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Martelli G, Barretta F, Vernieri C, Folli S, Pruneri G, Segattini S, Trapani A, Carolla C, Spatti G, Miceli R, Ferraris C. Prophylactic Salpingo-Oophorectomy and Survival After BRCA1/2 Breast Cancer Resection. JAMA Surg 2023; 158:1275-1284. [PMID: 37792368 PMCID: PMC10551816 DOI: 10.1001/jamasurg.2023.4770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 07/26/2023] [Indexed: 10/05/2023]
Abstract
Importance Few studies have investigated whether prophylactic salpingo-oophorectomy (PSO) for patients with previously resected breast cancer who carry pathogenic germline BRCA1 or BRCA2 variants is associated with a reduced risk of cancer-specific death. Objective To assess the association of PSO and prophylactic mastectomy (PM) with prognosis after quadrantectomy or mastectomy as primary treatment for patients with BRCA1 or BRCA2 breast cancer. Design, Setting, and Participants This retrospective cohort study was performed in a single-institution, tertiary referral center. Consecutive patients with invasive breast cancer treated surgically between 1972 and 2019 were recruited and followed up prospectively after they were found to carry the BRCA1 or BRCA2 gene variant. The data analysis was performed between April 2022 and July 2023. Exposure Following breast surgery, some patients underwent PSO, PM, or both, whereas others did not. Main Outcomes and Measures The primary study end point was overall survival as measured by the Kaplan-Meier method. Secondary end points were crude cumulative incidence of breast cancer-specific mortality, ipsilateral breast tumor recurrence (IBTR), contralateral breast cancer, ovarian cancer, and ovarian cancer-specific mortality. Results Of 480 patients included in the cohort (median age at initial surgery, 40.0 years; IQR, 34.0-46.0 years), PSO was associated with a significantly reduced risk of death (hazard ratio [HR], 0.40; 95% CI, 0.25-0.64; P < .001). This reduction was most evident for patients carrying the BRCA1 variant (HR, 0.35; 95% CI, 0.20-0.63; P = .001), those with triple-negative disease (HR, 0.21; 95% CI, 0.09-0.46; P = .002), and those with invasive ductal carcinoma (HR, 0.51; 95% CI, 0.31-0.84; P = .008). Prophylactic salpingo-oophorectomy was not associated with risk of contralateral breast cancer or IBTR. Initial or delayed PM was associated with a reduced risk of IBTR but not with overall survival or breast cancer-specific mortality. Conclusions The study findings suggest that PSO should be offered to all patients with BRCA1/2 breast cancer who undergo surgery with curative intent to reduce risk of death. In particular, PSO should be offered to patients with the BRCA1 variant at the time of breast surgery.
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Affiliation(s)
- Gabriele Martelli
- Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesco Barretta
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Vernieri
- Breast Unit, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM ETS, the AIRC Foundation of Molecular Oncology, Milan, Italy
| | - Secondo Folli
- Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giancarlo Pruneri
- Breast Unit, Pathology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- Oncology and Hemato-Oncology Department, University of Milan, Milan, Italy
| | | | - Anna Trapani
- Unit of Surgical Oncology, Humanitas Institute, Catania, Italy
| | - Claudia Carolla
- Department of Surgical and Oncological Sciences, Policlinico P. Giaccone, University of Palermo, Italy
| | - Gianbattista Spatti
- Unit of Gynecological Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Rosalba Miceli
- Department of Biostatistics for Clinical Research, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Cristina Ferraris
- Breast Unit, Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Mremi A, Gnanamuttupulle M, Ntundu SH, Henke O, Chilonga K, Msuya D. Invasive breast carcinoma of no special type with medullary pattern: A case report at a tertiary facility in Tanzania. Clin Case Rep 2023; 11:e7844. [PMID: 37621722 PMCID: PMC10444943 DOI: 10.1002/ccr3.7844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/31/2023] [Accepted: 08/08/2023] [Indexed: 08/26/2023] Open
Abstract
Key Clinical Message Describes a rare form of invasive breast cancer of no special type.Not a distinct morphological subtype.Characterized by dense lymphoid infiltrate, syncytial growth, pushing borders, and cells with high-grade nuclei.Clinically aggressive but carries a better prognosis than other more frequent invasive breast carcinomas. Abstract Invasive breast carcinoma of no special type with medullary pattern (BCNST-MP) is a rare form of breast tumor, accounting for less than 5% of all invasive breast carcinomas. Its diagnosis is based on histologic criteria. Historically, this tumor was known as medullary carcinoma. Poor morphological reproducibility led to re-classification. Despite having an aggressive biological behavior, these tumors usually carry a better prognosis compared with other more frequent forms of invasive breast carcinomas. Herein, we present a case of BCNST-MP in a 58-year-old African female, successfully treated in our institution through chemo-radiation, hormonal therapy and surgery.
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Affiliation(s)
- Alex Mremi
- Department of PathologyKilimanjaro Christian Medical CentreMoshiTanzania
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
| | - Marianne Gnanamuttupulle
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical CentreMoshiTanzania
| | | | - Oliver Henke
- Cancer Care CanterKilimanjaro Christian Medical CentreMoshiTanzania
- Section Global Health, Institute for Hygiene and Public HealthUniversity Hospital BonnBonnGermany
| | - Kondo Chilonga
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical CentreMoshiTanzania
| | - David Msuya
- Faculty of MedicineKilimanjaro Christian Medical University CollegeMoshiTanzania
- Department of General SurgeryKilimanjaro Christian Medical CentreMoshiTanzania
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Liu G, Kong X, Dai Q, Cheng H, Wang J, Gao J, Wang Y. Clinical Features and Prognoses of Patients With Breast Cancer Who Underwent Surgery. JAMA Netw Open 2023; 6:e2331078. [PMID: 37624596 PMCID: PMC10457722 DOI: 10.1001/jamanetworkopen.2023.31078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/20/2023] [Indexed: 08/26/2023] Open
Abstract
Importance Breast cancer (BC) remains a pervasive malignant neoplasm worldwide, with increasing incidence. However, there are a scarcity of studies examining the clinical characteristics and prognosis of Chinese patients with BC who have undergone surgery. Objective To evaluate overall survival (OS) and disease-free survival (DFS) in patients with surgically treated BC in China, focusing on histopathology and surgical approach. Design, Setting, and Participants This cohort study included a retrospective review of the medical records of patients with unilateral BC who underwent surgery between January 2009 and September 2017, with a median follow-up time of 7.69 years. Clinical features were extracted from these records, and survival analysis was performed. Data analysis was conducted in March 2023. Main Outcomes and Measures Patients' OS and DFS. Results The study included 14 782 patients (14 724 [99.6%] female patients; mean [SD] age, 51.6 [10.9] years). Invasive ductal carcinoma (IDC) was the most prevalent type, observed in 12 671 patients (85.6%). Stages 0, I, II, III, and IV accounted for 6.4% (919 patients), 32.0% (4579 patients), 40.5% (5791 patients), 20.2% (2896 patients), and 0.9% (126 patients) of cases, respectively. Hormone receptor (HR) positivity was observed in 10 241 patients (75.1%), and 3665 (29.1%) tested positive for ERBB2 (formerly HER2/neu). The HR-negative-ERBB2-negative, HR-negative-ERBB2-positive, HR-positive-ERBB2-negative, and HR-positive-ERBB2-positive subtypes constituted 13.3% (1666 patients), 12.7% (1595 patients), 57.8% (7251 patients), and 16.2% (2034 patients) of cases, respectively. Breast-conserving surgery (BCS) was performed in 2884 patients (19.5%). The 5-year and 10-year OS rates were 92.9% (13 689 of 14 732) and 87.4% (3287 of 3760), while the 5-year and 10-year DFS rates were 89.0% (12 916 of 14 512) and 82.9% (3078 of 3713), respectively. Multivariate analysis found that for patients with IDC, age, BCS, invasive tumor size, tumor grade, lymphovascular invasion (LVI), the number of lymph node metastases (LNMs), distant metastasis, Ki67, and HR status were associated with OS, whereas invasive tumor size, tumor grade, LVI, the number of LNMs, HR status, and ERBB2 status were associated with DFS. After propensity score matching, BCS was equivalent to mastectomy with respect to survival in patients with IDC. Conclusions and Relevance This cohort study of patients with BC who underwent surgery in China provides valuable insights into the histopathological characteristics and survival outcomes of this population. The diverse histopathological features emphasize the necessity for customized treatment strategies. The relatively low BCS rate in the study population suggests the need for heightened awareness and adoption of this approach, considering its potential advantages for survival.
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Affiliation(s)
- Gang Liu
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiangyi Kong
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qichen Dai
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Han Cheng
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jidong Gao
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital and Shenzhen Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Shenzhen, China
| | - Yipeng Wang
- Department of Breast Surgical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Chen H, Pu S, Wang L, Zhang H, Yan Y, He J, Zhang J. A risk stratification model to predict chemotherapy benefit in medullary carcinoma of the breast: a population-based SEER database. Sci Rep 2023; 13:10704. [PMID: 37400489 DOI: 10.1038/s41598-023-37915-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 06/29/2023] [Indexed: 07/05/2023] Open
Abstract
Whether patients with medullary breast carcinoma (MBC) receive chemotherapy is controversial. Therefore, the aim of our study was to screen out patients with MBC who benefit from chemotherapy. We enrolled 618 consecutive patients with MBC from The Surveillance, Epidemiology, and End Results (SEER) database (2010-2018). Cox regression analysis was used to identify independent prognostic factors. Next, a nomogram was constructed and evaluated using calibration plots and the area under the curve (AUC) of receiver operating characteristic (ROC) curves. Kaplan‒Meier curves were used to evaluate the overall survival (OS) benefit of chemotherapy in different risk groups. A total of 618 MBC patients were involved in our study, and an 8:2 ratio was used to randomly split them into a training cohort (n = 545) and a validation cohort (n = 136). Next, a nomogram predicting 3- and 5-year OS rates was constructed based on the five independent factors (age at diagnosis, T stage, N status, subtype and radiation). The nomogram AUCs for 3- and 5-year OS (training set: 0.793 and 0.797; validation set: 0.781 and 0.823) and calibration plots exhibited good discriminative and predictive ability. Additionally, a novel risk classification system for MBC patients demonstrated that we do not have enough evidence to support the benefit effect of chemotherapy for the high-risk group as the result is not statistically significant (total population: p = 0.180; training set: p = 0.340) but could improve OS in the low-risk group (total population: p = 0.001; training set: p = 0.001). Our results suggested that chemotherapy should be selected more carefully for high-risk groups based on a combination of factors and that the possibility of exemption from chemotherapy should be confirmed by more clinical trials in the future.
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Affiliation(s)
- Heyan Chen
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Shengyu Pu
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Lizhao Wang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Huimin Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Yu Yan
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China
| | - Jianjun He
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
| | - Jian Zhang
- Department of Breast Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, 277 West Yanta Road, Xi'an, 710061, Shaanxi, China.
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Shea EKH, Koh VCY, Tan PH. Invasive breast cancer: Current perspectives and emerging views. Pathol Int 2020; 70:242-252. [PMID: 32039524 DOI: 10.1111/pin.12910] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 01/21/2020] [Indexed: 12/18/2022]
Abstract
Invasive breast cancer constitutes a heterogeneous group of tumors. They comprise various histological types that differ in clinical presentation, imaging features, histopathological characteristics, biomarker profiles, prognostic and predictive parameters. The current classification of invasive breast cancer is based primarily on histopathological features. Invasive carcinoma of no special type accounts for the majority, with some rare entities also being described. With recent research and advances, there are emerging concepts, including new genetic insights of invasive breast cancer and the role of the stromal microenvironment. With greater understanding of the pathogenesis of invasive breast cancer, changes based on the correlation of histologic and genetic findings have been incorporated in the latest World Health Organization classification of breast tumors. Medullary carcinomas are subsumed as invasive carcinoma of no special type with basal-like and medullary features, regarded as part of the spectrum of tumor infiltrating lymphocyte-rich breast cancers. Tall cell carcinoma with reversed polarity is proposed as a distinct entity in recognition of unique IDH2 mutations. This article reviews conventional prognostic parameters, new histological entities, and updates on breast cancer classification, with inclusion of some genetic insights into breast cancer and the role of tumor infiltrating lymphocytes.
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Affiliation(s)
- Eric Ka Ho Shea
- Department of Clinical Pathology, Tuen Mun Hospital, Tuen Mun, Hong Kong.,Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Valerie Cui Yun Koh
- Department of Anatomical Pathology, Singapore General Hospital, Singapore, Singapore
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore, Singapore
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Ntekim AI, Folasire AM, Ali-Gombe M. Survival pattern of rare histological types of breast cancer in a Nigerian institution. Pan Afr Med J 2019; 34:114. [PMID: 31934255 PMCID: PMC6945379 DOI: 10.11604/pamj.2019.34.114.16925] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 12/12/2018] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION breast cancer is the most common cancer affecting women worldwide. It is a heterogeneous disease with diverse histological types that are associated with different natural history and response to therapy. Invasive ductal and lobular carcinoma are the most common histological types. There are rare histological types with different biological behaviours from the common types, although treatment approaches are the same. Data on rare histological types of breast cancer in our population are scarce raising the need to identify these patients and document their treatment outcome. The objectives of this study are to determine the proportion and treatment outcomes of breast cancer patients with rare histological types. METHODS this was an observational retrospective study using records of patients treated for breast cancer at the University College Hospital Ibadan Nigeria from 2008 to 2012. Patients with rare histological types were selected for further analysis. Data on patient and tumour characteristics were extracted and five-year survival pattern was determined using Kaplan Meier method. RESULTS the total number of patients with breast cancer was 761. Thirty-two (4.2%) had rare histology that consisted of medullary carcinoma 14(1.9%), mucinous carcinoma 10(1.4%) and 2(0.3%) each for squamous cell carcinoma, stromal sarcoma, cribriform carcinoma and Paget's disease. The overall five-year survival was 50% with median survival of 52 months. CONCLUSION the proportion of breast cancer patients with rare histology is low similar to other reports among Caucasians. Medullary adenocarcinoma was the most common subtype followed by mucinous adenocarcinoma.
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Affiliation(s)
- Atara Isaiah Ntekim
- Department of Radiation Oncology, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Musa Ali-Gombe
- Department of Radiology, Gombe State University, Gombe, Nigeria
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Romero P, Benhamo V, Deniziaut G, Fuhrmann L, Berger F, Manié E, Bhalshankar J, Vacher S, Laurent C, Marangoni E, Gruel N, MacGrogan G, Rouzier R, Delattre O, Popova T, Reyal F, Stern MH, Stoppa-Lyonnet D, Marchiò C, Bièche I, Vincent-Salomon A. Medullary Breast Carcinoma, a Triple-Negative Breast Cancer Associated with BCLG Overexpression. THE AMERICAN JOURNAL OF PATHOLOGY 2018; 188:2378-2391. [PMID: 30075151 DOI: 10.1016/j.ajpath.2018.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/15/2018] [Accepted: 06/19/2018] [Indexed: 02/06/2023]
Abstract
Medullary breast carcinoma (MBC) is a rare subtype of triple-negative breast cancer with specific genomic features within the spectrum of basal-like carcinoma (BLC). In this study of 19 MBCs and 36 non-MBC BLCs, we refined the transcriptomic and genomic knowledge about this entity. Unsupervised and supervised analysis of transcriptomic profiles confirmed that MBC clearly differs from non-MBC BLC, with 92 genes overexpressed and 154 genes underexpressed in MBC compared with non-MBC BLC. Immunity-related pathways are the most differentially represented pathways in MBC compared with non-MBC BLC. The proapoptotic gene BCLG (official name BCL2L14) is by far the most intensely overexpressed gene in MBC. A quantitative RT-PCR validation study conducted in 526 breast tumors corresponding to all molecular subtypes documented the specificity of BCLG overexpression in MBC, which was confirmed at the protein level by immunohistochemistry. We also found that most MBCs belong to the immunomodulatory triple-negative breast cancer subtype. Using pan-genomic analysis, it was found that MBC harbors more losses of heterozygosity than non-MBC BLC. These observations corroborate the notion that MBC remains a distinct entity that could benefit from specific treatment strategies (such as deescalation or targeted therapy) adapted to this rare tumor type.
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Affiliation(s)
- Pierre Romero
- Department of Pathology, Institut Curie, PSL Research University, Paris, France.
| | - Vanessa Benhamo
- INSERM U934, Institut Curie, PSL Research University, Paris, France; Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Gabrielle Deniziaut
- Department of Pathology, Institut Curie, PSL Research University, Paris, France
| | - Laetitia Fuhrmann
- Department of Pathology, Institut Curie, PSL Research University, Paris, France; INSERM U934, Institut Curie, PSL Research University, Paris, France
| | - Frédérique Berger
- Unit of Biometry, INSERM U900, Institut Curie, PSL Research University, Paris, France
| | - Elodie Manié
- INSERM U934, Institut Curie, PSL Research University, Paris, France
| | | | - Sophie Vacher
- Pharmacogenomics Unit, Department of Genetics, Institut Curie, PSL Research University, Paris, France
| | - Cécile Laurent
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Elisabetta Marangoni
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | - Nadège Gruel
- INSERM U934, Institut Curie, PSL Research University, Paris, France; Department of Translational Research, Institut Curie, PSL Research University, Paris, France
| | | | - Roman Rouzier
- Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - Olivier Delattre
- INSERM U934, Institut Curie, PSL Research University, Paris, France
| | - Tatiana Popova
- INSERM U934, Institut Curie, PSL Research University, Paris, France
| | - Fabien Reyal
- Department of Translational Research, Institut Curie, PSL Research University, Paris, France; Department of Surgery, Institut Curie, PSL Research University, Paris, France
| | - Marc-Henri Stern
- Department of Pathology, Institut Curie, PSL Research University, Paris, France; INSERM U934, Institut Curie, PSL Research University, Paris, France
| | - Dominique Stoppa-Lyonnet
- Department of Pathology, Institut Curie, PSL Research University, Paris, France; INSERM U934, Institut Curie, PSL Research University, Paris, France; Sorbonne Paris Cité, University Paris Descartes, Paris, France
| | - Caterina Marchiò
- Department of Pathology, Institut Curie, PSL Research University, Paris, France; Institute of Pathology at the Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ivan Bièche
- Pharmacogenomics Unit, Department of Genetics, Institut Curie, PSL Research University, Paris, France; EA 7331, University Paris Descartes, Paris, France
| | - Anne Vincent-Salomon
- Department of Pathology, Institut Curie, PSL Research University, Paris, France; INSERM U934, Institut Curie, PSL Research University, Paris, France
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Wang XX, Jiang YZ, Liu XY, Li JJ, Song CG, Shao ZM. Difference in characteristics and outcomes between medullary breast carcinoma and invasive ductal carcinoma: a population based study from SEER 18 database. Oncotarget 2017; 7:22665-73. [PMID: 27009810 PMCID: PMC5008390 DOI: 10.18632/oncotarget.8142] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 02/18/2016] [Indexed: 11/25/2022] Open
Abstract
Medullary breast carcinoma (MBC) is a unique histological subtype of breast cancer. Our study was designed to identify difference in characteristics and outcomes between MBC and invasive ductal carcinoma (IDC), and further confirm the prognostic factors of MBC. Utilizing Surveillance, Epidemiology, and End Results (SEER), we identified 84,764 eligible patients, including 309 MBC and 84,455 IDC. Compared with the IDC group, the MBC group was associated with younger age at diagnosis, higher grade, more advanced stage, larger tumor size, and higher proportion of triple-negative breast cancer (TNBC). Kaplan-Meier analysis and univariate Cox proportional hazard regression model showed that patients with IDC had significantly better breast cancer-specific survival (BCSS) compared to MBC, but they had similar overall survival (OS). However, MBC histology was no longer a surrogate for worse BCSS or OS after 1:1 matching by age, American Joint Committee on Cancer (AJCC) stage, grade and breast subtype. In addition, it was exposed that not married status, high grade, large tumor size, positive nodal status, the subtype of TNBC and no receipt of radiation therapy were significantly associated with poor BCSS and OS. In conclusion, MBC demonstrated more aggressive behavior but similar outcomes compared to IDC, which may be determined by prognostic factors such as breast subtype. These results not only confer deeper insight into MBC but contribute to individualized and tailored therapy, and thereby may improve clinical management and outcomes.
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Affiliation(s)
- Xiao-Xiao Wang
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Yi-Zhou Jiang
- Department of Breast Surgery, Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Xi-Yu Liu
- Department of Breast Surgery, Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jun-Jing Li
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Chuan-Gui Song
- Department of Breast Surgery, Affiliated Union Hospital, Fujian Medical University, Fuzhou, China
| | - Zhi-Ming Shao
- Department of Breast Surgery, Key Laboratory of Breast Cancer, Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University, Shanghai, China
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Bogolyubova AV, Belousov PV. Inflammatory immune infiltration in human tumors: Role in pathogenesis and prognostic and diagnostic value. BIOCHEMISTRY (MOSCOW) 2016; 81:1261-1273. [DOI: 10.1134/s0006297916110043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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10
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Mateo AM, Pezzi TA, Sundermeyer M, Kelley CA, Klimberg VS, Pezzi CM. Chemotherapy Significantly Improves Survival for Patients with T1c-T2N0M0 Medullary Breast Cancer: 3739 Cases From the National Cancer Data Base. Ann Surg Oncol 2016; 24:1050-1056. [DOI: 10.1245/s10434-016-5649-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Indexed: 11/18/2022]
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Abstract
Advances in basic science, technology and translational research have created a revolution in breast cancer diagnosis and therapy. Researchers' discoveries of genes defining variability in response to therapy and heterogeneity in clinical presentations and tumor biology are the foundation of the path to personalized medicine. The success of personalized breast cancer care depends on access to pertinent clinical information and risk factors, optimal imaging findings, well-established morphologic features, and traditional and contemporary prognostic/predictive testing. The integration of these entities provides an opportunity to identify patients who can benefit from specific therapies, and demonstrates the link between breast cancer subtypes and their association with different tumor biology. It is critical to recognize specific types of breast cancer in individual patients and design optimal personalized therapy. This article will highlight the roles of morphologic features and established tumor biomarkers on patient outcome.
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Affiliation(s)
- Shahla Masood
- Department of Pathology & Laboratory Medicine, University of Florida College of Medicine - Jacksonville, UF Health Breast Center, UF Health Jacksonville, 655 W. 8th Street, Box C-505, Jacksonville, FL 32209, USA
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Lim S, Park SH, Park HK, Hur MH, Oh SJ, Suh YJ. Prognostic Role of Adjuvant Chemotherapy in Node-Negative (N0), Triple-Negative (TN), Medullary Breast Cancer (MBC) in the Korean Population. PLoS One 2015; 10:e0140208. [PMID: 26562837 PMCID: PMC4642937 DOI: 10.1371/journal.pone.0140208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 09/03/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite the favorable prognosis for medullary breast cancer (MBC), the guidelines for the use of adjuvant chemotherapy for MBC have not been clearly established. This study investigated the prognostic role of adjuvant chemotherapy in Korean patients with node-negative (N0), triple-negative (TN) MBC patients. METHODS We included data from 252 patients with N0 TN MBC, obtained from the Korean Breast Cancer Registry database. Patients were categorized as those who did not undergo adjuvant chemotherapy (group I) or those who did (group II). Clinicopathological characteristics, breast cancer-specific survival (BCSS), and overall survival (OS) were compared between the groups. In addition, a subgroup analysis for survival based on tumor size was conducted. RESULTS A total of 252 N0 TN MBC patients with tumor sizes >1 cm who were diagnosed between April 1997 and March 2011 were enrolled. The median age was 44.95 years (range, 25-72 years), and the median follow-up period was 93.94 months (range, 23-195 months). Overall, the BCSS and OS in group II (97.3% and 97.3%, respectively) were significantly better compared with those in group I (89.2% and 86.2%, respectively). In the subgroup analysis, in patients with tumors >2 cm in size, those in group II had significant better BCSS and OS (97.5% and 97.5%, respectively) compared with those in group I (78.3% and 73.9%, respectively). In contrast in those with tumors 1-2 cm in size, there were no significant differences in BCSS and OS between the groups (both 97.1% for group I, and 95.2% and 92.9%, respectively for group II). Multivariate analysis revealed that adjuvant chemotherapy significantly improved BCSS (P = 0.009) and OS (P = 0.007), but only for patients with larger tumors (>2 cm). CONCLUSIONS In patients with N0 TN MBC, adjuvant chemotherapy had a significant clinical survival benefit, but only in those with tumors >2 cm.
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Affiliation(s)
- SeungTaek Lim
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Jungbu-daero 93, Paldal-gu, Suwon-si, Gyeonggi-do, 442-723, Republic of Korea
| | - Se Ho Park
- Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea
| | - Heong Kyu Park
- Breast Cancer Center, Department of Surgery, Gachon University Gill Hospital, 1198, Guwoldong, Incheon, 405-760, Republic of Korea
| | - Min Hee Hur
- Department of Surgery, Cheil General Hospital and Women`s Healthcare Center, Dankook University College of Medicine, 17 Seoae-ro 1-gil, Jung-gu, Seoul, 100-380, Republic of Korea
| | - Se Jeong Oh
- Department of Surgery, Incheon St. Mary`s Hospital, College of Medicine, The Catholic University of Korea, 56 Dongsu-ro, Bupyung-gu, Incheon, 403-720, Republic of Korea
| | - Young Jin Suh
- Division of Breast & Thyroid Surgical Oncology, Department of Surgery, College of Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Jungbu-daero 93, Paldal-gu, Suwon-si, Gyeonggi-do, 442-723, Republic of Korea
- * E-mail:
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Mulligan AM, Pinnaduwage D, Tchatchou S, Bull SB, Andrulis IL. Validation of Intratumoral T-bet+ Lymphoid Cells as Predictors of Disease-Free Survival in Breast Cancer. Cancer Immunol Res 2015; 4:41-8. [PMID: 26546451 DOI: 10.1158/2326-6066.cir-15-0051] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 08/24/2015] [Indexed: 11/16/2022]
Abstract
We previously observed T-bet(+) lymphocytes to be associated with a good prognosis in a cohort of women with familial breast cancer. To validate this finding, we evaluated lymphocyte T-bet expression in an independent unselected prospectively accrued series of women with lymph node-negative breast carcinoma. T-bet and clinicopathologic data were available for 614 women. Hormone receptors, HER2, Ki-67, CK5, EGFR, p53, and T-bet status were determined using IHC and/or biochemical methods. Tumors were assigned to luminal A, luminal B, HER2, and basal subtypes based on the expression of IHC markers. Multiple cutpoints were examined in a univariate penalized Cox model to stratify tumors into T-bet(+/high) and T-bet(-/low). Fisher exact test was used to analyze T-bet associations with clinicopathologic variables, IHC markers, and molecular subtype. Survival analyses were by the Cox proportional hazards model. All tests were two sided. A test with a P value < 0.05 was considered statistically significant. T-bet(+/high) tumor status was significantly associated with large tumor size, high grade, hormone receptor negativity, CK5, EGFR and p53 positivity, high Ki-67, and basal subtype. With a median follow-up of 96.5 months, T-bet(-/low) tumor status was associated with a reduced disease-free survival compared with T-bet(+/high) tumor status in multivariate analysis (P = 0.0027; relative risk = 5.62; 95% confidence intervals, 1.48-50.19). Despite being associated with adverse clinicopathologic characteristics, T-bet(+) tumor-infiltrating lymphoid cells are associated with a favorable outcome. This supports their role in Th1-mediated antitumor activity and may provide insight for the development of new therapeutic strategies.
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Affiliation(s)
- Anna Marie Mulligan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Laboratory Medicine Program, University Health Network, Toronto, Ontario, Canada
| | - Dushanthi Pinnaduwage
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Sandrine Tchatchou
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Shelley B Bull
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Irene L Andrulis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada. Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada. Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
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14
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Chu Z, Lin H, Liang X, Huang R, Zhan Q, Jiang J, Zhou X. Clinicopathologic characteristics of typical medullary breast carcinoma: a retrospective study of 117 cases. PLoS One 2014; 9:e111493. [PMID: 25375803 PMCID: PMC4222917 DOI: 10.1371/journal.pone.0111493] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/29/2014] [Indexed: 11/18/2022] Open
Abstract
PURPOSE This study analyzed the clinicopathologic characteristics of typical medullary breast carcinoma (TMBC) in a cohort of Chinese patients. METHODS We conducted a retrospective review of clinical data including general information, pathologic results, treatment regimens, and patient survival in cases of TMBC diagnosed between February 2004 and April 2011. RESULTS A total of 117 patients were enrolled, with a median age of 52 years (range, 28∼92 years). Stage I and II disease accounted for 31.6% and 61.6% of the cases, respectively. Hormonal receptor negative disease (estrogen receptor negative, 68.4%; progestogen receptor negative, 86.3%) was more prevalent in this population. Human epidermal growth factor receptor-2 (HER-2) positivity was 20.5%, while equivocal and HER-2 negative cases represented 16.2% and 63.2% of the cohort. The triple-negative, luminal, and HER-2 overexpressing subtypes constituted 44.4%, 31.6%, and 15.4% of the cases, respectively. The various TMBC subtypes showed no differences regarding tumor size, rates of lymph node(s) metastasis, TNM staging, treatment regimens, and 2-year recurrence rates. However, patients with triple-negative disease were more likely to be younger, when compared to those with luminal disease (P = 0.002). At a median follow-up of 56 months (range, 2-112 months), the 2-year disease-free survival and overall survival rates were 99.1% and 98.2%, respectively. CONCLUSION Early stage disease dominated the study cohort, and at two years after surgery, recurrence was extremely low. The heterogeneity of molecular subtypes was clearly shown, and no apparent differences were found among the clinicopathologic characteristics of the triple-negative, luminal, and HER-2 overexpressing subtypes.
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Affiliation(s)
- Zhaohui Chu
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
| | - Hao Lin
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
| | - Xiaohua Liang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
| | - Ruofan Huang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
| | - Qiong Zhan
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
| | - Jingwei Jiang
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
| | - Xinli Zhou
- Department of Oncology, Huashan Hospital, Fudan University, Shanghai, China, 200040
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China, 200032
- * E-mail:
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15
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The Surgical Management of Invasive Breast Cancer. Breast Cancer 2014. [DOI: 10.1007/978-1-4614-8063-1_16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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16
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Nurlaila I, Telisinghe PU, Ramasamy R. CD8+ lymphocytes and apoptosis in typical and atypical medullary carcinomas of the breast. Immunol Lett 2013; 156:123-6. [DOI: 10.1016/j.imlet.2013.10.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2013] [Revised: 09/20/2013] [Accepted: 10/01/2013] [Indexed: 10/26/2022]
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17
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Cao AY, He M, Huang L, Shao ZM, Di GH. Clinicopathologic characteristics at diagnosis and the survival of patients with medullary breast carcinoma in China: a comparison with infiltrating ductal carcinoma-not otherwise specified. World J Surg Oncol 2013; 11:91. [PMID: 23607710 PMCID: PMC3639167 DOI: 10.1186/1477-7819-11-91] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2012] [Accepted: 04/08/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have addressed the biological features of medullary breast carcinoma (MBC) in the context of clinical outcomes. We sought to compare the baseline demographics, standard pathologic factors and long-term clinical outcomes between MBC and infiltrating ductal carcinoma-not otherwise specified (IDC-NOS) using a large database. METHODS A total of 2,202 cases with pure IDC-NOS and 188 cases with typical MBC meeting the inclusion criteria were identified. The clinical and biological features, the overall survival (OS) and recurrence/metastasis-free survival (RFS) were compared for both groups. RESULTS There were a higher proportion of patients diagnosed prior to 40 years of age in the MBC group compared to the IDC-NOS group. MBC cases demonstrated less aggressive tumor features such as lower tumor stage, smaller tumor size and a lower proportion of nodal involvement than IDC-NOS; however, immunohistochemical staining revealed that MBC displayed the triple-negative phenotype more often than IDC-NOS cases (40.4% versus 26.2%; P <0.001). Although the clinical behavior of MBC was not commensurate with its pathologic features, women diagnosed with MBC had a lower frequency of recurrence/metastasis (P = 0.032) and death (P = 0.042) than those with IDC-NOS, and the 10-year OS and RFS were significantly higher for MBC (91% and 74%) compared to IDC-NOS (81% and 64%). Moreover, multivariate analysis revealed that TNM stage was a statistically significant factor for survival. CONCLUSIONS MBC in Chinese women demonstrated less aggressive behavior and better prognosis than IDC-NOS. This favorable outcome was maintained after 10 years.
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Affiliation(s)
- A-Yong Cao
- Breast Cancer Institute, Cancer Centre/Cancer Institute, Department of Oncology, Shanghai Medical College, Fudan University, 270 Dong'an Road, Shanghai 200032, People's Republic of China
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18
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Galzerano A, Rocco N, Accurso A, Ciancia G, Campanile AC, Caccavello F, Fulciniti F. Medullary breast carcinoma in an 18-year-old female: report on one case diagnosed on fine-needle cytology sample. Diagn Cytopathol 2013; 42:445-8. [PMID: 23341107 DOI: 10.1002/dc.22947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2012] [Accepted: 12/04/2012] [Indexed: 11/10/2022]
Abstract
Medullary breast carcinoma (MBC) is a rare epithelial malignancy of the breast accounting for about 1-7% of all breast carcinomas. It is characterized by well-defined borders, a syncytial/solid pattern of growth of high grade atypical cells showing no glandular differentiation and a massive diffuse lympho-plasmacytic peritumoral infiltrate. Despite the high-grade atypias characterizing this neoplasm, MBC has been reported to have a better prognosis when compared with the common infiltrating duct carcinoma. MBCs typically lack estrogen and progesterone receptor (ER and PgR) expression and have a low incidence of ERBB2 overexpression. Genetically, they are often associated with BRCA-1 oncogene mutations and TP53 alterations. While MBC generally occurs in middle-aged women, ranging from 45 to 52 years of age, we report the case of a 18-year-old female patient which was diagnosed by means of fine-needle cytology sample.
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Affiliation(s)
- Antonio Galzerano
- Serviço de Anatomia Patologica, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
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19
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Yang B, Ma C, Chen Z, Yi W, McNutt MA, Wang Y, Korteweg C, Gu J. Correlation of immunoglobulin G expression and histological subtype and stage in breast cancer. PLoS One 2013; 8:e58706. [PMID: 23554916 PMCID: PMC3595271 DOI: 10.1371/journal.pone.0058706] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 02/05/2013] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION Recently, growing evidence indicates that immunoglobulins (Igs) are not only produced by mature B lymphocytes or plasma cells, but also by various normal cells types at immune privileged sites and neoplasm, including breast cancer. However, the association of breast cancer derived IgG with genesis and development of the disease has not yet been established. METHODS In this study we examined the expression of IgG in 186 breast cancers, 20 benign breast lesions and 30 normal breast tissues. Both immunohistochemistry with antibodies to Igκ (immunoglobulin G κ light chain) and Igγ (immunoglobulin G heavy chain) and in situ hybridization with an antisense probe to IgG1 heavy chain constant region gene were performed. Various clinicopathological features were also analyzed. RESULTS We found that IgG is specifically expressed in human breast cancer cells. Both infiltrating ductal carcinoma and infiltrating lobular carcinoma had significantly greater numbers of Igκ and Igγ positive cancer cells as compared with medullary carcinoma, carcinoma in situ, and benign lesions (all p<0.05). In addition, IgG expression was correlated with breast cancer histological subtypes (p<0.01) and AJCC stages (p<0.05), with more abundance of IgG expression in more malignant histological subtypes or in more advanced stage of the disease. CONCLUSIONS IgG expression in breast cancer cells is correlated with malignancy and AJCC stages of the cancers. This suggests that breast cancer derived IgG may be associated with genesis, development and prognosis of the cancer.
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Affiliation(s)
- Baokai Yang
- Department of Pathology, School of Basic Medical Sciences, Peking (Beijing) University Health Science Center, Beijing, China
| | - Changchun Ma
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Department of Pathology and Pathophysiology, Shantou University Medical College, Shantou, China
- Department of Radiation Oncology, Cancer Hospital, Shantou University Medical College, Shantou, China
| | - Zhengshan Chen
- Department of Pathology, School of Basic Medical Sciences, Peking (Beijing) University Health Science Center, Beijing, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Department of Pathology and Pathophysiology, Shantou University Medical College, Shantou, China
| | - Weining Yi
- Department of Epidemiology and Biostatistics, School of Public Health, Peking (Beijing) University Health Science Center, Beijing, China
| | - Michael A. McNutt
- Department of Pathology, School of Basic Medical Sciences, Peking (Beijing) University Health Science Center, Beijing, China
| | - Yun Wang
- Department of Pathology, School of Basic Medical Sciences, Peking (Beijing) University Health Science Center, Beijing, China
- Laboratory of Molecular Pathophysiology, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, United States of America
| | - Christine Korteweg
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Department of Pathology and Pathophysiology, Shantou University Medical College, Shantou, China
| | - Jiang Gu
- Department of Pathology, School of Basic Medical Sciences, Peking (Beijing) University Health Science Center, Beijing, China
- Guangdong Provincial Key Laboratory of Infectious Diseases and Molecular Immunopathology, Department of Pathology and Pathophysiology, Shantou University Medical College, Shantou, China
- * E-mail:
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20
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Maria Regina Bareggi C, Consonni D, Galassi B, Gambini D, Locatelli E, Visintin R, Runza L, Giroda M, Sfondrini MS, Onida F, Tomirotti M. Uncommon Breast Malignancies: Presentation Pattern, Prognostic Issue and Treatment Outcome in an Italian Single Institution Experience. TUMORI JOURNAL 2013; 99:39-44. [DOI: 10.1177/030089161309900107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aims and background Often neglected by large clinical trials, patients with uncommon breast malignancies have been rarely analyzed in large series. Patients and methods Of 2,052 patients diagnosed with breast cancer and followed in our Institution from January 1985 to December 2009, we retrospectively collected data on those with uncommon histotypes, with the aim of investigating their presentation characteristics and treatment outcome. Results Rare histotypes were identified in 146 patients (7.1% of our total breast cancer population), being classified as follows: tubular carcinoma in 75 (51.4%), mucinous carcinoma in 36 (24.7%), medullary carcinoma in 25 (17.1%) and papillary carcinoma in 10 patients (6.8%). Whereas age at diagnosis was not significantly different among the diverse diagnostic groups, patients with medullary and papillary subtypes had a higher rate of lymph node involvement, similar to that of invasive ductal carcinoma. Early stage diagnosis was frequent, except for medullary carcinoma. Overall, in comparison with our invasive ductal carcinoma patients, those with rare histotypes showed a significantly lower risk of recurrence, with a hazard ratio of 0.28 (95% CI, 0.12–0.62; P = 0.002). Conclusions According to our analysis, patients with uncommon breast malignancies are often diagnosed at an early stage, resulting in a good prognosis with standard treatment.
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Affiliation(s)
- Claudia Maria Regina Bareggi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Barbara Galassi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Donatella Gambini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Elisa Locatelli
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Roberto Visintin
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Letterio Runza
- Pathology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Massimo Giroda
- Breast Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maria Silvia Sfondrini
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Francesco Onida
- Hematology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Maurizio Tomirotti
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
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21
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Huober J, Gelber S, Goldhirsch A, Coates AS, Viale G, Öhlschlegel C, Price KN, Gelber RD, Regan MM, Thürlimann B. Prognosis of medullary breast cancer: analysis of 13 International Breast Cancer Study Group (IBCSG) trials. Ann Oncol 2012; 23:2843-2851. [PMID: 22707751 PMCID: PMC3477879 DOI: 10.1093/annonc/mds105] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Revised: 01/03/2012] [Accepted: 02/27/2012] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To evaluate whether medullary breast cancer has a better prognosis compared with invasive ductal tumors. METHODS Among 12,409 patients, 127 were recorded as invasive medullary tumors and 8096 invasive ductal tumors. Medullary and ductal invasive tumors were compared with regard to stage, age at diagnosis, grade, hormone receptor status, peritumoral vascular invasion, and local and systemic treatment. Pattern of relapse, distant recurrence-free interval (DRFI), and overall survival (OS) were determined for both histological groups. Two cohorts were investigated: a full cohort including the pathologist-determined medullary histology without regard to any other tumor features and a cohort restricted to patients with ER-negative grade 3 tumors. RESULTS Fourteen-year DRFI and OS percents for medullary tumors (n = 127) and invasive ductal tumors (n = 8096) of the full cohort were 76% and 64% [hazard ratio (HR) 0.52, P = 0.0005] and 66% and 57% (HR = 0.75, P = 0.03), respectively. For the restricted cohort, 14-year DRFI and OS percents for the medullary (n = 47) and invasive ductal tumors (n = 1407) were 89% and 63% (HR 0.24, P = 0.002) and 74% and 54% (HR = 0.55, P = 0.01), respectively. Competing risk analysis for DRFI favored medullary tumors (HR medullary/ductal = 0.32; 95% confidence interval = 0.13-0.78, P = 0.01). CONCLUSION Medullary tumors have a favorable prognosis compared with invasive ductal tumors.
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MESH Headings
- Breast Neoplasms/mortality
- Breast Neoplasms/pathology
- Breast Neoplasms/therapy
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/therapy
- Carcinoma, Medullary/mortality
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/therapy
- ErbB Receptors/analysis
- Female
- Humans
- Middle Aged
- Neoplasm Grading
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Prognosis
- Receptors, Estrogen/analysis
- Receptors, Progesterone/analysis
- Risk Factors
- Survival Rate
- Treatment Outcome
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Affiliation(s)
- J. Huober
- Breast Center, Kantonsspital, St Gallen
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
| | - S. Gelber
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
- Frontier Science and Technology Research Foundation, Boston, USA
| | - A. Goldhirsch
- Department of Medicine, European Institute of Oncology, Milan, Italy
- Swiss Center for Breast Health, Sant'Anna Clinics, Lugano-Sorengo, Switzerland
| | - A. S. Coates
- International Breast Cancer Study Group and Australian New Zealand Breast Cancer Trials Group, University of Sydney, Sydney, Australia
| | - G. Viale
- Division of Pathology and Laboratory Medicine, IBCSG Central Pathology Office, European Institute of Oncology, University of Milan, Milan, Italy
| | - C. Öhlschlegel
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
- Department of Pathology, Kantonsspital, St Gallen, Switzerland
| | - K. N. Price
- Frontier Science and Technology Research Foundation, Boston, USA
| | - R. D. Gelber
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
- Frontier Science and Technology Research Foundation, Boston, USA
- Department of Biostatistics, Harvard School of Public Health, Harvard Medical School, Boston, USA
| | - M. M. Regan
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
- Department of Biostatistics, Harvard School of Public Health, Harvard Medical School, Boston, USA
| | - B. Thürlimann
- Breast Center, Kantonsspital, St Gallen
- Swiss Group for Clinical Cancer Research (SAKK), Berne, Switzerland
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Abstract
Breast cancer, rather than constituting a monolithic entity, comprises heterogeneous tumors with different clinical characteristics, disease courses, and responses to specific treatments. Tumor-intrinsic features, including classical histological and immunopathological classifications as well as more recently described molecular subtypes, separate breast tumors into multiple groups. Tumor-extrinsic features, including microenvironmental configuration, also have prognostic significance and further expand the list of tumor-defining variables. A better understanding of the features underlying heterogeneity, as well as of the mechanisms and consequences of their interactions, is essential to improve targeting of existing therapies and to develop novel agents addressing specific combinations of features.
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Affiliation(s)
- Nicholas R Bertos
- Rosalind and Morris Goodman Cancer Research Centre, McGill University, Montreal, Quebec, Canada.
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23
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Rakha EA, Reis-Filho JS, Baehner F, Dabbs DJ, Decker T, Eusebi V, Fox SB, Ichihara S, Jacquemier J, Lakhani SR, Palacios J, Richardson AL, Schnitt SJ, Schmitt FC, Tan PH, Tse GM, Badve S, Ellis IO. Breast cancer prognostic classification in the molecular era: the role of histological grade. Breast Cancer Res 2010; 12:207. [PMID: 20804570 PMCID: PMC2949637 DOI: 10.1186/bcr2607] [Citation(s) in RCA: 533] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Emad A Rakha
- Department of Histopathology, Nottingham City Hospital NHS Trust, Nottingham University, Nottingham, UK
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Albrektsen G, Heuch I, Thoresen SØ. Histological type and grade of breast cancer tumors by parity, age at birth, and time since birth: a register-based study in Norway. BMC Cancer 2010; 10:226. [PMID: 20492657 PMCID: PMC2889893 DOI: 10.1186/1471-2407-10-226] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 05/21/2010] [Indexed: 11/16/2022] Open
Abstract
Background Some studies have indicated that reproductive factors affect the risk of histological types of breast cancer differently. The long-term protective effect of a childbirth is preceded by a short-term adverse effect. Few studies have examined whether tumors diagnosed shortly after birth have specific histological characteristics. Methods In the present register-based study, comprising information for 22,867 Norwegian breast cancer cases (20-74 years), we examined whether histological type (9 categories) and grade of tumor (2 combined categories) differed by parity or age at first birth. Associations with time since birth were evaluated among 9709 women diagnosed before age 50 years. Chi-square tests were applied for comparing proportions, whereas odds ratios (each histological type vs. ductal, or grade 3-4 vs. grade 1-2) were estimated in polytomous and binary logistic regression analyses. Results Ductal tumors, the most common histological type, accounted for 81.4% of all cases, followed by lobular tumors (6.3%) and unspecified carcinomas (5.5%). Other subtypes accounted for 0.4%-1.5% of the cases each. For all histological types, the proportions differed significantly by age at diagnoses. The proportion of mucinous and tubular tumors decreased with increasing parity, whereas Paget disease and medullary tumors were most common in women of high parity. An increasing trend with increasing age at first birth was most pronounced for lobular tumors and unspecified carcinomas; an association in the opposite direction was seen in relation to medullary and tubular tumors. In age-adjusted analyses, only the proportions of unspecified carcinomas and lobular tumors decreased significantly with increasing time since first and last birth. However, ductal tumors, and malignant sarcomas, mainly phyllodes tumors, seemed to occur at higher frequency in women diagnosed <2 years after first childbirth. The proportions of medullary tumors and Paget disease were particularly high among women diagnosed 2-5 years after last birth. The high proportion of poorly differentiated tumors in women with a recent childbirth was partly explained by young age. Conclusion Our results support previous observations that reproductive factors affect the risk of histological types of breast cancer differently. Sarcomas, medullary tumors, and possible also Paget disease, may be particularly susceptible to pregnancy-related exposure.
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Affiliation(s)
- Grethe Albrektsen
- Department of Public Health and Primary Health Care, University of Bergen, Bergen, Norway.
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Rakha E, Aleskandarany M, El-Sayed M, Blamey R, Elston C, Ellis I, Lee A. The prognostic significance of inflammation and medullary histological type in invasive carcinoma of the breast. Eur J Cancer 2009; 45:1780-7. [DOI: 10.1016/j.ejca.2009.02.014] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2008] [Revised: 01/27/2009] [Accepted: 02/12/2009] [Indexed: 11/29/2022]
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Molecular and morphological analysis of adenoid cystic carcinoma of the breast with synchronous tubular adenosis. Virchows Arch 2008; 454:107-14. [PMID: 19031084 DOI: 10.1007/s00428-008-0700-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2008] [Revised: 11/03/2008] [Accepted: 11/05/2008] [Indexed: 01/11/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the breast is a rare tumour. Its recognition as a special type of breast carcinoma is very important because its prognosis is better than the not-otherwise-specified invasive ductal carcinoma and its treatment may not include axillary dissection. Tubular adenosis (TA) is a very rare condition of the breast that is histologically benign; however, it has been described in association with invasive ductal carcinoma. There are scant data regarding the molecular genomic alterations in ACC of the breast and no data has been presented on TA. Herein, we provide a morphological characterisation of TA arising synchronically with ACC in the breast. To characterise these lesions, we performed ultrastructural analysis, three-dimensional reconstruction and molecular analysis using immunohistochemistry and comparative genomic hybridisation. The copy number alterations found in ACC were restricted to small deletions on 16p and 17q only, whereas the TA harboured gains on 1q, 5p, 8q, 10q, 11p and 11q and losses on 1p, 10q, 11q, 12q, 14q, 15q and 16q. These molecular data highlight the genomic instability of TA, a benign florid proliferation intermingled with ACC, and do not provide evidence of molecular evolution from TA to ACC.
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Patho-biological aspects of basal-like breast cancer. Breast Cancer Res Treat 2008; 113:411-22. [DOI: 10.1007/s10549-008-9952-1] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2007] [Accepted: 02/21/2008] [Indexed: 12/28/2022]
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Louwman MWJ, Vriezen M, van Beek MWPM, Nolthenius-Puylaert MCBJET, van der Sangen MJC, Roumen RM, Kiemeney LALM, Coebergh JWW. Uncommon breast tumors in perspective: incidence, treatment and survival in the Netherlands. Int J Cancer 2007; 121:127-35. [PMID: 17330844 DOI: 10.1002/ijc.22625] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The relatively small group of patients with breast tumors other than the ductal, lobular or mixed ducto-lobular types, has reached nonnegligible numbers due to the ongoing increase in the incidence of breast cancer. We investigated stage and grade distribution of uncommon breast tumors using the nation-wide Netherlands Cancer Registry (population 16.5 million) and incidence patterns, treatment and long-term survival (up to 19 years) using the regional Eindhoven Cancer Registry (population 2.4 million). Incidence of all uncommon breast tumors together was 9.2/100,000 person years (age-standardized, ESR). The proportion of stage I tumors was 70% among patients with tubular (n = 3,456) and 40-50% for mucinous (n = 3,482), papillary (n = 1,078), cribriform (n = 503) and neuroendocrine (n = 76) tumors, contrasting to 27, 28 and 36%, respectively among patients with Signet ring cell cancer (n = 75), Paget's disease (n = 818) and the common invasive ductal carcinomas (n = 121,656). A better age-, stage-, and grade-adjusted prognosis was observed for patients with lobular (death risk ratio 0.8, 95%CI: 0.7-0.9), mucinous (0.5, 0.3-0.9), medullary (0.5, 0.3-0.9) and tubular (0.4, 0.2-0.6) carcinoma or phyllodes tumor (0.02, 0.0-0.2), compared with invasive ductal carcinomas. For patients with papillary (0.6, 0.2-1.6) and cribriform (0.1, 0.0-5.1) tumors better prognosis was not statistically significant. In conclusion, histologic type was an essential determinant of survival for about 10% of all newly diagnosed women with invasive breast cancer. Because patients with mucinous, tubular, medullary and phyllodes tumors have such a good prognosis, less aggressive treatment should be considered in some cases whereby specific guidelines are becoming increasingly desirable. Communication to patients with these specific histological types should reflect this.
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Affiliation(s)
- Marieke W J Louwman
- Eindhoven Cancer Registry, Comprehensive Cancer Centre South IKZ, Eindhoven, The Netherlands.
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Huper G, Marks JR. Isogenic normal basal and luminal mammary epithelial isolated by a novel method show a differential response to ionizing radiation. Cancer Res 2007; 67:2990-3001. [PMID: 17409405 DOI: 10.1158/0008-5472.can-06-4065] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Epithelial cells within the normal breast duct seem to be the primary target for neoplastic transformation events that eventually produce breast cancer. Normal epithelial cells are easily isolated and propagated using standard techniques. However, these techniques almost invariably result in populations of cells that are largely basal in character. Because only approximately 20% of human breast cancers exhibit a basal phenotype, our understanding of the disease may be skewed by using these cells as the primary comparator to cancer. Further, because germ line mutations in BRCA1 yield breast cancers that are most often of the basal type, a comparison of normal basal and luminal cells could yield insight into the tissue and cell type specificity of this hereditary cancer susceptibility gene. In this report, we describe a simplified and efficient method for isolating basal and luminal cells from normal human breast tissue. These isogenic cells can be independently propagated and maintain phenotypic markers consistent with their respective lineages. Using these cultured cells, we show that basal and luminal cells exhibit distinct responses to ionizing radiation. Basal cells undergo a rapid but labile cell cycle arrest, whereas luminal cells show a much more durable arrest, primarily at the G(2)-M boundary. Molecular markers, including p53 protein accumulation, p53-activated genes, and BRCA1 nuclear focus formation all correlate with the respective cell cycle responses. Further, we show that short-term cultures of human breast tissue fragments treated with ionizing radiation show a similar phenomenon as indicated by the biphasic accumulation of p53 protein in the basal versus luminal layer. Together, these results indicate that normal basal cells have a transitory cell cycle arrest after DNA damage that may underlie their increased susceptibility to transformation after the loss of functional BRCA1.
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Affiliation(s)
- Gudrun Huper
- Duke University Medical Center, Department of Surgery and Institute for Genome Sciences and Policy, Durham, North Carolina, USA
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Vu-Nishino H, Tavassoli FA, Ahrens WA, Haffty BG. Clinicopathologic features and long-term outcome of patients with medullary breast carcinoma managed with breast-conserving therapy (BCT). Int J Radiat Oncol Biol Phys 2005; 62:1040-7. [PMID: 15990007 DOI: 10.1016/j.ijrobp.2005.01.008] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2003] [Revised: 12/28/2004] [Accepted: 01/03/2005] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study is to compare the clinical characteristics and outcome of medullary carcinoma to infiltrating ductal carcinoma of the breast in a large cohort of conservatively managed patients with long-term follow-up. METHODS AND MATERIALS Chart records of patients with invasive breast cancer managed with breast-conserving therapy (BCT) at the therapeutic radiology facilities of Yale University School of Medicine before 2001 were reviewed. Forty-six cases (1971-2001) were identified with medullary histology; 1,444 patients with infiltrating ductal carcinoma served as a control group. RESULTS The medullary cohort presented at a younger age with a higher percentage of patients in the 35 years or younger age group (26.1% vs. 6.6%, p < 0.00001). Twelve patients with medullary histology underwent genetic screening, and 6 patients were identified with deleterious mutations. This group showed greater association with BRCA1/2 mutations compared with screened patients in the control group (50.0% vs. 15.8%, p = 0.0035). The medullary cohort was also significantly associated with greater T stage and tumor size (37.0% vs. 17.2% T2, mean size 3.2 vs. 2.5 cm, p = 0.00097) as well as negative ER (84.9% vs. 37.6%, p < 0.00001) and PR (87.5% vs. 48.1%, p = 0.00001) status. As of February 2003, median follow-up times for the medullary and control groups were 13.9 and 14.0 years, respectively. Although breast relapse-free rates were not significantly different (76.7% vs. 85.2%), 10-year distant relapse-free survival in the medullary cohort was significantly better than in the control group (94.9% vs. 77.5%, p = 0.028). CONCLUSIONS Despite poor clinicopathologic features, patients with medullary histology demonstrate favorable long-term distant relapse-free survival. Local control rates of patients with medullary and infiltrating ductal carcinoma are comparable. These findings suggest that patients diagnosed with medullary carcinoma are appropriate candidates for BCT and are associated with favorable long-term prognosis.
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Affiliation(s)
- Ha Vu-Nishino
- Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, USA
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Olivotto IA, Bajdik CD, Ravdin PM, Speers CH, Coldman AJ, Norris BD, Davis GJ, Chia SK, Gelmon KA. Population-based validation of the prognostic model ADJUVANT! for early breast cancer. J Clin Oncol 2005; 23:2716-25. [PMID: 15837986 DOI: 10.1200/jco.2005.06.178] [Citation(s) in RCA: 372] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Adjuvant! (www.adjuvantonline.com) is a web-based tool that predicts 10-year breast cancer outcomes with and without adjuvant systemic therapy, but it has not been independently validated. METHODS Using the British Columbia Breast Cancer Outcomes Unit (BCOU) database, demographic, pathologic, staging, and treatment data on 4,083 women diagnosed between 1989 and 1993 in British Columbia with T1-2, N0-1, M0 breast cancer were abstracted and entered into Adjuvant! to calculate predicted 10-year overall survival (OS), breast cancer-specific survival (BCSS), and event-free survival (EFS) for each patient. Individual BCOU observed outcomes at 10 years were independently determined. Predicted and observed outcomes were compared. RESULTS Across all 4,083 patients, 10-year predicted and observed outcomes were within 1% for OS, BCSS, and EFS (all P > .05). Predicted and observed outcomes were within 2% for most demographic, pathologic, and treatment-defined subgroups. Adjuvant! overestimated OS, BCSS, and EFS in women younger than age 35 years (predicted-observed = 8.6%, 9.6%, and 13.6%, respectively; all P < .001) or with lymphatic or vascular invasion (LVI; predicted-observed = 3.6%, 3.8%, and 4.2%, respectively; all P < .05); these two prognostic factors were not automatically incorporated within the Adjuvant! algorithm. After adjusting for the distribution of LVI, using the prognostic factor impact calculator in Adjuvant!, 10-year predicted and observed outcomes were no longer significantly different. CONCLUSION Adjuvant! performed reliably. Patients younger than age 35 or with known additional adverse prognostic factors such as LVI require adjustment of risks to derive reliable predictions of prognosis without adjuvant systemic therapy and the absolute benefits of adjuvant systemic therapy.
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Affiliation(s)
- Ivo A Olivotto
- Breast Cancer Outcomes Unit, Vancouver Island Centre, 2410 Lee Avenue, Victoria, BC V8R 6V5, Canada.
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Allemani C, Sant M, Berrino F, Aareleid T, Chaplain G, Coebergh JW, Colonna M, Contiero P, Danzon A, Federico M, Gafà L, Grosclaude P, Hédelin G, Macè-Lesech J, Garcia CM, Paci E, Raverdy N, Tretarre B, Williams EMI. Prognostic value of morphology and hormone receptor status in breast cancer - a population-based study. Br J Cancer 2004; 91:1263-8. [PMID: 15365566 PMCID: PMC2409902 DOI: 10.1038/sj.bjc.6602153] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We analysed the 5-year relative survival among 4473 breast cancer cases diagnosed in 1990–1992 from cancer registries in Estonia, France, Italy, Spain, the Netherlands and the UK. Among eight categories based on ICD-O codes (infiltrating ductal carcinoma, lobular plus mixed carcinoma, comedocarcinoma, ‘special types’, medullary carcinoma, not otherwise specified (NOS) carcinoma, other carcinoma and cancer without microscopic confirmation), the 5-year relative survival ranged from 66% (95% CI 61–71) for NOS carcinoma to 95% (95% CI 90–100) for special types (tubular, apocrine, cribriform, papillary, mucinous and signet ring cell); 27% (95% CI 18–36) for cases without microscopic confirmation. Differences in 5-year relative survival by tumor morphology and hormone receptor status were modelled using a multiple regression approach based on generalised linear models. Morphology and hormone receptor status were confirmed as significant survival predictors in this population-based study, even after adjusting for age and stage at diagnosis.
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Affiliation(s)
- C Allemani
- Epidemiology Unit, Istituto Nazionale per lo Studio e la Cura dei Tumori, Via Venezian 1, I-20133 Milano, Italy.
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Abstract
The recent observation that studies of BRCA1-associated tumors contain a high proportion of medullary carcinomas and ductal carcinomas with medullary features has re-introduced pathologists to an old diagnostic problem. The term "medullary carcinoma" dates to the 19th century, but the modern entity was introduced in 1949 by Moore and Foote, who described a carcinoma with a lymphoid infiltrate, a favorable prognosis, and low frequency of metastasis. Almost three decades later, Ridolfi et al proposed specific criteria for diagnosis, resulting in an entity with an even more favorable prognosis and a lower incidence. The reproducibility and clinical relevance of the diagnosis have been questioned recently, and new criteria have been proposed and compared. The tumors typically express cytokeratin 7, often vimentin and S100-protein, but not cytokeratin 20. The usual ones are positive for p53 and negative for estrogen receptor, Her2/neu, and bcl-2. Medullary carcinomas express e-cadherin and beta-catenin more often than ordinary high-grade ductal carcinomas, and the former have genetic differences from the latter. The lymphoid infiltrate of medullary carcinomas is related to beta-actin fragments exposed by apoptotic cells. The present review discusses historical and recent developments and emphasizes diagnostic criteria.
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Affiliation(s)
- John H Eichhorn
- James Homer Wright Pathology Laboratories, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA.
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Wong SL, Chao C, Edwards MJ, Carlson DJ, Laidley A, Noyes RD, McGlothin T, Ley PB, Tuttle T, Schadt M, Pennington R, Legenza M, Morgan J, McMasters KM. Frequency of sentinel lymph node metastases in patients with favorable breast cancer histologic subtypes. Am J Surg 2002; 184:492-8; discussion 498. [PMID: 12488144 DOI: 10.1016/s0002-9610(02)01057-7] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The need for axillary nodal staging in favorable histologic subtypes of breast cancer is controversial. METHODS Patients with clinical stage T1-2, N0 breast cancer were enrolled in a prospective, multi-institutional study. All patients underwent sentinel lymph node (SLN) biopsy followed by completion level I/II axillary dissection. RESULTS SLN were identified in 3,106 of 3,324 patients (93%). Axillary metastases were found in 35% and 40% of patients with infiltrating ductal carcinoma and infiltrating lobular carcinoma, respectively. Among tumor subtypes, positive nodes were found in 17% of patients with pure tubular carcinoma, 7% of patients with papillary cancer, 6% of patients with colloid (mucinous) carcinoma, 21% of patients with medullary carcinoma, and 8% of patients with DCIS with microinvasion. CONCLUSIONS Patients with favorable breast cancer subtypes have a significant rate of axillary nodal metastasis. Axillary nodal staging remains important in such patients; SLN biopsy is an ideal method to obtain this staging information.
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MESH Headings
- Adenocarcinoma/pathology
- Adenocarcinoma/surgery
- Adenocarcinoma, Mucinous/pathology
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Awards and Prizes
- Axilla
- Breast Neoplasms/pathology
- Breast Neoplasms/surgery
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Carcinoma, Intraductal, Noninfiltrating/surgery
- Carcinoma, Lobular/pathology
- Carcinoma, Lobular/surgery
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/surgery
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/surgery
- Female
- Humans
- Lymphatic Metastasis
- Middle Aged
- Neoplasm Staging
- Sentinel Lymph Node Biopsy
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Affiliation(s)
- Sandra L Wong
- Department of Surgery, Division of Surgical Oncology, 315 E. Broadway, Suite 309, Louisville, KY 40202, USA
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Lazzaro B, Anderson AE, Kajdacsy-Balla A, Hessner MJ. Antigenic characterization of medullary carcinoma of the breast: HLA-DR expression in lymph node positive cases. Appl Immunohistochem Mol Morphol 2001; 9:234-41. [PMID: 11556751 DOI: 10.1097/00129039-200109000-00007] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Medullary carcinoma of the breast has attracted attention because of its relatively good prognosis, in spite of its high cytologic grade. It has, by definition, a consistent, florid tumor infiltrating lymphocyte (TIL) population, probably the result of cytotoxic T-lymphocytes recognizing tumor cells in an HLA-DR-restricted manner. HLA-DR tends to be more highly expressed on primary medullary carcinoma cells than on ductal carcinoma cells; however, the MHC-class II antigenicity of the tumor cells themselves has not been analyzed extensively, and as yet there has been no comparative study of HLA-DR expression in medullary and ductal carcinomas metastatic to lymph nodes. Eleven cases of medullary carcinoma and 15 cases of ductal carcinoma, primaries, and respective lymph node metastases were analyzed by immunoperoxidase staining for HLA-DR and lymphocytes antigens. Polymerase chain reaction (PCR) analysis to identify HLA-DR subtypes from the paraffin blocks was performed on selected cases of primaries and nodal metastases of both tumor types. Immunoperoxidase staining for HLA-DR antigen revealed a marked difference in antigen expression between medullary and ductal carcinomas. In the medullary carcinomas, the mean percentage of cells staining for HLA-DR was 74.5% in the primary tumors and 67.3% in the nodal metastases. For the ductal carcinomas, the mean percentage of cells staining was 17.7% in the primaries and 7% in the metastases. There was a tendency for the level of HLA-DR expression to remain high in medullary carcinoma metastatic to nodes, whereas whatever HLA-DR was present within ductal primaries tended to diminish when cells metastasized to regional nodes. PCR analysis of the HLA-DR within the two tumor types revealed no emerging subtype or variant that could be associated with either the medullary or the ductal carcinomas. Medullary carcinoma cells express much greater quantities of HLA-DR, on the whole, than ductal carcinomas. Expression of HLA-DR is retained on medullary carcinoma cells that have spread to lymph nodes, whereas the smaller quantities of HLA-DR present within ductal primaries tend to diminish even further when the tumor cells are found in lymph nodes. No discernible HLA-DR mutations or predominant subtypes emerged on PCR analysis, and the authors therefore conclude that it is the quantity and not the quality of HLA-DR expression in medullary carcinoma that maintains the characteristic TIL infiltrate, not seen in ductal carcinomas.
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Affiliation(s)
- B Lazzaro
- Department of Surgical Pathology, Medical College of Wisconsin, Milwaukee, USA
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Yeung DK, Cheung HS, Tse GM. Human breast lesions: characterization with contrast-enhanced in vivo proton MR spectroscopy--initial results. Radiology 2001; 220:40-6. [PMID: 11425970 DOI: 10.1148/radiology.220.1.r01jl0240] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To assess the clinical usefulness of localized proton (hydrogen 1) magnetic resonance (MR) spectroscopy in the characterization of contrast material-enhanced breast lesions on the basis of choline detection. MATERIALS AND METHODS Examinations were performed at 1.5 T with use of a standard breast coil. Contrast-enhanced MR imaging was performed in 30 consecutive patients (mean age, 50 years; age range, 20--80 years) who had nonspecific lesions (>1.5 cm in diameter) on sonograms or mammograms. Single-voxel (1)H MR spectroscopy was performed in the enhancing lesions by using a point-resolved spectroscopic sequence with echo times of 38, 135, and 270 msec. MR spectroscopic and histopathologic findings were determined in blinded fashion and compared. RESULTS Twenty-four patients had carcinoma of the breast (tumor size, 2.0--11.2 cm; mean, 4.7 cm), and six had benign lesions (lesion size, 1.8--3.8 cm; mean, 2.7 cm). Choline was detected in 22 patients with carcinoma. Choline was not detected in five patients with benign lesions and in two patients with carcinoma. The preliminary results indicate that this technique had a sensitivity of 92%, specificity of 83%, and accuracy of 90%. CONCLUSION Choline can be reliably detected in less than 45 minutes in large contrast-enhanced breast lesions by using a multiecho point-resolved spectroscopic protocol. The presence of water-soluble choline metabolites obtainable with (1)H MR spectroscopy could complement MR imaging findings to improve specificity and to reduce the number of unnecessary biopsies.
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Affiliation(s)
- D K Yeung
- Department of Clinical Oncology, Medical Physics Division, Prince of Wales Hospital, 30-32 Ngan Shing St, Shatin, Hong Kong, China.
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Avidor B, Varon M, Marmor S, Lifschitz-Mercer B, Kletter Y, Ephros M, Giladi M. DNA Amplification for the Diagnosis of Cat-Scratch Disease in Small-Quantity Clinical Specimens. Am J Clin Pathol 2001. [DOI: 10.1309/y5wn-8dfd-wlvt-kkad] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Abstract
In recent years, a number of novel human autoantigens and tumor-associated antigens have been identified using patient sera. Several of these antigens have been used as diagnostic markers, but defining their role in disease pathogenesis has been hampered by the lack of cloned human antibodies and antigens. Focusing on the solid cancers of the breast and colon and on autoimmune hematologic diseases, we are studying the role of human antibodies in disease pathogenesis. We have generated several human monoclonal autoimmune and cancer-associated antibodies, using antibody phage display technology, and have identified, cloned, and expressed their corresponding (novel) antigens. Using the monoclonal human antibodies as probes, we are elucidating the processes that lead to the generation of these antibodies and their possible pathogenic or protective effect. These studies may lead to the development of reagents for diagnosis and therapeutic intervention of these important diseases.
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Affiliation(s)
- H J Ditzel
- Department of Immunology, The Scripps Research Institute, La Jolla, CA 92037, USA.
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Cheung YC, Chen SC, Lee KF, Wan YL, Ng SH. Sonographic and pathologic findings in typical and atypical medullary carcinomas of the breast. JOURNAL OF CLINICAL ULTRASOUND : JCU 2000; 28:325-331. [PMID: 10934331 DOI: 10.1002/1097-0096(200009)28:7<325::aid-jcu2>3.0.co;2-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
PURPOSE We investigated whether there was a relationship between the sonographic and histologic appearances of medullary carcinomas of the breast to determine whether sonography is helpful in the differentiation of typical and atypical medullary carcinomas. METHODS We retrospectively reviewed the histologic slides and sonograms of 20 patients who had been diagnosed with medullary carcinoma of the breast. We then classified the carcinomas as typical or atypical based on strict histologic criteria. We also evaluated the relationship between sonographic findings and the histologic reclassification. RESULTS Eight (40%) of the 20 medullary carcinomas were classified as typical, and 12 (60%) were classified as atypical. On sonography, a smooth outline was visualized in 6 (75%) of the 8 typical medullary carcinomas but in none of the 12 atypical carcinomas. A jagged margin was sonographically visualized in 10 (83%) of the 12 atypical carcinomas, and a focal irregularity in the margin was visualized in 2 (17%) of the 12 atypical carcinomas. Four of the typical medullary carcinomas had posterior enhancement, and 9 of the atypical medullary carcinomas showed retrotumoral shadowing. The difference in tumor-margin regularity between typical and atypical medullary carcinomas was found to be statistically significant (p < 0.001) using the 2-tailed Fisher's exact test. CONCLUSIONS To prevent overdiagnosis of medullary carcinoma, a thorough pathologic review of the entire tumor is recommended if sonography shows a jagged margin or a margin with focal irregularity.
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Affiliation(s)
- Y C Cheung
- Department of Diagnostic Radiology, Chang Gung Medical Center at LinKou, 5 Fu-Hsing Street, Tao Yuan Hsien, Taiwan
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Pedersen L, Holck S, Mouridsen HT, Schødt T, Zedeler K. Prognostic comparison of three classifications for medullary carcinoma of the breast. Histopathology 1999; 34:175-8. [PMID: 10064398 DOI: 10.1046/j.1365-2559.1999.00584.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Jensen ML, Kiaer H, Melsen F. Medullary breast carcinoma vs. poorly differentiated ductal carcinoma: an immunohistochemical study with keratin 19 and oestrogen receptor staining. Histopathology 1996; 29:241-5. [PMID: 8884352 DOI: 10.1111/j.1365-2559.1996.tb01397.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Sixty breast carcinomas previously indexed as medullary carcinomas over a 24-year-period were reviewed and reclassified according to definitions suggested by Ridolfi et al. as typical medullary carcinoma, atypical medullary carcinoma, and non-medullary carcinoma. Paraffin sections of tumour tissue were examined by an avidin-biotin complex method using two keratin 19-specific monoclonal antibodies (BA17, DAKO and clone 170-2-14, Boehringer) and a monoclonal oestrogen receptor antibody (DAKO). For comparison 52 ductal carcinomas of grade II and grade III were immunostained as well. The results showed that all 60 tumours with medullary features and all 52 ductal carcinomas reacted moderately to strongly positive with anti-keratin 19 (Boehringer). The staining was diffuse in all cases, except one case of ductal carcinoma (grade III), which stained focally. Immunostaining with the second keratin 19 antibody (BA17) revealed similar results with positive staining in 59 (95%) cases of carcinomas with medullary features and 51 (98%) cases of ductal carcinomas. Only one case in each group did not express keratin 19 (BA17), one re-classified case of non-medullary carcinoma with neuroendocrine features and one case of ductal carcinoma of grade III. None of the 13 cases of typical medullary carcinoma were oestrogen receptor positive and only seven (12%) of the carcinomas with medullary features (2 atypical, 5 non-medullary) were oestrogen receptor positive with quantitative values from 20 to 100%. The 52 ductal carcinomas of grade II and III were oestrogen receptor positive in 56% and 47% of cases. It is concluded that keratin 19 staining is of no particular value in differentiating medullary from poorly differentiated ductal carcinoma. A carcinoma with positive oestrogen receptor staining is not likely to be a typical medullary carcinoma.
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Affiliation(s)
- M L Jensen
- Institutes of Pathology, Aarhus University Hospital, Svendborg Hospital, Denmark
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