylethanolamine- binding protein 4 (hPEBP4) in endometrial carcinoma and its relation with progesterone receptor (PR) and estrogen receptor (ER).

METHODS

Forty-five samples of endometrioid endometrial carcinoma (EEC), 12 samples of atypical endometrial hyperplasia, and 30 samples of normal endometrium were examined. Samples were studied by immunohistochemistry for PR, ER and hPEBP4 expression. Expressions were statistically quantified and analyzed.

RESULTS

Expressions of PR and ER were significantly higher in normal endometrium than in cancer. Expression of hPEBP4 was significantly lower in normal endometrium. The expression of hPEBP4 was significantly higher in advanced-stage endometrial cancer, whilst higher but insignificant trend was noticed in higher grade carcinoma. Statistically insignificant trend of negative ER and PR expression with higher grade or stage was noticed. The expression of hPEBP4 was negatively correlated to ER and PR in EEC.

CONCLUSION

The expression pattern of hPEBP4 indicated that hPEBP4 interacted with ER and PR in EEC and could thus become a possible target for the development of novel treatment against this malignancy.

Change of influence of prognostic markers on metastasis free interval during and after adjuvant tamoxifen therapy in breast cancer patients

PURPOSE

To evaluate the influence of molecular biomarkers (estrogen receptor - ER, progesterone receptor - PR, and human epidermal growth factor receptor2 - HER2) and pathological parameters on metastasis free interval (MFI) in adjuvantly tamoxifen-treated breast cancer patients, during different follow up periods (0-2.5 years, 2.5-5 years and 5-12 years).

METHODS

The study included 113 postmenopausal breast cancer patients with known pathological parameters. Steroid receptors were determined by ligand-binding assay and HER2 amplification status by chromogenic in situ hybridization (CISH).

RESULTS

During the first 2.5 years of therapy patients with ER <5 fmol/mg, PR <5 fmol/mg or pT2 (≥2cm) tumors had higher probability of distant metastasis. For the period between 2.5-5 years, analysis of MFI according to pathological parameters and molecular biomarkers, separately, did not show any statistically significant difference. Patients with pT≥2 cm and HER2 amplification had much greater chance of developing distant metastasis when compared to other phenotypes (HER2-negative/pT1, HER2-negative/pT2 and HER2-positive/pT1). Patiens with ER ≥160 fmol/mg and PR ≥45 fmol/mg had good prognosis after 5 years of tamoxifen therapy.

CONCLUSION

Our study indicates that there is a change of influence of the analyzed pathological parameters on MFI, depending on different follow up periods. Steroid receptor status, tumor size and HER2 status (alone or in combination) are significant parameters for the course of disease of postmenopausal ER-positive breast cancer patients, but during different periods of follow up.

Evaluation of changes in biologic markers ER, PR, HER 2 and Ki-67 index in breast cancer with administration of neoadjuvant dose dense doxorubicin, cyclophosphamide followed by paclitaxel chemotherapy

PURPOSE

The aim of this study was to assess the changes in biologic markers of breast cancer ER, PR, HER 2 and Ki-67 in locally advanced breast cancer patients after neoadjuvant chemotherapy.

METHODS

Data from 63 locally advanced breast cancer patients (stage II or III), whose histological diagnosis was made by core biopsies were retrospectively evaluated. The patients were given 4 cyles of 600 mg/m(2) cyclophosphamide, 60 mg/m(2) doxorubicin every 15 days followed by 4 cycles of paclitaxel 175 mg/m(2) every 15 days, and they underwent surgery within two weeks after the last chemotherapy cycle. Expressions in the preoperative and postoperative status of ER, PR, HER 2 and Ki-67 were compared.

RESULTS

The patient mean age was 49.2 ±10.7 years and most (57.1%) were premenopausal. Clinical stages of patients ranged between T2N1 and T3N2. The pathological complete response (pCR) rate was 14.9 % (N=9). Two (5.7%) patients who were ER positive prior to treatment showed ER negativity after treatment. In 7 (21.17percnt;) patients PR became negative after neoadjuvant chemotherapy and in 3 (9.0%) patients PR became positive. Changes in ER and PR receptors were not statistically significant (ER p=0.500 and PR p=0.549, respectively), whereas in 2 (5. 8%) patients hormonal status changed significantly when compared to initial biopsies (p=0.003). In addition, median value for PR intensity decreased from 20 to 10% (p=0.003) and Ki-67 values decreased from 10 to 1% (p<0.001) following neoadjuvant therapy. Six (17%) patients exhibited some changes in HER 2 staining. HER 2 expression became 2+ in 3 patients who were HER 2 negative prior to treatment, and HER 2 expression became negative in two patients with HER 2 1+ and 2+ prior to treatment following neoadjuvant chemotherapy.

CONCLUSION

The biological markers ER, PR, HER 2 and Ki- 67 index demonstrated differences after neoadjuvant treatment in breast cancer patients. These changes may affect the treatment decision.

The prognostic impact of obesity on molecular subtypes of breast cancer in premenopausal women

PURPOSE

The increasing incidence of obesity throughout the world will result in expansion of the number of women at risk for developing breast cancer. Obesity is associated with adverse outcomes in postmenopausal women with breast cancer. In premenopausal women, the association is less clear. We investigated the impact of obesity on tumor features, hormonal status, recurrence and mortality in premenopausal breast cancer patients, classified according to molecular subtypes.

METHODS

818 premenopausal women with nonmetastatic breast cancer were analysed. Patients were classified into 3 groups according to body mass index (BMI): i) normal body weight (BMI: 18.5-24.9 kg/m(2)); ii) overweight (BMI: 25-29.9 kg/ m(2)); and iii) obese (BMI:>30 kg/ m(2)). Clinocopathologic characteristics and survival rates were analyzed for triple negative, HER-2 overexpressing and luminal subtypes.

RESULTS

Obese patients compared with normal-weight women were older at diagnosis (p<0.001) and more often had high grade tumor (57.1 vs 42.3%; p=0.04) with lymphovascular invasion (79.5 vs 63.9%; p=0.03). The median follow-up period after diagnosis was 29 months. According to the molecular subtypes, overall survival (OS) and disease free survival (DFS) were significantly shorter in obese patients with triple negative breast cancer (TNBC) (p=0.001 and p=0.006, respectively). Obesity (HR 1.4; 95% CI 1.0-2.1; p=0.04) and lymphovascular invasion (HR 2.1; 95% CI 1.3- 3.3; p=0.02) were found to be independent prognostic factors for TNBC mortality.

CONCLUSION

Obesity is associated with estrogen (ER) and progesterone receptor (PR) negative tumors and poor OS in premenopausal women with breast cancer.

Estrogen and progesterone receptors in patients with bladder pain syndrome

OBJECTIVE

Analyze if bladder mucosa of patients with bladder pain syndrome (BPS) have more estrogen receptor (ER) and progesterone receptor (PR) than the normal population.

MATERIAL AND METHOD

Between July 2009 and December 2010, 15 female patients with chronic bladder pain syndrome and 10 female patients without bladder pain were enrolled in the present study. Three pieces of trigonal bladder mucosa were biopsied and sent for estrogen receptor and progesterone receptor immunohistochemistry staining by the Benchmark automated machine. The results were reported as positive and negative and then compared between the two groups.

RESULTS

Estrogen receptor was found in 14 out of 15 patients in the BPS group (93%) and in 7 out of 10 patients in the control group (70%). Progesterone receptor was found in 10 out of 15 patients in the BPS group (66.7%) and 5 out of 10 patients in the control group. Both were not significantly different with p = 0.267 and p = 0.678, respectively.

CONCLUSION

The authors concluded that ER and PR might not play a role in the etiopathogenesis of BPS/IC. However other receptors should be further investigated about their role in this type of pain.

Influence of hormonal status on thermography findings in breast cancer

The aim of this study was to investigate the association of infrared imaging findings and hormone receptor (estrogen and progesterone) status in breast cancers. The study was carried out at Department of Surgical Oncology and Department of Pathology, Sestre milosrdnice University Hospital Center, in collaboration with licensed infrared thermography experts. The study involved 75 female patients with invasive breast tumors. Thermography findings were compared with different immunohistochemical findings (hormone status positive or negative). Seventy-five female patients aged 36 to 86 years, mean age 64 +/- 11.36 years, were examined. The tumor itself and the breast containing the tumor were statistically significantly warmer (p < 0.001) than the healthy breast in all study patients. There was no statistically significant difference (p > 0.05) between patients with positive and those with negative estrogen receptors. Unlike all previously published results of various thermographic studies, results obtained in this study on the hormone receptor status analyzed and its impact on thermographic findings indicated that estrogen negative tumors had a higher maximum and average temperature than estrogen positive tumors. It was also observed that estrogen negative tumors had lower impact on warming of the entire breast, and that maximum and average temperature of the affected breast was higher in estrogen positive tumors. Arithmetic means of maximum and average tumor temperatures were statistically significantly higher for progesterone negative tumors compared with progesterone positive tumors (p < 0.05). Thermographic findings correlated with the specific hormonal status of breast invasive tumors, which reflects the biological behavior of tumors as well as their clinical variables.

A case of male invasive breast carcinoma presenting as a non-healing wound

Breast cancer in male patients accounts for less than 1 percent of malignancies in men. When compared to women, men with breast cancer are, on average, older, diagnosed at a more advanced stage, more likely to be hormone-receptor positive, less likely to overexpress HER2/neu, and have a lower overall survival. Owing to the paucity of data, male breast cancer treatment is typically guided by trials from female breast cancer. We report a case of invasive ductal carcinoma in a male patient with the initial presenting morphology of a non-healing chest wound. Interestingly, immunostaining identified positivity for estrogen receptor, progesterone receptor, and HER2/neu in the patients tumor. Although rare, breast carcinoma is an important consideration in any male with a breast mass, retracted nipple, or ulceration, as was seen in our patient.

Predictive value of Ki67 for adjuvant chemotherapy in node-negative, hormone receptor-positive breast cancer

BACKGROUND

Ki67 labeling index (Ki67 LI) is a measure of tumor proliferation. In breast cancer, evidence supporting its prognostic value is clear and its predictive value for response to treatment finds some benefits. However studies of Ki67 LI as a predictive marker in early breast cancer are still limited worldwide and there is no data in Thailand.

OBJECTIVE

To assess the predictive value of Ki67 expression for adjuvant chemotherapy in patients with node-negative, hormone receptor-positive breast cancer

MATERIAL AND METHOD

The authors retrospectively evaluated 127 diagnosed early breast cancer with node-negative, hormone receptor-positive patients and receiving adjuvant systemic treatment at Siriraj hospital. Disease free survival (DFS) was compared with the log-rank test according to Ki67 LI and adjuvant systemic treatment (chemoendocrine therapy and endocrine therapy alone).

RESULTS

At a median follow-up of 3.3 years. The 5-year DFS rate was 79% for patients with low Ki67 expression and 75% for patients with high Ki67 expression. Of the 127 patients, 56 (44.1%) received chemoendocrine therapy and 71 (55.9%) were treated with endocrine therapy alone. There was no different effect of DFS among those receiving adjuvant endocrine therapy alone and those receiving adjuvant chemoendocrine therapy depending on Ki67 expression.

CONCLUSION

Among patients with node-negative, hormone receptor-positive breast cancer, a high Ki67 LI had worse DFS trend than a low Ki67 LI but the Ki67 LI did not predict the efficacy of adjuvant chemotherapy.

[Clinical and morphological features and treatment for lobular breast cancer]

The study presents data on the treatment of lobular breast cancer. On the basis of the studied morphological and molecular-biological characteristics there were substantiated types of treatment that improved the survival of patients with invasive lobular carcinoma. It was showed the efficacy of systemic treatment for lobular breast cancer and also studied long-term outcomes of lobular breast cancer depending on the morphological and biological features.

Adjuvant therapy for intrahepatic cholangiocarcinoma: the debate continues

Presentation of the Case A 37-year-old woman presented at 35 weeks of gestation with her third child with failure to adequately gain weight and was noted by her obstetrician to have delay in the growth of her baby. Ultrasound of the abdomen incidentally revealed the presence of a liver lesion. After additional evaluation, she ultimately delivered her daughter at 36 weeks uneventfully. She subsequently underwent additional evaluation. Liver magnetic resonance imaging (MRI) revealed a 5-cm solitary solid mass in segment 4A of the liver, concerning for malignancy. Serum α-fetoprotein, carcinoembryonic antigen, cancer antigen (CA)19-9, CA15-3, and CA125 were all normal. Liver biopsy was positive for adenocarcinoma. The tumor cells demonstrated a phenotype suggesting a possible breast primary, although the immunohistochemistry did not support that diagnosis and the tumor was negative for mammaglobin, gross cystic disease fluid protein (GCDFP)-15, estrogen receptor (ER), and progesterone receptor (PR) (Table 1). The tumor was also CDX2 and cardiotrophin-1 negative, but cytokeratin (CK) 19 positive. Her endoscopic retrograde cholangiopancreatography, upper endoscopy, colonoscopy, breast mammogram, and breast MRI were completely normal. A positron emission tomography-computed tomography scan showed a fluorodeoxyglucose-avid 5.8-cm × 6.0-cm hypoattenuating lesion with peripheral enhancement involving segment 4 and segment 8 at the dome. In addition, central necrosis within the lesion was noted. The left main portal vein was mildly attenuated by the mass. She eventually underwent a left hepatectomy en bloc with caudate resection, portal lymphadenectomy, cholecystectomy, and omental pedicle flap. On exploration of the abdomen, no additional disease was noted. The final pathology revealed a 9.4-cm moderately to poorly differentiated adenocarcinoma of the intrahepatic bile ducts. Venous invasion was present. Perineural invasion was absent. The margins were negative. Thirteen lymph nodes were obtained, all of which were negative, consistent with a stage T2, N0, MX intrahepatic cholangiocarcinoma. The tumor was positive for CK7, CK19, and CA19-9 and negative for CK20, CDX2, CA125, ER, PR, GCDFP-15, synaptophysin, and chromogranin (Table 1). The uninvolved liver was unremarkable and a trichrome stain showed no fibrosis. Following an uneventful postoperative recovery, she was referred for consideration of adjuvant therapy.