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D'Alessandris N, Santoro A, Arciuolo D, Angelico G, Valente M, Scaglione G, Sfregola S, Carlino A, Navarra E, Mulè A, Zannoni GF. What Can Trigger Spontaneous Regression of Breast Cancer? Diagnostics (Basel) 2023; 13:diagnostics13071224. [PMID: 37046442 PMCID: PMC10093529 DOI: 10.3390/diagnostics13071224] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/05/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND Spontaneous regression of tumors is a rare phenomenon in which cancer volume is reduced or, alternatively, a tumor completely disappears in the absence of any pharmacological treatment. This phenomenon has previously been described in several tumors, such as neuroblastomas, testicular malignancies, renal cell carcinomas, melanomas, and lymphomas. Spontaneous remission has also been documented in breast cancer; however, it represents an extremely rare and poorly understood phenomenon, with only a few reported cases in the literature. METHODS We herein report two cases of breast cancer that showed spontaneous tumor regression in the surgical specimen after a pathologically confirmed diagnosis of invasive breast cancer in core needle biopsy samples. RESULTS Macroscopically, both the surgical samples revealed a whitish, fibrous area with a rubbery consistency. On histological examination, diffuse fibrous tissue, hemosiderin deposition, and chronic inflammation were observed. The first case showed the complete disappearance of the tumor, whereas the second case showed just a small (3 mm), residual nest of neoplastic cells. CONCLUSIONS Although spontaneous regression of breast cancer is a rare event, it is important to know that it might happen. It is also of great importance to try to better explain, over time, its underlying mechanism. This knowledge could help us to further develop cancer prevention methods and predict the clinical course of these kinds of neoplasms.
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Affiliation(s)
- Nicoletta D'Alessandris
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Angela Santoro
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Damiano Arciuolo
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giuseppe Angelico
- Department of Medical and Surgical Sciences and Advanced Technologies G. F. Ingrassia, Anatomic Pathology, University of Catania, 95123 Catania, Italy
| | - Michele Valente
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Giulia Scaglione
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Stefania Sfregola
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Angela Carlino
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Elena Navarra
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Antonino Mulè
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Gian Franco Zannoni
- Pathology Unit, Department of Woman and Child's Health and Public Health Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
- Pathology Institute, Catholic University of Sacred Heart, 00168 Rome, Italy
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Acar E, Esendağlı G, Yazıcı O, Dursun A. Tumor-Infiltrating Lymphocytes (TIL), Tertiary Lymphoid Structures (TLS), and Expression of PD-1, TIM-3, LAG-3 on TIL in Invasive and In Situ Ductal Breast Carcinomas and Their Relationship with Prognostic Factors. Clin Breast Cancer 2022; 22:e901-e915. [PMID: 36089459 DOI: 10.1016/j.clbc.2022.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 08/03/2022] [Accepted: 08/14/2022] [Indexed: 01/25/2023]
Abstract
INTRODUCTION Immunotherapy has been determined as an important choice in breast carcinomas, especially in tumors with markedly inflammatory response. About this promising subject, tumor-infiltrating lymphocytes (TIL) and the expression of immune control point receptors on TIL have gained importance. MATERIALS AND METHODS In this study, stromal TIL and tertiary lymphoid structures (TLS) were determined in tumor tissues of 312 invasive and 68 in situ breast cancer patients. Expression rates of PD-1, LAG-3, and TIM-3 on intratumoral and stromal TIL were immunohistochemically evaluated. RESULTS In invasive breast carcinomas, stromal TIL was found to be significantly associated with lymph node metastasis, HR and HER2 expression, and basal-like phenotype, as the presence of TLS with neoadjuvant therapy, recurrence, death, and expression of HR and HER2. PD-1, LAG-3, and TIM-3 expressions were found to be associated with HR and HER2 status, stromal TIL rates, and TLS. In multivariate analysis, high stromal TIL and PD-1 expression in intratumoral TIL were found to be independent prognostic factors in terms of overall survival and disease-free survival. CONCLUSION Evaluation of TIL and immune control point receptor expressions in breast cancer is particularly important in terms of planning the therapeutic approaches based on immunotherapy protocols.
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Affiliation(s)
- Elif Acar
- Department of Medical Pathology, Ömer Halis Demir University, Niğde, Turkey.
| | - Güldal Esendağlı
- Department of Medical Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ozan Yazıcı
- Department of Medical Oncology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ayşe Dursun
- Department of Medical Pathology, Gazi University Faculty of Medicine, Ankara, Turkey
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Akashi M, Yamaguchi R, Kusano H, Obara H, Yamaguchi M, Toh U, Akiba J, Kakuma T, Tanaka M, Akagi Y, Yano H. Diverse histomorphology of HER2‐positive breast carcinomas based on differential ER expression. Histopathology 2020; 76:560-571. [DOI: 10.1111/his.14003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 09/22/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Momoko Akashi
- Department of Pathology Kurume University School of Medicine Kurume Fukuoka Japan
- Department of Surgery Kurume University School of Medicine Kurume Fukuoka Japan
| | - Rin Yamaguchi
- Department of Pathology Kurume University School of Medicine Kurume Fukuoka Japan
- Department of Pathology and Laboratory Medicine Kurume University Medical Centre Kurume Fukuoka Japan
| | - Hironori Kusano
- Department of Pathology Kurume University School of Medicine Kurume Fukuoka Japan
| | - Hitoshi Obara
- Biostatistics Centre Kurume University School of Medicine Kurume Fukuoka Japan
| | - Miki Yamaguchi
- Department of Surgery Japan Community Healthcare Organization Kurume General HospitalKurume Fukuoka Japan
| | - Uhi Toh
- Department of Surgery Kurume University School of Medicine Kurume Fukuoka Japan
| | - Jun Akiba
- Department of Diagnostic Pathology Kurume University Hospital Kurume Fukuoka Japan
| | - Tatsuyuki Kakuma
- Biostatistics Centre Kurume University School of Medicine Kurume Fukuoka Japan
| | - Maki Tanaka
- Department of Surgery Japan Community Healthcare Organization Kurume General HospitalKurume Fukuoka Japan
| | - Yoshito Akagi
- Department of Surgery Kurume University School of Medicine Kurume Fukuoka Japan
| | - Hirohisa Yano
- Department of Pathology Kurume University School of Medicine Kurume Fukuoka Japan
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Doyle A, Ryan C, O' Doherty A, Quinn C. Isolated calcification on needle core breast biopsy: A potential pitfall for under diagnosis of ductal carcinoma in situ of the breast. Breast J 2017; 23:762-763. [PMID: 28397332 DOI: 10.1111/tbj.12816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 07/05/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Aoife Doyle
- Histopathology, St James's Hospital, Dublin, Ireland
| | - Ciara Ryan
- Histopathology, St James's Hospital, Dublin, Ireland
| | | | - Cecily Quinn
- St. Vincent's University Hospital, Dublin, Ireland
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Horimoto Y, Hayashi T, Arakawa A. Pathology of healing: what else might we look at? Cancer Med 2016; 5:3586-3587. [PMID: 27781408 PMCID: PMC5224836 DOI: 10.1002/cam4.952] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/22/2016] [Accepted: 09/23/2016] [Indexed: 01/22/2023] Open
Abstract
Several aspects of the article by Morita et al. (Cancer Medicine 5:1607‐18, 2016), examining the spontaneous healing phenomenon with reference to tumor infiltrating lymphocytes (TILs), require clarification. The concept of “healing”, which can perhaps be more accurately termed “regressive change”, remains controversial due to a lack of concrete evidence. Since regressive change is characterized by fibrosis and lymphocytes, a cancer nest that appears to lack a distinct basement membrane, surrounded only by lymphocytes, as in Morita et al's Figure 2F, should be meticulously examined because the appearance may correspond to a tumor having just completed the process of invasion. In our experience, a layer of myoepithelial cells in such foci is often difficult to detect even with immunohistochemistry. Thus, we suggest evaluating the viability of cancer cells within the nest by employing several markers, such as Ki67 and apoptotic markers, to judge whether the tumor is intraductal. It might also be useful to compare cases with versus without regressive change to elucidate the biology of such tumors. For these reasons, a tumor, floating within a pool of TILs and lacking obvious fibrous bands, might be an interesting material to examine in future studies.
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Affiliation(s)
- Yoshiya Horimoto
- Department of Breast Oncology, Juntendo University School of Medicine, Tokyo, Japan.,Department of Pathology and Oncology, Juntendo University School of Medicine, Tokyo, Japan
| | - Takuo Hayashi
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
| | - Atsushi Arakawa
- Department of Human Pathology, Juntendo University School of Medicine, Tokyo, Japan
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Ito E, Nakano S, Otsuka M, Mibu A, Karikomi M, Oinuma T, Yamamoto M. Spontaneous breast cancer remission: A case report. Int J Surg Case Rep 2016; 25:132-6. [PMID: 27372025 PMCID: PMC4929343 DOI: 10.1016/j.ijscr.2016.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 06/04/2016] [Accepted: 06/05/2016] [Indexed: 11/19/2022] Open
Abstract
Spontaneous cancer remission without treatment is a known phenomenon with various types of cancer. Although spontaneous breast cancer remission has been thought to be a rare, this may occurs at a certain rate(not rare phenomenon). When cancer was not detected in the pathological specimen and there were no known biological markers to provide information for the decision regarding adjuvant therapy, observation without further treatment can be option.
Introduction Spontaneous breast cancer remission is a rare phenomenon. We report the disappearance from the remaining breast of a new primary carcinoma that had been confirmed through cytology of a pathological specimen, in a case that is strongly suspected to be spontaneous remission. Presentation of case A 44-year-old woman underwent breast-conserving surgery for a tumor located on the border between the upper-outer and lower-outer quadrants of the left breast (T2, N1, M0; Stage IIB). Eleven years after surgery, computed tomography indicated a mass in the upper-inner quadrant of the left breast. Excisional biopsy was initially planned for treatment following the definitive diagnosis because cytology revealed malignancy. The patient had noticed tumor regression one month after fine-needle aspiration and repeat ultrasonography performed the day before excisional biopsy confirmed the tumor reduction. On pathological examination, no tumor cells were observed in the mass. Discussion There was a discrepancy between FNA cytology and pathological diagnosis in our patient. The cytological findings indicated malignancy, but the pathological findings did not. When a tumor’s pathological diagnosis is not malignant even though its FNA cytology diagnosis was malignant, sampling error, cytological over-diagnosis or some other error may have occurred. In this case, however, these were not detected. Because fibrosis was visible on pathological examination, we believe that these events corresponded to spontaneous remission. Conclusion We report a rare case of spontaneous remission in which the cancer disappeared on pathological examination although the cytological diagnosis had been malignant.
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Affiliation(s)
- Eisaku Ito
- Department of Surgery, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Satoko Nakano
- Department of Surgery, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Masahiko Otsuka
- Department of Surgery, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Akemi Mibu
- Department of Laboratory, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Masahito Karikomi
- Department of Radiology, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan.
| | - Toshinori Oinuma
- Department of Pathology, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan
| | - Masahiro Yamamoto
- Department of Pathology, Kawaguchi Municipal Medical Center, 180 Nishi-Araijyuku, Kawaguchi City, Saitama, 333-0833, Japan.
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Morita M, Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Kanomata N, Naito Y, Akiba J, Hattori S, Minami S, Eguchi S, Yano H. CD8(+) tumor-infiltrating lymphocytes contribute to spontaneous "healing" in HER2-positive ductal carcinoma in situ. Cancer Med 2016; 5:1607-18. [PMID: 27061242 PMCID: PMC4944888 DOI: 10.1002/cam4.715] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 02/29/2016] [Accepted: 03/01/2016] [Indexed: 11/18/2022] Open
Abstract
We evaluated the associations between tumor‐infiltrating lymphocytes (TIL) including CD8‐positive [+] lymphocytes in ductal carcinoma in situ (DCIS) and histopathologic factors, particularly spontaneous “healing” and immunohistochemical (IHC)‐based subtypes, to clarify the effects of host immune response to cancer cells proliferation during early carcinogenesis for the breast cancer. This cohort enrolled 82 DCIS patients. We examined the relationships between clinicopathologic factors including age, DCIS architecture, Van Nuys classification, grade, comedo necrosis, apocrine features, TIL, CD8+ lymphocytes, healing, estrogen receptor and HER2 positivity, and IHC‐based subtypes [luminal, luminal‐HER2, HER2‐positive, triple negative (TN)]. The results were analyzed by univariate and multivariate analyses. High numbers of TIL (high‐TIL) and healing were seen in 30.5% and 39.0% of the cohort, respectively. The distributions of luminal, luminal‐HER2, HER2 and TN subtypes were 73.2%, 9.8%, 13.4%, and 3.6%, respectively. High Van Nuys grading, high‐grade, comedo necrosis, apocrine features, high‐TIL, high CD8+ lymphocytes and healing were significantly associated with HER2‐positive (luminal‐HER2, HER2), and TN subtypes. High‐TIL was significantly associated with high‐grade, comedo necrosis, apocrine features, healing, high CD8+ lymphocytes and HER2 and TN subtypes. Healing was significantly correlated with high CD8+ lymphocytes, high‐grade, comedo necrosis, apocrine features, and HER2‐positive and TN subtypes. Logistic regression analysis revealed a strong association between healing and TIL (odds ratio: 11.72, P = 0.024). High CD8+ lymphocytes was also significantly associated with healing (odds ratio: 9.26, P = 0.009). The results of this study suggested that the spontaneous healing phenomenon might be induced by CD8+ high‐TIL associated with high‐grade, comedo necrosis, apocrine features and HER2‐positive DCIS.
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Affiliation(s)
- Michi Morita
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan.,Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan.,Department of Surgery, Japan Community Health Care Organization Kurume General Hospital, Kurume, Fukuoka, Japan
| | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan.,Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Maki Tanaka
- Department of Surgery, Japan Community Health Care Organization Kurume General Hospital, Kurume, Fukuoka, Japan
| | - Gary M Tse
- Department of Anatomical and Cellular Pathology, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Miki Yamaguchi
- Department of Surgery, Japan Community Health Care Organization Kurume General Hospital, Kurume, Fukuoka, Japan
| | - Naoki Kanomata
- Department of Pathology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - Yoshiki Naito
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Jun Akiba
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Satoshi Hattori
- Department of Biostatistics Center, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Shigeki Minami
- Department of Surgery, Nagasaki Harbor Medical Center City Hospital, Nagasaki, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Hirohisa Yano
- Department of Pathology, Kurume University School of Medicine, Kurume, Fukuoka, Japan
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8
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Morita M, Yamaguchi R, Tanaka M, Tse GM, Yamaguchi M, Otsuka H, Kanomata N, Minami S, Eguchi S, Yano H. Two progressive pathways of microinvasive carcinoma: low-grade luminal pathway and high-grade HER2 pathway based on high tumour-infiltrating lymphocytes. J Clin Pathol 2016; 69:890-8. [DOI: 10.1136/jclinpath-2015-203506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Accepted: 03/07/2016] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Healing is a phenomenon by which the intraductal component of breast cancer disappears and is replaced by fibrous tissue. Focally localized healing often prevents confirmation of the continuity of intraductal carcinoma. OBJECTIVE To clarify the clinicopathological characteristics of breast cancer with healing. PATIENTS AND METHODS At our hospital, 308 patients (311 breasts) underwent breast conservation therapy without neoadjuvant chemotherapy for breast cancer in 2000. These surgical specimens were histopathologically investigated with 5 mm serial sections. We assessed the proportion and the characteristics of breast cancer with healing. RESULTS (1) The proportion of breast cancer with healing was 7% (21/311). (2) In the 21 patients, the mean age was 59.2 years, and the mean diameter was 2.8 cm. (3) The histological type of the breast cancer varied: noninvasive ductal carcinoma in 2 cases, papillotubular carcinoma in 5, solid-tubular carcinoma in 8, scirrhous carcinoma in 5, invasive lobular carcinoma in 1, and Paget's disease in 1. However in all cases, the histologic type of the intraductal carcinoma foci was the comedo/solid type and the nuclear grade of cancer cells was high. (4) In cases with healing, areas of healing were seen in an average of 5 (1-26) blocks, compared with intraductal carcinoma foci in 13 blocks (2-40). Healing was located on the nipple side of the main lesion in 8 cases, the peripheral side in 9, and both sides in 4. In 3 cases, healing was seen at the surgical margin of the partial mastectomy specimen. CONCLUSION The proportion of breast cancer cases with healing was 7% and these cases were intraductal carcinoma of the comedo/solid type, consisting of highly malignant cancer cells.
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Affiliation(s)
- Rie Horii
- Department of Breast Pathology, the Cancer Institute of the Japanese Foundation for Cancer Research, 3-10-6, Ariake, Koto-ku, Tokyo 135-8550, Japan.
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Silverstein MJ. Prognostic Factors and Local Recurrence in Patients with Ductal Carcinoma In Situ of the Breast. Breast J 2003. [DOI: 10.1046/j.1524-4741.1998.450349.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Sneige N, McNeese MD, Atkinson EN, Ames FC, Kemp B, Sahin A, Ayala AG. Ductal carcinoma in situ treated with lumpectomy and irradiation: histopathological analysis of 49 specimens with emphasis on risk factors and long term results. Hum Pathol 1995; 26:642-9. [PMID: 7774895 DOI: 10.1016/0046-8177(95)90170-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Forty-nine women with ductal carcinoma in situ (DCIS) treated with lumpectomy and irradiation were studied retrospectively. The median age was 50 years (range, 29 to 73 years) and the median follow-up time from initiation of therapy was 86 months (range, 17 to 230 months). Twelve patients presented with palpable masses (0.4 to 4 cm), three with breast thickening, and three with nipple discharge. In 31 patients the tumors were detected by mammography. Intraoperatively, excision of lesions was confirmed by specimen x-ray (38 specimens) or gross inspection (five specimens) and was recorded to be complete. No record was available in the other six patients. Margins of excision free of DCIS were microscopically confirmed in 25 specimens. The size of impalpable DCIS lesions recorded in 25 patients ranged from 0.4 to 5.0 cm (mean, 1.5 cm). Using Lagios' classification system, there were 18 classic comedocarcinomas, high nuclear grade (NG) with necrosis; seven cribriform/papillary, high NG with necrosis; 17 cribriform/micropapillary, intermediate NG with or without necrosis; and seven cribriform/micropapillary, low NG without necrosis. In two patients residual malignant calcifications were present on the postoperative mammogram. Disease recurred in the treated breast at the site of incision in five patients at 18 months and 8, 11, and 12 (two patients) years from initial therapy. The rate of local disease recurrence was 2% at 5 years and 6% at 10 years; three recurrences showed invasive ductal carcinoma and two were DCIS. To evaluate risk factors the following characteristics were considered: necrosis, NG, histological type, periductal fibrosis, periductal lymphoid infiltrate, margin status, age, and method of tumor detection. The end points chosen were recurrence and death from any cause (because only one patient died of disease). Although the recurrences were attributed to residual disease in two patients, of the clinical and pathological parameters evaluated, only periductal fibrosis showed a significant relationship with outcome, with a P value < or = .05 by the Wilcoxon test. On the other hand, using the proportional hazards model, necrosis was a significant predictor for recurrence (P = .02), as was the pair fibrosis and tumor detection when taken together (P = .05). Fibrosis significantly associated with high NG, Lagios' histological subtypes I and II, periductal lymphoid infiltrate, and necrosis (P < or = .0006).(ABSTRACT TRUNCATED AT 400 WORDS)
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MESH Headings
- Adult
- Aged
- Breast Neoplasms/pathology
- Breast Neoplasms/radiotherapy
- Breast Neoplasms/surgery
- Carcinoma in Situ/pathology
- Carcinoma in Situ/radiotherapy
- Carcinoma in Situ/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/radiotherapy
- Carcinoma, Ductal, Breast/surgery
- Combined Modality Therapy
- Female
- Fibrosis
- Follow-Up Studies
- Humans
- Mastectomy, Segmental
- Middle Aged
- Necrosis
- Neoplasm Recurrence, Local/pathology
- Neoplasm Recurrence, Local/radiotherapy
- Neoplasm Recurrence, Local/surgery
- Retrospective Studies
- Risk Factors
- Treatment Outcome
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Affiliation(s)
- N Sneige
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA
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Fisher ER, Anderson S, Redmond C, Fisher B. Pathologic findings from the National Surgical Adjuvant Breast Project protocol B-06. 10-year pathologic and clinical prognostic discriminants. Cancer 1993; 71:2507-14. [PMID: 8453574 DOI: 10.1002/1097-0142(19930415)71:8<2507::aid-cncr2820710813>3.0.co;2-0] [Citation(s) in RCA: 215] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Prognostic pathologic and clinical features for 10-year survival were determined from 22 pathologic and 5 clinical variables encountered in 1090 node-negative and 651 node-positive patients enrolled in NSABP protocol B-06. METHODS All factors were first screened univariately. Those exhibiting P values < 0.01 were entered into multivariate Cox regression models. The model with the best fit consisted of 951 negative-node and 496 node-positive patients. RESULTS Better survival in node-negative patients was noted for whites rather than blacks, for patients with favorable tumor types (tubular, mucinous, papillary) rather than intermediate (lobular invasive, classical medullary, and not otherwise specified [NOS] combinations) or unfavorable forms (NOS pure and atypical medullary), and for tumors with good rather than poor nuclear grade. Number of nodal metastases, degree of tumor elastosis, and patient age younger than 40 years of age and 65 years of age and older in addition to nuclear grade and race were found significant for node-positive patients. Relative risks for combinations of these prognostic factors were multiplicative. CONCLUSIONS The prognostic factors for node-negative patients were similar to those observed for this cohort at 8 years. Some differences noted between patients of both nodal groups in NSABP B-04 and B-06 may be related to selection requirements in the latter and hence different patient characteristics or more speculatively a change in tumor biology.
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Affiliation(s)
- E R Fisher
- Headquarters National Surgical Adjuvant Breast Project, Shadyside Hospital, Pennsylvania
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Bellamy CO, McDonald C, Salter DM, Chetty U, Anderson TJ. Noninvasive ductal carcinoma of the breast: the relevance of histologic categorization. Hum Pathol 1993; 24:16-23. [PMID: 8380275 DOI: 10.1016/0046-8177(93)90057-n] [Citation(s) in RCA: 200] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A consecutive series of 130 review-confirmed cases of noninvasive ductal carcinoma of breast (DCIS) in women without previous breast carcinoma was analyzed. Histologic variables assessed included histologic pattern, nuclear grade, necrosis, and involved duct counts. These were correlated with presentation, extent of DCIS in the breast, completeness of excision, and outcome. Comedo DCIS had an occult presentation significantly more often than noncomedo DCIS. Micropapillary DCIS was significantly more likely than other patterns to involve multiple quadrants of breast, irrespective of nuclear grade or necrosis. Solid DCIS was significantly more often completely excised when compared with all other patterns, while high-grade DCIS was significantly more often incompletely excised compared with low-grade DCIS. Follow-up showed invasive recurrence in 16% of cases treated by primary local excision only and 3% cases treated by mastectomy or with re-excision. Of local excision cases with follow-up longer than 3 years, 22% had invasive recurrence. Invasive recurrence only followed high-grade DCIS and most often followed comedo DCIS. The need for strict definition of categories of DCIS is stressed.
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Affiliation(s)
- C O Bellamy
- Department of Pathology, University of Edinburgh, Scotland
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Affiliation(s)
- L Weiss
- Department of Experimental Pathology, Roswell Park Memorial Institute, Buffalo, New York 14263
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Tamimi SO, Ahmed A. Stromal changes in early invasive and non-invasive breast carcinoma: an ultrastructural study. J Pathol 1986; 150:43-9. [PMID: 3023597 DOI: 10.1002/path.1711500108] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Six examples of histologically diagnosed, non-invasive breast carcinomas were studied by electron microscopy to elucidate the ultrastructural features for an accurate diagnosis of in situ carcinoma. The results obtained revealed two patterns of basal lamina/stromal cells relationship. One pattern showed intact basal lamina with associated periductal stromal cells consisting entirely of fibroblasts, the other pattern showed disruption of basal lamina by gaps and malignant cell protrusions with associated stromal cells consisting of both fibroblasts and myofibroblasts. As myofibroblasts are not a component of normal breast stroma but are known to be a prominent feature in the stroma of infiltrating breast carcinoma, the present observations suggest that myofibroblastic proliferation around in situ carcinoma represents an early sign of carcinomatous infiltration. Hence the definitive diagnosis of non-invasive carcinoma of the breast requires an intact basal lamina and a complete absence of a myofibroblastic reaction.
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Fisher ER, Sass R, Fisher B, Wickerham L, Paik SM. Pathologic findings from the National Surgical Adjuvant Breast Project (protocol 6). I. Intraductal carcinoma (DCIS). Cancer 1986; 57:197-208. [PMID: 3002577 DOI: 10.1002/1097-0142(19860115)57:2<197::aid-cncr2820570203>3.0.co;2-n] [Citation(s) in RCA: 220] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Seventy-eight examples of intraductal carcinoma (DCIS) were identified after pathologic review of 2072 specimens obtained from National Surgical Adjuvant Breast Project protocol 6. This randomized clinical trial compares the therapeutic merit of total mastectomy (TM) with lumpectomy (L), with (LX) and without (LO) postoperative irradiation. All patients were subjected to axillary lymph node dissection. Seven (14%) of the 51 patients with DCIS treated by L exhibited breast recurrence within or close to the site of the initial lesion 4 to 53 months (average, 16 months) after L. Only 2 (7%) of these events occurred in the 29 women treated by LX, as opposed to 23% in the LO group. No pathologic features were noticed that might have been considered predictive of local breast recurrence. The three DCIS recurrences and the four invasive forms noted are considered to represent overlooked or incompletely excised foci of cancer because of the multifocality (not multicentricity) of some breast cancers. The possibility that DCIS may represent a marker of risk for the development of cancer rather than a precursor lesion per se is suggested. Despite apparent difficulties in the pathologic diagnosis of DCIS as well as uncertainty concerning its natural history, no evidence was found to indicate that it represents a more ominous disease than invasive cancer. Indeed, treatment failure occurred in only one patient treated by LX and a similar number subjected to TM (4% versus 2%). Although these observations are short term (average follow-up, 39 months), estimates of the probability of local recurrence or survival suggest that they will not be significantly altered after longer periods of surveillance. Thus, there are no compelling reasons why DCIS may not be treated in a cosmetically acceptable manner by LX. A randomized clinical trial addressing this issue is now in progress.
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Sheffer DB, Price TE, Loughry CW, Bolyard BL, Morek WM, Varga RS. Validity and reliability of biostereometric measurement of the human female breast. Ann Biomed Eng 1986; 14:1-14. [PMID: 3706852 DOI: 10.1007/bf02364645] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
A measurement technique has been developed for application in the area of noninvasive breast cancer detection. The measurement process involves the use of close-range stereophotogrammetry as a data acquisition device necessary for determination of breast volume and volume distribution. This report details the methodology used to acquire and analyze stereopair photographs necessary to document the validity and reliability of this application. The volume of a test object was determined by both water displacement and stereophotogrammetric analysis to estimate the precision of the proposed methodology. Additionally, the reliability component of the study was documented by analyzing variability of coordinates representing a series of locations marked on the surface of an irregularly shaped object. Both tests confirm that this stereometric analysis is a reliable and valid method of measurement and may be well suited for further development in the field of breast cancer detection.
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Anastassiades OT, Bouropoulou V, Kontogeorgos G, Tsakraklides EV. Duct elastosis in infiltrating carcinoma of the breast. Pathol Res Pract 1979; 165:411-21. [PMID: 530894 DOI: 10.1016/s0344-0338(79)80033-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Duct elastosis was studied in 219 patients subjected to radical mastectomy for infiltrating carcinoma of the breast, with a 10-year follow-up. Duct elastosis is a frequent finding in infiltrating breast cancer (65% of our cases). It develops in tumors of all three grades of malignancy, but it is more frequent in tumors of low grade malignancy (76% and 74% in grades I and II, respectively, and 47% in grade III tumors). In spite of their greater incidence in low malignancy tumors, the elastotic cases have a greater metastatic ratio than the non-elastotic cases (66% vs 45%). The elastotic cases also contain a significantly greater proportion of scirrhous tumors than the non-elastotic cases (86% vs. 32%). Duct elastosis and scirrhous reaction are two processes which develop in parallel, but are not related etiologically. They seem to be correlated with more advanced stages of the neoplastic disease. The influence of duct elastosis upon the ten year survival of the patients is unfavorable. this influence is not direct, and it is particularly evident in the metastatic cases. It seems to be related to the greater duration of the neoplastic disease and to the slow clinical course of tumors of low degree of malignancy.
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Martinez-Hernandez A, Francis DJ, Silverberg SG. Elastosis and other stromal reactions in benign and malignant breast tissue: an ultrastructural study. Cancer 1977; 40:600-6. [PMID: 196733 DOI: 10.1002/1097-0142(197708)40:2<700::aid-cncr2820400217>3.0.co;2-w] [Citation(s) in RCA: 44] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The stroma and stromal reaction in normal breast, benign, and malignant breast tissue was studied by electron microscopy. Elastosis is the main stromal response in infiltrating duct and lobular carcinomas. Medullary carcinoma elicits no significant elastosis but intraductal carcinoma has significant local elastosis. Benign conditions such as fibroadenoma and sclerosing adenosis produced no significant elastosis. The high number of elastic fibers and the high microfibril:elastin ratio indicate that most of the elastic fibers are recently secreted, probably by fibroblasts and myofibroblasts. The factors stimulating the increased production of elastic fibers and the prognostic significance of elastosis remain unclear.
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Fisher ER, Gregorio RM, Fisher B, Redmond C, Vellios F, Sommers SC. The pathology of invasive breast cancer. A syllabus derived from findings of the National Surgical Adjuvant Breast Project (protocol no. 4). Cancer 1975; 36:1-85. [PMID: 173455 DOI: 10.1002/1097-0142(197507)36:1<1::aid-cncr2820360102>3.0.co;2-4] [Citation(s) in RCA: 625] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The inter-relationships of 32 pathologic and 7 clinical parameters encountered in the study of 1000 examples of invasive breast carcinoma have been presented. In some instances the biological significance of these associations is at present unclear. In others it is to be noted that there is no information provided as to the rank of their significance. Nevertheless, the associations that were encountered not only help further characterize the various forms of breast cancer but also provide information regarding the possible biological significance of some of their features. Although it is not our intention to minimize the possible significance of the inter-relationships of pathologic parameters, most emphasis in the summarizing statements which follow has been placed upon those correlations which may relate to prognosis. In this regard reference has been made to short-term treatment failure, vis a vis local recurrence and/or metastases, which may not necessarily accurately reflect patient survival, although generally such a relationship exists. Information in this regard as well as to the rank of the significance of these pathologic features shall be forthcoming when sufficient time has elapsed since the inception of this study to allow for such conclusions, i.e. survival or long-term treatment failure rates. Lastly, it becomes evident that the guidelines followed in the examination of these specimens appear to represent at least the minimum requirements necessary for a meaningful pathologic evaluation of breast carcinoma.
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Bussolati G, Pich A, Alfani V. Immunofluorescence detection of casein in human mammary dysplastic and neoplastic tissues. VIRCHOWS ARCHIV. A, PATHOLOGICAL ANATOMY AND HISTOLOGY 1975; 365:15-21. [PMID: 164730 DOI: 10.1007/bf00439282] [Citation(s) in RCA: 37] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
To detect and localize casein in human mammary dysplastic and neoplastic tissues, an indirect immunofluorescence method has been devised. Anti-casein antibodies have been obtained from rabbits immunized with casein isolated from human milk. Cryostat sections post-fixed in alcohol and paraffin sections from routinely formalin-fixed tissues proved suitable. The immuno-fluorescence method revealed the presence of casein in epithelial cells in mammary dysplasia and in some, but not all, cases of carcinoma of the breast. Well differentiated (Grade I) carcinomas were shown to contain casein, mainly localized at the inner border of the epithelial cells; the milk protein was present also in cells metastatic in lymph nodes. In Paget's disease of the nipple, casein could be detected in neoplastic cells in the ducts and also in cells identifiable with the typical intra-epidermal Paget cells. This finding is evidence of a functional differentiation of Paget cells along lines proper to the mammary epithelium.
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Davies JD. Hyperelastosis, obliteration and fibrous plaques in major ducts of the human breast. J Pathol 1973; 110:13-26. [PMID: 4124885 DOI: 10.1002/path.1711100103] [Citation(s) in RCA: 38] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Jeffcoate TNA, Davie TB, Harrison CV. Intra-Epidermal Carcinoma (Bowen's Disease) of the Vulva. (A Report on Two Cases). BJOG 1944. [DOI: 10.1111/j.1471-0528.1944.tb07357.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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