Mammary analogue secretory carcinoma of the parotid: An arduous maze to solve

Mammary analogue secretory carcinoma (MASC) is an unusual and rare salivary gland malignancy that recapitulates the genetic and microscopic features of secretory carcinoma of the breast (SCB) which is an equally rare entity. MASC and SCB express S-100 protein, vimentin, mammaglobin, and harbor a t (12; 15) (p13; q25) translocation which leads to ETV6-NTRK3 fusion product. The morphology of MASC is not specific and can overlap with many salivary gland tumors. S100 and mammaglobin抯 strong positivity confirm the diagnosis of MASC. The morphology along with immunohistochemical findings provides important clues for diagnosis. Recent advances in molecular pathology help in investigating both differential diagnosis and prognosis in salivary gland oncology. Molecular testing is recommended to arrive at a diagnosis of MASC. We report a case of MASC of the parotid gland in a 47-year-old male patient with his immunohistochemical profile.

Effect of neoadjuvant chemotherapy on breast invasive ductal carcinoma and changes of estrogen receptor, progesterone receptor, human epidermal growth factor receptor 2 and Ki67 in tissues / 中国综合临床

Objective:To observe the clinical effect on patients of invasive ductal carcinoma of the breast by neoadjuvant chemotherapy, and to analyze the changes of estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor-2 (HER-2) and Ki67 in neoplasm.Methods:A total of 83 patients which were treated by neoadjuvant chemotherapy in breast invasive ductal carcinoma diagnosed were selected in North China University of Science and Technology Affiliated Hopital from January 2014 to December 2020. There were 30 cases of Luminal type A, 31 cases of Luminal type B, 10 cases of HER-2 positive type and 12 cases of triple negative type. To observe the clinical effect of different molecular subtypes, detect the expression of Er, PR, HER-2 and Ki67 in pathological tissues before and after neoadjuvant chemotherapy, and conduct a retrospective case-control study. Comparison between the two groups use χ2 test, matched χ2 and accurate probability method. Results:Fifty-eight cases were clinically effective, the total effective rate was 69.8% (58/83), and 9 cases were pathological complete response (pCR), accounting for 10.8% (9/83). After neoadjuvant chemotherapy, the highest clinical efficacy was luminal type B in 26 cases, and the highest PCR was triple negative type in 3 cases. The pathological results showed that the expression of ER (6 cases of positive expression were increased, χ2=1.03, P=0.310), PR (8 cases of positive expression were increased, χ2=1.56, P=0.210) and HER-2 (2 cases of positive expression were decreased, χ2=0.10, P=0.748) was not different before and after neoadjuvant chemotherapy. The expression of Ki67 was decreased in 25 cases (30.1%) after chemotherapy compared with 59 cases (71.1%) before chemotherapy (34 cases of positive expression were decreased, χ2=27.85, P<0.001). Five cases were added among Luminal type A after chemotherapy, all of which were transformed from Luminal type B, but the kappa value was 0.919 (>0.75), the consistency rate was 91.9%. The consistency was idea before and after chemotherapy. Five cases were added after Luminal type A chemotherapy, all of which were transformed from Luminal type B, but the kappa value was 0.919 ( P>0.75), and the consistency rate was 91.9%,The consistency before and after chemotherapy was good. After chemotherapy, HER-2 expression remained unchanged in 59 cases (clinically effective in 48 cases), up-regulated in 9 cases (clinically effective in 4 cases) and down regulated in 15 cases (clinically effective in 6 cases)( χ2=12.82, P=0.002). Ki67 expression remained unchanged in 35 cases (20 cases were clinically effective), up-regulated in 7 cases (2 cases were clinically effective) and down regulated in 41 cases (36 cases were clinically effective)( χ2=14.63, P=0.001). Conclusion:The clinical effect of neoadjuvant chemotherapy in the treatment of breast invasive ductal carcinoma is ideal. The clinical effective rate of Luminal B type is the highest, and the pCR rate of triple negative type is the highest.And it can significantly reduce the expression of Ki67. The down-regulation of HER-2 and Ki67 is significant for clinical efficiency.

Study of targeted four node sampling of axilla in management of carcinoma of breast

Background: Axillary lymph node sampling is considered as one of the most pivotal investigations in determining the lymph node status in management of carcinoma breast. The present study attempts to assess sensitivity, specificity and positive predictive value of axillary four node sampling (FNS) in management of carcinoma of breast, and its efficacy in downstaged patients.Methods: A total of 35 patients, node negative operable cases of carcinoma breast and locally advanced breast cancer (LABC) patients downstaged after 3 cycles of neoadjuvant chemotherapy, were enrolled. Lymph node mapping was done by injecting 3 - 5 ml of methylene blue dye, just before surgery. Level 1 lymph nodes stained by methylene blue were sampled and axillary dissection was carried out, level 3 lymph nodes were identified and sampled, rest of the axillary dissection specimen was sent as a separate sample for histopathological examination , node positivity was compared in level 1 and level 3 , and conclusions were drawn.Results: The sensitivity, specificity for FNS in node negative operable cases were found to be 83.33% and 91.3% respectively.  The negative and positive predictive value were found to be 95.40% and 71.42% respectively. Specificity of FNS in LABC downstaged patients was found to be 40%.Conclusions: Targeted four node sampling using methylene blue dye can be considered as an alternative method for sentinel lymph node. Further study should be conducted to establish it as a reliable method for axillary lymph node staging.

Comparison of Baska Laryngeal Mask Airway and Endotracheal Tube in Adult Patients Undergoing Surgery under General Anesthesia: A Prospective Randomized Study

Background: Airway management is considered as an integral part of general anesthesia. Use of Baska mask, since asupraglottic airway device, could result in the low incidence of hemodynamic alterations and post-operative pharyngolaryngealcomplications. We conducted this study to compare the hemodynamic parameters, i.e., systolic blood pressure (SBP),diastolic blood pressure, mean arterial pressure (MAP), heart rate (HR), ease of insertion, time of insertion, and post-operativepharyngolaryngeal complications during Baska mask and endotracheal tube (ETT) insertion.Materials and Methods: It was a prospective randomized study which was conducted on 80 adult patients admitted for electivesurgery under general anesthesia (GA) of 60–90 min duration. A total of 80 patients were randomly allocated into two groups,i.e., Group B and Group E of 40 each. Group B patients underwent Baska mask insertion and Group E patients underwent ETTinsertion. The statistical analysis was done by Student’s t-test and Chi-square test. P < 0.05 was considered statistically significant.Results: There was a statistically significant rise in SBP, diastolic blood pressure, MAP, and HR during ETT insertion as comparedto Baska mask insertion. The mean time of insertion of Baska mask was 12.8 ± 1.36 s and of ETT was 15.93 ± 1.51 s. Insertionof Baska mask was easy in 85% whereas insertion of ETT was easy in 65%.Conclusion: Baska mask can be used as an alternative to ETT in adult patients undergoing surgeries under GA of 60–90 minduration with minimal hemodynamic alterations and post-operative pharyngolaryngeal complications.

Association of JMJD3, MMP-2 and VEGF expressions with clinicopathological features of invasive ductal breast carcinoma / 南方医科大学学报

OBJECTIVE@#To examine the expressions of JMJD3, matrix metalloproteinase-2 (MMP-2) and vascular endothelial growth factor (VEGF) in invasive ductal breast carcinoma, their association with the clinicopathological features of the patients and the effect of JMJD3 overexpression on proliferation and MMP-2 and VEGF expressions in breast cancer cells.@*METHODS@#The protein and mRNA expressions of JMJD3, MMP-2, and VEGF in invasive ductal breast carcinoma and paired adjacent tissues were detected by immunohistochemistry and RT-PCR, respectively, and their correlation with the clinicopathological characteristics of the patients was analyzed. Kaplan-Meier survival analysis was used to evaluate the correlation of JMJD3, MMP-2 and VEGF expression levels with the survival of the patients. In breast cancer MDA-MB-231 cells transfected with a JMJD3-expression plasmid, the expression of Ki67 was examined immunohistochemically, the cell proliferation was assessed with CCK8 assay, and the mRNA expressions of MMP-2 and VEGF were detected with RT-PCR.@*RESULTS@#Breast cancer tissues had significantly lower JMJD3 expression and higher MMP-2 and VEGF expressions at both the mRNA and protein levels than the adjacent tissue (@*CONCLUSIONS@#The expressions of JMJD3, MMP-2 and VEGF in invasive ductal breast carcinoma are closely correlated to tumor proliferation, invasion, metastasis and prognosis and can be used for prognostic evaluation of breast cancer.

​Fine-Needle Aspiration Cytology In Palpable As Well As In Non-Palpable Breast Lesions: A Study Of 430 Cases

Background: Fine-needle aspiration cytology (FNAC) is an established, highly accurate, and cost-effective method for diagnosinglesions in different organs including the breast. The method is minimally invasive without unwanted side effects. At present,accurate diagnosis of breast lesions depends on a triple assessment approach that is combined clinical, radiological, andpathological diagnosis. FNAC is widely adopted for pathological diagnosis of different types of the breast lesions. In developingcountries, like India, malignant causes as well as non-malignant causes are the most common causes of breast lump. FNACproves to be a valuable tool in diagnosing these cases.Aims: This study intended to look the frequencies and various cytomorphological presentations of different lesions on FNACof breast lump.Materials and Methods: In a study period of January 2015–December 2017, in the Pathology Department, GMERS MedicalCollege, Ahmedabad, 430 patients of breast lesions for FNAC came. Those were subjected to cytological evaluation withhematoxylin and eosin, Giemsa, Papanicolaou, and Ziehl–Neelsen stained smears. We assessed the age of the patients, lesionsize, site, type of lesion, and axillary lymph node metastasis in case of malignancies. In addition, the ultrasonography/mammographyof these patients with the clinical presentation was also studied.Results: Age ranges from 13 to 100 years with a mean age of 38 years. Among the lesions, 31.86% fibroadenoma, 23.02%malignant lesions, 11.81% fibrocystic changes, and 20.23% inflammatory lesions were identified. Mean lesion size was3.37 ± 2.08 cm. 12 (12.12%) of malignant lesion cases showed metastasis in axillary lymph nodes.Conclusion: FNAC serves as a safe, rapid, economical, requiring minimal instrumentation, and highly sensitive tool forthe diagnosis of different kind of the breast lesions and ductal carcinoma. The cytomorphological examination of theselesions before operation or treatment serves as an important diagnostic modality. The sensitivity can be further increased bycomplementing with radiological and clinical findings.

Study of the expressions of NF-κB and MTA2 in infiltrating ductal carcinoma of breast and their correlation / 国际检验医学杂志

Objective To investigate the expression of NF-κB and MTA2 in infiltrating ductal carcinoma of breast and their correlations to clinicopathologic character.Methods The expressions of and MTA2 in breast cancer and paired adjacent normal breast tissues of 68 breast invasive ductal cancer patients were detected by real-time quantitative PCR method,and their correlations to the clinicopathologic characteristics of breast invasive ductal cancer were analyzed.Results The expressions of NF-κB and MTA2 in breast invasive ductal carcinoma were not related to age,tumor size and histological stage (P＞0.05),and were positively correlated with lymph node metastasis and TNM stage (P＜0.05).In addition,MTA2 was highly expressed in the tissues of ER positive breast invasive ductal cancer patients (P＜0.05).There was a positive correlation between the expression of NF-κB and the expression of MTA2 in breast cancer tissue of the infiltrating ductal carcinoma of breast patients(r=0.808,P=0.012).Conclusion Measurement of NF-κB and MTA2 from breast invasive ductal carcinoma tissue may provide a theoretical basis for the diagnosis,progression and prognosis of infiltrating ductal carcinoma of breast.

Expression and clinical significance of HMGA1 and CXCR4 in invasive ductal carcinoma of breast / 临床与实验病理学杂志

Purpose To investigate the expression of high mobility group protein Al (HMGA1) and C-X-C chemokine receptor 4 (CXCR4) in breast invasive ductal carcinoma and its clinical significance. Methods Immunohistochemical method was used to detect the expression of HMGA1 and CXCR4 in 105 cases of breast invasive ductal carcinoma and 80 cases of breast adenosis. The correlation between HMGA1 and CXCR4 expression and clinicopathological features was analyzed. Results The positive rate of HMGA1 and CXCR4 in breast invasive ductal carcinoma was significantly higher than that of breast adenosis(77.14％ vs 26.25％, 73.33％ vs 23.75％ ), the difference was statistically significant (P＜ 0.001). There was no significant correlation between HMGA1 and CXCR4 expression in breast cancer tissues (r = 0.104, P =0.289), suggesting that the expression of them were independent of each other. The combined detection of HMGA1 and CXCR4 could improve the sensitivity of diagnosis of (either positive) and specificity of(both positive). The positive rate of CXCR4 in PR positive breast cancer (87.5％ ) was higher than that in PR negative(60.0％ ), the difference was statistically significant (P =0.008) Conclusion HMGA1 is highly expressed in breast invasive ductal carcinoma, and CXCR4 expression is mainly low in breast invasive ductal carcinoma. HMGA1 and CXCR4 have higher sensitivity, and the combined detection of them can significantly improve the sensitivity and specificity of breast cancer diagnosis. The high expression of HMGA1 and CXCR4 in breast cancer has a certain clinical significance for the diagnosis and prognosis of breast cancer, which is expected to provide a new theoretical basis for the diagnosis and treatment of clinical breast cancer.

A clinicopathologic analysis of 31 patients with solid papillary carcinoma of breast / 肿瘤研究与临床

Objective To study the clinicopathologic features,immunophenotype,diagnosis and differential diagnosis of solid papillary carcinoma (SPC) of breast.Methods A retrospective study was performed to analyse the clinicopathologic features and immunophenotype of 31 cases of SPC with or without invasion.The cytokeratins (CK),myoepithelial markers,neuroendocrine markers,proliferation marker Ki-67,estrogen receptor (ER),progesterone receptor (PR),HER2,ect were detected by immunohistochemical staining,and HER2 was detected by FISH.All patients were followed up.Results All the patients were females with a mean age of (67.0±12.5) years.The presenting symptom was a painless mass with or without nipple discharge.In 19 cases who had undergone axillar lymph node dissection,only one metastasis was observed.General observation showed that tumors had substantive and nodular lesions,accompanied by cyst formation.Microscopy examination showed that tumors had swell and substantive nodules with only fine fiber vascular axis,and lacked obvious nipples and screen structure.The cells were lack of atypia,adhesive in cells nest.20 patients were accompanied by mucus secretion.Immunohistochemical study showed that the tumor cells expressed CK8/18,ER,PR,but didn' t express basal cell CK5/6,34β12.The positive rates of CK5/6,34β12,p63 were 3.23 ％ (1/31),9.68 ％ (3/31),6.45 ％ (2/31) in the myoepithelial layers of axis of papillary,and were 19.25 ％ (6/31),38.71％ (12/31),16.13 ％ (5/31) in peripheral cell nests and tumors,respectively.The positive rates of CgA,Syn,NSE,Cd56 were 83.87 ％ (26/31),87.10 ％ (27/31),93.55 ％ (29/31),90.32 ％ (28/31),respectively.The staining of HER2 oncoprotein was negative mostly,and the FISH detection outcome of 15 cases were all negative.The average positive index of Ki-67 was 4.12 ％.28 cases (90.23 ％) received follow-up,only 1 patient died,and the rest patients were without tumor recurrence or metastasis.Conclusions SPC of breast,a rare pathologic type,usually occurs in old females.The diagnosis depends on pathological characteristics and its unique immune phenotypic characteristics.SPC of breast has close relationship with mucinous carcinoma and neuroendocrine carcinoma,with a relatively inert biological behavior.

Correlated expression of Pim-3 and NF-κB in infiltrating ductal carcinoma of breast / 重庆医学

Objective to investigate the role of Pim‐3 and NF‐κB in the development and progression of infiltrating ductal carcinoma of the breast .Methods Here ,we used immunohistochemistry to detect expression of Pim‐3 and NF‐κB in 75 samples of infiltrating ductal breast carcinoma ,21 samples of intraductal breast carcinoma and 30 normal breast tissues .The relationship of their expression ,as well as their correlation with clinicopathological features and patient survival were assessed .Results In con‐trast ,both Pim‐3 and NF‐κB were more commonly detected in infiltrating ductal carcinoma than in intraductal carcinoma and normal tissue .In the infiltrating ductal carcinoma ,the positive expression rate of Pim‐3 was 77 .3% ,and that of NF‐κB was 68 .0% ;in duc‐tal carcinoma of the breast ,the positive expression rate of Pim‐3 was 52 .4% ,and that of NF‐κB was 42 .9% ;in the normal breast tissue ,the positive expression rate of Pim‐3 was 23 .3% ,and that of NF‐κB was 16 .7% ;the positive expression rate of Pim‐3 was correlated with tumor size ,histological grade ,and clinicopathological stage ;and that of NF‐κB was correlated with tumor size ,histo‐logical grade ,lymph node metastasis of breast cancer .Spearman rank correlation analysis revealed a positive correlation between Pim‐3 expression and NF‐κB expression in infiltrating breast cancer (r=0 .243) .Conclusion Our results demonstrate that Pim‐3 and NF‐κB play a role in the initiation and development of breast cancer ,thus ,these proteins may serve as useful diagnostic and prognostic markers of invasive breast cancer .

A study of assessing cardiotoxicity by MUGA technique in patients treated for carcinoma breast

Introduction: Adriamycin is one of the commonly used chemotherapeutic drugs in breast cancer which induce cardiotoxicity ranges from benign arrhythmias to potentially lethal cardiomyopathy. Aim: To study on assessing adriamycin induced early cardiotoxicity in breast cancer with MUGA scan by estimating LVEF. Materials and methods: In this prospective study with a subject of 30 female patients, histologically confirmed breast cancer stage-I –III without any co-morbidities and higher risk factors (as per protocol) with baseline LVEF >50% estimated with TC-99M MUGA scan and 2D Echo received 4 cycles of AC + RT + Paclitoxal + HT. Chemotherapy given based on BSA with dosage of A=60 mg/m2 , C = 600 mg/m2; EBRT = 5040 Gy/5000 gy to chest wall and p=175 mg/m2 . Results: Out of 30 patients, 4 patients received320 mg; 14 patients received 360 mg; 4 patients received 380 mg; 5 patients received 400 mg; 1 patient received 340 mg; 1 patient received 450 mg and 1 patient received 600 mg. In all the patients there is a decline in LVEF from baseline to 1st MUGA scan and Baseline to 2nd MUGA scan. From baseline - 2 nd MUGA scan out of 30 patient, 3 patients had protocol defined decline LVEF i.e. <50% at doses of 380 mg, 400mg and 600 mg respectively i.e. 3 patients developed protocol defined subclinical cardiotoxicity. 2D Echo was also done in all patients at 3rd MUGA scan. In 2D Echo even though there is a decline in LVEF, no patient developed protocol defined subclinical cardiotoxicity. Mean and standard deviation (SD) was Bukya Sheela, Madisetty Adi Lakshmi, Chinta Sanjeeva Kumari. A study of assessing cardiotoxicity by MUGA technique in patients treated for carcinoma breast. IAIM, 2016; 3(10): 272-279. Page 273 51.97±2.72 for MUGA-3 based on null lypothesis, p value is scored as = 0.9 which is insignificant for adriamycin cardiotoxicity. Conclusions: Out weighing the benefits and risks at lower cumulative doses, adriamycin is still considered as treatment of choice. Specific cardiac monitoring guidelines should be formed to evaluate adriamycin cardiotoxicity

A study of histopathological assessment of mastectomy specimens at tertiary care centre in western India.

Background: Carcinoma of the breast is the most common malignancy in adult women and the second leading cause of cancer death in women. There is an uncertainty over natural history and factors leading to emergence of cancer of breast in women as well as in men. Aims & Objective: To study the various morphological types of malignant lesions and their age distribution, from Mastectomy and Post lumpectomy Mastectomy received from in and around Ahmadabad district, at Department of Pathology, Smt NHL MMC and Sheth VS Hospital, Ahmedabad. Material and Methods: Out of the specimens of breast which presented as mastectomy and post lumpectomy mastectomy specimens of breast to the Department of Pathology, Smt NHL MMC and Sheth VS Hospital, Ahmedabad for histopathological examination, 100 cases were taken up for this study. Detailed clinical data were noted as per the proforma with emphasis on history, gross examination and microscopic examination. Results: Majority of cases were carcinoma (87%). Majority of women (63%) were of age 41-60. Painless lump (77%) was found as most common symptoms, while nipple retraction was found in 3% cases and Peaude orange skin was found in 1% cases. Majority of patients had lump in the left breast (53%) followed by right breast (47%). 40% of patients presented with lump in the upper outer quadrant and 11% in lower outer quadrant. Out of the total 88 carcinomas of breast encountered, 85.2%, were Infiltrating Duct Carcinoma [IDC (NOS)], 1.1% were Ductal Carcinoma in Situ (DCIS), 1.1% each of mucinous carcinoma, invasive papillary carcinoma and acinic cell carcinoma, 2.2% were metaplastic carcinoma and 6.8% were invasive lobular carcinoma. Most of tumour was T3 (53.48%) followed by T2 (29.06%). In the case of pathological staging The majority of patients were present in stage IIIA (25.58%), stage IIB (24.41%) and stage IIIC (22.09%), followed by Stage IIA (18.60%). Vascular invasion was 21.3% in the case of IDC, 66.6% in the case of ILC and 25% in the case of stromal carcinoma. Conclusion: This study highlights the importance of histopathological examination in breast lumps not only in establishing the final diagnosis, but also in predicting the prognosis by typing, staging and grading malignant neoplasm of breast.

Sudden death: Following metastasis from carcinoma of breast.

We report a case on sudden death brought to the Department of Forensic Medicine, Gauhati medical college, Assam. Death was due to syncope as a result of cardiac tamponade due to pericardial effusion following metastasis from carcinoma of breast. Death from cardiac tamponade following carcinoma breast is not a usual finding on the autopsy table. These sudden deaths make forensic pathologists aware of the course of natural diseases. Cardiovascular diseases accounts for vast majority of cases and certain neoplasm may also present as sudden death. Malignancy of breast is one of the commonest malignancies in females and often it presents late with metastasis to the underlying organs. The importance of autopsy lies here in the fact that it alleviates the doubts in the minds of the relatives of the deceased and relieves the law of the burden of un-necessary investigations. Moreover, role of pathology in Forensic Medicine in such cases is inevitable in establishing the cause of death.

Membrane activator of the 72 kDa type IV collagenase in malignant breast carcinoma patients: Expression of membrane-type 1-matrix metalloproteinase (MT1-MMP)

In this study, we determined proMMP-2 activating capacity of membrane extract prepared from the tissue of invasive ductal carcinoma of breast by zymogram gel analysis. We compared the effect of membrane extract on the activation of the latent type IV collagenases with that of the organic mercurial compound leg, APMA)-induced self cleavage of the latent type IV collagenases. We also compared the expression levels of MT1-MMP between invasive carcinoma and normal tissue by Western blot, Northern blot and semi-quantitative RT-PCR analysis. Our result demonstrated that the specificity of processing by breast carcinoma membrane activator corresponds to the specificity of MT1-MMP, which clearly showed the conversion of 72-kDa proMMP-2 to the activated form while APMA processed both 72- and 92-kDa proMMPs to their activated forms. MT1-MMP protein and mRNA were expressed both in invasive carcinoma and normal tissues, and the expression levels in both tissues were comparable. Quantitative analysis of the mRNA level by RT-PCR revealed that the difference of MT1-MMP mRNA between carcinomas and normal tissues was not statistically significant on Wilcoxon signed-ranks test (P>0.05). The results from the study on the expression of MT1-MMP gene suggest that the cellular activation of MMP-2 in breast tissue, requires additional effects in addition to up-regulation of MT1-MMP.