1
|
Koufopoulos N, Nasi D, Goudeli C, Antoniadou F, Kokkali S, Pigadioti E, Provatas I, Maggo E, Ardavanis A, Terzakis E, Arkoumani E, J Agnantis N, Apostolikas N, Khaldi L. Primary squamous cell carcinoma of the ovary. Review of the literature. J BUON 2019; 24:1776-1784. [PMID: 31786837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
PURPOSE Primary squamous cell carcinoma (SCC) of the ovary is rare. Most cases arise from a cystic teratoma or less frequently from Brenner tumor or endometriosis. We reviewed 36 cases of primary ovarian SCC reported in the literature including a case diagnosed and treated in our institution. METHODS Data was collected by using the key-words "primary squamous cell carcinoma" and "ovary" on Google Scholar and PubMed in April 2018. All reviewed cases were analyzed according to diagnosis, surgical approach, adjuvant therapy and outcome. RESULTS To date 23 articles presenting 36 cases of primary ovarian SCC are reported. Nine patients had stage I, 8 stage II, 11 stage III and 5 stage IV disease, whereas 3 patients had in situ carcinoma. All patients underwent surgery (mainly hysterectomy with bilateral salpingo-oophorectomy). Adjuvant therapy was reported in 24 patients, 15 of which received chemotherapy, 6 radiotherapy and 3 a combination of both. Chemotherapy regimens were similar to the ones used in ovarian carcinoma (more often platinum plus paclitaxel). Follow-up period was in general short and survival varied between 9 days and 14 years, depending on the stage at diagnosis. CONCLUSIONS Primary ovarian SCC is a rare entity with poor prognosis, compared to serous carcinoma. Treatment is usually extrapolated from classical ovarian carcinoma algorithms, including surgical management combined with adjuvant chemotherapy with or without radiotherapy. Further investigations are needed to define optimal treatment, such as chemotherapy regimens and the role of radiotherapy and lymph node dissection.
Collapse
Affiliation(s)
- Nektarios Koufopoulos
- Department of Pathology, Anticancer Oncologic Hospital "Saint Savvas", Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Tryfonopoulos D, Oikonomopoulos G, Demiri S, Lekakis L, Pistamaltzian NF, Koumakis G, Panopoulos CG, Koufopoulos N, Apostolikas N, Misitzis I, Efremidis AP. Clinicopathologic characteristics of triple-negative breast cancer and relationship to basal markers. J Clin Oncol 2012. [DOI: 10.1200/jco.2012.30.15_suppl.e11519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11519 Background: Triple negative breast cancers are immunohistochemical surrogates of basal-like breast cancers. There is no complete overlap between triple negative and basal-like tumors and as gene expression studies evolve, further subclassification bearing clinical relevance is underway. Our purpose was to correlate clinicopathologic characteristics of triple negative breast cancer tumors with expression of basal markers in an effort to define immunohistochemically subgroups of this heterogenous disease Methods: Data were retrieved and analysed using our electronic databank. Patient samples were reviewed by an expert breast cancer pathologist and stained additionally for EGFR and CK 5/6 antibodies. Results: Sixty-five women with triple negative breast cancer were identified. Mean age was 58.3±12.9 years. Most tumors (86%) were of ductal histology, 53% grade 3, 48% having high Ki-67 index (>14%). 10% of patients presented with Stage IV, 25% with Stage III, 38% with stage II and 27% with stage I disease. 63% of patients were postmenopausal. EGFR staining was present in 43% of tumor samples, whereas CK 5/6 in 38.5%. Both EGFR and CK 5/6 expression was found in 18.5%, whereas 37% of tumors expressed neither EGFR or CK 5/6. No difference was observed between tumors expressing any of these 2 basal markers as compared to EGFR and CK 5/6 negative tumors in terms of Ki-67 index, grade, tumor size and nodal involvement. Lymphovascular invasion and non-ductal histology tended to occur more frequently (p=ns) in non-basal tumors. Additionally, patients with expression of any of the basal markers tended to be more obese than the non-basal triple negative breast cancer patients (p=ns). Conclusions: Further immunohistochemical markers apart from EGFR and CK 5/6 are needed in order to further define clinically meaningful subgroups of triple negative breast cancer.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | - Ioannis Misitzis
- The Breast Clinic, "Saint Savvas," Anticancer Hospital, Athens, Greece
| | | |
Collapse
|
3
|
Tsoukalas N, Apostolikas N, Tolia M, Papakostidi A, Lypas G, Pistamalntzian N, Panopoulos C, Koumakis G, Barbounis V, Efremidis A. 171 Primary Mucinous Breast Carcinoma of Columnar Cells Resembling Ovarian Cancer. Eur J Cancer 2012. [DOI: 10.1016/s0959-8049(12)70239-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
4
|
Pistamaltzian NF, Tzavara C, Papadimitriou C, Gyftaki R, Tryfonopoulos D, Panopoulos C, Tsoukalas N, Koumakis G, Demiri S, Koufopoulos N, Misitzis Y, Apostolikas N, Efremidis A. P4-11-15: Increased Propability of Triple Negative Breast Cancer (TNBC) in Premenopausal Patients after Exogenous Hormonal Intake (EHI). Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p4-11-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: HRT is a known risk factor for breast cancer (BC) among post-menopausal women. Our knowledge in relation to EHI (estrogens and/or progestin) and BC among pre-menopausal women is scarce. We have studied whether previous EHI influences BC phenotype, clinical and pathologic characteristics and correlation with other known BC risk factors.
Patients and methods: A prospective analysis (data recorded upon patients first presentation) of an electronic database at a tertiary cancer centre was performed. Patients’ demographics, risk factors for BC (smoking, alcohol use, obesity, family history), clinical profile, EHI parameters (duration, cause) and the tumors’ histopathology (type, grade,ER/PgR and HER2 by IHC and FISH) were analyzed. Premenopausal patients without an EHI history consisted control group.
Results: Out of 938 patients treated for BC between 2006 and 2010, 333(35,5%) were premenopausal and 131(39%) of them reported any use of hormones. Median age was identical (43 years,range:20–57) among premenopausal patients with and without EHI history. Mean duration of use was 28 months (range:1–180). Causes of EHI were contraception (35%), pregnancy(17%), menstrual abnormalities(17%) and medically assisted fertilization(17%). Smoking, alcohol use and obesity didn't differ among two groups. Family history for BC was more common (31, 3% vs. 22,8%, p=0,08)among women with EHI. No correlation was found among duration of use and the time of cancer diagnosis, while the mean time from the cessation of hormones to cancer diagnosis was 13 years(range:1–32). Only 18% of breast cancers were diagnosed within the first 5 years after exogenous hormones cessation.
TNBC was found to be significantly increased among premenopausal women with a history for EHI (23,6% vs. 13,4%, p=0,016). This increase was independent of the existence of positive family history for BC (p=0,61). EHI conferred a twofold increase in the risk for a TNBC (OR=1,99 p=0,019). No other clinical or histopathologic parameter showed any difference among the two groups.
Conclusion: Prior use of exogenous hormones, for any cause and irrespective of the coexistence of other risk factors and family history, increases the probability of a triple negative breast cancer diagnosis by twofold. Whether this represents a trend of a changing epidemiology in the types of BC in prior hormone users vs. nonusers, poses an extremely challenging hypothesis to be verified in large epidemiologic studies — given the young age and the treating difficulties of this patient population.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P4-11-15.
Collapse
Affiliation(s)
- NF Pistamaltzian
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - C Tzavara
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - C Papadimitriou
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - R Gyftaki
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - D Tryfonopoulos
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - C Panopoulos
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - N Tsoukalas
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - G Koumakis
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - S Demiri
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - N Koufopoulos
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - Y Misitzis
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - N Apostolikas
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| | - A Efremidis
- 1Agios Savvas Cancer Hospital of Athens, Athens, Greece; University of Athens, Athens, Greece
| |
Collapse
|
5
|
Pistamaltzian NF, Papadimitriou C, Panopoulos C, Koumakis G, Demiri S, Tsoukalas N, Yannoukakos D, Apostolikas N, Panagopoulos E, Efremidis A. Abstract P6-10-06: Metachronous Contralateral Breast Cancer (CBC) Has More Aggressive Biology and Clinical Characteristics Compared to Synchronous Bilateral Breast Cancer (BBC). Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-p6-10-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Bilateral breast cancer is an uncommon clinical entity. There is no specific treatment strategy and controversial issues concerning diagnostic criteria, management and classification exist.
Method: In order to address some of these issues, a prospective analysis (data recorded upon patients first presentation) of an electronic breast cancer database at a tertiary cancer centre was performed. Patients’ epidemiologic characteristics, clinical profile, genomic analysis information and the tumours’ histopathology were analyzed.
Results: Out of 900 patients treated for breast cancer between 2006 and 2009, 44 diagnosed with bilateral disease (5% of total)having a median age of 53 years(range 32-73). 16 of them (36%)suffered from synchronous disease and 28 (64%)from metachronous { >3 months apart between the initial diagnosis and subsequent contralateral breast tumour).
Genetic analysis revealed 3 patients with inherited breast cancer syndromes (2 with BRCA1 and one with CDH-1 mutation). Among those with synchronous BBC 63% (10/16)were postmenopausal, 50% (8/16)had a positive family history for breast cancer and upon initial diagnosis 80% (13/16)of them presented with early stage disease (stages I,II).Contralateral disease was diagnosed incidentally. In contrast to these patients with synchronous BBC,57% of the patients (16/28)with metachronous CBC were premenopausal and 68% (19/28)had advanced disease (stages III,IV) upon the second diagnosis. Etrogens’ use didn't differ among the two groups, obesity was more common in patients with metachronous CBC, and smoking in the synchronous BBC patients.
Of the 88 tumours, 81(92%) were invasive, with ductal adenoCa being the more common (53% of specimens).
Of synchronous BBC tumours 12/16 (75%)were HR+ positive and 80%(13/16) expressed the same biologic features bilaterally. Of the metachronous tumours, upon initial diagnosis,26% were triple negative and only 7% were found with HER2 amplification, compared with 41% and 26% respectively in the second diagnosis. Conclusions: Synchronous BBC is less prevalent than Metachronous CBC, has more favourable characteristics (earlier stage at diagnosis, hormonal receptor positivity), and occurs mainly among postmenopausal women with positive family history.
Metachronous CBC is more common in premenopausal women and has a tendency to change its biological and clinical characteristics to a more aggressive phenotype (triple negative, HER2 amplification) between initial and latter diagnosis.
If this phenomenon is a result of previously given chemo/radio-therapy or it reperesents the natural evolution to a second primary, remains a challenging question to be answered.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-10-06.
Collapse
Affiliation(s)
- NF Pistamaltzian
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - C Papadimitriou
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - C Panopoulos
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - G Koumakis
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - S Demiri
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - N Tsoukalas
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - D Yannoukakos
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - N Apostolikas
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - E Panagopoulos
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| | - A. Efremidis
- Agios Savvas Cancer Hospital, Athens, Greece; NSCR Demokritos, Athens, Greece
| |
Collapse
|
6
|
Tryfonopoulos D, Christakou H, Rapti V, Kontou N, Panopoulos C, Koumakis G, Demiri S, Papadimitriou C, Missitzis I, Apostolikas N, Efremidis A. Abstract PD09-02: Prognostic Effect of Obesity on Breast Cancer. Cancer Res 2010. [DOI: 10.1158/0008-5472.sabcs10-pd09-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Body mass index (BMI), prior estrogen use, and family history have been described as risk factors for invasive breast cancer. Our purpose was to investigate the influence of obesity on established prognostic pathologic and molecular characteristics of breast cancer. Material and methods: Five-hundred and twelve female consecutive breast cancer patients of mean age 53±11 years were included in this study. Data were recorded in a prospective electronic databank upon first presentation. Risk factors (BMI, family history, prior estrogen use, menopausal status, parity, metabolic syndrome, smoking, alcohol, hypertension, hyperlipidaemia and diabetes) as well as histologic characteristics (TNM, nodal status, grade, LVI) and tumor phenotype (ER, PR, Cerb-B2) were obtained. Patients with a BMI<27 were considered of normal weight whereas patients with a BMI≥27 were considered as obese. Univariate and logistic regression analysis were performed. Results: The 2 groups did not differ for age (p=ns). Patients with a BMI≥27 were more frequently node positive, had a higher incidence of grade 3, LVI positive tumors and had more often a positive family history of breast cancer (P<0.05). On the contrary, patients with a BMI<27 reported more frequently prior estrogen use and were more commonly nulliparous (P<0.05). Regression analysis confirmed that in patients with BMI<27 age and menopausal status were associated with node positive disease, independently of tumor phenotype, grade, LVI, family history, estrogen use and parity (0.951, 95%CI 0.91-0.99 and 3.232, 95%CI 1.2-8.5). Using the same analysis, in patients with BMI≥27 LVI was associated with node positive disease, independently of all other factors (5.253, 95%CI 1.1-26.9).
Discussion: Different risk factors appear to influence lean and obese breast cancer patients. Patients with BMI<27 more frequently have a history of estrogen use and nulliparity. Age and menopausal status are independently associated with node + disease in lean patients. Obese patients (BMI>27) have more frequently positive family history and more aggressive histology (node +, grade 3, LVI+). LVI in obese patients appears to be independently associated with node + disease.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr PD09-02.
Collapse
Affiliation(s)
| | - H Christakou
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - V Rapti
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - N Kontou
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - C Panopoulos
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - G Koumakis
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - S Demiri
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | | | - I Missitzis
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - N Apostolikas
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| | - A. Efremidis
- St Savvas Anticancer Oncology Hospital, Athens, Greece
| |
Collapse
|
7
|
Pakos EE, Gogou PV, Apostolikas N, Batistatou A, Tsekeris PG. Factors associated with outcome in liposarcomas of the extremities and trunk. J BUON 2010; 15:518-523. [PMID: 20941821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE Liposarcomas are malignant tumors that arise from primitive mesenchymal cells rather than mature adipose tissue. We aimed to evaluate the outcomes of patients with extremities and superficial trunk liposarcomas in relation to some clinicopathological factors. METHODS Sixty-three surgically treated patients with liposarcoma, with mean age 53 years, were included in this study. The 5-and 10-year survival rates were analyzed with respect to local recurrences, distant metastases and death with the Kaplan-Meier method. Cox models estimated univariate and multivariate hazard ratios for each candidate predictor of interest. RESULTS The 5-year overall survival was 77.8% (95% CI 65.5-87.3) and the 10-year overall survival was 63.5% (95% CI 50.4-75.3). The 5-and 10-year recurrence-free survival were 60% and 57%, respectively. The 5-and 10-year metastasis-free survival were 86% and 84%, respectively. In univariate analysis factors that were significantly associated with outcomes were grade III tumors, amputation procedures, use of chemotherapy and development of local recurrences. No significant association was observed in multivariate analysis. CONCLUSION Patients with liposarcoma surviving for 5 years, have also a high probability to be alive at 10 years. The development of metastases is observed within the first 5-years from diagnosis. Metastatic disease after that period is rare. The possibility of local recurrence is not negligible after the 5th year of follow up.
Collapse
Affiliation(s)
- E E Pakos
- Department of Radiation Therapy, University of Ioannina, School of Medicine, Ioannina, Greece.
| | | | | | | | | |
Collapse
|
8
|
Terzakis E, Androutsopoulos G, Derdelis G, Zygouris D, Grigoriadis C, Apostolikas N. Loop electrosurgical excision procedure in Greek patients with vulvar intraepithelial neoplasia. EUR J GYNAECOL ONCOL 2010; 31:191-193. [PMID: 20527238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The aim of our study was to evaluate the therapeutic effectiveness of loop electrosurgical excision procedure (LEEP) in Greek patients with vulvar intraepithelial neoplasia (VIN). MATERIALS AND METHODS Between January 2002 and January 2009, 55 women with histologically confirmed VIN usual type were included in our study. For the LEEP procedure we used a high frequency electrosurgical unit with at least 80 W output. The tissue was removed to the second surgical plane. Statistical analyses were performed using the SPSS-13 for Windows. RESULTS Complete response rate at 12-month follow-up was 100%. Complete response rate at 48 months of follow-up was 80%. Recurrence rate at 48 months of follow-up was 20%. CONCLUSION LEEP may constitute a valuable excisional method for the treatment of VIN. It provides an interpretable specimen of the whole lesion within a few minutes. It needs a short period of training and has low cost.
Collapse
Affiliation(s)
- E Terzakis
- 2nd Department of Gynaecology, St. Savvas Anticancer-Oncologic Hospital, Athens, Greece
| | | | | | | | | | | |
Collapse
|
9
|
Arnogiannaki N, Martzoukou I, Kountourakis P, Dimitriadis E, Papathanasaki A, Nastoulis E, Gazalidou M, Fida A, Apostolikas N, Agnantis NJ. Synchronous presentation of GISTs and other primary neoplasms: a single center experience. In Vivo 2010; 24:109-115. [PMID: 20133985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND Gastrointestinal stromal tumors (GISTs) are common mesenchymal neoplasms of the digestive tract and may occasionally arise within the abdomen without gastrointestinal tract connection. GISTs have recently attracted widespread interest because of the development of effective targeted molecular agents against it. While synchronous occurrence of a GIST with a tumor of different histogenesis was thought to be very rare, it is now apparent that they are more common than previously believed. PATIENTS AND METHODS We report our experience with GISTs and also six cases of GIST coexisting with other primary neoplasms. Using immunohistochemistry and mutational analysis, a possible correlation was investigated. A review of the literature was also conducted. RESULTS There were no significant differences in the immumohistochemical and molecular profile between single GISTs and GISTs coexisting with other tumors, nor was there any mutational correlation between GISTs and the coexistent tumors of different histogenesis regarding KIT and PDGFRA genes. CONCLUSION Further molecular biology studies are required in order to investigate thoroughly the simultaneous development of tumors with different histotypes.
Collapse
Affiliation(s)
- Niki Arnogiannaki
- Department of Surgical Pathology, Saint Savvas Anticancer Hospital, Athens, Greece.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Tsoukalas N, Apostolikas N, Lypas G, Papadimitriou C, Pistamalntzian N, Panopoulos C, Demiri S, Koumakis G, Barbounis V, Efremidis A. 5101 Demographic clinical and pathologic features of breast cancer in males. EJC Suppl 2009. [DOI: 10.1016/s1359-6349(09)70993-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
11
|
Panopoulos CG, Tzavara C, Papadimitriou K, Pistalmatzian N, Lypas G, Barbounis V, Demiri S, Koumakis G, Apostolikas N, Efremidis A. Relationship between lymphovascular invasion (LVI) and prognostic markers in different subtypes of breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e22109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e22109 Background: Prognostic and predictive factors for invasive breast cancer (BC) are well established. LVI was added to the list of prognostic factors for node negative patients (St.Gallen 2006). The aim of this study was to investigate the relationship of LVI with known prognostic markers and its role on different subtypes of breast cancer. Methods: 367 patients with primary BC were evaluated in this study. Tumoral and peritumoral breast tissue was examined for LVI. The patient's age, menopausal status, tumor histology, tumor size, histologic grade, lymph node (LN) involvement, hormone receptor (HR) status and HER-2 status were determined as markers of prognosis. The association of LVI with the aforementioned markers was evaluated using multiple logistic regression analysis. Results: The distribution of the patients was as follows: 40.9% were HR + and HER-2 - (luminal type), (32.4%) were triple negative, 26.7% were HER-2 Positive (9.5% of them were HER-2 + and HR -, while 17.2% were HER-2 + and HR+). Almost half of the patients (48.8%) had one or more positive nodes. Multiple analysis revealed that histologic grade, LN involvement and HER-2 positivity were independently associated with LVI. Patients with histologic grade II and III had 5.31 (95% CI: 1.14–24.75) and 7.03 (95% CI: 1.47- 33.53) times greater odds for LVI respectively compared to those with grade I. Patients with one or more than three nodes involved had 3.95 (95% CI: 2.13–7.33) and 6.29 (95% CI: 3.14–12.63) times greater odds for LVI respectively compared with node negative tumors. Furthermore, HER-2 positive patients had almost twofold likelihood for LVI (OR=1.80, 95% CI: 1.02–3.16). The effect of HER-2 positivity on LVI was independent of HR status. Age, menopausal status, tumor histology, tumor size and HR status were not significantly associated with LVI. Conclusions: LVI shows a close relationship with known markers of poor prognosis as histologic grade, and LN invasion. More aggressive tumors as HER-2 + tumors have a significantly higher probability of LVI, which may be used as an indicator of more aggressive behavior of the primary tumor. No significant financial relationships to disclose.
Collapse
Affiliation(s)
- C. G. Panopoulos
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - C. Tzavara
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - K. Papadimitriou
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - N. Pistalmatzian
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - G. Lypas
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - V. Barbounis
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - S. Demiri
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - G. Koumakis
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - N. Apostolikas
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| | - A. Efremidis
- Agios Savvas Cancer Hospital, Athens, Greece; Medical School, Athens, Greece
| |
Collapse
|
12
|
Perez SA, Bisias S, Kallinteris NL, Ardavanis A, Georgakopoulou KG, Apostolikas N, Thanos A, Papamichail M, von Hofe E, Baxevanis CN. Results from the first phase I clinical study of the novel Ii-Key/HER2/neu(776–790) hybrid peptide vaccine in patients with prostate cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.3011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3011 Background: HER-2/neu(776–790) represents an immunogenic epitope from the HER-2/neu oncoprotein whose immunogenicity is highly potentiated upon linkage with the Ii-Key moiety (LRMK) from the MHC class II invariant chain. Herein, we present the results of the first phase I clinical trial of the Ii-Key/HER-2/neu(776–790) (AE37) vaccine in patients (pts) with prostate cancer. Methods: Androgen-dependent (AD) and androgen-independent (AI) pts with HER-2/neu+ (IHC: 1–3) prostate adenocarcinomas were eligible. Concomitant medication with bicatulamide and LHRH or docitaxel was allowed. All pts received 6 monthly vaccinations with the AE37 vaccine (500 μg of AE37 plus 125 μg of GM-CSF) administered in two doses intradermally 5cm apart in the same extremity for each vaccination cycle. Immunologic responses were measured monthly in vitro by the IFNγ-based ELISPOT assay using pts’ PBMC and in vivo at the beginning and end of immunizations using DTH. Local dermal reactions were also measured after each vaccination. Results: Eligible pts [AD (n=18), AI (n=10)] were at stages T1–3N0M0, GS: 3–7 (n=18); T1–3N+M0, GS: 6–7 (n=2); T1–3N0M+, GS: 6–9 (n=4) and T1–3N+M+, GS: 6–9 (n=4). All pts had standard treatment prior to vaccinations, including surgery (S) (n=9); hormonal treatment (HT) (n=4); S+HT (n=6); S+HT+radiotherapy (RT); (n=2); S+chemotherapy (CH) (n=2); HT+RT (n=2); CH (n=3) and S+HT+CH (n=2). During vaccinations, 11 pts were free of any treatment, while 5 pts who had progressive disease received additional chemotherapy; the remainder received HT alone or combined with RT. 25 pts completed all vaccinations. Toxicity and side effects beyond grade-2 were not observed. GM-CSF was reduced by 50% for subsequent vaccinations when a local reaction of 100mm or greater was observed. DTH reactions to the parent HER-2/neu(776–790) peptide were increased (compared to pre-vaccination) for all pts, while approximately half the pts responded with significantly increased IFNγ responses to AE37 and/or parent HER-2/neu(776–790) peptide in at least 2 sequential vaccination cycles. Conclusions: The AE37 vaccine is safe and well tolerated. AE37 is also capable of eliciting potent and specific immunologic responses in prostate cancer pts. [Table: see text]
Collapse
Affiliation(s)
- S. A. Perez
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - S. Bisias
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - N. L. Kallinteris
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - A. Ardavanis
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - K. G. Georgakopoulou
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - N. Apostolikas
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - A. Thanos
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - M. Papamichail
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - E. von Hofe
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| | - C. N. Baxevanis
- Saint Savas Cancer Hospital, Athens, Greece; Antigen Express, Inc., Worcester, MA
| |
Collapse
|
13
|
Gogou PN, Batistatou A, Pakos EE, Apostolikas N, Stefanou D, Tsekeris PG. E-cadherin, b-catenin and topoisomerase II expression in rhabdomyosarcomas. J BUON 2009; 14:323-324. [PMID: 19650189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
|
14
|
Korkolis DP, Aggeli C, Plataniotis GD, Gontikakis E, Zerbinis H, Papantoniou N, Xinopoulos D, Apostolikas N, Vassilopoulos PP. Successful en bloc resection of primary hepatocellular carcinoma directly invading the stomach and pancreas. World J Gastroenterol 2009; 15:1134-7. [PMID: 19266609 PMCID: PMC2655177 DOI: 10.3748/wjg.15.1134] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Multivisceral surgical resection for cure was successfully performed in a 70-year-old man suffering from a primary hepatocellular carcinoma (HCC) associated with direct invasion to the stomach and pancreas. The patient presented with gastric outlet obstruction, upper abdominal pain and a history of chronic liver disease due to hepatitis B virus (HBV) infection. Upper gastrointestinal (GI) endoscopy revealed an infiltrating tumor protruding through the gastric wall and obliterating the lumen. Computer tomograghy (CT) and magnetic resonance imaging (MRI) scan demonstrated a 15-cm tumor in the left lateral segment of the liver with invasion to the stomach and pancreas. Alpha-foetoprotein (AFP) levels and liver function tests were normal. The patient underwent an en bloc left hepatectomy, total gastrectomy, distal pancreatectomy with splenectomy and radical lymphadenectomy. Pathology revealed a poorly differentiated, giant cell HCC involving the stomach and pancreas. Disease-free margins of resection were achieved. The patient’s postoperative course was uneventful. Sixteen months after surgery, he has no recurrence or distal metastasis. Direct invasion of HCC into the GI tract is rarely encountered. Complete surgical resection should be considered in selected patients with an appropriate hepatic functional reserve.
Collapse
|
15
|
Korkontzelos I, Fragkoulidis M, Stavroulis A, Apostolikas N, Terzakis E. Adenoid cystic carcinoma of the Bartholin's gland in a young patient: eight-year follow-up. EUR J GYNAECOL ONCOL 2009; 30:686-688. [PMID: 20099506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Adenoid cystic carcinoma (ACC) of the Bartholin's gland is one of the rarest neoplasms of the female genital tract. Including this report there are 65 cases mentioned in the literature. We report a case of a 36-year-old woman who presented at our hospital after excision of the right Bartholin gland elsewhere which proved to be ACC. The therapy of this rare tumor has many controversial questions and dilemmas, especially in young patients. Our patient underwent surgical treatment only (hemivulvectomy and lymph node dissection) without radiotherapy and is free of disease eight years after.
Collapse
Affiliation(s)
- I Korkontzelos
- 2nd Department of Gynecology, Saint Savvas Anticancer Hospital, Athens, Greece.
| | | | | | | | | |
Collapse
|
16
|
Kountourakis P, Arnogiannaki N, Stavrinides I, Apostolikas N, Rigatos G. Concomitant gastric adenocarcinoma and stromal tumor in a woman with polymyalgia rheumatica. World J Gastroenterol 2008; 14:6750-2. [PMID: 19034984 PMCID: PMC2773323 DOI: 10.3748/wjg.14.6750] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal stromal tumors (GISTs) are rare neoplasms (1%) of the gastrointestinal tract and to our knowledge only rare cases of synchronous presentation of gastric carcinomas and GISTs are reported in the literature. A 72-year-old female with a simultaneous presentation of gastric adenocarcinoma and GIST is presented. Moreover, due to polymyalgia rheumatica the patient received corticosteroids as treatment for the last 3 years. The concomitant occurrence of these neoplasms may involve common carcinogenic factors and there could be an association with polymyalgia rheumatica either as a paraneoplastic presentation or due to its treatment with corticosteroids.
Collapse
|
17
|
Mitropoulou G, Georgalis A, Tsakanika K, Rempelakos A, Apostolikas N, Thanos A, Panotopoulou E. MP-07.02: Bcl-2, bax expression in prostate carcinogenesis. Urology 2007. [DOI: 10.1016/j.urology.2007.06.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
18
|
Mitropoulou G, Georgalis A, Tsakanika K, Rempelakos A, Apostolikas N, Thanos A, Panotopoulou E. POS-02.45: Bag-1 and bax expression in benign prostatic hyperplasia and prostate cancer. Urology 2007. [DOI: 10.1016/j.urology.2007.06.785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
19
|
Korkolopoulou P, Saetta AA, Levidou G, Gigelou F, Lazaris A, Thymara I, Scliri M, Bousboukea K, Michalopoulos NV, Apostolikas N, Konstantinidou A, Tzivras M, Patsouris E. c-FLIP expression in colorectal carcinomas: association with Fas/FasL expression and prognostic implications. Histopathology 2007; 51:150-6. [PMID: 17559541 DOI: 10.1111/j.1365-2559.2007.02723.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS Disruption of apoptotic cell death has been implicated in tumour aggressiveness in colonic carcinogenesis. The Fas-Fas ligand (FasL) system is involved in the execution of apoptosis induced by the immune system. c-FLIP protein constitutes an inhibitor of Fas and other (TRAIL) death receptor-mediated apoptosis. The aim of this study was to investigate the simultaneous expression of Fas, FasL and c-FLIP in relation to standard clinicopathological parameters and patients' outcome in colorectal cancer. METHODS AND RESULTS Levels of Fas, FasL and c-FLIP protein expression were quantified immunohistochemically in paraffin-embedded tissues from 90 patients. Immunopositivity was detected for Fas, FasL and c-FLIP in 71%, 35.5% and 68.8% of cases, respectively. Concurrent expression of Fas/FasL was seen in 28 samples (31%), of which 24 (85.7%) also displayed c-FLIP positivity (P = 0.04). c-FLIP overexpression (> 10%) tended to prevail marginally in higher stage tumours (P = 0.09). Additionally, FasL and c-FLIP adversely affected survival on both univariate (P = 0.001 and P = 0.0024, respectively) and multivariate analysis [hazard ratio (HR) 3.491, P = 0.005 and HR 2.960, P = 0.036, respectively]. CONCLUSIONS The frequent expression and coexpression of Fas, FasL and c-FLIP in colorectal carcinoma implicates c-FLIP as an inhibitor of the Fas-FasL-induced death pathway in these tumours. Moreover, c-FLIP conveys independent prognostic information in the presence of classical prognosticators.
Collapse
Affiliation(s)
- P Korkolopoulou
- Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Karamouzis MV, Fida A, Apostolikas N, Rigatos G. A case of HER-2(+) squamous cell breast carcinoma: An unusual presentation of an unusual clinical entity. Eur J Surg Oncol 2006; 32:1250-1. [PMID: 16797157 DOI: 10.1016/j.ejso.2006.05.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 05/10/2006] [Indexed: 11/22/2022] Open
Affiliation(s)
- M V Karamouzis
- First Department of Medical Oncology, St. Savvas Anticancer-Oncologic Hospital, Anatolikis Thrakis 20, 15669 Papagou, 15669 Athens, Greece.
| | | | | | | |
Collapse
|
21
|
Tserkezoglou A, Kontou S, Hadjieleftheriou G, Apostolikas N, Vassilomanolakis M, Sikiotis K, Salamalekis E, Tseke P, Magiakos G. Primary and metastatic ovarian cancer in patients with prior breast carcinoma. Pre-operative markers and treatment results. Anticancer Res 2006; 26:2339-44. [PMID: 16821613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND The pre-operative diagnosis of primary and metastatic malignant ovarian tumors in patients treated for breast cancer is difficult. The objective of this study was to analyze and compare the characteristics and outcome of women with a history of breast cancer in order to identify pre-operative markers useful in differential diagnosis and the role of surgery in their management. MATERIALS AND METHODS The medical records of 36 patients with a history of breast cancer, who had been operated on either for primary or metastatic cancer between 1987 and 2003, were reviewed retrospectively. RESULTS Twenty-seven patients had been diagnosed with primary epithelial ovarian cancer (POC) and nine had metastatic disease (MOC), resulting in a 3:1 ratio. The median age of breast and ovarian cancer diagnosis was 45 and 56 years, respectively, and the median interval was 8 years. The serum CA 125 level was elevated in the majority of cases, in 70% of the POC group and 56% of the MOC, but the median level was higher, though not statistically significant, in the former. Serum CA 15-3 levels were elevated >100 U/ml in 89% of patients with MOC (p = 0.0002). BrCA mutation risk, as calculated with the BRCAPRO software program, was 41.8% and 9% in primary and metastatic tumors, respectively (p=0.0477). Ovarian spread was not the only site of metastatic breast cancer in 55.5% of the MOC group, compared to 11% of the POC patients Disease was disseminated in the abdominal cavity at the time of diagnosis in both groups, however, 78% of patients had unilateral tumors in the POC group and bilateral disease in the MOC (p=0.0133). Cytoreduction to less than 2 cm tumor diameter was feasible in 67% of primary and 44% of metastatic neoplasms. In the follow-up period (12-204 months), the median survival was 10 months for patients with metastatic disease, compared to 33 months for those with primary tumors (p<0.05). CONCLUSION Small bilateral ovarian enlargements and minor serum elevation of CA 125 titers in patients with initial Stage IV breast cancer, suffering from multiple metastatic disease, are likely to illustrate MOC. Unilateral ovarian mass and high serum levels of CA 125 in apparently disease-free patients with a positive family history and high prevelance of BRCA mutations are suggestive of primary tumors. Optimal cytoreduction was feasible in both groups, but survival was longer in patients with primary tumors (p<0.05).
Collapse
Affiliation(s)
- Aliki Tserkezoglou
- First Department of Gynecology, St. Savas Hospital, 171 Alexandras Avenue, 11522 Athens, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Karamouzis MV, Ardavanis A, Alexopoulos A, Papadopoulou A, Apostolikas N, Rigatos G. Multiple cutaneous acral metastases in a woman with breast adenocarcinoma treated with pegylated liposomal doxorubicin: incidental or aetiological association? Eur J Cancer Care (Engl) 2005; 14:267-71. [PMID: 15952972 DOI: 10.1111/j.1365-2354.2005.00573.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This paper reports the case of a 45-year-old female with histologically documented, multiple cutaneous metastases in the palmar and plantar surface of the fingers and toes originating from a breast adenocarcinoma after treatment with a docetaxel and pegylated liposomal doxorubicin regimen. The rarity of such a metastatic pattern from breast cancer and the eventual association with the chemotherapy administered are thoroughly discussed.
Collapse
Affiliation(s)
- M V Karamouzis
- 1st Department of Medical Oncology, St. Savvas Anticancer-Oncologic Hospital, 11522 Athens, Greece.
| | | | | | | | | | | |
Collapse
|
23
|
Vassilomanolakis M, Koumakis G, Barbounis V, Demiri M, Panopoulos C, Chrissohoou M, Apostolikas N, Efremidis AP. First-line chemotherapy with docetaxel and cisplatin in metastatic breast cancer. Breast 2005; 14:136-41. [PMID: 15767183 DOI: 10.1016/j.breast.2004.08.017] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2004] [Revised: 06/14/2004] [Accepted: 08/12/2004] [Indexed: 11/21/2022] Open
Abstract
The purpose of this study was to evaluate the efficacy and tolerance of combined treatment with docetaxel-cisplatin as first-line chemotherapy in patients with metastatic breast cancer (MBC). Consecutive eligible chemonaive patients received docetaxel 75 mg/m(2) on day 1 and cisplatin 75 mg/m(2) on day 2 every 3 weeks for 6 cycles, with prophylactic recombinant human granulocyte colony-stimulating factor (rHuG-CSF) on days 4-11. Thirty-two patients (64%) had received prior adjuvant chemotherapy; these included 16 (32%) who had received anthracyclines. In 50 evaluable patients with a median age (range) of 56 (31-72) years, the overall response rate was 68% (95% CI, 55-81%), with 7 (14%) complete and 27 (54%) partial responses. Stable and progressive disease was observed in 10 (20%), and 6 (12%) patients, respectively. The median duration of response was 10 months, and the median time to progression was 39 weeks. Grade 3/4 hematological toxicity included--neutropenia in 9 patients (18%), anemia in 2 (4%) and thrombocytopenia in 1 (2%). One patient (2%) with febrile neutropenia required hospitalization. Grade 3/4 nonhematological toxicities included nausea/vomiting in 18%, nephrotoxicity in 14%, asthenia (4%), and neurotoxicity (2%). Toxicity was common in older patients (>56 years). There were no treatment-related deaths. A combination of docetaxel-cisplatin with rHuG-CSF support is well tolerated and effective as first-line chemotherapy in MBC.
Collapse
Affiliation(s)
- M Vassilomanolakis
- 2nd Medical Oncology Department, St. Savas Regional Oncology Hospital, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Tserkezoglou A, Kontou S, Hatjieleftheriou G, Nikolaidou ME, Plataniotis G, Apostolikas N, Magiakos G. Solitary parenchymal splenic recurrence of ovarian adenocarcinoma: a case report and review of the literature. Anticancer Res 2005; 25:1471-6. [PMID: 15865107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
We report a rare case of solitary parenchymal splenic recurrence of epithelial ovarian cancer which developed 27 months after the initial treatment. The patient, a 53-year-old woman, with a history of breast cancer, underwent total abdominal hysterectomy bilateral salpingo-ophorectomy (TAH & BSO), omentectomy and pelvic lymph node sampling for a serous carcinoma of the ovaries (stage IIIB). She subsequently received 6 cycles of cisplatinum chemotherapy. During follow-up, rising CA 125 serum levels heralded the 6 x 6 cm parenchymal splenic lesion which was documented by CT scan. She underwent splenectomy after pneumococcal vaccination, sandostatin and chemoprophylaxis. Histopathological evaluation revealed metastatic parenchymal disease consistent with recurrent ovarian cancer. She remains alive and disease-free for 20 months since the last operation. Isolated parenchymal splenic lesions are very rare and may occur as a late recurrence in epithelial ovarian cancer. Splenectomy can be performed with acceptable morbidity and confers a substantial survival benefit to patients.
Collapse
|
25
|
Karamouzis MV, Apostolikas N, Georganta C, Lainakis G, Kandylis K, Rigatos G. Case of relapsed CD20(+) mixed-cellularity Hodgkin disease treated with sequential rituximab and radiotherapy. Am J Hematol 2004; 77:418-9. [PMID: 15551291 DOI: 10.1002/ajh.20224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
26
|
Rapidis AD, Andressakis DD, Stavrianos SD, Faratzis G, Arnogiannaki-Liappi N, Lagogiannis GA, Valsamis SV, Apostolikas N. Ameloblastomas of the jaws: clinico-pathological review of 11 patients. Eur J Surg Oncol 2004; 30:998-1002. [PMID: 15498648 DOI: 10.1016/j.ejso.2004.07.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2004] [Indexed: 11/29/2022] Open
Abstract
AIMS The ameloblastoma is an uncommon benign odontogenic neoplasm of the maxillofacial region constituting less than 1% of tumours of the oral cavity. The purpose of this paper is to discuss and evaluate the surgical treatment and the outcome from a series of 11 patients with ameloblastomas. METHODS Between the years 1995 and 2003, 11 patients (eight female and three male) aged 17-86 years (mean 52.7) suffering from ameloblastomas of the jaws were seen in our Department. RESULTS Ten patients were treated surgically. In eight of those radical surgery was applied. Patients with maxillary tumours were subjected to hemimaxillectomy and local excision. Radical treatment with segmental resection of the mandible was performed in six patients with multilocular (solid) mandibular ameloblastomas, with immediate reconstruction of the defect. Follow-up ranged from 3 months to 7.5 years. CONCLUSION Multilocular (solid) type of tumours should be approached with radical surgical treatment. Enucleation and rarely marsupialization can be applied selectively to unilocular ameloblastomas.
Collapse
Affiliation(s)
- A D Rapidis
- Department of Maxillofacial Surgery, Greek Anticancer Institute, St Savvas Hospital, 171 Alexandras Ave, Athens 115 22, Greece.
| | | | | | | | | | | | | | | |
Collapse
|
27
|
Rizou H, Bardi G, Arnaourti M, Apostolikas N, Sfikas K, Charlaftis A, Polichronis A, Agnantis NJ, Pandis N. Metaphase and interphase cytogenetics in fibroadenomas of the breast. In Vivo 2004; 18:703-11. [PMID: 15646810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Short-term cultures of fifty-two samples of fibroadenomas were cytogenetically analyzed. Thirty-three of the successfully karyotyped fibroadenomas were further investigated for the presence of amplifications in the CCND1, c-MYC and HER/2-neu genes by means of FISH analysis. Compared to carcinomas, fibroadenomas seem to have less complex cytogenetic rearrangements and limited alterations on HER-2/neu, CCND1 and c-MYC loci. A cytogenetic subgroup of fibroadenomas with hyperdiploid karyotypes and only numerical changes was observed. Amplification of CCND1 seems to play a more substantial role in benign tumor progression. These findings confirm that fibroadenomas do have genetic alterations and support the hypothesis that a fibroadenoma subset displays changes also found in carcinomas, thus indicating that patients belonging to this group might have an increased risk for subsequent breast cancer.
Collapse
Affiliation(s)
- Helen Rizou
- Department of Genetics, Saint Savas Anticancer Hospital, 171 Alexandras Ave, Athens, Greece.
| | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Korkolis DP, Koulaxouzidis GV, Apostolikas N, Vassilopoulos PP. Ovarian fibrothecoma associated with Meigs' syndrome and elevated serum CA 125. J BUON 2004; 9:473-5. [PMID: 17415856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 in postmenopausal women with a solid adnexal mass, ascites and pleural effusion is highly suggestive of a malignant ovarian tumor. We report on an unusual case of a benign fibrothecoma of the ovary associated with Meigs' syndrome and elevated CA 125 level in an 62-year-old white female. Although rarely, a benign ovarian tumor should be considered in the differential diagnosis of an adnexal mass associated with Meigs' syndrome and elevated serum CA 125 levels.
Collapse
Affiliation(s)
- D P Korkolis
- First Department of Surgery, Hellenic Anticancer Institute, "St. Savvas" Hospital, Athens, Greece
| | | | | | | |
Collapse
|
29
|
Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, Borisch B, Connolly CE, Decker T, Dervan P, Drijkoningen M, Ellis IO, Elston CW, Eusebi V, Faverly D, Heikkila P, Holland R, Kerner H, Kulka J, Jacquemier J, Lacerda M, Martinez-Penuela J, De Miguel C, Peterse JL, Rank F, Regitnig P, Reiner A, Sapino A, Sigal-Zafrani B, Tanous AM, Thorstenson S, Zozaya E, Fejes G, Wells CA. Discrepancies in current practice of pathological evaluation of sentinel lymph nodes in breast cancer. Results of a questionnaire based survey by the European Working Group for Breast Screening Pathology. J Clin Pathol 2004; 57:695-701. [PMID: 15220360 PMCID: PMC1770358 DOI: 10.1136/jcp.2003.013599] [Citation(s) in RCA: 138] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIMS To evaluate aspects of the current practice of sentinel lymph node (SLN) pathology in breast cancer via a questionnaire based survey, to recognise major issues that the European guidelines for mammography screening should address in the next revision. METHODS A questionnaire was circulated by mail or electronically by the authors in their respective countries. Replies from pathology units dealing with SLN specimens were evaluated further. RESULTS Of the 382 respondents, 240 European pathology units were dealing with SLN specimens. Sixty per cent of these units carried out intraoperative assessment, most commonly consisting of frozen sections. Most units slice larger SLNs into pieces and only 12% assess these slices on a single haematoxylin and eosin (HE) stained slide. Seventy one per cent of the units routinely use immunohistochemistry in all cases negative by HE. The terms micrometastasis, submicrometastasis, and isolated tumour cells (ITCs) are used in 93%, 22%, and 71% of units, respectively, but have a rather heterogeneous interpretation. Molecular SLN staging was reported by only 10 units (4%). Most institutions have their own guidelines for SLN processing, but some countries also have well recognised national guidelines. CONCLUSIONS Pathological examination of SLNs throughout Europe varies considerably and is not standardised. The European guidelines should focus on standardising examination. They should recommend techniques that identify metastases > 2 mm as a minimum standard. Uniform reporting of additional findings may also be important, because micrometastases and ITCs may in the future be shown to have clinical relevance.
Collapse
Affiliation(s)
- G Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, H-6000 Kecskemét, Hungary.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Wells CA, Sloane JP, Coleman D, Munt C, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, Bussolati G, Connolly CE, Dervan P, Drijkoningen M, Ellis IO, Elston CW, Eusebi V, Faverly D, Heikkila P, Holland R, Jacquemier J, Lacerda M, Martinez-Penuela J, De Miguel C, Peterse JL, Rank F, Reiner A, Saksela E, Sigal-Zafrani B, Sylvan M, Borisch B, Cserni G, Decker T, Kerner H, Kulka J, Regitnig P, Sapino A, Tanous AM, Thorstenson S, Zozaya E. Consistency of staining and reporting of oestrogen receptor immunocytochemistry within the European Union—an inter-laboratory study. Virchows Arch 2004; 445:119-28. [PMID: 15221370 DOI: 10.1007/s00428-004-1063-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2004] [Accepted: 05/28/2004] [Indexed: 11/29/2022]
Abstract
To assess the variability of oestrogen receptor (ER) testing using immunocytochemistry, centrally stained and unstained slides from breast cancers were circulated to the members of the European Working Group for Breast Screening Pathology, who were asked to report on both slides. The results showed that there was almost complete concordance among readers (kappa=0.95) in ER-negative tumours on the stained slide and excellent concordance among readers (kappa=0.82) on the slides stained in each individual laboratory. Tumours showing strong positivity were reasonably well assessed (kappa=0.57 and 0.4, respectively), but there was less concordance in tumours with moderate and low levels of ER, especially when these were heterogeneous in their staining. Because of the variation, the Working Group recommends that laboratories performing these stains should take part in a external quality assurance scheme for immunocytochemistry, should include a tumour with low ER levels as a weak positive control and should audit the percentage positive tumours in their laboratory against the accepted norms annually. The Quick score method of receptor assessment may also have too many categories for good concordance, and grouping of these into fewer categories may remove some of the variation among laboratories.
Collapse
Affiliation(s)
- C A Wells
- Department of Histopathology, St. Bartholomew's Hospital Medical School, West Smithfield, London, EC1A 7BE, United Kingdom.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Kokka F, Vorgias G, Tserkezoglou A, Tsiaousi I, Hadjieleftheriou G, Andriotis M, Akrivos T, Fotiou S, Apostolikas N. Preoperative work-up of early cervical cancer (stages Ib-IIa). EUR J GYNAECOL ONCOL 2003; 24:175-7. [PMID: 12701973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
OBJECTIVE To determine the effectiveness of preoperative investigations in early cervical cancer. MATERIALS We retrospectively reviewed the medical records of 309 patients with previously untreated early cervical carcinoma who completed pretreatment evaluation at "St. Savas" Cancer Hospital of Athens and "Metaxas" Memorial Hospital of Peireas between January 1986 and September 1, 2000. Ages ranged from 18-77 years old with a mean age of 48 and S.D. of 12.25. FIGO staging was Ib (200 pts.), IIa (105 pts.), IV (4 pts.). Histologic type was squamous (267 pts.), adenoid (35 pts.), adenosquamous (7 pts.). The patients were clinically examined and routinely evaluated with blood work-up, chest X-ray, IVP, abdominal CT scan, barium enema, sigmoidoscopy, cystoscopy, and/or urine cytology. Patients with early stage cervical carcinoma were treated with Wertheim-Meigs radical hysterectomy and pelvic lymphadenectomy, while those with advanced stage cervical carcinoma were treated with radiotherapy and chemotherapy. RESULTS In urinary tract investigation, CT showed a sensitivity of 100% and a specificity of 99.67%. In gastrointestinal tract investigation CT showed a sensitivity of 50% and a specificity of 99.67%. When we compared the histologic findings of the pelvic lymph nodes that were extracted in surgically treated patients with the preoperative CT findings, we found that CT had a sensitivity of 63.33% and a specificity of 88.57%. CONCLUSION In our series of patients with early stage cervical carcinoma, imaging and endoscopic tests added limited information over pelvic examination and altered in four cases (1.29%) the choice of the appropriate treatment modality. CT scans proved adequate in this series of patients in the evaluation of the bladder and colon. All other tests could have been performed only when CT was suspicious of invasion. Moreover, CT served as a baseline examination for future comparative studies in the follow-up of patients.
Collapse
Affiliation(s)
- F Kokka
- 1st Dept. of Gynecology, St. Savas Cancer Hospital, Greece
| | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Cserni G, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Bussolati G, Boecker W, Borisch B, Connolly CE, Decker T, Dervan P, Drijkoningen M, Ellis IO, Elston CW, Eusebi V, Faverly D, Heikkila P, Holland R, Kerner H, Kulka J, Jacquemier J, Lacerda M, Martinez-Penuela J, De Miguel C, Peterse JL, Rank F, Regitnig P, Reiner A, Sapino A, Sigal-Zafrani B, Tanous AM, Thorstenson S, Zozaya E, Wells CA. Pathological work-up of sentinel lymph nodes in breast cancer. Review of current data to be considered for the formulation of guidelines. Eur J Cancer 2003; 39:1654-67. [PMID: 12888359 DOI: 10.1016/s0959-8049(03)00203-x] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Controversies and inconsistencies regarding the pathological work-up of sentinel lymph nodes (SNs) led the European Working Group for Breast Screening Pathology (EWGBSP) to review published data and current evidence that can promote the formulation of European guidelines for the pathological work-up of SNs. After an evaluation of the accuracy of SN biopsy as a staging procedure, the yields of different sectioning methods and the immunohistochemical detection of metastatic cells are reviewed. Currently published data do not allow the significance of micrometastases or isolated tumour cells to be established, but it is suggested that approximately 18% of the cases may be associated with further nodal (non-SN) metastases, i.e. approximately 2% of all patients initially staged by SN biopsy. The methods for the intraoperative and molecular assessment of SNs are also surveyed.
Collapse
Affiliation(s)
- G Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Tserkezoglou AJ, Tigas K, Hatzieleftheriou G, Desypris N, Apostolikas N, Katsilieris J, Fotiou SK. OVERALL SURVIVAL AND PROGNOSTIC FACTORS IN STAGE IB-IIA CERVICAL CANCER TREATED BY RADICAL SURGERY WITH OR WITHOUT RADIOTHERAPY. Int J Gynecol Cancer 2003. [DOI: 10.1136/ijgc-00009577-200303001-00347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
|
34
|
Pantou D, Tsarouha H, Papadopoulou A, Mahaira L, Kyriazoglou I, Apostolikas N, Markidou S, Trangas T, Pandis N, Bardi G. Cytogenetic profile of unknown primary tumors: clues for their pathogenesis and clinical management. Neoplasia 2003; 5:23-31. [PMID: 12659667 PMCID: PMC1502119 DOI: 10.1016/s1476-5586(03)80014-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Unknown primary tumors (UPTs) represent an entity of great clinical and biological interest, whose origin cannot be determined even after medical workup. To better understand their pathogenesis by outlining their genetic composition, 20 UPTs were investigated by G-banding, supplemented with Fluorescence In Situ Hybridization and Comparative Genomic Hybridization analyses. The data obtained were sufficient to reach a diagnosis in five cases-four lymphomas and one Ewing sarcoma-demonstrating that in a subset of UPTs, cytogenetics can be an adjunct for differential diagnosis. In the remaining 15 UPTs, an aggressive cytogenetic pattern was revealed. The most frequently rearranged chromosome regions were 1q21, 3p13, 6q15-23, 7q22, 11p12-5, and 11q14-24, pinpointing gene loci probably associated with the peculiar pathogenesis of UPTs. The preferential involvement of 4q31, 6q15, 10q25, and 13q22 in adenocarcinomas (whereas 11q22 is involved in the rest of the carcinomas)-in addition to the marked divergence in the mean average of chromosomal changes, 16 and 3, respectively-demonstrates genotypic differences between the two histologic subgroups. Furthermore, the significantly shorter survival in cases displaying massive chromosome changes compared with those having a few changes indicates that the cytogenetic pattern might be used as a tool to assess prognosis in UPTs, even without the detection of their primary site.
Collapse
Affiliation(s)
- Dimitra Pantou
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| | - Haroula Tsarouha
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| | - Anna Papadopoulou
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| | - Louiza Mahaira
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| | - Ioannis Kyriazoglou
- Department of Orthopedics, Saint Savas Regional Oncological Hospital of Athens, Athens, Greece
| | - Nikiforos Apostolikas
- Department of Pathology Saint Savas Regional Oncological Hospital of Athens, Athens, Greece
| | - Sophia Markidou
- Department of Cytology, Saint Savas Regional Oncological Hospital of Athens, Athens, Greece
| | - Theoni Trangas
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| | - Nikos Pandis
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| | - Georgia Bardi
- Department of Genetics, G. Papanikolaou Research Center Athens, Greece
| |
Collapse
|
35
|
Tsakraklides V, Apostolikas N, Gourgoulianis K, Agnantis N. Breast cancer status in Greece: 35-years experience. Breast J 2002; 8:323-4. [PMID: 12199766 DOI: 10.1046/j.1524-4741.2002.08519.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
36
|
Xinopoulos D, Dimitroulopoulos D, Tsamakidis K, Apostolikas N, Paraskevas E. Treatment of malignant colonic obstructions with metal stents and laser. Hepatogastroenterology 2002; 49:359-62. [PMID: 11995450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND/AIMS The aim of this study was to evaluate the efficacy and safety of combined endoscopic therapy with self-expanding metallic endoprostheses and laser application in the management of malignant colonic obstruction. METHODOLOGY Between March 1998 and September 2000, obstruction of the distal colon was diagnosed in a total of 11 patients (6 M, 5 F, age range: 67-87 years, mean: 73). The site of obstruction was located in the rectosigmoid colon (n = 6), in the sigmoid colon (n = 4) and in the descending colon (n = 1). The etiology of stenosis was colorectal adenocarcinoma (n = 8), ovarian cancer (n = 2) and infiltrating bladder carcinoma (n = 1). In all patients the tumor was considered non-resectable. Six patients had confirmed metastases, one refused colostomy and 4 were unable to undergo surgery. After radiological visualization of the proximal extent of the stricture, the stenosis was dilated with Savary-like (10 patients) and pneumatic balloon dilators (1 patient-descending colon). RESULTS Stents were placed successfully in 10 patients. Prostheses migration distal to lesion, into the sigmoid colon, was observed in one patient (bladder cancer). A mild autoresolved bleeding was observed in 8 patients. Five patients remained free of clinical colonic obstruction until their death, which occurred 6-16 weeks (mean: 10) after stent placement. A moderate non-occlusive ingrowth of tumor into the stent lumen was documented in the other 5 cases. These patients were treated with introspective application of Diomed laser in a total of 16 sessions (4120-12,476 Joules each session, mean: 6258, power 10-14 W, interval between 2 sessions 6 weeks) and died of progressive disease without clinical signs and endoscopic findings of reobstruction 22-56 weeks (mean: 32) after stent placement. CONCLUSIONS Metallic stent placement is an adequate palliative and cost-effective option, effective and save, in advanced colonic obstruction due to non-resectable tumors. It circumvents the need for colostomy and allows the patient a better quality of life. Delayed stent occlusion with tumor ingrowth requires a regular follow-up and can be treated with introspective laser ablation.
Collapse
Affiliation(s)
- D Xinopoulos
- Gastroenterology Unit, Saint Savvas Anticancer Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
37
|
Elston CW, Sloane JP, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, Bussolati G, Coleman D, Connolly CE, Dervan P, Drijkoningen M, Eusebi V, Faverly D, Holland R, Jacquemier J, Lacerda M, Martinez-Penuela J, de Miguel C, Mossi S, Munt C, Peterse JL, Rank F, Reiner A, Sylvan M, Wells CA, Zafrani B. Causes of inconsistency in diagnosing and classifying intraductal proliferations of the breast. European Commission Working Group on Breast Screening Pathology. Eur J Cancer 2000; 36:1769-72. [PMID: 10974624 DOI: 10.1016/s0959-8049(00)00181-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
It is now widely recognised that classifying ductal carcinoma in situ (DCIS) of the breast and diagnosing atypical ductal hyperplasia are associated with significant interobserver variation. Two possible reasons for this inconsistency are differences in the interpretation of specified histological features and field selection where morphology is heterogeneous. In order to investigate the relative contribution of these two factors to inconsistent interpretation of intraductal proliferations, histological sections of 32 lesions were sent to 23 European pathologists followed 3 years later by images of small parts of these sections. Kappa statistics for diagnosing hyperplasia of usual type, atypical ductal hyperplasia and ductal carcinoma in situ were 0.54, 0.35 and 0.78 for sections and 0.47, 0.29 and 0.78 for images, respectively, showing that most of the inconsistency is due to differences in morphological interpretation. Improvements can thus be expected only if diagnostic criteria or methodology are changed. In contrast, kappa for classifying DCIS by growth pattern was very low at 0.23 for sections and better at 0.47 for images, reflecting the widely recognised variation in the growth pattern of DCIS. Higher kappa statistics were obtained when any mention of an individual growth pattern was included in that category, thus allowing multiple categories per case; but kappa was still higher for images than sections. Classifying DCIS by nuclear grade gave kappa values of 0.36 for sections and 0.49 for images, indicating that intralesional heterogeneity has hitherto been underestimated as a cause of inconsistency in classifying DCIS by this method. More rigorous assessment of the proportions of the different nuclear grades present could lead to an improvement in consistency.
Collapse
Affiliation(s)
- C W Elston
- Department of Pathology, City Hospital, NG5 1PB, Nottingham, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Fotiou S, Hatjieleftheriou G, Kyrousis G, Kokka F, Apostolikas N. Long-term tamoxifen treatment: a possible aetiological factor in the development of uterine carcinosarcoma: two case-reports and review of the literature. Anticancer Res 2000; 20:2015-20. [PMID: 10928144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Abstract
Two cases of uterine carcinosarcoma developing after long-term tamoxifen (TAM) treatment are presented. The patients, 67 and 72 years old, were treated with TAM for 6 and 7 years, continuously. They both developed an heterologous malignant mixed Mullerian tumor (mmMt). At laparotomy, an advanced stage of disease was found with peritoneal spread. In spite of the surgical and the postoperative treatment, they both died of disease, 3 and 10 months later. There are only 10, well documented, similar cases reported. Another 7 were identified in series of uterine malignancies developing after TAM treatment. Considerable evidence suggests that mmMt represents an epithelial cancer with sarcomatous dedifferentiation. Prolonged (> 5 years) TAM treatment may represent a causative factor in the development of this highly lethal disease (80% of the reported patients had a dismal prognosis). Large uterine polyps with special histological features, may represent an intermediate step in the tumor formation. Close follow-up of the patients is warranted.
Collapse
Affiliation(s)
- S Fotiou
- Department of Gynecology, Saint Savas Cancer Hospital of Athens, Greece. FosteOTENET.GR
| | | | | | | | | |
Collapse
|
39
|
Sloane JP, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, Bussolati G, Coleman D, Connolly CE, Eusebi V, De Miguel C, Dervan P, Drijkoningen R, Elston CW, Faverly D, Gad A, Jacquemier J, Lacerda M, Martinez-Penuela J, Munt C, Peterse JL, Rank F, Sylvan M, Tsakraklides V, Zafrani B. Consistency achieved by 23 European pathologists from 12 countries in diagnosing breast disease and reporting prognostic features of carcinomas. European Commission Working Group on Breast Screening Pathology. Virchows Arch 1999; 434:3-10. [PMID: 10071228 DOI: 10.1007/s004280050297] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A detailed analysis of the consistency with which pathologists from 12 different European countries diagnose and classify breast disease was undertaken as part of the quality assurance programme of the European Breast Screening Pilot Network funded by the Europe against Cancer Programme. Altogether 107 cases were examined by 23 pathologists in 4 rounds. Kappa statistics for major diagnostic categories were: benign (not otherwise specified) 0.74, atypical ductal hyperplasia (ADH) 0.27, ductal carcinoma in situ (DCIS) 0.87 and invasive carcinoma 0.94. ADH was the majority diagnosis in only 2 cases but was diagnosed by at least 2 participants in another 14, in 9 of which the majority diagnosis was benign (explaining the relatively low kappa for this category). DCIS in 4 (all low nuclear grade) and invasive carcinoma (a solitary 1-mm focus) in 1. The histological features of these cases were extremely variable; although one feature that nearly all shared was the presence of cells with small, uniform, hyperchromatic nuclei and a high nucleo-cytoplasmic ratio. The majority diagnosis was DCIS in 33 cases; kappa for classifying by nuclear grade was 0.38 using three categories and 0.46 when only two (high and other) were used. When ADH was included with low nuclear grade DCIS there was only a slight improvement in kappa. Size measurement of DCIS was less consistent than that of invasive carcinoma. The majority diagnosis was invasive carcinoma in 57 cases, the size of the majority being 100% in 49. The remainder were either special subtypes (adenoid cystic, tubular, colloid, secretory, ductal/medullary) or possible microinvasive carcinomas. Subtyping was most consistent for mucinous (kappa, 0.92) and least consistent for medullary carcinomas (kappa, 0.56). Consistency of grading using the Nottingham method was moderate (kappa=0.53) and consistency of diagnosing vascular invasion, fair (kappa=0.38). There was no tendency for consistency to improve from one round to the next, suggesting that further improvements are unlikely without changes in guidelines or methodology.
Collapse
Affiliation(s)
- J P Sloane
- Department of Pathology, University of Liverpool, United Kingdom
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
40
|
Pandis N, Bardi G, Petersson C, Apostolikas N, Mandahl N. Cytogenetic findings in a malignant fibrous histiocytoma of the breast. Cancer Genet Cytogenet 1999; 108:87-9. [PMID: 9973933 DOI: 10.1016/s0165-4608(98)00117-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
41
|
Sloane JP, Amendoeira I, Apostolikas N, Bellocq JP, Bianchi S, Boecker W, Bussolati G, Coleman D, Connolly CE, Dervan P, Eusebi V, De Miguel C, Drijkoningen M, Elston CW, Faverley D, Gad A, Jacquemier J, Lacerda M, Martinez-Penuela J, Munt C, Peterse JL, Rank F, Sylvan M, Tsakraklides V, Zafrani B. Consistency achieved by 23 European pathologists in categorizing ductal carcinoma in situ of the breast using five classifications. European Commission Working Group on Breast Screening Pathology. Hum Pathol 1998; 29:1056-62. [PMID: 9781641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The increased detection of ductal carcinoma in situ (DCIS) by mammographic screening, the greater use of breast-conserving surgery, and the recognition that certain histological subtypes are associated with a greater risk of local recurrence has led to the formulation of several new classifications of DCIS in recent years. There are, however, no data concerning the degree of consistency with which these schemes can be applied by reasonable numbers of pathologists. Thirty-three cases of DCIS were thus examined by a working group of 23 European pathologists who categorized them using five recently published classifications: (1) that of the European Pathologists' Working Group based on differentiation (a combination of nuclear grade and cell polarization) with categories of poorly, intermediately, and well differentiated; (2) one based entirely on nuclear grade with categories of high, intermediate, and low, currently in use in the UK national and EC-funded breast screening programs; (3) the same classification in which only two categories, high nuclear grade and other, were used; (4) the Van Nuys system in which lesions are divided into high grade, non-high grade with necrosis and non-high grade without necrosis; and (5) a two-category classification based entirely on the presence or absence of comedo necrosis. Of the three systems with three categories, Van Nuys gave the highest overall kappa statistic of 0.42. Others gave similar values of 0.37 and 0.35 showing that assessing cell polarization in addition to nuclear grade neither improves nor worsens consistency. In all three systems, the middle category was associated with the lowest value for kappa. Of the two systems with two categories, that based on nuclear grade gave the highest overall kappa of 0.46 and that based on comedo necrosis the lowest of 0.34. The most robust histological features were thus high- and low-grade nuclei and necrosis as long as the latter did not involve the recognition of a comedo growth pattern. These values probably represent the maximum achievable, at least by reasonable numbers of pathologists in everyday practice. They are better than those previously reported for classification based entirely on architecture, but further improvement is needed.
Collapse
|
42
|
Ardavanis A, Scorilas A, Loukeri A, Gerakini F, Pissakas G, Missitzis I, Apostolikas N, Yiotis I. Cathepsin D may help in discriminating node-negative breast cancer patients at risk for local-regional recurrence. Anticancer Res 1998; 18:2885-90. [PMID: 9713481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of this retrospective study was to define the prognostic value of cathepsin D (CD) in the node-negative (N-) and node-positive (N+) subsets of breast cancer (BC) patients. PATIENTS AND METHODS In primary tumor cytosols of 348, stage I-III, BC patients, with a complete standard histological examination and a 56 months mean follow-up, the ER, PR and CD concentrations were measured by standardized assays. CD values were then compared to the classical prognostic factors, the type of treatment and the outcome, in terms of Disease-Free-Survival (DFS) and type of Relapse, after stratification according to the nodal status. Statistical methods used were Cox regression and logistic regression. RESULTS Using univariate analysis, CD > 60 pmol/mg prot in N- patients was significantly associated with shorter DFS as well as local-regional recurrence (LRR) while in multivariate analysis the same CD levels, together with T status, are the best predictors of short DFS. However, CD > 60 is the only potent predictor of LRR in N- patients. No prognostic value of CD was identified in N+ patients. The cutoff value of CD should be 60 pmol/mgprot. The combination of tumor size, ER status and CD concentration may yield reliable prediction of primary BC outcome in N- patients. CONCLUSION CD is a marker of invasiveness, particularly loco-regional in node-negative breast cancer. The integration of this marker, in the routine of initial prognostic evaluation of this subset of patients is proposed.
Collapse
Affiliation(s)
- A Ardavanis
- Cancer Prognostic Markers Hellenic Study Group, St Savvas Cancer Hospital, Athens, Greece
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Pandis N, Teixeira MR, Adeyinka A, Rizou H, Bardi G, Mertens F, Andersen JA, Bondeson L, Sfikas K, Qvist H, Apostolikas N, Mitelman F, Heim S. Cytogenetic comparison of primary tumors and lymph node metastases in breast cancer patients. Genes Chromosomes Cancer 1998. [DOI: 10.1002/(sici)1098-2264(199806)22:2<122::aid-gcc6>3.0.co;2-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
44
|
Pandis N, Teixeira MR, Adeyinka A, Rizou H, Bardi G, Mertens F, Andersen JA, Bondeson L, Sfikas K, Qvist H, Apostolikas N, Mitelman F, Heim S. Cytogenetic comparison of primary tumors and lymph node metastases in breast cancer patients. Genes Chromosomes Cancer 1998; 22:122-9. [PMID: 9598799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Chromosome banding analysis of primary tumors and axillary lymph node metastases from 10 breast cancer patients revealed abnormal karyotypes in all samples with cytogenetic similarities between the primary tumor and the metastasis in all informative pairs. Although karyotypically unrelated clones were also found in the lymph node samples, they were less numerous than in the primary tumors, indicating that there was more genetic heterogeneity among the neoplastic cells in the primary than in the secondary tumors. On the other hand, some of the clones had become more complex in the metastases as a result of clonal evolution, and by and large these metastatic breast cancer cases had more karyotypic anomalies than do unselected primary breast carcinomas. Among the aberrations occurring more frequently, and that consequently may predispose to disease spread, were losses of chromosomes 17 and 22 and homogeneously staining regions, a cytogenetic sign of gene amplification.
Collapse
Affiliation(s)
- N Pandis
- Department of Clinical Genetics, University Hospital, Lund, Sweden.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Koukourakis MI, Giatromanolaki A, Kakolyris S, O'Byrne KJ, Apostolikas N, Skarlatos J, Gatter KC, Harris AL. Different patterns of stromal and cancer cell thymidine phosphorylase reactivity in non-small-cell lung cancer: impact on tumour neoangiogenesis and survival. Br J Cancer 1998; 77:1696-703. [PMID: 9635852 PMCID: PMC2150048 DOI: 10.1038/bjc.1998.280] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Angiogenesis is recognized as an important step in tumour pathogenesis that is related to invasion and metastatic spread and which consequently results in poor clinical outcome. In this study, we have examined the role of tumour stroma-activated fibroblasts and macrophage infiltration in the development of the angiogenic and metastatic phenotype in non-small-cell lung cancer (NSCLC). A total of 141 cases of early stage I-II NSCLC treated with surgery alone were analysed. The JC-70 (anti-CD31) MAb was used for the assessment of vascular grade. The P-GF.44C MAb was used to assess thymidine phosphorylase (TP) reactivity in cancer cells, stromal fibroblasts and macrophages. Cancer cell TP overexpression related to high vascular grade and to advanced T stage (P = 0.0004 and P = 0.02). Expression of TP in stromal fibroblasts also correlated with high angiogenesis (P = 0.01), but was independent of cancer cell expression. Fibroblast TP overexpression was related to abundant stroma (P = 0.003), suggesting that TP may be a marker of active stroma. Moreover, intense macrophage infiltration was associated with fibroblast TP reactivity, regardless of the amount of stroma, suggesting that macrophages may be a major contributor to TP expression in stroma. Survival analysis showed that cancer cell TP overexpression was related to poor prognosis (P = 0.005). Although stroma TP is related to angiogenesis, in the low vascular grade group it defined a group of patients with better prognosis (P = 0.02). It may be that fibroblast TP reactivity is an indirect marker of tumour infiltration by functional macrophages, which have an antitumour effect. We conclude that stromal macrophage and fibroblast TP reactivity may have an important role in non-small-cell lung cancer behaviour. Understanding the role of stromal fibroblasts and inflammatory cells and their interaction with oncoprotein expression is essential for the elucidation of lung cancer pathogenesis.
Collapse
Affiliation(s)
- M I Koukourakis
- Department of Radiotherapy/Oncology and Saint Nikolas Histopathology Unit, University Hospital of Iraklion, Crete, Greece
| | | | | | | | | | | | | | | |
Collapse
|
46
|
Zissis C, Apostolikas N, Konstantinidou A, Griniatsos J, Vassilopoulos PP. The extent of surgery and prognosis of patients with phyllodes tumor of the breast. Breast Cancer Res Treat 1998; 48:205-10. [PMID: 9598867 DOI: 10.1023/a:1005980831359] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
In an attempt to clarify the controversial issues related to prognosis and therapeutic aspects of phyllodes tumors (PT), we retrospectively reviewed all cases of PT treated in our hospital during the last fifteen years. Re-examining the pathology material we found 84 cases, while thirteen more cases which had been initially classified as fibroadenomas with areas of phyllodes tumor were rejected from the analysis because they were classified as fibroadenomas. Based on the criteria proposed by Azzopardi and Salvadori and adopted by WHO, we found 55 benign PT (65.14%), 14 borderline PT (16.6%), and 15 malignant PT (17.8%). The median age of the patients with benign PT was 34 years, compared to 46.5 years for those with borderline tumors and 52 years for those with malignant. The median size of benign tumors was 3 cm, 9.5 cm for borderline, and 7.25 cm for malignant. Out of 55 patients with benign PTs, 37 underwent wide local excision and the remaining 18, with small tumors, underwent enucleation. In this group of patients, there was no recurrence after a median interval of 6.65 years. Eleven patients with borderline PT underwent wide local excision and three mastectomy; one immediately after an incomplete PT excision and the remaining two 8 months and 2 years later due to a locally recurrent PT (the last one proven histologically in the permanent biopsy of the recurrence to be malignant). Twelve patients with malignant PT underwent mastectomy, either during the same operation or following the results of the permanent section biopsy. Three more patients with malignant PT underwent wide local excision. The size of the tumor in these patients was relatively small and the pathology report indicated clear margins with normal breast tissue surrounding the tumor. One patient with 8 cm diameter malignant PT, who underwent mastectomy, passed away sixteen months later from widely spread metastases. Applying the criteria of Azzopardi and Salvadori, each case of PT can be managed successfully avoiding unnecessary mastectomies.
Collapse
Affiliation(s)
- C Zissis
- Department of Surgical Oncology, Anticancer Hospital, Athens, Greece
| | | | | | | | | |
Collapse
|
47
|
Fotiou S, Tserkezoglou A, Hadjieleftheriou G, Apostolikas N, Karydas I, Stravolemos K. Tamoxifen associated uterine pathology in breast cancer patients with abnormal bleeding. Anticancer Res 1998; 18:625-9. [PMID: 9584044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The purpose of this study was to evaluate the underlying pathology in breast cancer patients treated with tamoxifen who present with abnormal bleeding. A total of 56 cases were studied and the histopathologic features of 50 curettage and 18 laparotomy specimens were reviewed. All patients were under tamoxifen treatment (10-40 mg daily) for a period ranging from 5 months to 15 years. Cervical and endometrial polyps were the most common finding in the D and C material (44%). Hyperplasia was the most frequent feature identified at hysterectomy, often combined with leiomyomas, adenomyosis and ovarian tumors. Five primary adenocarcinomas of the endometrium, most of them Stage I beta, Grade I minimally invading, were found as well. These data support the hypothesis that tamoxifen exerts a proliferative estrogen-like effect on the uterus. Abnormal bleeding in women under TAM treatment warrants prompt investigation and careful follow up of the patients.
Collapse
Affiliation(s)
- S Fotiou
- Department of Gynecology, Saint Savas Cancer Hospital of Athens, Greece
| | | | | | | | | | | |
Collapse
|
48
|
Dietrich CU, Pandis N, Rizou H, Petersson C, Bardi G, Qvist H, Apostolikas N, Bøhler PJ, Andersen JA, Idvall I, Mitelman F, Heim S. Cytogenetic findings in phyllodes tumors of the breast: karyotypic complexity differentiates between malignant and benign tumors. Hum Pathol 1997; 28:1379-82. [PMID: 9416694 DOI: 10.1016/s0046-8177(97)90227-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Clonal karyotypic abnormalities were detected in short-term cell cultures from six phyllodes tumors of the breast. Whereas all five benign tumors had simple chromosomal changes, the highly malignant one had a near-triploid stemline, indicating that karyotypic complexity is a marker of malignancy in phyllodes tumors. Interstitial deletions of the short arm of chromosome 3, del(3)(p12p14) and del(3)(p21p23),were the only aberrations in two benign tumors. Cytogenetic polyclonality was detected in three benign tumors: two had cytogenetically unrelated clones, whereas the third had three different, karyotypically related cell populations as evidence of clonal evolution. The finding of clonal chromosome abnormalities in both the epithelial and connective tissue components of the phyllodes tumors indicates that they are genuinely biphasic, that is, that both components are part of the neoplastic parenchyma.
Collapse
Affiliation(s)
- C U Dietrich
- Department of Pathology, The Norwegian Radium Hospital and Institute for Cancer Research, Oslo
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Panotopoulou E, Fidas A, Apostolikas N, Besbeas S, Papas T, Kottaridis D. Isolation of a cDNA clone from colon carcinoma. Anticancer Res 1997; 17:3441-4. [PMID: 9413184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
cDNA clones of differentially expressed mRNAs in a colon carcinoma have been isolated by subtractive cDNA cloning. The substracted material was at least 90x enriched for differentially expressed sequences and can be used for the construction of substractive cDNA libraries and polymerase chain reaction (PCR) amplification to generate differential probes. In this way rare mRNA (less than 0.1% abundance) which are differentially expressed, can be isolated utilising this procedure. A cDNA clone which we call IH12 has been isolated. Its mRNA is expressed exclusively in actively proliferating cells.
Collapse
Affiliation(s)
- E Panotopoulou
- Papanikolaou Research Center of Oncology, Athens, Greece
| | | | | | | | | | | |
Collapse
|
50
|
Ardavanis A, Gerakini F, Amanatidou A, Scorilas A, Pateras C, Garoufali A, Pissakas G, Stravolemos K, Apostolikas N, Yiotis I. Relationships between cathepsin-D, pS2 protein and hormonal receptors in breast cancer cytosols: inconsistency with their established prognostic significance. Anticancer Res 1997; 17:3665-9. [PMID: 9413220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
In this study the unexpected findings from the analysis of 278 breast cancer tissue specimens are reported. A surprising strongly positive correlation between an unfavourable and a favourable prognosis with markers cathepsin D and pS2 respectively, was revealed by linear regression analysis (Pearson, Student-T-Test). In the relevant literature reviewed only one similar, although indirect, observation was found. On the other hand, a weak relationship between pS2 and ER has emerged using the same method, while the pS2/PgR association remained strong. The latter supports the hypothesis that pS2 positivity is associated with positive PgR and may be a marker of functioning ER, irrespective of ER status. These and other similar findings underline the need for a better understanding of the underlying molecular events as well as the necessity of an effective prognostic evaluation model for breast cancer.
Collapse
Affiliation(s)
- A Ardavanis
- 1st Medical Oncology Department, St Savvas Cancer Hospital, Athens, Greece
| | | | | | | | | | | | | | | | | | | |
Collapse
|