Glucagonoma occurring as a large cystic abdominal mass.

We have described a 77-year-old woman with a 14 x 15 cm cystic mass arising from the head of pancreas. The serum glucagon level was elevated, and electron microscopy revealed large numbers of alpha granules within the tumor cells. Glucagonoma syndrome should be considered in the differential diagnosis of a large abdominal mass even if skin rash is minimal.

Histologic and staging classification of breast cancer: implications for therapy.

Breast cancer has 20 different histologic descriptions grouped into four categories, A, B, C, and D, based on prognosis. An analysis of 3,902 patients has revealed significant differences in outcome. Class A disease--for the most part in situ--was relatively benign, with a frequency distribution of 5%. Positive nodes were found in 1.6%, and five-year survival curves exceeded 91%. Class B (mucinous, medullary, etc) occurred in 4.1% of patients. Fewer advanced stages indicated less aggressive tumors, and survival at five years was 75%. The most common class, C (85%), had a five-year survival of 66%, closely related to stage. Class D tumors, 4.3% with ill defined, wildly infiltrative borders, and undifferentiation, were ominous with 33% demonstrating distant spread at first diagnosis. The five-year survival was only 46%. Epidemiologic findings revealed a high incidence of bilaterality and high family risk in some categories, but not in others. Mammography should be done in all class A lesions. A complete pretreatment metastatic survey is recommended for class D patients, as well as those with advanced stage II and III lesions. Indications for various surgical and adjuvant therapies are described.

Multidisciplinary approach to breast cancer control.

A multidisciplinary approach to breast cancer control was developed through a network of 22 hospitals, and data were collected over two time periods to evaluate the impact of the network. A total of 1,800 cases of female breast cancer treated during the baseline period of 1971 to 1973 were compared with 2,102 current cases treated during the 1975 to 1977 study period. These cases were compared with regard to detection, diagnosis, and primary therapy. Several improvements in the diagnosis and treatment of patients studied in the later period indicate the program has had a positive impact. Improvements include an increase in case accrual by an average of 100 cases per year; an increase in detection of early (in situ and localized) and advanced disease; an increase in the proportion of patients whose interval from first symptoms to diagnosis was less than one month; a threefold increase in the proportion of patients diagnosed before admission; the increased use of simple or modified radical mastectomy (from 11% to 25%); a reduction in the number of patients whose mastectomy was done by a physician who did five or fewer mastectomies per year; an increase in the number of patients receiving bone, liver, or spleen scans; and an improvement in the quantity and quality of information in hospital charts, such as family history of cancer, history of benign breast disease, and menstrual history. Data are also provided on primary therapy and method of detection according to stage and tumor size.

Morphologic types of breast cancer: age, bilaterality, and family history.

Morphologic type is not generally included in the study of cancer risk factors. In breast cancer, attention is being given to age at diagnosis. In this study cases were analyzed by morphologic type as well as age at diagnosis for occurrence of bilateral disease and for family history of breast cancer. Of the morphologic types which were more frequent in younger patients--lobular in situ, medullary, and intraductal comedo--only lobular in situ had an increased frequency of bilaterality (fourfold increase). Of these, only patients with intraductal comedo reported familial breast cancer more frequently than the average. Lobular infiltrating carcinoma is diagnosed more frequently in elderly patients and is associated with 2.6 times more bilaterality and increased familial risk. Diagnosis at age 45 to 54 is also associated with increased bilaterality, but the diagnosis of lobular carcinoma has much stronger association with bilaterality than early age at diagnosis. Because of the high risk of bilaterality in lobular neoplasia and in those with a family history of cancer occurring before the menopause, bilateral biopsies and subsequent screening for malignancy should be done in these women.

Antitumor antibodies in human breast cancer sera as detected by fixed cell immunofluorescence and living cell membrane immunofluorescence assays.

The reactions of patients' sera with cultured human breast cancer cells were studied by fixed cell immunofluorescence (FCF) and living cell membrane immunofluorescence (MF) tests. The results suggested that the FCF reaction detected antibodies that were cell or organ specific, whereas the MF test was more indicative of an antineoplastic immune response.

Adrenalectomy and oophorectomy plus limited-term chemotherapy in the treatment of breast cancer.

A prospective study employing adrenalectomy and oophorectomy followed by limited-term combination chemotherapy was used in the treatment of 39 patients with advanced breast cancer. Chemotherapy was abruptly stopped at 8 weeks in order to take advantage of rebound immunocompetence. Delayed hypersensitivity was tested by dinitrochlorobenzene skin tests and responses to phytohemagglutinin. There were 22 CRs among 33 patients who entered remission. Eleven patients had a PR with greater than 50% reduction of tumor. Thirteen of 20 patients with visceral disease had a CR. There was a close association between response and competence of the cell-mediated immune system. The median duration of unmaintained remission in those patients with a CR was greater than 16 months. Four of the six failures had had recent radiation therapy to the chest wall which may have influenced immunocompetence. Responses to chemotherapy appear to be additive to endocrine ablation. Rebound of immunocompetence after chemotherapeutic immunosuppression may be related to remission induction and maintenance.

The tissue culture and morphology of human breast tumor cell line BOT-2.

A continuous human breast tumor cell line (BOT-2) was derived from an infiltrating duct carcinoma. The tumor cell line was grown as a monolayer in flasks, but the cells could be readily adapted to growth in roller cultures. These studies indicate that BOT-2 cells have a 16- to 18-hr doubling time and a modal chromosomal number of 63. The original BOT-2 cell culture has been in continuous cultivation for almost 2 years and has been passed 137 times. The BOT-2 cell line has been differentiated from HeLa cells by isoenzyme studies and chromosomal analysis.

Therapeutic regimens in advanced breast cancer.

A retrospective study of the methods of treatment in 98 patients with advanced breast cancer over the past five years showed striking differences in remission rates, duration of remissions, and overall survival according to the method of treatment. Adrenalectomy and oophorectomy produced remissions in 58% of patients, with a median duration of 22 months. Survival curves were impressive and favored the surgically ablated group, who had a median survival of 32 months. Sixty-seven percent of responders continue to survive at four years. Chemotherapy with single agents produced remissions in 30% of patients, having a median duration of nine months. Additive endocrine therapy produced 33% to 36% remission rates, with median durations of 12 to 16 months. Responses were more frequent and longer lasting in older patients. Radiotherapy, when used without supplemental therapy, resulted in good local control, but a short median survival of 7.5 months.