ABSTRACT
BACKGROUND: Recent experimental evidence has shown a potential role of interleukin (IL)-11 and its receptor in breast cancer development and progression. However, there is little clinical information to support this hypothesis. We examined the expression of IL-11 and its receptor in primary breast cancer tissue samples and correlated their level of expression with the clinical outcome. METHODS: Primary breast cancer samples (n=109) and matched background tissue obtained from patients in the cohort (n=33) were processed for frozen section and RNA extraction. Frozen sections from matched tissues were immunostained with IL-11 and IL-11 receptor antibodies. Staining intensity was analyzed by computer image analysis. RNA was reverse-transcribed and quantified before analysis by quantitative polymerase chain reaction. Results were expressed as the number of transcripts (standardized by beta-actin). The data were compared with the clinical outcome of the disease. RESULTS: The intensity of staining for both IL-11 and the IL-11 receptor was distinctly high in tumor samples (P<.01). The transcript level of IL-11 was significantly higher in node-positive tumor samples compared with node-negative samples (P=.02). Tumors with a poor prognostic index and poor histological grade showed a higher level of IL-11. A higher level of IL-11 was linked to poorer survival with Kaplan-Meier survival analysis. CONCLUSIONS: IL-11 can be a predictor of poor prognosis in human breast cancer.
Subject(s)
Breast Neoplasms/diagnosis , Interleukin-11/metabolism , Receptors, Interleukin/metabolism , Breast Neoplasms/genetics , Breast Neoplasms/pathology , Case-Control Studies , Female , Frozen Sections , Humans , Immunoenzyme Techniques , Interleukin-11/genetics , Interleukin-11 Receptor alpha Subunit , Neoplasm Recurrence, Local/pathology , Prognosis , RNA, Messenger/genetics , RNA, Messenger/metabolism , Receptors, Interleukin/genetics , Receptors, Interleukin-11 , Reverse Transcriptase Polymerase Chain Reaction , Survival RateABSTRACT
Gynaecomastia affects half of the male population at some stage in their life. Only a small proportion of them would require treatment for cosmetic appearance or to relieve pain and tenderness. Recently, tamoxifen has shown some promising results in the management of gynaecomastia. To assess the efficacy of tamoxifen, we carried out a retrospective study of all men treated for gynaecomastia with particular emphasis on those treated medically. Men with painful gynaecomastia were given 10 mg of tamoxifen for 3 months. Response to treatment was categorised as good, moderate and no response. Thirteen men (median age 36) were placed on tamoxifen. Ten patients responded well to tamoxifen. One patient developed calf tenderness and stopped the medication. No other adverse effects were reported. Two patients could not be followed up. Tamoxifen appears safe and effective in men with painful idiopathic or physiological gynaecomastia and should be considered as an initial option before contemplating surgery.
Subject(s)
Gynecomastia/drug therapy , Selective Estrogen Receptor Modulators/therapeutic use , Tamoxifen/therapeutic use , Adolescent , Adult , Aged , Aged, 80 and over , Child , England/epidemiology , Gynecomastia/diagnostic imaging , Gynecomastia/epidemiology , Gynecomastia/pathology , Humans , Male , Medical Records , Middle Aged , Radiography , Retrospective Studies , Selective Estrogen Receptor Modulators/administration & dosage , Tamoxifen/administration & dosage , Treatment OutcomeABSTRACT
Mammillary fistulas are uncommon, but when they occur they cause prolonged morbidity. The etiology and management strategies are less well established. The purpose of this study is to evaluate the etiologic factors and assess the results of surgical treatment. It is a retrospective study of all patients treated for mammillary fistula from 1990 to 2001. The clinical data, including complications of surgical treatment, were collected from medical records. Fistulas were segregated into simple and complex fistulas before analyzing the results of surgical treatment. Thirty-five patients were treated during this period. A history of either drainage of a subareolar abscess or spontaneous rupture of an inflammatory mass preceded the development of mammillary fistula in the majority of patients. Previous Hadfield's procedure for duct ectasia contributed to the development of fistula in seven patients. Seventeen patients presented with simple fistula. A large proportion of them were treated by total duct excision in recent years, with a higher rate of recurrence (4/6). Eighteen patients presented with complex fistulas; two of them had recurrences following surgical treatment. The overall recurrence rate was 23%. The majority of the patients showed features of periductal mastitis on histologic examination. Postoperative wound infection was positively associated with fistula recurrence. The best management of mammillary fistula remains a problem. Simple fistulas should be treated by fistulectomy and primary closure. Total duct excision should be reserved for complex fistulas. Postoperative wound infection is also a major factor in fistula recurrence. All patients should receive antibiotics. Surgery for duct ectasia has caused fistulas in 20% of cases in our study, raising the issue of restricting total duct excision to more severe forms of the disease. Mammillary fistulas should be treated more appropriately in a specialized breast unit with particular interest in benign breast disease.
