Predictors of axillary lymph node metastases in patients with T1 breast cancer. A multivariate analysis.

BACKGROUND: In T1 tumors, the reported incidence of lymph node metastases ranges from 21% to 35%. The authors analyzed the pathology parameters of T1 tumors for their association with the likelihood of axillary lymph node metastases. METHODS: Two hundred sixty-three patients with T1 unilateral invasive breast cancer were studied. All underwent axillary dissection, and the pathologic status of the nodes was known. The parameters of the primary tumor evaluated included size, histologic subtype, nuclear grade, DNA ploidy, S-phase fraction (SPF), hormone receptor status, lymphatic/vascular invasion (LVI), and host reaction. RESULTS: Seventy-two (27%) patients had nodes that were positive for metastasis. Univariate analysis showed that lymph node metastases were associated with tumors larger than 1 cm (P = 0.001), moderate or poorly differentiated nuclear grade (P = 0.005), high SPF (P = 0.041), presence of LVI (P < 0.001) and patients younger than 60 years (P = 0.01). However, independent predictors of lymph node metastasis in the multivariate logistic regression analyses were tumor size and LVI. Twenty-five patients had tumors larger than 1.0 cm and presence of LVI; of these, 17 (68%) had lymph node metastases. Of the 79 patients who had neither of these features, only 7 (9%) had lymph node metastases. CONCLUSIONS: The authors conclude that characteristics of the primary tumor can help assess the risk for axillary lymph node metastases. Selected patients who are assessed to be at minimal risk might be spared routine axillary dissection or radiation therapy to the axilla.

Gastrointestinal neoplasia in young HIV antibody-positive patients.

In a period of less than one year, the authors observed three young patients in whom primary gastrointestinal carcinomas developed. Two of them had acquired immune deficiency syndrome and the other one was human immunodeficiency virus (HIV) antibody-positive drug abuser. This report is intended to alert the medical profession to gastrointestinal malignancy as a possible complication of HIV infection.

Histopathology of testis in acquired immune deficiency syndrome.

Histologic sections from the testes of 32 autopsied patients with acquired immune deficiency syndrome (AIDS) were examined. Almost invariably the testes displayed decreased spermatogenesis, and 20 of the 32 cases showed marked hypospermatogenesis with Sertoli cells predominantly lining the tubules. Although the seminiferous tubules were generally of normal size, the tunica propria at the periphery of the tubules was mildly to moderately thickened in 19 cases and markedly thickened in 10. The interstitial cells of Leydig were unaltered in most patients, with only 4 testes showing Leydig cell hyperplasia. The testicular blood vessels were slightly thickened in many patients, but 5 exhibited moderate to marked intimal proliferation with narrowing of the lumen. Mononuclear inflammatory infiltration of the testicular interstitium was slight in 11 cases, moderate in 6. Only 7 of the 28 AIDS patients with opportunistic infections had evidence of direct involvement of the testes by the infectious organisms. We concluded that the extragonadal endocrine balance of AIDS patients may be deranged due to the infectious process and so deserves clinical evaluation.

Terminal ileitis associated with Mycobacterium avium-intracellulare infection in a homosexual man with acquired immune deficiency syndrome.

A 38-yr-old homosexual man developed fever, diarrhea, and weight loss. An upper gastrointestinal examination revealed terminal ileitis, and stains of stool revealed acid-fast bacilli that were subsequently identified as Mycobacterium avium-intracellulare. Antimycobacterial therapy was associated with weight gain and loss of fever and diarrhea. Several months later, cutaneous Kaposi's sarcoma was observed. When the patient developed strictures in the terminal ileum, a surgical resection was performed. Numerous granulomas and acid-fast bacilli, later identified as M. avium-intracellulare, were present in the resected terminal ileum. This report demonstrates that infection of the terminal ileum with M. avium-intracellulare in a patient with acquired immune deficiency syndrome can present with a clinical and radiologic picture resembling Crohn's disease. It also demonstrates symptomatic improvement of this infection temporally related to the administration of antimycobacterial therapy and the ability of an acquired immune deficiency syndrome patient to tolerate major abdominal surgery.

Intraepithelial carcinoma of the anus in homosexual men.

Anal warts (condylomata acuminata) from seven homosexual men revealed intraepithelial carcinoma (carcinoma in situ) within the condylomatous tissue or in adjacent anal mucosa. All lesions displayed morphologic evidence of papillomavirus infection and two of the seven revealed histologic changes characteristic of herpes simplex infection. This association of viral infection with malignant transformation indicates that persistent or recurrent anal warts should be excised and thoroughly examined by histologic techniques. Since four of the seven patients had histories suspicious for or diagnostic of the acquired immunodeficiency syndrome (AIDS), we further suggest that homosexual men with persistent or recurrent perianal lesions be evaluated for the presence of the syndrome.

Carcinoma of the breast: interrelationships among histopathologic features, estrogen receptor activity, and age of the patient.

Of 398 cases of breast cancer, 350 included data for all of the following: patient age, tumor size, histologic type, presence or absence of lymph node metastasis, nuclear grade of the cancer cells, extent of lymphocytic infiltration around these cells, and estrogen receptor status of the neoplastic tissue. This series is representative of and comparable with those reported in other studies of breast carcinoma. Initial evaluation suggested a relationship of cytologic differentiation and lymphocytic infiltration to estrogen receptor activity. More extensive statistical analyses, however, demonstrated that three factor interrelationships best explain the data concerning nuclear grade, lymphocytic infiltration, and estrogen receptor activity of the tumors in this study. Thus, the results of this investigation serve to warn against inferential judgments based on limited data or restricted evaluation. In addition, the analyses call attention to a significant association between age and lymphocytic infiltration around the tumor cells.

Estrogen receptor activity in primary argyrophil carcinoma of the breast.

Of seven primary breast neoplasms with exceptionally high estrogen receptor activity (> 350 fm/mg protein), all displayed positive argyrophilia with the Grimelius stain and a negative argentaffin reaction by the Fontana method. Two of the seven had a typical carcinoid pattern in conventional histologic sections, and both ultrastructually revealed cytoplasmic granules, 200-350 nm, often with a moderately dense core and a pale halo intervening between the core and the limiting membrane. Of the remaining five, four were originally diagnosed as breast carcinomas of "no special type" (NST), the fifth as a mucinous carcinoma. Reinspection confirmed the mucinous tumor, but the NST tumors revealed a densely hyalinized stroma with intervening trabeculae composed of small cells containing argyrophil-positive cytoplasmic granules. We propose to test the hypothesis that argyrophil cell carcinomas will regularly demonstrate estrogen receptor activity, often at high levels.