Correlación ecográfica, mamográfica e histopatológica en el diagnóstico de cáncer de mama en Guantánamo, 2010-2015

RESUMEN Introducción: El cáncer de mama se conoce desde épocas remotas, el tumor de mama es la neoplasia maligna más importante en la mujer. Se considera la primera causa de muerte por cáncer en las mujeres en el mundo. Objetivo: Evaluar la correlación ecográfica, mamográfica e histopatológica del carcinoma de mama en la provincia de Guantánamo. Método: Se realizó un estudio observacional, descriptivo, retrospectivo en 140 pacientes durante el período de 2010 a 2015 en el Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. El dato primario se obtuvo del Registro Provincial de Cáncer con diagnóstico de tumor maligno de mama. Resultados: La mayor incidencia de la enfermedad se registró a partir de los 45 años (80 %), el promedio de edad del diagnóstico fue de 57 más menos 15 años. La mama izquierda tuvo una mayor frecuencia a verse afectada con respecto a la mama la derecha (53 % vs. 46 %), fue poco frecuente que ambas mamas se encontrasen afectadas de forma sincrónica (menos del 1 %). El 53 % presentó una lesión de aspecto espiculado en la mamografía, de aspecto sólido en la ecografía y correspondiente a un carcinoma ductal infiltrante por histología. Conclusiones: Existe correlación entre los diagnósticos ecográficos, mamográficos y el diagnóstico definitivo histopatológico del cáncer de mama.

ABSTRACT Introduction: Since ancient times, breast cancer has been studied. It is current the most important invasive neoplasm in women and considered the leading cause of cancer deaths in women worldwide. Objective: To assess the ultrasound, mammographic and histopathological correlation for the diagnosis of breast cancer in Guantanamo province. Method: An observational, descriptive, and retrospective study was conducted in 140 patients during the period 2010-2015 at the Hospital General Docente "Dr. Agostinho Neto" in Guantánamo. The primary information was obtained from the Provincial Registry Database of Cancer with the diagnosis of malignant breast tumor. Results: The highest incidence of the disease was recorded in patients 45 plus years of age (80%), the average age at diagnosis was 57 ± 15 years. The left breast was more frequently affected than the right breast (53% vs. 46%), it was not common for both breasts be affected synchronously (less than 1%). The 53% of patients presented a lesion with a speculated appearance on mammography, solid appearance on ultrasound. This lesion, as per histology criteria, it corresponded to an infiltrating ductal carcinoma. Conclusions: There is a correlation between ultrasound, mammographic diagnoses and the breast cancer related definitive histopathological diagnosis.

RESUMO Introdução: O câncer de mama é conhecido desde a antiguidade, sendo o tumor de mama a neoplasia maligna mais importante na mulher. É considerada a principal causa de morte por câncer em mulheres no mundo. Objetivo: Avaliar a correlação ecográfica, mamográfica e histopatológica do carcinoma de mama na província de Guantánamo. Método: Estudo observacional, descritivo, retrospectivo, realizado em 140 pacientes durante o período de 2010 a 2015 no Hospital General Docente "Dr. Agostinho Neto" de Guantánamo. Os dados primários foram obtidos do Registro Provincial de Câncer com diagnóstico de tumor maligno de mama. Resultados: A maior incidência da doença foi registrada após 45 anos (80%), a média de idade do diagnóstico foi de 57 anos mais ou menos 15 anos. A mama esquerda teve maior frequência de acometimento em relação à mama direita (53% vs. 46%), sendo raro que ambas as mamas fossem acometidas de forma síncrona (menos de 1%). 53% apresentavam lesão com aspecto espiculado na mamografia, aspecto sólido na ultrassonografia e correspondendo a carcinoma ductal infiltrante pela histologia. Conclusões: Existe correlação entre os diagnósticos ultrassonográfico e mamográfico e o diagnóstico histopatológico definitivo de câncer de mama.

Extensive intraductal component positive carcinoma of breast: two year study with special reference to ER/PR/HER2NEU/Ki67 in a tertiary care centre of Barak Valley

Background: Extensive intraductal component positive carcinoma (EICPC) of breast is defined by Schnitt et al as-A. 25% or more of Ductal carcinoma in situ (DCIS) is present along the invasive lesion and DCIS is also present outside the area of invasive carcinoma. B. EICPC also include carcinomas in which DCIS is associated with a “small” (approximately 10 mm or less) invasive carcinoma or carcinomas. In Extensive Intraductal Carcinoma (EIDC) most of the cases were associated with recurrence when surgical margin status is not evaluated or focally involved. Our objective was to study the prevalence of EIDC and expression of estrogen receptor (ER)/progesterone receptor (PR)/human epidermal growth factor (HER2NEU)/Ki67(antigen identified by monoclonal antibody KI67) in those cases.Methods: It was a retrospective cross sectional study conducted over a period of 2017 to August 2019.All the histologically confirmed cases of EIDC was retrieved from the institute.Results: Out of 65 cases of invasive carcinoma 17 (26.1%) cases were positive for EICPC. Age of patients ranged from 27 to 73years with mean age of 43 years and 5 patients (29.4%) were postmenopausal. Most of the cases  i.e. 6(35.2%) had a ER+/PR+/HER2NEU- status with most of the cases having high 6(47%)Ki-67 index. According to the BLOOM RICHARDSON GRADING 14 cases were grade II (82.3%) and 3 cases were grade I (17.7%) and in pT and pN staging majority were stage pT1 - 7 (41.1%). Most of the cases were mastectomy cases 11 (64.4%) with a base free status except in one lumpectomy case where margin was involved.Conclusions: In this study majority of the cases were ER+//PR+/HER2NEU- with most of the cases having high Ki67 index. Evaluation of EIDC, along with the negative margin status is important to prevent recurrence.

Calretinin expression in molecular subtypes of invasive carcinoma breast

Background: Breast cancer is a leading cause of cancer death  in women worldwide. Breast carcinoma is currently managed by assessing clinicopathological features. Elucidation of molecular mechanisms of pathogenesis of breast carcinoma  may lead to the development of new targeted therapies, particularly in triple negative cancers. Literature shows a few studies on the expression of calretinin  in breast carcinoma particularly in basal like type and its prognostic significance.  In this study, authors are trying  to assess the expression of  a new marker calretinin in different molecular subtypes of invasive carcinoma breast.Methods: This study was done in  107 cases of invasive carcinoma breast specimens received in  Department of Pathology, Government Medical college, Kottayam from December  2017 to May 2019.Results: Among the molecular subtypes, Basal like tumours showed 68.4% of cases with high level and 31.6% of cases with low level calretinin expression which is comparable with the study by Farrag et al. All the other molecular subgroups showed predominantly low level of calretinin expression.Conclusions: Different molecular subtypes of invasive carcinoma breast showed varied calretinin expression. High level calretinin expression was significantly associated with grade 3 (p value = 0.002), ER negativity (p = 0.004), PR negativity (p = 0.018)  and Basal like molecular subtype (p : <0.001). This suggests that calretinin might play a role in pathogenesis of basal like breast carcinomas.

Ultrasonographic features of different molecular subtypes of no specific type invasive breast carcinoma / 中国医学影像技术

Objective To explore the ultrasonographic features of different molecular subtypes of no specific type invasive breast carcinoma. Methods According to immunohistochemical results, 193 patients with no specific type invasive breast carcinoma were divided into 4 molecular subtypes, i.e. Luminal A-like type (n=46), Luminal B-like type (n=98), HER-2 expression type (n=22) and basal-like type (n=27). The ultrasonographic features of the 4 molecular subtypes breast carcinoma were retrospectively analyzed, including the shape, edge, direction, internal echo, rear echo change, calcification, blood flow, tumor sizes, histopathological grade and lymph node metastasis. Results There was no statistically significant difference in the tumor sizes (0.05), but in the histopathological grade (grade , Ⅱ, III), there was a statistically significant difference (P<0.01). Totally 6 ultrasonographic features (shape, edge, direction, internal echo, rear echo change and calcification) had statistically significant differences among 4 subtypes (all P<0.01), while the blood flow had no statistically significant difference (P=0.16). Conclusion The ultrasonographic features of different molecular subtypes of no specific type invasive breast carcinoma have certain characteristics. The difference of ultrasonographic features is limited between Luminal A-like and Luminal B-like types, which may bring difficulties for differential diagnosis.

Intraductal Papillary Mucinous Neoplasm Presenting as Bleeding Duodenal Mass: A Surgical Rarity

@#Intraductal papillary mucinous neoplasm (IPMN) is a rare pancreatic neoplasm. The presentation varies from recurrent pancreatitis, steatorrhea and weight loss to incidental findings during imaging studies. The recognition of IPMN is crucial in deciding for prompt surgical intervention, which is the best treatment modality for this precancerous condition. Here, we report a case of 55-year-old man with massive upper gastro intestinal bleeding arising from a huge fungating duodenal mass. In view of massive bleeding, a decision for emergency Whipple's pancreaticoduodenectomy was made. Final histological diagnosis confirmed as IPMN. To the best of our knowledge, this is the first case of IPMN presented with a huge fungating duodenal mass causing massive UGIB requiring surgical intervention.

Preoperative predictors of pancreatic mucinous cystic neoplasm with invasive carcinoma / 中华胰腺病杂志

Objective To investigate the predictors for the preoperative diagnosis of pancreatic mucinous cystic neoplasm with invasive carcinoma (MCN-IC).Methods Clinical data of 132 patients with pancreatic mucinous cystic neoplasm ( MCN ) who underwent surgery and were pathologically diagnosed in Shanghai Changhai Hospital and General Hospital of Xinjiang Military Region from August 2000 to December 2013, including gender, age, medical history, clinical presentations, laboratory examinations and imaging findings and etc , were retrospectively analyzed .All cases were classified into two groups:MCN with noinvasive carcinoma ( MCN-nIC, including MCN with low-or intermediate-grade dysplasia and MCN with high-grade dysplasia ) and MCN-IC.The univariate and multivariate logistic regression was used to analyze the differences on laboratory examinations and imaging findings and the like to identify the predictors for the preoperative diagnosis of MCN-IC.Receiver operator characteristic ( ROC) curve was used to evaluate fitting performance and Hosmer-Lemeshow test was performed to evaluate goodness of fit .Results Of the 132 patients, 115 (87.12％) were MCN-nIC, 17(12.88％) were MCN-IC.Univariate analysis identified old age(≥60 years), abdominal pain, anorexia, GLU elevated, CEA≥5 ng/ml, CA19-9≥37 U/ml, unclear border of tumor , thick wall (>2 mm) , presence of mural nodules and absence of the septa as independent predictors for MCN-IC. Multivariate analysis identified old age (≥60 years), abdominal pain, CA19-9≥37 U/mL, unclear border of tumor, presence of mural nodules and absence of the septa as the predictors for MCN -IC.The maximal area under ROC ( AUC) was 0.947, which indicated that the fitting performance of the model was satisfactory and the goodness of fit was better (P=0.056).Conclusions MCN-IC had a generally low prevalence .Old age (≥60 years), abdominal pain, CA19-9≥37 U/ml, unclear border of tumor, presence of mural nodules and absence of the septa may predict the diagnosis of MCN-IC.

Clinical analysis of 76 patients with colorectal high grade intraepithelial neoplasia diagnosed by colonoscopic biopsy / 中华消化杂志

Objective To analyze colonoscopic appearances,computed tomography (CT) imaging features and their correlation with postoperative pathology in patients with colorectal high grade intraepithelial neoplasia (HGIN) diagnosed by colonoscopic biopsy.Methods From October 2009 to October 2015,patients diagnosed as colorectal HGIN by colonoscopic biopsy who received endoscopic resection or operation,and had complete postoperative pathological data were enrolled.The results of CT imaging before operation,postoperative pathological type,the maximum diameter of lesions,sessile lesions or pedunculated lesions and enlarged lymph nodes were analyzed.Chi-square test were performed for statistical analysis.Sensitivity and specificity of CT imaging before operation in the detection of invasive colorectal cancer were calculated.Results Among the 76 patients,21.1％ (16/76) patients were HGIN,and 78.9％ (60/76) were invasive cancer confirmed by postoperative pathology.The incidence rate of invasive carcinoma in patients aged ≤50 years (3/14) was significantly lower than that of patients aged ＞50 years (91.9％,57/62),and the difference was statistically significant (x2 =30.05,P＜0.01).The incidence rate of invasive carcinoma in protruding lesions with maximum diameter ≥ 3.0 cm was 98.3％ (57/58),which was higher than that of lesions with maximum diameter ＜3.0 cm(2/16),and the difference was statistically significant (x2 =51.91,P＜0.01).The incidence rate of invasive carcinoma in pedicle polyps group (2/13) was lower than that of sessile lesions (93.4％,57/61),and the difference was statistically significant (x2 =35.72,P＜0.01).The sensitivity and specificity of CT in the diagnosis of invasive colorectal cancer was 95.0％ and 84.6％,respectively.The incidence rate of invasive carcinoma in patients with enlarged lymph nodes detected by CT (93.3 ％,42/45) was significantly higher than that of patients without enlarged lymph nodes (64.3％,18/28),and the difference was statistically significant (x2=9.95,P =0.002).Conclusions CT examination can compensate for the diagnostic deficiency of colonoscopic biopsy which inadequately diagnosed some invasive carcinoma as HGIN.The incidence of invasive cancer is high in patients with age over 50 years,large lesions,sessile lesions,CT indicating colorectal neoplasms and with enlarged lymph nodes.

Cáncer de mama en una paciente de 21 años / Breast cancer in a 21 years patient

Se presenta el caso clínico de una paciente de 21 años de edad, quien acudió a la consulta de Oncología del Hospital Gubernamental de Mbabane en Suazilandia por presentar un nódulo en la mama derecha con manifestaciones de dolor intenso desde hacía 1 mes. Fue remitida a la consulta de Cirugía donde le realizaron una biopsia con aguja gruesa, cuyo resultado indicó la presencia de un carcinoma ductal invasivo, clasificado en estadio IIIB al realizar los exámenes complementarios necesarios. La paciente fue trasladada a Sudáfrica para recibir quimioterapia neoadyuvante, con la cual obtuvo mejoría evolutiva clínica y humoral, evidenciada por la reducción del tumor y las cifras del marcador tumoral CA 15-3.

The case report of a 21 years patient who went to the Oncology service in the Government Hospital of Mbabane in Suaziland is presented. She had a nodule in her right breast with manifestations of acute pain for a month. She was referred to the Surgery service where she underwent a core-needle biopsy whose result indicated the presence of a ductal invasive carcinoma, classified in IIIB stage when carrying out the necessary complementary tests. The patient was transferred to South Africa to receive neoadyuvant chemotherapy, with which clinical and humoral response was obtained which was evidenced by tumor reduction and the values of the tumoral marker CA 15-3.

Invasive Ductal Carcinoma Arising within a Mammary Hamartoma: Case Report

Breast hamartomas are typically a benign condition and rarely develop into malignant lesions. The coexistence of carcinoma and a breast hamartoma is rare; only 15 cases have been reported in the literature. Here, we report a case of invasive ductal carcinoma associated with hamartoma in a 60-year-old woman. Mammography, ultrasonography and magnetic resonance imaging showed typical features of a breast hamartoma and a suspicious mass with microcalcifications arising within the hamartoma.

Intraductal Papillary Mucinous Neoplasm with an Associated Invasive Carcinoma Manifested by Acute Pancreatitis / 대한췌담도학회지

Idiopathic acute pancreatitis (IAP) is defined as acute pancreatitis for which the standard initial evaluation has failed to reveal the etiology. Although a tumor is a rare cause of IAP, it is important to consider it in advance, because prognosis is poor if diagnosis is delayed. We describe a case of presumed IAP at the index presentation that was finally diagnosed as intraductal papillary mucinous neoplasm with an associated invasive carcinoma in a 70-year-old woman after surgery to remove a mass identified during follow-up endoscopic ultrasonography. Therefore, this is a case in which suspicion of malignancy and follow-up endoscopic ultrasonography helped to appropriately diagnose and treat the tumor.

Clinicopathologic characteristics of invasive lobular carcinoma of the breast / 临床与实验病理学杂志

Purpose To investigate the clinicopathological characteristics and the survival outcomes of invasive lobular carcinoma. Methods A retrospective analysis of 98 patients with invasive lobular carcinoma and 530 invasive carcinoma of no special type was performed in order to observe the histological features and the clinical outcomes of invasive lobular carcinoma. Results Median follow-up was 68. 5 months for invasive lobular carcinoma and 67 months for invasive carcinoma of no special type. Invasive lobular carcinoma presented with a larger tumor size, more histopathological grade 2 tumors, increased rate of hormonal receptor positivity, human epider-mal growth factor 2 (HER-2) negativity, and had a lower proliferative index as compared to invasive carcinoma of no special type, more frequently presented with the luminal A subtype (P<0. 001). The classical invasive lobular carcinoma presented with a smaller tumor size, to have a lower histological grade and proliferative index compared to the non-classic type, and more frequently presented with the luminal A subtype, whereas the non-classic invasive lobular carcinoma patients more frequently presented with the luminal B, HER-2 overexpression, or triple negative subtype (P=0. 035). A statistically significant difference in the outcome was observed at un-ivariate analysis for patients with non-classic for disease-free survival (P=0. 043) and for overall survival (P=0. 048), as compared with patients with classical invasive lobular carcinoma. The disease-free survival difference between the invasive lobular carcinoma and the invasive carcinoma of no special type was not significant (P=0. 537), and the overall survival rates were not statistically different between the two groups (P=0. 397). A statistically significant difference of overall survival was observed at multivariate analysis for patients with HER-2 positive and triple negative subtypes versus patients with luminal A invasive lobular carcinoma (P=0. 015, P=0. 016) . Conclusions The outcome of invasive lobular carcinoma is significantly correlated with histological and immunohistochemi-cally defined molecular subtypes. New tailored strategies should be explored in these subgroups of patients with poor outcome.

Invasive Cribriform Carcinoma Arising in Malignant Phyllodes Tumor of Breast: A Case Report

Phyllodes tumor is an uncommon fibroepithelial neoplasm of the breast. And it is characterized by expanded stroma with increased cellularity and elongated epithelium-lined clefts. Mammary carcinomas within phyllodes tumors have been rarely reported. To date, however, no reports have described the invasive cribriform carcinoma arising in malignant phyllodes tumor. Here, we report a 62-year-old woman who presented with a large breast mass. Microscopically, the mass was a typical malignant phyllodes tumor showing well developed leaf-like architecture and stromal overgrowth with high cellularity and nuclear pleomorphism. In a portion of the tumor, however, the epithelial component showed a cribriform pattern of proliferation in the absence of myoepithelial cells, suggestive of the invasive cribriform carcinoma. To our knowledge, this is rare and it is difficult to make a differential diagnosis of it. Here, we report our case with a review of literatures.

Immunohistochemical and morphologic findings in columnar cell lesions of the breast.

Background: Columnar cell lesions (CCLs) with or without atypia frequently coexist with invasive or in situ breast carcinomas. In this study, 39 mastectomy specimens containing CCLs coexisting with invasive carcinomas were retrospectively analyzed for cellular characteristics and structural pattern of CCL neighboring the tumor. Materials and Methods: The expression of estrogen receptor (ER), progesterone receptor (PR), and p53 antibodies in CCL and coexisting invasive tumors, type of invasive tumor, histopathologic grade, and presence of atypia in CCL have been studied. Results: Sixteen (41%) of all CCLs were with atypia, whereas 23 (59%) of them were without atypia. No correlations were found between the presence of CCLs with atypia and either the morphologic type of carcinoma or histopathologic grade of the tumors. Presence of atypia in the CCL was not correlated with the expression of p53 in the invasive tumors. CCLs without atypia dominated in Grade III tumors. The percentages of CCLs without atypia were also higher in both ER (−) and PR (−) tumors. Conclusions: CCL with atypia is generally considered to be a precursor of invasive carcinoma; however, in our study, CCLs without atypia more frequently coexisted with breast carcinoma.

Determination of Malignant and Invasive Predictors in Branch Duct Type Intraductal Papillary Mucinous Neoplasms of the Pancreas: A Suggested Scoring Formula

Prediction of malignancy or invasiveness of branch duct type intraductal papillary mucinous neoplasm (Br-IPMN) is difficult, and proper treatment strategy has not been well established. The authors investigated the characteristics of Br-IPMN and explored its malignancy or invasiveness predicting factors to suggest a scoring formula for predicting pathologic results. From 1994 to 2008, 237 patients who were diagnosed as Br-IPMN at 11 tertiary referral centers in Korea were retrospectively reviewed. The patients' mean age was 63.1 +/- 9.2 yr. One hundred ninty-eight (83.5%) patients had nonmalignant IPMN (81 adenoma, 117 borderline atypia), and 39 (16.5%) had malignant IPMN (13 carcinoma in situ, 26 invasive carcinoma). Cyst size and mural nodule were malignancy determining factors by multivariate analysis. Elevated CEA, cyst size and mural nodule were factors determining invasiveness by multivariate analysis. Using the regression coefficient for significant predictors on multivariate analysis, we constructed a malignancy-predicting scoring formula: 22.4 (mural nodule [0 or 1]) + 0.5 (cyst size [mm]). In invasive IPMN, the formula was expressed as invasiveness-predicting score = 36.6 (mural nodule [0 or 1]) + 32.2 (elevated serum CEA [0 or 1]) + 0.6 (cyst size [mm]). Here we present a scoring formula for prediction of malignancy or invasiveness of Br-IPMN which can be used to determine a proper treatment strategy.

A cytological and histomorphological case study of an uncommon breast carcinoma: Invasive papillary type.

Pure papillary carcinoma of the breast is a rare tumour affecting elderly postmenopausal women. We report one case in a relatively younger woman presenting with a clinically benign breast lump.The tumour showed extensive apocrine metaplasia. The ease with which abundant material with highly cellular papillary clumps is obtained on fine needle aspirate should be an important consideration favouring papillary carcinoma. The quality and quantity of stroma in papillae rather than the presence or absence of stromal support should also be a guiding criteria for excluding benign papillary lesions.

Determination of Malignancy Predictors in Branch Duct TypeIntraductal Papillary Mucinous Neoplasms of the Pancreas

PURPOSE: Branch duct type intraductal papillary mucinous neoplasms (Br-IPMN) have better prognosis and lower malignancy rate than do main duct type IPMNs (M-IPMN). However, surgical resection is necessary when malignancy is suspected, and radical resection should be performed in cases of invasive IPMN. The objectives of this study were to investigate the characteristics of Br-IPMN and related predictive malignancy/invasiveness factors and to present a standardized scoring system for predicting pathologic results. METHODS: We conducted a retrospective review of 91 patients diagnosed with Br-IPMNs between 1998 and 2007. Mean patient age was 62.5+/-9.0 years. Eighty (87.9%) patients had benign IPMNs (17 adenoma, 63 borderline malignancy), and 11 (12.1%) patients had malignant IPMNs (4 carcinoma in situ, 7 invasive carcinoma). Eighty-four (92.3%) patients had noninvasive IPMN, and 7 (7.7%) patients had invasive IPMN. RESULTS: The size of the cystic mass and the presence and size of the mural nodule were found by univariate analysis to be significantly different between the benign and malignant groups. History of DM, size of the cystic mass, size of the mural nodule, and thickness of the cystic wall were significantly different between the noninvasive and invasive IPMN groups on univariate analysis. The regression coefficients for the size of the cystic mass and for the size and presence of the mural nodule were calculated using multivariate analysis, and the scores predicting malignant and invasive IPMN determined (P=0.001, P=0.000, respectively). CONCLUSION: There are no universally held guidelines for surgical management of Br-IPMN patients. Hence, many clinicians have difficulty deciding the specific character of the resection they will pursue. By using malignancy- and invasiveness-predicting scores, we expect that much of this difficulty can be avoided in the future.

The Clinical Significance of the Absolute and Relative Classification of the Depth of Invasion for Submucosal Invasive Carcinomas of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.

The Clinical Significance of the Absolute and Relative Classification of the Depth of Invasion for Submucosal Invasive Carcinomas of the Colon / 대한소화기내시경학회지

BACKGROUND/AIMS: We investigated the clinical significance of the criteria of the absolute and relative depth of invasion for submucosal invasive colorectal carcinomas. METHODS: We analyzed retrospectively the clinicopathological features of 29 submucosal invasive colorectal cancers. The relative depth of submucosal invasion was evaluated by a relative (sm1, 2, 3) classification and the absolute depth of submucosal invasion was measured in micrometers from the lower border of the muscularis mucosa to the deepest cancer gland. RESULTS: All sm1 cancers showed a submucosal layer invasion of less than 1,000micronm; invasion was seen between 500micronm and 1,000micronm. The rate of lymphovascular invasion was higher for sm1c, sm2 and sm3 than for sm1a and sm1b, and the rate of invasion was higher for a level of 500micronm or more than for a level of 500micronm or less for the depth of submucosal invasion. One of sixteen patients that underwent surgery showed lymph node involvement. For this patient, the relative depth of invasion was sm1c and the absolute depth was 900micronm. CONCLUSIONS: Endoscopically treated submucosal colorectal cancer needs to be evaluated by the absolute depth in addition to the relative depth. It seems that a submucosal invasive cancer less than 500micronm in submucosal depth probably can be treated by endoscopic resection.

Stroma reaction and clinical significance in benign lesion and invasive carcinoma of breast / 上海第二医科大学学报

Objective To study the expression and clinical significance of CD34 and smooth muscle actin (SMA) in stroma of breast tissues and lesions. Methods Seventy cases of breast tissues and lesions, including 20 fibroadenomas, 10 sclerosing adnoses, 30 invasive ductal carcinomas and 10 invasive lobular carcinomas were investigated, and 10 normal breast tissues were served as controls. Immunohistochemical staining was applied to compare the distribution of CD34+ fibrocytes and SMA-reactive myofibroblasts. Results The stroma of normal breast tissue contained CD34+ fibrocytes, whereas SMA-reactive myofibroblasts were absent (100% for both). All benign breast lesions exhibited astromal CD34+ fibrobytes, and fibroadenomas showed SMA-reactive myofibroblasts as well. In invasive ductal and lobular carcinoma the stroma was devoid of CD34+ fibrocytes, but a varying number of stromal SMA-reactive myofibroblasts were detectable (100%). Conclusion In breast carcer, immunohistochemical staining used in detecting expressions of CD34 and SMA is helpful in distinguishing benign lesions from malignancies.

Correlation between Tumor Angiogenesis and Metastasis in Invasive Breast Carcinoma

Tumor angiogenesis(TA) refers to the growth of new vessels toward and within a tumor. TA is necessary both at the beginning and at the end of the metastatic cascade of events. Recently, experimental evidence suggests that the growth of a tumor beyond a certain size requires angiogenesis. To investigate how tumor angiogenesis correlates with metastases in breast carcinoma, the microvessels were counted (per 200 / field) in the most active areas of neovas-cularization by two investigators. The microvessels within breast carcinoma were highlighted by in imunohistochemical staining for factor VIII-related antigen. Microvessel count(MVC) in node-positive carcinoma(59.66=35) was significantly higher than in node-negative carcinoma(44.76=17)(p=0.009). MVC was also statistically correlated with tumor size and stage, but not with histologic grading, DNA ploidy, or hormonal receptors(estro-gen and progesterone). MVC in invasive breast carcinoma may be one of many prognostic predictors of node-positive breast carcinoma. Assessment of tumor angiogenesis may therefore be valuable in selecting patients with early breast carcinoma for aggressive therapy.