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Prognostic Factors and Survival Outcomes of Patients With Early HER2+ Breast Cancer Treated With Trastuzumab in a Brazilian Public Reference Center: A Real-World Study. Clin Breast Cancer 2023; 23:864-875.e7. [PMID: 37802752 DOI: 10.1016/j.clbc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Trastuzumab was introduced into the Brazilian public health care service for early breast cancer (BC) in 2012. This study describes the survival outcomes and prognostic factors related to early HER2+ BC treatment in a Brazilian reference cancer center. PATIENTS AND METHODS This were a retrospective, single-center, observational study of early HER2+ BC patients treated with trastuzumab in the (neo)adjuvant setting between 2012 and 2018 at Hospital Pérola Byington. Demographic, clinical, disease-free survival (DFS) and overall survival (OS) data were evaluated. Multivariate analysis was performed to assess independent prognostic factors. RESULTS One hundred seventy-six and 353 patients treated in the neoadjuvant and adjuvant setting were included, respectively. The 3- and 5-year OS rates were 79% and 56% for the neoadjuvant group and 97% and 92% for the adjuvant group, respectively. Node positivity at diagnosis predicted poor OS for both groups. In the neoadjuvant group, stage III disease at diagnosis, delayed surgery, and lack of pathological complete response (pCR) predicted poor prognosis. The 3- and 5-year DFS rates were 67% and 46% in the neoadjuvant group and 91% and 86% in the adjuvant group, respectively. Histological grade 2, stage III disease at diagnosis, and lack of pCR predicted poor DFS for the neoadjuvant group. For the adjuvant group, node positivity at diagnosis predicted poor DFS. CONCLUSION Our results reveal multiple clinical parameters affecting survival outcomes according to the treatment setting. Patients treated with neoadjuvant therapy have a poor prognosis since they present with more advanced disease, indicating the importance of early diagnosis and optimized treatment.
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Diagnosing molecular subtypes of breast cancer by means of Raman spectroscopy. Lasers Surg Med Suppl 2022; 54:1143-1156. [PMID: 35789102 DOI: 10.1002/lsm.23580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Raman spectroscopy has been used to discriminate human breast cancer and its different tumor molecular subtypes (luminal A, luminal B, HER2, and triple-negative) from normal tissue in surgical specimens. MATERIALS AND METHODS Breast cancer and normal tissue samples from 31 patients were obtained by surgical resection and submitted for histopathology. Before anatomopathological processing, the samples had been submitted to Raman spectroscopy (830 nm, 25 mW excitation laser parameters). In total, 424 Raman spectra were obtained. Principal component analysis (PCA) was used in an exploratory analysis to unveil the compositional differences between the tumors and normal tissues. Discriminant models were developed to distinguish the different cancer subtypes by means of partial least squares (PLS) regression. RESULTS PCA vectors showed spectral features referred to the biochemical constitution of breast tissues, such as lipids, proteins, amino acids, and carotenoids, where lipids were decreased and proteins were increased in breast tumors. Despite the small spectral differences between the different subtypes of tumor and normal tissues, the discriminant model based on PLS was able to discriminate the spectra of the breast tumors from normal tissues with an accuracy of 97.3%, between luminal and nonluminal subtypes with an accuracy of 89.9%, between nontriple-negative and triple-negative with an accuracy of 94.7%, and each molecular subtype with an accuracy of 73.0%. CONCLUSION PCA could reveal the compositional difference between tumors and normal tissues, and PLS could discriminate the Raman spectra of breast tissues regarding the molecular subtypes of cancer, being a useful tool for cancer diagnosis.
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Substantial Reduction in Adjuvant Chemotherapy With the Use of the 21-Gene Test to Manage Early Breast Cancer in a Public Hospital in Brazil. JCO Glob Oncol 2021; 7:1003-1011. [PMID: 34181482 PMCID: PMC8457870 DOI: 10.1200/go.20.00609] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
We evaluated the impact of 21-gene test results on treatment decisions for patients with early-stage breast cancer treated under the public health care system in Brazil, Sistema Único de Saúde.
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The impact of letrozole administration on oocyte morphology in breast cancer patients undergoing fertility preservation. JBRA Assist Reprod 2020; 24:257-264. [PMID: 32293820 PMCID: PMC7365524 DOI: 10.5935/1518-0557.20200002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: Patients submitted to oncological fertility preservation with letrozole and gonadotropins seem to present a higher rate of immature oocytes and lower fertilization rates in comparison to infertile patients submitted to IVF cycles with gonadotropins. The aim of this study was to evaluate the influence of letrozole on oocyte morphology in patients with breast cancer submitted to fertility preservation. Methods: Retrospective analysis performed at a public tertiary hospital in São Paulo, Brazil. The oocytes were retrieved from patients with breast cancer undergoing fertility preservation (n=69), and from infertile women undergoing in vitro fertilization (n=92). We evaluated 750 oocytes obtained from breast cancer patients submitted to ovarian stimulation with letrozole and gonadotropins, and 699 oocytes from patients without breast cancer submitted to ovarian stimulation for in vitro fertilization with gonadotropins only due to male factor infertility. The mature oocytes retrieved were analyzed for the presence of refractile bodies, ooplasm color and regularity, central granulation degree, cortical granules, zona pellucida staining and regularity, perivitelline space, presence of vacuoles or abnormal smooth-surfaced endoplasmic reticle and oocyte retraction. Results: There was a higher incidence of alterations in oocyte morphology in the letrozole group when compared to the control group: increased perivitelline space (p=0.007), irregular zona pellucida (p<0.001), refractile bodies (p<0.001), dark ooplasm (p<0.001), granular ooplasm (p<0.001), irregular ooplasm (p<0.001) and dense central granulation (p<0.001). Conclusion: Letrozole is a risk factor for worse oocyte morphology. However, the clinical impact of ovarian stimulation protocol with combined use of gonadotropins and letrozole for fertility preservation remains unclear in this setting. These data underline the importance of establishing the predictive potential of morphological dimorphisms of human oocytes in IVF outcomes.
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Abstract P4-03-04: Stereotactic vaccum-assisted breast biopsy: A cost effective diagnostic method for suspicious calcifications investigation in Brazil. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Mammographic screening carried out in Brazil's Public Health System (SUS) is opportunistic and restricted to large cities mainly in the South and Southeast regions. However, only 30% of the suspicious calcifications are confirmed to be malignancy after the biopsy. The surgical procedure to investigate is still the routine in most centers in Brazil. A vacuum assisted stereotactic biopsy (VASB) is expensive and it is not available in most centers in the developing countries. Objective: To estimate saved values in SUS by performing VASB instead of performing classic surgical procedure in the investigation of suspicious calcifications. Methods: We’ve performed a retrospective and descriptive study from July, 2012 to June, 2019, in which 1,809 patients diagnosed with suspicious calcifications on mammography (BIRADS 4 and 5) had VASB performed at Hospital Estadual Pérola Byington. The device used was Surus Pearl (Hologic, Malbolrough, Massachusetts, USA) with probe gauge 9. The biopsy`s costs were calculated and estimated in terms of American Dollars (US$) in 2019. No direct medical and nonmedical or indirect costs have been evaluated. Results: the histopathological study of the lesions revealed benign alterations in 1,179 (65.1%) The findings were positive for malignancy in 533 (29.5%) and the precursor lesions were diagnosed in 97 (5.4%) VASB is an outpatient procedure; a single biopsy has an average cost of US$ 36. Instead, the classic surgical procedure is a procedure that requires hospitalization and general anesthesia with estimated cost of US$ 97 for every single procedure. The saved values in that time by SUS were US$ 29,077. Conclusion: we found a high economic impact of VASB in the SUS scenario. Lower costs than surgical procedures and being an outpatient procedure may indirectly increase hospital beds` supply for cancer treatment. Studies focusing on other direct and indirect costs are desirable, especially in developing countries.
Keywords: calcifications; vacuum-assisted stereotactic biopsy; breast cancer.
Citation Format: Andressa Amorim, Marcellus N. M. Ramos, Maria Isabela B. A. C. Sawada, André Mattar, Jorge Y. Shida, Luiz H. Gebrim. Stereotactic vaccum-assisted breast biopsy: A cost effective diagnostic method for suspicious calcifications investigation in Brazil [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-03-04.
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Abstract P4-03-03: Accuracy of stereotactic vacuum-assisted breast biopsy for investigating suspicious calcifications in 1,809 patients a public hospital in Brazil. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-03-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. Stereotactic vacuum assisted breast biopsy (VASB) can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VASB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up, especially when stereotactic VASB is used to investigate microcalcifications. This method is expensive but cost effective when used to investigate microcalcifications classified as BI-RADS 4 and 5. Objectives: To evaluate the accuracy of VASB in the investigation of suspicious calcifications. Methods: We’ve performed a retrospective study from July, 2012 to June, 2019, in which 1,809 women with suspicious calcifications detected on mammography (BI-RADS 4 and 5) had VASB performed at Hospital Estadual Pérola Byington, a public Hospital in São Paulo, Brazil. The device used was Surus Pearl (Hologic, Malbolrough, Massachusetts, USA), with probe gauge 9. Fragments were obtained and sent to anatomopathological study; a metal clip was placed on the biopsy site. Four groups were analyzed, based on the biopsy results: benign, precursor lesions, Ductal Carcinoma In Situ (DCIS) and malignant. Most patients with positive or discordant cases underwent surgical treatment and the previous biopsy results were compared to surgery results. Results: patients median age was 55y (49-63). Pathology results on VASB and surgery were classified respectively as benign n=1,179 (65.1%), precursor lesions n=97 (5.4%), DCIS n=414 (22.9%) and malignant n=119 (6.6%). Benign and lesion precursor lesions results were clustered to form a new group (lower risk lesions) and so DCIS and malignant lesions (higher risk lesions). ROC curve and AUC were calculated to compare the results of lower and higher risk lesions groups according to VASB and surgery results (AUC=0,642). The X2 test was performed between the groups (p<0,05). The sensitivity of the method was 84.4 %, specificity was 96.1%, false negative rate was 4.5%, positive predictive value (PPV) was 89.8%, negative predictive value (NPV) was 93.8%. Conclusion: the VASB method has a good accuracy to distinguish lower and higher risk lesions groups comparing to the gold standard. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning.
Keywords: Calcifications; Vacuum-assisted stereotactic biopsy; Breast cancer; Diagnosis
Citation Format: Andressa Amorim, Marcellus N. M. Ramos, André Mattar, Maria Isabela B. A. C. Sawada, Jorge Y. Shida, Luiz H. Gebrim. Accuracy of stereotactic vacuum-assisted breast biopsy for investigating suspicious calcifications in 1,809 patients a public hospital in Brazil [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-03-03.
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Abstract P3-04-01: The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p3-04-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The gold standard for breast biopsy procedures is currently an open excision of the suspected lesion. However, an excisional biopsy inevitably makes a scar. The cost and morbidity associated with this procedure has prompted many physicians to evaluate less invasive, alternative procedures. More recently, image-guided percutaneous core-needle biopsy has become a frequently used method for diagnosing palpable and non-palpable breast lesions. Although sensitivity rates for core-needle biopsy are high, it has the disadvantage of histological underestimation, which renders the management of atypical ductal hyperplasia, papillary lesions, and fibroepithelial lesions somewhat difficult. Stereotactic vacuum assisted breast biopsy (VABB) was developed to overcome some of these negative aspects of core-needle biopsy. VABB allows for a sufficient specimen to be obtained with a single insertion and can provide a more accurate diagnosis and completely remove the lesion under real-time ultrasonic guidance. The advantage of complete lesion removal with VABB is to reduce or eliminate sampling error, to decrease the likelihood of a histological underestimation, to decrease imaging-histological discordance, to decrease the re-biopsy rate, and to diminish the likelihood of subsequent growth on follow-up, especially when stereotactic VABB is used to investigate microcalcifications. This method is expensive but cost effective when used to investigate microcalcifications classified as BI-RADS 4 and 5.
Methodology: We performed a review in 1,354 patients with suspicious mammography microcalcifications, classified as BI-RADS 4 or 5 that were seen in Perola Byington Hospital from July 2012 to July 2017 in São Paulo-Brazil. We have used aHologic Lorad Multicare Platinum Stereotactic Prone Breast Biopsy and a Surus Pearl (Hologic, Malbolrough, Massachusetts, USA), with gauge 9 probe. Four to eight fragments (median of 6) were obtained with the placement of a metal clip in the bed that the biopsy was performed, and histopathological analysis was made.
Results:The histopathological study of the lesions revealed benign alterations in 956 (68%) of our patients. The findings were positive for malignancy in 358 patients (29%) and the precursor lesions were diagnosed in 40 (3%). In 81 cases (5.9%) the findings were discordant. The sensitivity of the method was 84.4%, specificity was 96.1%, false negative rate was 4.5%, positive predictive value (PPV) was 89.8%, negative predictive value (NPV) was 93.8%. In literature review the sensitivity varies 91.5-100%, specificity 81.9-110%, false negative rate 0-3.3%, PPV 92.2-100% and NPV 80.5-99.5%. All patients with positive or discordant cases underwent surgical treatment to increase the margin or complete removal of the lesion. Conclusions: The VABB is an outpatient procedure that avoids hospital admissions for diagnostic elucidation in most of cases suspected of malignancy. It has high predictive value in both benign and malignant lesions, guiding therapeutic planning. In addition to presenting the cost lower than the surgical biopsy it indirect increases the supply of hospital beds for cancer treatment.
Citation Format: Mattar A, Amorim AG, Ramos MdNM, Shida JY, Fonseca GR, Hegg R, Gebrim LH. The value of stereotactic vacuum-assisted biopsy in the investigation of microcalcifications in 1354 patients in public Brazilian hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P3-04-01.
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Specific protocols of controlled ovarian stimulation for oocyte cryopreservation in breast cancer patients. ACTA ACUST UNITED AC 2018; 25:e527-e532. [PMID: 30607119 DOI: 10.3747/co.25.3889] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Fertility preservation is an important concern in breast cancer patients. In the present investigation, we set out to create a specific protocol of controlled ovarian stimulation (cos) for oocyte cryopreservation in breast cancer patients. Methods From November 2014 to December 2016, 109 patients were studied. The patients were assigned to a specific random-start ovarian stimulation protocol for oocyte cryopreservation. The endpoints were the numbers of oocytes retrieved and of mature oocytes cryopreserved, the total number of days of ovarian stimulation, the total dose of gonadotropin administered, and the estradiol level on the day of the trigger. Results Mean age in this cohort was 31.27 ± 4.23 years. The average duration of cos was 10.0 ± 1.39 days. The mean number of oocytes collected was 11.62 ± 7.96 and the mean number of vitrified oocytes was 9.60 ± 6.87. The mean estradiol concentration on triggering day was 706.30 ± 450.48 pg/mL, and the mean dose of gonadotropins administered was 2610.00 ± 716.51 IU. When comparing outcomes by phase of the cycle in which cos was commenced, we observed no significant differences in the numbers of oocytes collected and vitrified, the length of ovarian stimulation, and the estradiol level on trigger day. The total dose of follicle-stimulating hormone and human menopausal gonadotropin administered was statistically greater in the group starting cos in the luteal phase than in the group starting in the late follicular phase. Conclusions Our results suggest that using a specific protocol with random-start ovarian stimulation for oocyte cryopreservation in breast cancer patients is effective and could be offered to young women undergoing oncologic treatment.
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Preimplantation genetic diagnosis for a patient with multiple endocrine neoplasia type 1: case report. JBRA Assist Reprod 2018; 22:67-70. [PMID: 29266898 PMCID: PMC5844663 DOI: 10.5935/1518-0557.20180010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Preimplantation genetic diagnosis was carried out for embryonic analysis in a
patient with multiple endocrine neoplasia type 1 (MEN1). This is a rare
autosomal-dominant cancer syndrome and the patients with MEN1 are characterized
by the occurrence of tumors in multiple endocrine tissues, associated with
germline and somatic inactivating mutations in the MEN1 gene. This case report
documents a successful preimplantation genetic diagnosis (PGD) involving a
couple at-risk for MEN1 syndrome, with a birth of a healthy infant. The couple
underwent a cycle of controlled ovarian stimulation and intracytoplasmic sperm
injection (ICSI). Embryos were biopsied at the blastocyst stage and
cryopreserved; we used PCR-based DNA analysis for PGD testing. Only one of the
five embryos analyzed for MEN1 syndrome was unaffected. This embryo was thawed
and transferred following endometrial preparation. After positive βHCG
test; clinical pregnancy was confirmed by ultrasound, and a healthy infant was
born. PGD for single gene disorders has been an emerging therapeutic tool for
couples who are at risk of passing a genetic disease on to their offspring.
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Abstract P6-02-06: Safety and feasibility of neoadjuvant combined chemotherapy of breast cancer with paclitaxel carried in a lipid nanoemulsion (LDE) associated with adriamycin and cyclophosphamide. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p6-02-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
The introduction of neoadjuvant chemotherapy considerably changed the natural history of breast cancer by permitting a big tumors to be operable, permitting less aggressive surgical procedures and when achieving complete pathological response prolonging the disease-free period. However, the chemotherapy schemes bear high toxicity rates and are even life-threatening.
Neoadjuvant chemotherapy aims at reducing mortality and improving surgical options and offers an in vivo chemosensitivity testing at the same time. It is the ideal setting for clinical and translational research. Compared to the classical adjuvant treatment, it offers several advantages.
Methods
We performed a pilot study to evaluate the safety and feasibility of neoadjuvant combined chemotherapy of breast cancer with paclitaxel carried in a lipid nanoemulsion (LDE) associated with adriamycin and cyclophosphamide in comparison to the classical neoadjuvant chemotherapy paclitaxel, adriamicyn and cyclofosfamide (TAC). All the patients were women with recently diagnosed breast cancer who needed primary chemotherapy as the first treatment selected from Perola Byington Hospital in São Paulo - Brazil.
Results
From April 2006 to June 2008, 39 patients from a center for breast disorders (Pérola Byington Hospital) were included in the study. These patients were randomized to the standard chemotherapy scheme (control arm – n=16) or LDE-paclitaxel (LDE arm – N=17). Six patients were excluded from the study because they did not complete at least 5 cycles of chemotherapy. We also excluded three patients because of lack of follow up. The majority of patients had stage III (37% IIIA and 27% IIIB). There was no significant difference among the groups, considering the clinical variables, so the sample was considered homogeneous. The patients were grouped in four different groups regarding the expression of ER, PR and CerbB2: Luminal subtype, Triple Negative, Her2-positive and Hybrid Luminal. We observed 37,5% of complete response in the control arm and 23,5% in the LDE arm. The partial response were 43,7% in the control group and 58,8% in the LDE group. The toxicity particularly in grade 3 and 4 events were substantially lower in LDE group: Nausea 11% vs 2,2%; Vomiting 7,3% vs 0.7% and neutropenia 8,8% vs 2,2%.
Conclusion
LDE scheme was effective and had lower grad 3 and 4 events than the TAC regiment. More studies are necessary to evaluate this approach.
Citation Format: Andre Mattar, Luciana B Ferreira, Luiz H Gebrim, Roberto Hegg, Raul C Maranhão. Safety and feasibility of neoadjuvant combined chemotherapy of breast cancer with paclitaxel carried in a lipid nanoemulsion (LDE) associated with adriamycin and cyclophosphamide [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-02-06.
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Evaluation of bone metastases from breast cancer by bone scintigraphy and positron emission tomography/computed tomography imaging. Eur J Obstet Gynecol Reprod Biol 2014; 180:138-41. [PMID: 25037283 DOI: 10.1016/j.ejogrb.2014.06.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Revised: 06/03/2014] [Accepted: 06/19/2014] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to compare bone scintigraphy (BS) and positron emission tomography/computed tomography (PET/CT) for the detection of bone metastases from breast cancer. STUDY DESIGN Twenty patients with breast cancer and bone pain were submitted to both bone scintigraphy and 18-F-fluorodeoxyglucose PET/CT imaging between July 2012 and June 2013. Scintigraphy was performed following an intravenous injection of technetium-99m-methylene diphosphonate (99mTc-MDP) around 10 days before the PET/CT scan, performed using an intravenous injection of 18-F-fluorodeoxyglucose followed by whole-body computed tomography (CT) to characterize metastases by both methods. Student's t-test for paired samples was used in the comparative data analysis, with significance at p<0.05. RESULTS CT identified 429 metastatic implants in the 20 patients, with scintigraphy showing 244 of these lesions (57%) and PET/CT showing 307 (72%); however, there was no statistically significant difference between the mean number of lesions detected per patient with the two imaging modalities (p=0.367). CONCLUSION In the present study, no difference was found between PET/CT and bone scintigraphy in the detection of bone metastases from breast cancer.
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Abstract P5-09-15: Polymorphism of the CYP2D6 gene in Brazilian women with breast cancer treated with tamoxifen. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p5-09-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
The prodrug tamoxifen is the standard endocrine treatment for estrogen receptor-positive breast cancer. Its effect depends on activation by the CYP2D6 enzyme, which is encoded by a highly polymorphic gene that varies according to ethnicity. The most important polymorphic variants are *4 (abolished enzyme activity), *10 and *17 (decreased enzyme activity) found in 25%, 38-70% and 35% of Caucasians, Asians and Africans, respectively, resulting in low endoxifen levels (a major metabolite), a lack of response to tamoxifen and a poor prognosis. There is a widespread racial miscegenation in Brazil and the country's public health care system has made tamoxifen available and free of charge to all women with hormone-sensitive breast tumor despite the undetermined genetic profile of these patients.This study aims to evaluate polymorphism frequency of the CYP2D6*4, *10 and *17 alleles in Brazilian breast cancer patients under tamoxifen treatment and metabolism phenotype. Methods: The study was approved by the Internal Review Board of the Federal University of Piauí. All patients signed an informed consent term before study entry. Sixty-five women with estrogen and progesterone receptor-positive and Her-2 negative breast carcinomas were enrolled in the study. A 3-ml peripheral blood sample was collected from each patient, using specific polymerase chain reaction technique (PCR) to analyze haplotypes *1, *4, *10 and *17, determined by studies of different Single-Nucleotide Polymorphism (SNP). Microsoft Office Excel software 2010 was used to compile and analyze the data obtained. Results: The frequency of CYP2D6 alleles *4, *10 and *17 was 17%, 37% and 3%, respectively. Haplotype *1/*10 was present in 26%, while the phenotype of intermediate metabolism occurred in 12% of the women studied. Conclusion: The present study showed a polymorphism frequency of CYP2D6, mainly of allele *10 and a deficiency in tamoxifen metabolism, characterized by intermediate metabolism in 12% of the women studied. Nevertheless, further studies must be developed with a larger sample of women to study not only the presence of the polymorphic variant but also disease prognosis.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-09-15.
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Abstract 1506: Changes in the expression profile of microRNAs and their predicted targets in fibroblasts associated with breast carcinoma compared to fibroblasts from normal breast tissue. Cancer Res 2013. [DOI: 10.1158/1538-7445.am2013-1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Cancer-associated fibroblasts (CAFs) contribute to tumor growth and progression in breast cancer. CAFs are functional and phenotypically distinct from normal breast tissue (NAFs). Epigenetic modifications and post-transcriptional gene regulation by microRNAs may contribute to the phenotype of CAFs.
Objective: To identify the changes in microRNAs expression profile in fibroblasts associated with breast cancer as compared to those observed in fibroblasts obtained from samples of mammoplasty.
Methodology: Fibroblast primary culture from breast carcinoma (n= 04) and normal breast (n= 06) tissues were established and characterized by Immunohistochemistry. Total RNA extraction and purification were realized using Mirvana kit and miRNAs differentially expressed were identified by qPCR TaqMan® Low Density Array. Potential targets of these miRNAs were identified by in sílico analysis using DIANAm T, Miranda, miRWalk, PICTAR5 and TargetScan databases and compared to microarray profile determined using the U133 plus v.2 Affymetrix chip.
Results: All primary cultures from fibroblast were characterized by presence of vimentin, total absence of CD31 and pan-cytokeratin expression but CAFs exhibited a higher proportion of cells positive for alpha-actin and S100A4. The five microRNAs differentially expressed identified by statistical analysis and grouped hierarchically (hs_miR_655, hs_miR_383, hs_miR_129_3p, hs_miR_15b, hs_miR_489) (FDR≤10% and p<0.05) allowed the separation of the samples into two distinct groups: NAFs and CAFs. The Gene Ontology analysis of predicted target genes to each one of the microRNAs listed above and also identified by microarray, revealed their involvement in important biological processes including cellular morphogenesis and protein localization.
Further detailed studies of these miRNAs and their targets in CAFs may help to better understand the contribution of the mammary tumor microenvironment to breast carcinogenesis and progression.
Financial Support: FAPESP 09/100088-7, FAPESP 2011/08194-3
Citation Format: Simone V. Costa, Rosimeire A. Roela, Fatima S. Pasini, Maria L H Katayama, Tatiane K. F. Mazzotti, Luiz H. Gebrim, Vanessa C.L. Resende, Miguel S. Neto, M Mitzi Brentani. Changes in the expression profile of microRNAs and their predicted targets in fibroblasts associated with breast carcinoma compared to fibroblasts from normal breast tissue. [abstract]. In: Proceedings of the 104th Annual Meeting of the American Association for Cancer Research; 2013 Apr 6-10; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2013;73(8 Suppl):Abstract nr 1506. doi:10.1158/1538-7445.AM2013-1506
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Abstract P2-05-17: Correlation between cyclin D1, estrogen and progesterone receptors in invasive breast cancer after short-term treatment with tamoxifen or anastrozole. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p2-05-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION: Hormone therapy is associated with reduced breast cancer mortality. The use of biomarkers that are predictive of early cellular responses has been explored as a predictor of hormone resistance. Estrogen and progesterone receptor positivity and cyclin D1 have been associated with resistance to treatment with tamoxifen.
OBJECTIVES: The aim of this study was to investigate the variations in the levels of cyclin D1 and the estrogen and progesterone receptors (ER and PR, respectively) in postmenopausal patients with ER− or PR-positive breast cancer after short-term treatment (26 days) with tamoxifen, anastrozole or a placebo.
METHODS: This was a prospective, randomized double-blind study conducted in 71 patients with infiltrating ductal carcinoma (stages II and III) receiving care at either Pérola Byington Hospital or São Paulo Hospital (São Paulo, Brazil). The patients were divided into three groups based on their treatment during the preoperative period (26 days): P (placebo, N = 26), T (tamoxifen, 20 mg/day, N = 22) and A (anastrozole, 1 mg/day, N = 23). The biopsies were performed at diagnosis and after mastectomy (26th day), and the tumors were isolated by tissue microarray. Immunohistochemistry was performed using anti-cyclin D1 (Novocastra DCS-6), anti-ER (Dako-M7047) and anti-PR (Dako-M3569) antibodies. The semiquantitative analyses were performed using Allred criteria, and the statistical analyses were performed with the ANOVA parametric test (p ≤ 0.05).
RESULTS: A reduction in the mean PR level from 4.22 (pre-treatment) to 1.94 (post-treatment) was observed only in patients treated with anastrozole (p = 0.01). A positive linear correlation between cyclin D1 and PR levels was observed in group A (p = 0.0001), whereas group T exhibited a negative correlation (p = 0.0001). No correlation was observed in group P (p = 0.35).
CONCLUSION: PR and cyclin D1 are likely predictive of an early response to aromatase inhibitors in breast cancer.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P2-05-17.
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P3-07-37: Clinical Characteristics and Treatment of Brazilian Women with Breast Cancer at Public and Private Institutions. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p3-07-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer is the most common type of cancer among Brazilian women with almost 50.000 new cases per year. There are few data regarding the clinical presentation, treatment and specially outcome of this population. Brazilian health system is composed by Public institutions (Pu); Private centers (Pr) and some institutions that assist both Public and Private patients (PuPr).
Material and Methods: We collected data from 17 cancer centers distributed throughout Brazil among Pu; Pr and PuPr centers. We've analyzed data from 1-clinical characteristics, 2- pathologic characteristics and 3-type of treatment received among 2435 patients from May 2008 to May 2009.
Results: Mean age at diagnosis was 53 years, with about 30% below age 50. Most of the cases were Invasive Ductal Cancer (83%). Stage 0 was seen in 3.2%, Stage I in 21,8%, Stage II in 46,6%, Stage 3 in 24,6% and Stage IV in 3,9 %. Clinical Stage III + IV was seen in 18,5% of the Pu institutions, only 3,7% of the Pr ones and about 6,2% among those PuPr. Hormone receptors were positive in 55%. Her-2 was overexpressed in 27,3% of the patients, and triple negative were seen in 11,6%. Most of the patients were submitted to surgery (92,9%). In Pu institutions only 36% of the patients were submitted to Breast Conserving Surgery (BCS) and in the Pr institutions 49,4% of the patients were submitted to BCS and in the PuPr 47%. Breast reconstruction was made in 15,8% and did not differ between Pu and Pr institutions. Sentinel node biopsy was done in 30,6% of the patients (26,8% of the patients from the Pr institutions and 26,8% of the Pu ones and 33% among PuPr). Neoadjuvant treatment was done in 21,5% of the patients (Pu=27,2%; Pr=13,9% and PuPr 13,2%). Most of this neoadjuvant treatment was chemotherapy (93,8%) and only 4,3% was hormonetherapy (HT). 30% of the patients received AC, 41% A+taxane and 18,9% FAC/FEC. Besides we have almost 30% of Her-2 overexpressed only 1,1% of the patients received trastuzumab in the neoadjuvant setting. Tamoxifen was used in 48,3% when neoadjuvant HT was done, and aromatase inhibitor (AI) was used in 34,5%. Most of the patients received any kind of adjuvant treatment (89,2%). Chemotherapy was done in 76,6% and hormonetherapy in 69,8%. When chemotherapy was used the preference regiment was FAC/FEC (27,3%), followed by CMF (17,5%) and AC (11,9%). Trastuzumab was use in only 5,8% of the patients (Pu=6,8%, Pr=18,3% and PuPr 3% among all patients that received chemotherapy). In the adjuvant setting, Tamoxifen (TAM) was prescribed in 69,8% of the cases (Pu=87,6%, Pr=79,6% and PuPr 78,8%), AI in 8,2% (Pu=5,9%, Pr=9,3% and PuPr 13,8%), and sequential TAM/AI in 6,6% (Pu=6,1%, Pr=8,3% and PuPr 6,4%). About 17% of the patients had metastasis.
Conclusions: There are important differences between the public and private institutions in Brazil, the patients from the Pu institutions were five times more likely to be diagnosed in stage III or IV, they usually receive neoadjuvant treatment, and when surgery was done, most of them were treated with radical procedures. Besides the overexpression of Her-2 (30%) a minority of the patients received treatment with trastuzumab even for the Private centers (high cost for a developing country).
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-07-37.
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P5-07-06: Effect of Angiotensin-(1-7) and Angiotensin II on T47D Breast Cancer Cells in the Proliferation and cAMP Production. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p5-07-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Angiotensin-(1-7) [Ang(1-7)] is a peptide hormone that produces opposite responses to those of the well-characterized peptide angiotensin II (Ang II). The main actions of Ang(1-7) and AII occur, respectively, via MAS and Angiotensin type 1 receptor (AT1R), respectively. Ang (1-7) has blood pressure and proliferative effects contrary to those of AngII, exhibits significant antiangiogenic activity and may be a novel therapeutic agent for lung cancer treatment targeting a specific AT(1-7) receptor (Soto-Pantoja et al., 2009). Here, our aim was to evaluate T47D breast cancer cell proliferation and cAMP production after treatment with Ang (1-7) and AngII.By means of the cyclic AMP (cAMP) competitive enzymeimmunoassay system we measured cAMP content of T47D cells. Cell proliferation was measured using incorporation of BrdU after Ang (1-7) and AII stimulation. Intracellular cAMP increasing drugs like Forskolin (FK) and isobutylmethylxanthine (IBMX) were also used to stimulate T47D cells.AII inhibited cAMP production (−39%) and A-(1-7) increased its formation (48%). Pattern of cAMP production was not altered when cells were previously incubated with FK. Results were inverted after IBMX incubation. In proliferation, opposite responses were observed for Ang II and Ang (1-7), that is, increasing (7.6 times) and decreasing (7.5 times) proliferation rates respectively. Also both peptides decreased proliferation when cells were stimulated by FK. Exactly the opposite happened after IBMX stimulation, both peptides increased proliferation. These results suggest that Ang (1-7) inhibits growth of T47D cells probably through inhibition of the via RAS/RAF/MAP quinase, what corroboraties previous findings. On the other hand, AngII can induce cell proliferation by an alternative via (CREB/growth factor). Therefore, Ang (1-7) seems to be not only a promising target to develop novel lung cancer therapeutic drugs, but it also might help to prevent the molecular changes that lead the normal breast epithelial cells to cancer initiation.
Financial Support: FAPESP.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-07-06.
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Correlation Between Anthropometric Measures and Biomarker Changes After Neoadjuvant Therapy With Tamoxifen or Anastrozole in Postmenopausal Women With Breast Cancer. World J Oncol 2010; 1:111-117. [PMID: 29147190 PMCID: PMC5649934 DOI: 10.4021/wjon2010.06.224w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2010] [Indexed: 11/03/2022] Open
Abstract
Background Epidemiological studies have reported positive associations between anthropometric measures and risk for developing breast cancers that express hormone receptors and associated mortality. However, the impact of nutritional status on the molecular response to endocrine therapy has yet to be described. Methods Body mass index (BMI), waist circumference (WC), hip circumference (HP), and waist-to-hip ratio (WHR) were measured in patients with invasive ductal carcinoma (IDC) before and after neoadjuvant treatment with either tamoxifen or anastrozole, and a possible correlation with prognostic factors, as estrogen receptor (ER), progesterone receptor (PgR), and proliferative index (Ki-67), was analyzed. Fifty-seven patients with palpable ER-positive IDC were randomized into three neoadjuvant treatment groups and received anastrozole or placebo or tamoxifen for twenty-one days. Biomarker status was obtained by comparing the immunohistochemical evaluation of samples collected before and after treatment, using the Allred scoring system. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS). Results and Conclusions After treatment, the anastrozole group showed reduced ER and PgR expression (p < 0.05), and both the anastrozole and tamoxifen groups showed lower Ki-67 status. A significant reduction in PgR positivity (p < 0.05) was found in women with large WC and HC who were treated with anastrozole. Reduction in PgR positivity also tended to be associated with BMI (p = 0.09) in the anastrozole group. BMI, WC, HC and WHR correlated neither with biomarker levels in the tamoxifen and placebo groups nor with ER and Ki-67 status in the anastrozole group after primary endocrine treatment.
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Effects of short-time tamoxifen therapy on breast cancer apoptosis and cell cycle regulators. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-3017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Abstract #3017
Background: Tamoxifen is the most used endocrine therapy in patients with estrogen and/or progesterone positive receptors breast cancer. Tamoxifen acts in a complex manner as estrogen antagonists in tumor tissue, and its interaction with growth factors may lead to inhibition of cell proliferation.
 Objectives: The aim of this study was to evaluate the expression of estrogen receptor (ER), progesterone receptor (PR), COX-2, Ciclyn D-1, Bcl-2, BAK, BAX and nitric oxide synthase (NOS I, II and III) in breast carcinoma cells using immunohistochemical essay on tumor samples before and after short-time (14 days) exposure to tamoxifen.
 Material and Methods: A randomized double-blind study was performed with 29 stage II and III breast cancer patients divided according to the following groups: Group C (n= 15 / control) and Group T (n=14 / 20mg of TAM/day for 14 days). Immunohistochemical expression of ER, PR, COX-2, Ciclyn D-1, Bcl-2, BAK, BAX and NOS I, II and III were evaluated before (diagnosis biopsy) and after treatment. The results were classified according Allred score (semi quantitative), based on the intensity and fraction marked cells. The scores of each reaction were compared pre and post treatment, and also to the control group.
 Results: The mean scores of each reaction before and after treatment for Group T and Group C are seen in the table 1.
 
 No significant difference was observed with short-time tamoxifen therapy (table 2 - Mann Whitney test).
 
 Discussion: Although tamoxifen has been in clinical use for over 30 years in oncology, its complex manner of action is not totally elucidated. Our results did not show a significant change in breast cancer apoptosis and cell cycle regulators, but bring new data about the short-time exposure to tamoxifen.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 3017.
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Study of p53 codon 72 polymorphism in patients with breast cancer. EUR J GYNAECOL ONCOL 2008; 29:364-367. [PMID: 18714570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Breast cancer is a common disease in Western societies, with an incidence of 46.31/100,000 women/year in Brazil. The tumor suppressor gene TP53 is one of the most studied genes regarding the presence of mutations. Indeed, 50% of all tumors are known to exhibit changes in the TP53 nucleotide sequence due to carcinogenic processes. As to the presence of polymorphism, the TP53 gene is polymorphic at the nucleotide residue 347 (codon 72). In the current study, we examine if this polymorphism is associated with the clinicopathological parameters of breast cancer patients in a Brazilian population. One hundred and thirteen patients with breast cancer were included. The polymorphic region of the TP53 gene was PCR-amplified from genomic DNA obtained from buccal cells. Specific primers for the Pro and Arg allele were used. Correlations of polymorphism with age, staging, nuclear grade, lymph node status, estrogen receptor status and lymphatic and/or blood vessel invasion were evaluated. Statistical analysis was performed using the Fisher's exact test. The frequency of p53 Arg/Arg was 57% and of the heterozygous allele Arg/Pro it was 39%. There was no correlation between polymorphism and clinicopathological parameters. According to our results, the TP53 polymorphism, at the 347 residue, is not associated with any clinicopathological findings of patients with breast cancer.
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Apoptotic index in breast carcinoma cells following tamoxifen treatment. Int J Gynaecol Obstet 2006; 95:64-5. [PMID: 16828763 DOI: 10.1016/j.ijgo.2006.05.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 04/26/2006] [Accepted: 05/18/2006] [Indexed: 11/23/2022]
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Differential gene expression assessed by cDNA microarray analysis in breast cancer tissue under tamoxifen treatment. EUR J GYNAECOL ONCOL 2005; 26:501-4. [PMID: 16285565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Our purpose was to identify tamoxifen (TAM) responsive genes after 30 days of TAM treatment in tumor tissues obtained from women with breast cancer using microarray expression analysis. In our study, we identified 12 candidates to be considered as tamoxifen-modulated genes. Among them, we selected two candidates the TEGT BI-1 (testis enhanced gene transcript Bax Inhibitor-1) and the CD63 gene in order to further confirm their differential expression under tamoxifen effects. We observed that both were down-regulated in tumor tissues of patients during TAM treatment. TEGT is able to inhibit the expression of Bax, which is known to promote apoptosis. On the other hand, CD63 encodes a cell membrane protein and it seems to be involved in mechanisms of platelet activation, cell adhesion and cell motility. We therefore hypothesize that TAM would be able to modulate tumor growth by down-regulating genes involved in mechanisms such as cell cycle control, tumor invasion and metastasis.
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Tamoxifen down-regulates CaMKII messenger RNA levels in normal human breast tissue. CLIN EXP OBSTET GYN 2004; 31:204-8. [PMID: 15491065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Tamoxifen was proven to reduce the incidence of breast cancer by 49% in women at increased risk of the disease in the Breast Cancer Prevention Trial. In order to identify potential candidates to explain the preventive effect induced by tamoxifen on breast cancer, normal breast tissue obtained from 42 fibroadenoma patients, randomly assigned to receive placebo or tamoxifen, was analyzed by the reverse Northern blot and RT-PCR techniques. The cDNA fragments used on Northern blot membranes were generated by the Human Cancer Genome Project funded by the Ludwig Institute for Cancer Research and FAPESP (Fundação de Amparo à Pesquisa do Estado de São Paulo, Brazil). Total RNA was obtained from normal breast tissue from patients with clinical, cytological and ultrasound diagnosis of fibroadenoma. After a 50-day treatment with tamoxifen (10 or 20 mg/day) or placebo, normal breast tissue adjacent to the tumor was collected during lumpectomy with local anesthesia. One differentially expressed gene, Calcium/calmodulin-dependent protein kinase II (CaMKII), was found to be down-regulated during TAM treatment. CaMKII is an ubiquitous serine/threonine protein kinase that has been implicated in the diverse effects of hormones utilizing Ca2+ as a second messenger as well as in c-fos activation. These results indicate that the down-regulation of CaMKII induced by TAM might represent alternative or additional mechanisms of the action of this drug on cell cycle control and response to hormones in normal human breast tissue.
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Early nuclear alterations and immunohistochemical expression of Ki-67, Erb-B2, vascular endothelial growth factor (VEGF), transforming growth factor (TGF-beta1) and integrine-linked kinase (ILK) two days after tamoxifen in breast carcinoma. Neoplasma 2004; 51:481-6. [PMID: 15640959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The purpose of the present study was to evaluate breast carcinoma samples before and two days after treatment with tamoxifen in order to analyse early histopathological alterations--particularlynuclear alterations-- as well as immunohistochemical expression of Ki-67, Erb-B2, VEGF, TGF-beta1 and ILK proteins. Twenty one cases of invasive ductal and lobular breast carcinoma were studied. Patients were submitted to biopsy of the lesion and, after confirmation of the diagnosis, they received 20 mg of tamoxifen a day, beginning two days before surgery. The samples obtained during biopsy and after surgery were stained with HE for histopathological diagnosis. Estrogen receptor was positive in 18 cases and negative in 3. The immunohistochemical method was applied for the detection of Ki-67, Erb-B2, protein, vascular endothelial growth factor (VEGF), transforming growth factor beta (TGF-beta1) and integrin linked kinase (ILK). Two days after tamoxifen treatment, the following results were observed: 1) decrease in the cell volume, chomatine condensation, nucleoli less evident and clearly defined nuclear limits; 2) significant reduction in the expression of Erb-B2 protein and significant increase in the expression of TGF-beta1 protein; 3) expression of others proteins (Ki-67, VEGF and ILK) was not altered during the indicated time frame. Our results suggest that analyzing nuclear alterations and expression of Erb-B2 and TGF-beta1 proteins would be useful to assess the initial response to tamoxifen.
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Abstract
For almost three decades, tamoxifen has been used in the adjuvant treatment of breast cancer. It has also proven effective in the chemoprophylaxis of this disease and in the treatment of cyclic mastalgia. Since a fibroadenoma is a benign hormone-dependent neoplasm which contains estrogen receptor (ER) levels higher than in the mammary lobule, an evaluation of the effect of this drug on the proliferative activity of both the epithelium and the stroma of fibroadenomas in premenopausal women following the administration of 10 or 20 mg/day over 22 days was proposed. Forty women with fibroadenoma were selected for a randomized double-blind trial. They had regular menstrual cycles and had received neither hormones nor become pregnant 12 months prior to this study. Patients were divided into three groups: A (n = 14; placebo), B (n = 13; tamoxifen 10 mg/day), and C (n = 13; tamoxifen 20 mg/day). The treatment was initiated on the first day of their menstrual cycle and the surgeries were performed on the 22nd day. Estradiol, progesterone, and steroid hormone binding globulin (SHBG) were measured twice. The first measurement was performed on the 22nd day of the previous menstrual cycle and the second one was performed on the day of surgery. The fibroadenoma was fixed in 10% formaldehyde solution and stained with hematoxylin and eosin and then processed through immunohistochemical reaction (PC-10, DAKO code number M879, Denmark A/S). The immunoexpression of the proliferative cell nuclear antigen (PCNA) of at least 500 epithelial and 500 stromal cells was evaluated. Such cells were interactively counted using the Kontron Imaging System KS-300 computerized analysis system, with x 400 magnification. As to PCNA expression in the fibroadenomas' epithelium, the average percentage of stained nuclei in groups A, B, and C was 25.2, 19.3, and 18.0, respectively. However, no significant difference was found in the variance analysis of these data (p = 0.168). As to the study of the fibroadenomas' stroma, the average percentage of stained nuclei found in groups A, B, and C was 32.4, 23.2, and 18.4, respectively. The variance analysis (p = 0.031) and Fisher's multiple comparison test (1.39; 26.67 confidence interval [CI]) confirmed that the number of PCNA-expressing nuclei in the stroma was significantly lower in group C (20 mg/day) compared to group A (control). However, there was no significant difference between group B (10 mg/day) and group C (20 mg/day). It was found that tamoxifen reduced the expression of PCNA in the epithelium and the stroma of the fibroadenoma. However, the effect was only statistically significant in the stroma when a 20 mg/day dose was administered.
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Abstract
The aim of this study was to determine the effects of low doses of tamoxifen (5 and 10mg/day) for 50 days compared with the standard dose (20 mg/day) on breast biomarkers measured in normal breast tissue from premenopausal patients. A randomised double-blind study was performed using tissue from 56 premenopausal women with a diagnosis of fibroadenoma of the breast. Excisional biopsy was performed on the 50th day of therapy. Normal breast tissue samples were collected during surgery. The patients were divided in groups: A (placebo, n=11); group B (5 mg, n=16), group C (10 mg, n=14) and group D (20 mg, n=15). In this cross-sectional study, differences in the expression of Oestrogen Receptor alpha (ERalpha), Progesterone Receptor (PR), Ki-67, apoptotic bodies and mitotic index between the different groups after treatment can be seen on the normal breast tissue. We believe that a lower dose of tamoxifen could reduce the side-effects associated with treatment without affecting its chemopreventive activity in the breast.
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Evaluation of the ultrasonographic volume of breast fibroadenomas in women treated with tamoxifen. MINERVA GINECOLOGICA 2002; 54:531-5. [PMID: 12432338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Fibroadenomas are the most frequent benign breast neoplasias. Although they are hormone-dependent, no hormonal treatment of proven effectiveness is available for these neoplasias. The objective of the present study was to evaluate the ultrasonographic volume of fibroadenomas in premenopausal women treated with tamoxifen at the doses of 5, 10, 20 mg/day or with placebo for 50 days, starting on the 1st day of the menstrual cycle. METHODS A prospective and randomized study was conducted on 62 eumenorrheic women aged 15 to 45 years with no hormonal treatment or pregnancy during the last 12 months, with a clinical, cytologic and ultrasonographic diagnosis of fibroadenoma, later followed by a biopsy diagnosis. The patients were divided at random into 4 groups: A (n=15; placebo), B (n= 16; 5 mg/day tamoxifen), C (n=16; 10 mg/day tamoxifen), and D (n=15; 20 mg/day tamoxifen). Fibroadenoma volume was measured by ultrasound at 3 different times: on the 22nd day of the cycle that preceded the beginning of tamoxifen treatment, after 1 month of treatment, and on the day of the biopsy (50th day). The mean volume obtained for groups A, B, C and D was 3, 3.3, 1.9, and 2.3 cm3, respecti-vely. RESULTS Statistical analysis revealed a significant reduction in nodule size only in group D (p=0.0024). CONCLUSIONS We conclude that tamoxifen significantly reduced fibroadenoma volume when administered for 50 days at the dose of 20 mg/day. Further clinical studies are needed using the drug for a longer period of time, and in order to exclude the need for unnecessary treatment in some women.
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The effect of tamoxifen on the proliferative activity of fibroadenomas. Int J Gynaecol Obstet 2002; 77:155-6. [PMID: 12031568 DOI: 10.1016/s0020-7292(02)00009-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Evaluation of monoclonal antibody MIB-1 in the mammary epithelium adjacent to fibroadenomas in premenopausal women treated with tamoxifen. Breast J 2001; 7:392-7. [PMID: 11843850 DOI: 10.1046/j.1524-4741.2001.07603.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The purpose of this study was to study the monoclonal antibody MIB-1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle who were treated with tamoxifen at doses of 10 and 20 mg for 22 days. The proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry on the basis of the monoclonal antibody MIB-1 (Immunotech, catalog No. 0505, lot 001). The study was randomized and double blind and was conducted on 44 women with fibroadenomas divided into three groups: A (n=16, placebo), B (n=15, tamoxifen, 10 mg), and C (n=13, tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle, and a biopsy was taken on the 23rd day. Serum estradiol, progesterone, sex hormone binding globulin, follicle-stimulating hormone, luteinizing hormone, and prolactin were measured before treatment (21st and 24th day of the previous menstrual cycle) and on the day of the biopsy. The mean percentage of stained nuclei per 1,000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. The Fisher's test revealed that tamoxifen significantly reduced MIB-1 at doses of 10 and 20 mg compared with the placebo group (p < 0.0001), with no significant differences between doses in terms of proliferative activity (p=0.21). Groups B and C presented a significant increase in progesterone (p=0.038), estradiol (p < 0.001), and sex hormone binding globulin (p=0.001) levels. Elevation of serum follicle-stimulating hormone concentration (p=0.0045) and a fall in prolactin levels (p=0.0055) were observed. We conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.
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Morphologic and morphometric study of the breast parenchyma of rats in persistent estrus treated with tamoxifen and conjugated estrogens. CLIN EXP OBSTET GYN 2001; 28:60-2. [PMID: 11332594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
PURPOSE To evaluate the morphological and morphometric alterations produced by tamoxifen and conjugated estrogens in the mammary epithelium of rats in persistent estrus. METHODS 33 adult female rats with persistent estrus induced by 1.25 mg testosterone propionate were divided at random into three groups: group I (n=12), receiving only water and used as a control; group II (n=10), treated with 500 microg tamoxifen daily; group III (n= 11), treated with 30 microg conjugated estrogens daily. The first abdominal-inguinal pair of breasts was extirpated and processed for morphological and morphometric study. Data were analyzed statistically by the Kruskal-Wallis rank analysis of variance (p<0.05). RESULTS The morphological study revealed signs of epithelial atrophy and the morphometric study showed a significant reduction in mean number of ducts and alveoli in groups II (10.1 and 1.9, respectively) and III (11.1 and 3.5, respectively) compared to the control group 1 (25.0 and 6.6, respectively). There was no significant difference between groups II and III. CONCLUSIONS The present results indicate that, at the doses and during the time of treatment used, both tamoxifen and conjugated estrogens induced atrophy of the mammary epithelium of rats in persistent estrus.
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Malignant phyllodes tumor in the right breast and invasive lobular carcinoma within fibroadenoma in the other: case report. SAO PAULO MED J 2000; 118:46-8. [PMID: 10772696 DOI: 10.1590/s1516-31802000000200004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
CONTEXT The malignant variety of the phyllodes tumor is rare. The occurrence of invasive lobular carcinoma within fibroadenoma is rare as well. DESIGN Case report. CASE REPORT A 58-year-old black female patient was referred to the Mastology unit of the Department of Gynecology, Federal University of São Paulo / Escola Paulista de Medicina, in February 1990, presenting an ulcerated tumor in the right breast with fast growth over the preceding six months. She was a virgin, with meno-pause at the age of 45 years and had not undergone hormone replacement treatment. The physical examination showed, in her right breast, an ulcerated tumor of 20 x 30 cm which was not adher-ent to the muscle level, multilobular and with fibroelastic consistency. The axillary lymph nodes were not palpable. The left breast showed a 2 x 3 cm painless, movable nodule, with well-defined edges, and fibroelastic consistency. We performed left-breast mammography, which showed several nodules with well-defined edges, the largest being 2 x 3 cm and exhibiting rough calcification and grouped microcalcifications within it. The patient underwent a frozen biopsy that showed a malignant variant of the phyllodes tumor in the right breast and fibroadenoma in the left one. After that, we performed a total mastectomy in the right breast and an excision biopsy in the left one. Paraffin study confirmed the frozen biopsy result from the right breast, yet we observed that in the interior of the fibroadenoma that was removed on the left, there was a focal area of invasive lobular carcinoma measuring 0.4 cm. The patient then underwent a modi-fied radical mastectomy with total axillary lymphadenectomy. None of the 21 dissected lymph nodes showed evidence of metastasis. In the follow-up, the patient evolved asymptomatically and with normal physical and laboratory examination results up to July 1997.
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Abstract
OBJECTIVES To investigate the proliferative activity of the mammary gland epithelium and plasma levels of progesterone, estradiol, prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH) and sex hormone-binding globulin (SHBG) in premenopausal women treated with 10 and 20 mg of tamoxifen (TAM) for 22 days. PATIENTS AND METHODS A randomized double-blind study was performed with 43 premenopausal women with a diagnosis of fibroadenoma of the breast. The patients were divided into three groups: A (n = 15, placebo); B (n = 15, TAM 10 mg/day) and C (n = 13, TAM 20 mg/day). They started taking an oral dose of TAM or placebo on the very first day of the menstrual cycle. Lumpectomy was performed on the 22nd day of therapy. Normal breast tissue samples were collected during surgery, immediately immersed in 10% buffered formalin, processed for routine histology and immunohistochemistry for proliferating cell nuclear antigen (PCNA) detection. Two peripheral blood samples were collected, both on the 22nd day of the menstrual cycle, in order to evaluate the hormone levels. PCNA expressing epithelial cells were quantified by using a digital program Kontron Image System KS-300 in 1000 cells (400 x ). RESULTS The percentage of cells expressing PCNA was significantly higher in the group receiving placebo (group A, 50.3%) when compared to groups receiving TAM 10 or 20 mg/day (group B, 24.1%; and group C, 23.2%, respectively) (P < 0.001). Differences between groups B and C were not significant. Levels of progesterone, estradiol and SHBG were significantly higher in B and C groups compared to group A. Increasing concentrations of FSH (P < 0.0045) and lower levels of prolactin (P < 0.0055) were only found in the group receiving 20 mg/day of TAM (group C). CONCLUSIONS A 22-day TAM therapy, either with 10 or 20 mg/day, significantly reduced the PCNA expression and therefore the proliferative activity of the normal human breast tissue. Increasing levels of estradiol, progesterone and SHBG were associated with TAM therapy at 10 or 20 mg/day. However, a significant change of the level of FSH and prolactin was reached only with a 20-mg/day dose.
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Abstract
OBJECTIVES The effect of tamoxifen on cyclic mastalgia and on chemoprophylaxis against breast cancer is little known, mainly due to the difficulties in studying the normal human gland. We proposed to evaluate the mitotic index and the nuclear volume of the lobule of women medicated with tamoxifen only during the luteal phase of the menstrual cycle in order to observe the effect of tamoxifen on the normal human mammary gland. METHODS Twenty-four premenopausal women with fibroadenoma diagnosed via biopsy were studied. The phase of the cycle was determined by the date of menstruation and serum progesterone level in the luteal phase (> or = 3 ng/ml). The patients admitted to the study and were given written informed consent to participate in the investigation, which was previously approved of by the hospital Ethics Committee. Patients were divided at random into two groups: Group I consisted of 12 untreated women (control) and Group II consisted of 12 patients treated with 20 mg/day tamoxifen for 10 consecutive days beginning on the 13th day of the menstrual cycle. In both groups, the patients were submitted to biopsies of the nodule and of a 1-cm3 fragment of adjacent mammary parenchyma between the 23rd and 26th day of the cycle. The mitotic index (number of mitoses/1000 nuclei counted) and mean nuclear volume (mean of 10 nuclear volumes for each case) were measured. RESULTS No mitosis was observed in Group II. There was a reduction in the mean nuclear volume in Group II (Mann-Whitney test). CONCLUSIONS Tamoxifen, when administered only during the luteal phase of the menstrual cycle, significantly reduces the nuclear volume and mitotic activity of the epithelium. This data demonstrates an antagonistic action of tamoxifen on estrogen even when administered for short periods of time.
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Study of the action of tamoxifen on the mammary gland epithelium of premenopausal patients by lysosome quantification. SAO PAULO MED J 1997; 115:1390-4. [PMID: 9460299 DOI: 10.1590/s1516-31801997000200004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Tamoxifen is an antiestrogen drug widely utilized for the adjuvant hormonal treatment of breast carcinoma. Its use in the primary prophylaxis of this disease is currently being proposed. Although the drug has few side effects, its precise action on breast tissue that has not undergone neoplastic transformation has not been fully elucidated. This prospective, randomized study assessed the estrogen activity of tamoxifen on the mammary gland epithelium of premenopausal patients using a quantitative analysis of mammary epithelium lysosome identified by the cytochemical technique of GOMORI for acid phosphatase and by light microscopy. Tamoxifen significantly increased the number of lysosomes only during the secretory phase of the menstrual cycle. We concluded that the early effect of the drug on normal mammary tissue is synergistic with the effect of estrogen during the premenopausal period.
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Tamoxifen down-regulates CD36 messenger RNA levels in normal and neoplastic human breast tissues. Cancer Res 1997; 57:378-81. [PMID: 9012459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Tamoxifen (TAM) exerts a long-term suppressive effect on human breast cancer cell proliferation. To determine whether the effects of TAM are mediated by specific gene activation or repression, normal and tumoral human breast tissues obtained before and during TAM treatment were analyzed by differential display technique. Total RNA for differential display analysis was obtained from breast tissues from two women with the diagnosis of estrogen receptor-positive stage II (T2N1M0) infiltrating ductal carcinoma, made by incisional biopsy, followed by modified radical mastectomy performed after a 30-day treatment with TAM (20 mg/day). One 202-bp cDNA band, AP5-1, was present in normal and tumoral biopsy samples, but was absent in breast tissue obtained during TAM treatment, and was confirmed by Northern hybridization, which showed a 2.7-kb band in both patients. The differentially expressed cDNA fragment showed 99% homology to Homo sapiens CD36 gene, a glycoprotein that acts as a receptor for the extracellular matrix proteins thrombospondin-1, collagen types I and IV, and oxidized low-density lipoprotein. These results indicate that the down-regulation of CD36 induced by TAM might represent alternative or additional mechanisms of action of this drug affecting the functions of thrombospondin-1, which is involved in hematogenous tumor spread, invasion and angiogenesis, and oxidized low-density lipoprotein, playing a role in inhibition of arteriosclerosis. The multiple functions affected by the down-regulation of CD36 by TAM warrant the need for additional studies.
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Estrogenic activity of tamoxifen on normal mammary parenchyma in the luteal phase of the menstrual cycle. Int J Gynaecol Obstet 1997; 56:19-24. [PMID: 9049690 DOI: 10.1016/s0020-7292(96)02791-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Tamoxifen, an anti-estrogenic drug used in the adjuvant treatment of breast cancer, deserves more investigation for the determination of its efficacy as a prophylactic agent against breast cancer in high risk women. Thus, the action of tamoxifen on the human mammary gland was studied by measuring the number of lysosomes in normal mammary epithelium during the administration of tamoxifen. METHODS Tamoxifen was administered only during the luteal phase of the menstrual cycle to avoid interference with corpus luteum formation. A fragment of breast tissue adjacent to a fibroadenoma was obtained during surgery from 35 premenopausal women aged 15 to 37 years who had been eumenorrheic for at least 6 months; 18 of these patients were treated with tamoxifen and 17 were used as controls. Lysosome counts were performed under the light microscope on slides submitted to the acid phosphatase cytochemical technique and the data were analyzed statistically by the Mann-Whitney test. RESULTS The fragments from the group treated with tamoxifen showed a significant decrease in lysosome numbers. CONCLUSIONS Tamoxifen administered after ovulation significantly decreases the number of lysosomes in the cells of normal mammary epithelium, demonstrating the antiestrogenic effect of the drug on this target tissue.
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Invasive ductal carcinoma, fibroadenoma and adjacent breast stroma angiogenesis: an immunohistochemical and morphometrical study. BULLETIN DE L'ASSOCIATION DES ANATOMISTES 1996; 80:17-9. [PMID: 9127689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The authors investigate the differences between the angiogenesis that occurs in malignant and benign breast tumours (10 specimens of invasive ductal carcinoma and 10 specimens of fibroadenoma) as well as in the adjacent breast stroma of these women highlighting the microvessels by staining their endothelial cells for factor VIII immunohistochemically. The number of vessels counted in invasive ductal carcinoma was significantly higher than the number of vessels counted in fibroadenoma and in the adjacent breast stroma. There was no difference between the number of vessels counted in the fibroadenoma and its adjacent stroma. Even though the patients with invasive ductal carcinoma showed a adjacent stroma with a higher number of vessels, the difference was not significant when compared with the adjacent stroma obtained from patients with fibroadenoma.
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Abstract
A rare case of leiomyoma of the breast is reported, with a discussion of the clinical aspects and of the differential diagnosis. Excluding tumors originating from the areolar-papillary complex and the skin, this neoplasm is extremely rare, with only 11 cases reported so far. The histogenesis of the lesion is still controversial.
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Prognostic value of the histopathologic private characteristics of breast cancer in patients with no axillary lymph node involvement. SAO PAULO MED J 1994; 112:522-8. [PMID: 7871319 DOI: 10.1590/s1516-31801994000100010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
The biological behavior of breast cancer supports the impression that it is often a systemic disease which can recur many years after the treatment of the local lesion. Since 35% of patients without axillary nodal metastasis will have recurrence of the disease after mastectomy, prognostic indicators are necessary to identify the high-risk patients to allow a more rational adjuvant therapy. We studied the prognostic value of fatty tissue invasion, perineural involvement and lymphatic and venous peritumoral embolization in T2NOMO primary breast carcinomas. Fifty-three patients were studied after initial treatment (only Halsted mastectomy). They were divided into two groups: A (control), with 25 patients with 15 years of survival without clinical and laboratory evidence of metastasis, and group B, with 28 patients who developed metastasis after initial treatment. The results were analysed by the chi-square test (p < 0.05). The fatty tissue invasion was identified in 56.0% and 78.5% in the A and B groups respectively, while venous embolization was only detected in 8.0% of the group A tumors and in 10.7% of those in group B. Neither showed significant variation when analyzed according to the chi-square test. Lymphatic embolization and perineural involvement were found respectively in 36.0% and 40.0% in the group A tumors and in 67.8% and 71.4% of those in group B, exhibiting a significant statistical variation. When analysing the histopathological characteristics in the pre- and post-menopausal patients, the chi-square test disclosed that lymphatic embolization and perineural involvement had a significantly higher incidence only in premenopausal patients in group B.
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Primary lymphoma of the breast. REVISTA PAULISTA DE MEDICINA 1992; 110:177-9. [PMID: 1341008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe a case of primary lymphoma of the breast which clinically mimicked a phyllodes tumor. The diagnosis and treatment of this rare neoplasm are discussed. The lymphomas, neoplasias of the immune system, comprise a large group of proliferative diseases of the lymphoreticular tissue which are classified into two histological types, i.e., Hodgkin and non-Hodgkin. Primary lymphomas of the breast are quite rare, with an incidence ranging from 0.4 to 0.53% of all malignant breast tumors (2). They are characterized by uni- or bilateral involvement of the breast, with or without homolateral axillary lymphadenopathy, and by the absence of lymphatic disease at another site (7). We report here a case of primary non-Hodgkin lymphoma of the left breast and we discuss its clinical aspects and the treatment instituted.
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[Mammary tuberculosis: a report of 2 cases]. REVISTA PAULISTA DE MEDICINA 1988; 106:6-8. [PMID: 3238266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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