A Case of Secretory Carcinoma of the Breast

Secretory carcinoma is an uncommon type of carcinoma and the only well-documented type that may arise in children and adults of both sexes. Secretory carcinomas do not occur with any particular frequency in any part of the breast. Usually, the primary symptom is a painless mass that may be present for years before biopsy. We encountered a case of a secretory carcinoma of the breast. The patient was a 34-year-old woman. She visited our hospital due to a painless mass located in the upper portion of the left breast in the direction of 11 o,clock and at a distance of 1 cm from the areola. On palpation, it showed a firm and fixed tumor mass. A secretory carcinoma was diagnosed based on excisional biopsy. The patient underwent an Auchincloss, modified radical mastectomy. Multistep cross sections showed an ill-defined brownish, white tumor mass with a gritty sensation and measuring 2.0 1.4 cm in size. Metastasis was found in 1 of 8 axillary lymph nodes. Compared with typical breast cancer, the prognosis is better, but a similar therapeutic strategy may be necessary.

Relation Between Expression of p53 Proteins and Established Prognostic Factors in Breast Carcinomas

BACKGROUND: Recent studies have conflicting results concerning the role of p53 protein related to the discovery that a wild-type of p53 is a nuclear protein that plays a role both as a tumor suppressor and may play roles in the control of transcription and as a negative regulator of cell growth, whereas mutant p53 supports tumor formation in experimental oncogenic settings and is overexpressed in some human tumors. The mutant p53 is abnormally stable, leading to increased expression. p53 has been most widely studied by the immunohistochemical method. p53 overexpression often found in some studies, but not always in other studies, have been shown to be an independent predictor of poor prognosis. METHODS: To evaluate a possible prognostic factor, we studied the expression of the p53 protein by an immunohistochemical method and compared these results with the established prognostic factors for breast carcinomas. RESULTS: 78 patients aged 28-69 were included in this study. The mean age was 46.3, and 53 patients out of 78 were less than 50 years old. There were 28 cases with tumor diameters of less than 2 cm, and 50 with tumor diameters of more than 2 cm. The most common pathologic type was an infiltrating duct carcinoma, 71 out of 78 cases (91.0%), and proportions of histologic grade I, II, and III tumors was 23 (29.5%), 41 (52.6%), 14 (17.9%), respectively. Cases with lymph node metastasis numbered 52 of 78 (66.7%). We observed a remarkable increase in the nuclear staining intensity at the invasive margins of some tumors, which may be linked to a higher incidence of proliferating cells. CONCLUSIONS: p53 overexpression was associated with tumor size (p<0.05), but was not associated with lymph node status, age, histologic grade, or estrogen receptor status.

An Analysis of Biliary Drainage Procedures / 한국간담췌외과학회지

The aim of this study is to appraise the efficacy of both recent therapeutic modalities and the prognosis after the biliary drainage procedure of various biliary diseases. A retrospective review of biliary drainage procedures for biliary disease was done from January 1986 to June 1996. We have experienced 252 cases at Pusan National University Hospital. The results were obtained as follows: 1) The most common age group was the 6th decade, and the ratio of male to female was 1:1.3. 2) Operative procedures consisted of sphincteroplasty in 62 cases(24.6%), choledochoduodenostomy in 63 cases(25%), choledochojejunostomy in 72 cases(28.6%), and choledochojejunostomy with defunctionalized jejunal limb in 55 cases(21.7%). 3) The indications for operative procedures of biliary drainage were as follows: intrahepatic stone in 67 cases(26.6%), dilated CBD with muddy stones in 57 cases(22.6%), CBD stone with stenosis of sphincter in 15 cases(5.9%), recurrent or residual stones in 89 cases(35.3%), and malignant disease in 24 cases(9.6%). 4) The preoperative diagnostic procedures were operative cholangiography, T-tube cholangiogram, ultrasound, ERCP, PTC, and abdominal CT. 5) The postoperative procedures for remaining stones after operation were choledochoscopic extraction, saline irrigation and reoperation. 6) The postoperative complications included wound infection (18 cases, 7.1%), respiratory infection (4 cases, 1.6%), GI trouble (19 cases, 7.5%), cholangitis ( 2 cases, 0.8%), residual stone (25 cases, 11%), pancreatitis ( 1 case, 0.4%), and biliary fistula (5 cases, 1.9%). Recently many therapeutic techniques have contributed to improving biliary drainage. We suggest that an apprapriate operation be selected according to the situation when performing biliary drainage for biliary diseases.