Immunohistochemical Survey of Invasive Ductal Carcinoma of the Breast, using ER, PR, HER2 and KI-67 biomarkers, in Uyo, Nigeria

Background: Breast's Invasive Ductal Carcinoma (IDC), which is the commonest type of malignancy in females worldwide, can be characterized using immunohistochemistry in view of personalized cancer therapy. In this study, we aimed to determine the pattern of immunohistochemical profiles of IDC using oestrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor 2 receptor (HER2) and proliferative index (Ki-67) biomarkers in our tertiary healthcare facility in Uyo, Akwa Ibom State, Nigeria given the dearth of its data in our environment. Materials and methods: We carried out a retrospective hospital-based immunohistochemical study of archival IDC tissue blocks over a four- and half-year period. Using systematic random sampling method, 64 formalin fixed paraffin embedded (FFPE) IDC tissue blocks were selected for this study. We carried out immunohistochemical evaluation using ER, PR, HER2 and Ki-67 biomarkers. Subsequently, we presented the results and classification schemes as text, tables, graphs, and photomicrographs. Results: We found that the proportion of expressions were ER-negative (88.7%), PR-negative (87.3%), HER2-negative (68.3%) and Ki-67 (<20%) being 83.6% respectively. The immunohistochemical-based classification which was done using combined immunohistochemical profiles of ER/PR/HER2 and ER/PR/HER2/Ki-67 biomarkers respectively, revealed five immunohistochemical-based subtypes. These subtypes were ER-positive luminal A (ER+/±PR+/HER2-) [5.56%], ER-positive luminal B (ER+/±PR+/HER2+) [5.56%], HER2-overexpression (ER-/±PR+/HER2+) [16.66%], Triple negative (ER-/PR-/HER2-) [66.67%] and Unclassified subtypes (ER-/PR+/HER2-) [5.56%]. Furthermore, these five subtypes were further subcategorized into low (Ki-67 <20%) and high (Ki-67 ≥20%) proliferation subtypes accordingly. Conclusion: The commonest pattern of immunohistochemical profile expression of IDC in Uyo was found to be the Triple negative subtype.

Single Circulating Blast in the Peripheral Blood Film in Normal Individuals and Patients of Non-neoplastic Haematological Disorders and Non-hematological Neoplasms/Disorders- A Study at a Tertiary Care Centre

Introduction: The blasts in the peripheral blood is usuallyassociated with a haematological disorder. Study aimed tosee if a single blast seen in a peripheral blood film of healthyindividuals and patients of non-neoplastic haematologicaldisorders and non-hematological neoplasms/disorders didhave any clinical significance.Material and Methods: The period of study was from 2014to 2018 conducted at a tertiary care hospital. The study wasdone exclusively on Peripheral Blood Films. The films werestained with Leishman stain. An occasional blast was detectedin some healthy subjects and patients of non-neoplastichaematological disorders and non-hematological neoplasms/disorders.Result: The routine smears were analyzed with caution afterthe first case of a patient of Iron Deficiency Anemia revealeda clear-cut Blast. In the period of 4 years from 2014 to 2018,a total of 23 cases of apparently normal individuals or patientswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1% on oneseparate occasion.Conclusion: A careful morphological examination in theperipheral smears of few normal individuals and individualswith non neoplastic haematological disorders and nonhematological neoplasms/disorders showed at least 1%Blast on one separate occasion. The cells were clear cutblasts with a large size, fine nuclear chromatin, one to twonucleoli with round to slightly irregular nuclear contours anda mild amount of pale agranular cytoplasm. On thoroughinvestigations of these individuals there was no evidence ofa neoplastic haematological disorder. Therefore a single blastin a peripheral blood seen in a healthy individuals or patientswith benign haematological disorder and non-neoplasticneoplasms/disorders may not always indicate a neoplasticprocess.

Adaptación del Inventario de Duelo Complicado en población colombiana / Adaptation of the Complicated Grief Inventory to the Colombian Population / Adaptação do Inventário de Luto Complicado na População Colombiana

Resumen Se realizó la adaptación del Inventario de Duelo Complicado (IDC) en población colombiana. Cinco jurados evaluaron el contenido y ajuste cultural del cuestionario y luego éste fue aplicado a una muestra de 120 adultos que experimentaron el fallecimiento de un familiar. Los análisis psicométricos indicaron una consistencia interna similar a la de la prueba original y superior a la de la adaptación española, buena estabilidad temporal, asociaciones positivas con pruebas de depresión y ansiedad usadas para evaluar la validez convergente y tres factores significativos. Se concluye que la versión adaptada del IDC tiene propiedades psicométricas adecuadas por lo que puede ser usada en población colombiana, pero se recomienda realizar una validación con una muestra más grande y usar herramientas como una entrevista clínica para establecer el alcance diagnóstico del inventario.

Abstract The Inventory of Complicated Grief (ICG) was adapted to Colombian people. Five juries evaluated the language and cultural adjustment of the Spanish version and then, the questionnaire was applied to 120 adults who had lost a family member. Psychometrical analysis showed an internal consistency similar to that one found in the original ICG, but higher than the one found in the Spain application. Convergent validity showed positive correlations between ICG and depression and anxiety tests, and three significant factors were identified. In brief, this adapted spanish version of the ICG has good psychometric properties and it can be used with Colombian people, but a validation study with a larger sample and using tools such as a clinical interview to determine the diagnostic power of this inventory is recommended.

Resumo Realizou-se a adaptação do Inventário de Luto Complicado (IDC, em espanhol) na população colombiana. Cinco jurados avaliaram o conteúdo e o ajuste cultural do questionário e, em seguida, este foi aplicado a uma amostra de 120 adultos que experimentaram o falecimento de um familiar. As análises psicométricas indicaram uma consistência interna semelhante à do teste original e superior à da adaptação espanhola, boa estabilidade temporal, associações positivas com testes de depressão e ansiedade usados para avaliar a validade convergente e três fatores significativos. Conclui-se que a versão adaptada do idc tem propriedades psicométricas adequadas, portanto pode ser usada na população colombiana, mas se recomenda realizar uma validação com uma amostra maior e usar ferramentas como uma entrevista clínica para estabelecer o alcance diagnóstico do inventário.

Expression and significance of fascin in ductal intraepithelial neoplasia and invasive ductal carcinoma / 基础医学与临床

Objective_To study the significance of fascin protein expression in ductal intraepithelial neoplasia ( DIN) and invasive ductal carcinoma ( IDC) .Methods_Thirty cases of usual ductal hyperplasia ( UDH) , 30 ca-ses of flat epithelial atypia (FEA,DIN1a), 15 cases of atypical ductal hyperplasia (ADH,DIN1b), 2 cases of DCIS grade1(DIN1c),10 cases of DCIS grade2(DIN2)and 18 cases of DCIS grade3(DIN3)were immunohisto-chemically investigated using monoclonal antifascin antibody and compared with 120 cases of invasive ductal carci-noma (IDC).Results_Fascin protein expression was not found in normal breast tissue, UDH, FEA (DIN1a), ADH(DIN1b),DCIS grade1(DIN1c)and DCIS grade2(DIN2),but only seen in 2 of 18 cases of DCIS grade3 (DIN3)(11.1%), and 18 out of 120 cases of IDC (15%).Fascin protein expression was correlated with ER neg-ative( P<0.05) , PR negative( P<0.05) , tumor grade( P<0.05) and axillary lymph node status( P<0.05) , but not correlated with age,location,tumor sizeand HER2 expression.Conclusions_Fascin protein expression seems to be a late event, usually present in carcinoma.Targetting the fascin pathway may be a noval therapeutic strategy of mammary carcinoma.

Expression of γH2AX may help in defining a genetically more stable subtype of infiltrating ductal carcinoma of breast.

Background & objectives: Gamma H2AX, a marker of DNA double stranded breaks (DSB) has been found to be over expressed in various tumours. The objective of the present work was to study the expression of γH2AX in infiltrating ductal carcinoma (IDC) and fibroadenoma (FA) cases and to associate the expression in IDC with cytomorphological features and DNA ploidy. Methods: The expression of γH2AX was studied in fine needle aspirates of 16 cases of IDC and 15 FA cases. The expression in IDC was correlated with the cytological grade, apoptotic (AI) and mitotic indices (MI) and ploidy status. Results: A high γH2AX expression was noted in IDC as compared to FA. Amongst the IDC cases the γH2AX was found to be significantly over expressed in DNA diploid IDC cases as compared to the aneuploid ones. Interpretation & conclusions: The study suggests a role of γH2AX in breast carcinogenesis which needs to be explored further. Moreover, the γH2AX expression together with ploidy status may serve as a means of assigning the patients of IDC to a better prognostic category irrespective of the cytomorphogical parameters.

O papel das Classificações da OMS - CID e CIF nas definições de deficiência e incapacidade / The role of WHO Classifications - ICD and ICF - on definitions of disability

A Organização Mundial de Saúde tem hoje duas classificações de referência para a descrição dos estados de saúde: a Classificação Estatística Internacional de Doenças e Problemas Relacionados à Saúde, que corresponde à décima revisão da Classificação Internacional de Doenças (CID-10) e a Classificação Internacional de Funcionalidade, Incapacidade e Saúde (CIF). A utilização da CIF vem sendo aguardada com grande expectativa pelas organizações de pessoas com deficiências e instituições relacionadas. A falta de definição clara de "deficiência" ou "incapacidade" tem sido apontada como um impedimento para a promoção de saúde de pessoas com deficiência. É importante que essas definições, especialmente no âmbito legislativo e regulamentar, sejam consistentes e se fundamentem num modelo coerente sobre o processo que origina as situações de incapacidade. Este artigo tem como objetivo apresentar elementos da CID-10 e da CIF, e o papel que desempenham para definir deficiência e incapacidade. Os componentes da CIF podem contribuir para diferentes campos de aplicabilidade no que diz respeito ao entendimento das definições de deficiência ou incapacidade a partir do conceito de funcionalidade e dos fatores contextuais.

Assessment of MIB1 (Ki-67) Labeling Index and Correlation with Other Well Established Prognostic Factors in Breast Cancer

PURPOSE: The MIB1 labeling index is new method utilizing a monoclonal antibody against Ki-67 antigen and useful for evaluating the proliferation rate in breast cancer due to its ease of use and reliability. We compared the MIB1 labeling index to other, well established prognostic factors and assessed the prognostic value of MIB1 in 564 breast cancers. METHODS: The MIB1 (Ki-67 equivalent monoclonal antibody) proliferation rate, MIB1 labeling index, was determined in formalin-fixed, paraffin-embedded tissue specimens of 564 primary breast cancer patients who underwent surgery between March 1998 and February 2000 at Seoul National University Hospital. The clinicopathologic characteristics of the primary tumor such as age, tumor size, histologic type, nuclear grade, histologic grade, hormone receptor status and various tumor markers (p53, c-erbB-2, bcl-2) were compared with the value of the MIB1 labeling Index. RESULTS: The mean value of MIB1 labeling index was 6.9. MIB1 labeling index was correlated to younger age (p= 0.011), histologic types, low nuclear grade (p=0.0001), high histologic grade (p=0.0001), p53 positive (IDC) (p=0.0001), c-erbB-2 positive (DCIS) (p=0.01), comedo type (DCIS) (p= 0.001) and inversely correlated to hormone receptor positivity (p=0.0001), bcl-2 positive (IDC) (p=0.001). No correlation was found in tumor size, lymph node status and c-erbB-2 positive (IDC). CONCLUSION: The MIB1 labeling index correlated well with well-established poor prognostic factors. The MIB1 labeling index may be an important prognostic determinant in breast cancer.