Abstract P1-07-08: Mixed ductal-lobular carcinomas of the breast: Abrogated cell adhesion in the clonal evolution from ductal to lobular morphology

Mixed ductal-lobular carcinomas (MDL) display both ductal and lobular morphology, and are a clear example of intratumour morphological heterogeneity. The evolution of MDL carcinomas is not well understood. There is a paucity of data surrounding the genetic origin of the different morphological compartments and it remains to be seen whether the coincident presentation of these distinct morphological entities represents two independent tumours that have collided (so called 'collision tumours'), or whether they arise from a common clone. We propose that clonal progression during the evolution of these tumours is associated with a change in phenotype. To address this, a cohort of 82 MDLs was studied for clinical, morphological and molecular features. Key findings include: i) MDLs more frequently co-exist with ductal carcinoma in situ (DCIS) than lobular carcinoma in situ (LCIS); ii) the E-cadherin-catenin complex was recurrently normal in the ductal component but aberrantly localised in the lobular component of the same tumour; iii) E-cadherin deregulation in the lobular component was almost always aberrantly located to the cytoplasm, conversely classic ILCs are typically completely negative for this molecule; iv) epithelial to mesenchymal transition marker expression was not associated with E-cadherin deregulation. Comparative Genomic Hybridsation (CGH) and exome sequencing was performed to investigate clonal relationships between the different intratumour morphologies and identify mechanisms underlying the change in phenotype. Our analysis revealed that i) all morphological components within a case are clonally related; ii) divergence of the morphological components may occur early during tumour evolution (where both DCIS and LCIS are present) or later during tumour progression (cases with only DCIS detectible); and iii) mutations were identified in genes such as CDH1 and ESR1, and other breast cancer driver genes. Together, these data strongly support the concept that the disparate morphological components of these mixed tumours are clonally related, and are not the result of a collision event. Furthermore, we show that lobular morphology can arise via a 'ductal' pathway of tumour progression. The mechanisms driving the change in phenotype are yet to be fully elucidated, but there is significant intertumour heterogeneity and each case may utilise a unique molecular mechanism.

Citation Format: McCart Reed AE, Kutasovic JR, Nones K, da Silva L, Melville L, Jayanthan J, Vargas AC, Reid LE, Saunus JM, Cummings MM, Porter A, Evans E, Waddell N, Lakhani SR, Simpson PT. Mixed ductal-lobular carcinomas of the breast: Abrogated cell adhesion in the clonal evolution from ductal to lobular morphology [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-07-08.

Developing and implementing a comprehensive program for children and adolescents with eating disorders

TOPIC

Treatment of eating disorders in children and adolescents across a continuum of care.

PURPOSE

To describe the development and implementation of a comprehensive pilot program for children and adolescents with eating disorders.

SOURCES

Published literature and clinical experience.

CONCLUSIONS

The pilot program to provide comprehensive care to children and adolescents has been successful. As of November 2000, the inpatient modal eating disorder census has been 4 (highest = 10, lowest = 1). With the focus on prevention and early intervention, the multidisciplinary team continues to educate the public and providers.

Senator Lister Hill, 1894-1984

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The effect of U.S. policies on the economics of libraries

The decline in federal support of educational programs has made it difficult for libraries to apply new technologies to improve practices and services. While federal support has declined in constant dollars, there has been a modest increase in grants from private foundations. Current U.S. policies require federal agencies to recover full costs of rendering services (Circular A-25) and require the transfer of many federal service-oriented activities to the commercial sector (Circular A-76). Additionally, the Paperwork Reduction Act of 1980 is inhibiting the production and dissemination of federal publications. Government pursuit of these policies adds a heavy economic burden to libraries and threatens to reduce access to the scholarly and scientific record.

The Medical Library Assistance Act: an analysis of the NLM extramural programs, 1965-1970

The imbalance between medical library resources and information needs of the health professional led to a reexamination of the mandate for the National Library of Medicine. Legislation known as the Medical Library Assistance Act (MLAA) was passed in 1965 which enabled the NLM to (1) initiate programs to assist the nation's medical libraries and (2) develop a medical library network with the establishment of regional medical libraries to link the NLM with local institutions. The National Library of Medicine, through the MLAA, has made available $40.8 million to the medical library community under a competitive grant and contract mechanism for the period July 1965-June 1970. A total of 604 projects has been executed in resources, research and development, training, construction, regional medical libraries, publications, and special scientific projects. An assessment is given of each of these programs and their impact on both the National Library of Medicine and individual medical libraries. In the aggregate, these programs have significantly improved library and information services to the professional health user. The principal limitation has been inadequate funding to accomplish the level of originally stated objectives.