Non-specifically labelled cells that simulate bone marrow metastases in patients with non-metastatic breast cancer.

AIMS: To determine whether the presence of disseminated bone marrow tumour cells at diagnosis is a prognostic factor for breast cancer patients at high risk of recurrence or bone metastasis, and to assess their presence as a criterion for evaluation of the potential benefits of adjuvant chemotherapy. METHODS: Multiple bone marrow aspirates from 72 breast cancer patients free from metastasis were obtained during surgery at the time of diagnosis and were tested immunologically by alkaline phosphatase antialkaline phosphatase technique with a panel of three antiepithelial monoclonal antibodies (MoAb) KL1, EMA, and HMFG2. RESULTS: In nine of 72 patients, with each MoAb tested, numerous strongly positive cells always isolated were observed. However, it was demonstrated that these cells were non-specifically labelled and could be found in normal controls. CONCLUSIONS: There was no evidence of marrow tumour cells in 72 operable breast cancer patients. It is suggested that published results may be greatly overestimated and that non-specific labelling may be undetected. More specific MoAb should be found and a correlation with molecular biology should be performed if this criterion is to be considered as a prognostic factor.

[A comparative study of 4 sequential first-line chemotherapy protocols in locally advanced breast cancer]. / Etude comparative de 4 protocoles successifs de chimiothérapie première dans le cancer du sein localement avancé.

Between 1977 and 1994, our center administered successively 4 different chemotherapy regimens to 242 evaluable patients with locally advanced breast cancer. Patients with inflammatory signs were excluded. Sixty-eight patients were treated by AVCF (A (adriamycine) + V (vincristine) + C (cytoxan) + F (5FU)), 47 by AECF (A + E (vindesine) + C + F), 81 by CAFP (C + A + F + P (prednisone)) and 46 by AN (A + N (vinorelbine)). The mean number of cycle was 3. One hundred and twenty-five patients (52.5%) responded to chemotherapy and we recorded 35 complete response (14.7%). The response rates at the different combinations were respectively: AVCF: 29.4%, AECF: 53.2%, CAFP: 64.9%, AN: 65.2%, and were independent of tumor size, grade and receptor status. The response rate at the AVCF regimen was significantly worse than the others (p = 0.0005). Breast conserving surgery was performed in 31 patients (14%) and 17 patients (8%) had a complete response. Among the 35 patients with complete response, 21 were treated by radiotherapy alone. Local recurrence occurred in 19 patients (7.9%) and 96 (40%) had advanced disease. The mean follow-up of AVCF regimen was 150 months, 115 months for AECF, 111 for CAFP and 42 months for AN. The disease-free survival and the overall survival were significantly better with AECF, CAFP and AN regimens (DFS p < 0.04, OS p < 0.02). Survival was better in those patients with an objective response (p = 0.002) or with non-affected axillary node at the time of surgery. Our study showed already that AVCF combination was significantly lower than AECF, CAFP, AN in terms of response rate, disease-free survival and overall survival. Waiting the results of randomized studies about the impact of neoadjuvant chemotherapy on survival, we look for chemotherapy regimen improving the rate of conservative surgery.

[Study of mdm2 gene amplification in primary breast tumors]. / Etude de l'amplification du gène mdm2 dans les tumeurs primitives du sein.

mdm2 (mouse double minute) protein seems lead to p53 inactivation and therefore might potentially play a role in carcinogenesis. We have studied mdm2 gene amplification from 239 primary breast cancer tissues. mdm2 gene was amplified in 10% of cases (25/239). mdm2 amplification was associated with c-erbB2 amplification (P < 10(-3)). No other correlation was found. However there was inverse correlation between c-erbB2 gene amplification and hormonal receptors (P < 10(-4)), only from patients without mdm2 gene amplification.

[Breast metastasis revealing cancer of the kidney. Apropos of a new case and review of the literature]. / Métastase mammaire révélatrice d'un cancer du rein. A propos d'un nouveau cas et revue de la littérature.

Metastases are rarely located in the breast. Generally, breast metastases appear during the course of a known primitive cancer and renal origin is very rare. It is even more exceptional that metastasis reveals renal cancer as observed in this case. Five similar cases have been reported in the literature.

Analysis of C-myc amplification by the differential polymerase chain-reaction (d-PCR), study in breast-cancer.

c-myc proto-oncogene amplification seems to have a prognostic value in breast cancer. In this study, quantitative analysis of c-myc amplification was carried out by differential polymerase chain reaction technique (d-PCR) using beta-globin as the reference gene. d-PCR assessment showed coampIification products of c-myc and beta-globin depend on variations in reaction factors such as the genomic DNA concentration, the relative concentrations of the various amplimers, the thermostable DNA polymerase concentration and the number of cycles. However, amplification of c-myc can be estimated quantitatively. In addition, results of individual sets of d-PCR can be expressed on a standard reference scale. A clinical study of 309 patients with breast cancer found c-myc amplification, respectively in 19% (45/236) of primary tumour tissues, 21% (4/19) of subsequent second primary cancers, 36% (4/11) of tumours of patients with bilateral lesions, 40% (8/20) of local recurrence tumours and 22% (5/23) of metastatic lesions. Amplification of c-myc was observed more frequently in histological grades 2-3 (p<0.02), in ER negative (p<0.01) and PgR negative tumours (p<0.02), but was not associated with age, tumour size, nodal status, histology, cytosolic cathepsin D or pS2. d-PCR appears amenable to automation and should facilitate large scale, inter laboratory gene amplification studies.

[Treatment of cancer of the anal canal with combination radiochemotherapy: apropos of 12 cases]. / Traitement des cancers du canal anal par association radio-chimiothérapie: à propos de 12 cas.

We present 12 patients (3 male, 9 female) aged from 53-88 years with squamous cell cancer of the anal canal treated with combined radiotherapy-chemotherapy (5 FU-mitomycin C); the distribution of the tumours was 2 T4, 6 T3, 3 T2, 1 T1). In 11 patients evaluated, complete remission was obtained in 8 with partial remission in 2 others. In spite of this good result with combined treatment, 4 patients had a recurrence between 9 and 26 months. Five patients survived and 2 died without disease (16-38 month), 3 patients died and one survived with disease. The small series confirms the efficacy of this combination which treated bulky tumours (T3-T4). It is necessary however to compare these results with radiation alone in a randomised trial.

[Echography and computed tomography in the evaluation and follow-up of uterine cancers]. / Echographie et scanographie dans le bilan et la surveillance des cancers de l'utérus.

In this review of 139 cancers of the cervix uteri and 43 cancers of the corpus uteri, the authors compare clinical, sonographic and CT data. For the 58 patients with cervical cancer who presented infiltration of the parametrium at physical examination under general anesthesia, sonography gave 11 false negative errors while CT gave 8 false positives. By contrast, for the 47 tumors staged IIb after examination under general anesthesia, sonography disclosed additional abnormalities in 20 cases and CT in 22 cases. A series of 52 disease recurrences in patients who had received curative treatment for uterine cancer was also reviewed; overall, an association of physical examination and ultrasonography had the same value as CT. In light of these results, the authors propose an algorithm for the exploration of uterine cancers in which the results of physical examination condition examination by ultrasonography or CT.

Factors affecting relapse in node-negative breast cancer. A multivariate analysis including the labeling index.

Between 1975 and 1982, 167 patients with carcinoma of the breast without axillary lymph node metastases were studied. The thymidine labeling index (LI), representing the percentage of cells in the DNA synthesis phase, was measured in all these patients. High LI values were more frequently encountered in young patients (P = 0.05), in low estrogen receptor (ER) tumor content (P = 0.007) and in high grade tumors (P = 0.0002). The overall 8-year relapse-free survival (RFS) was 68%. Univariate analysis demonstrated that RFS was influenced by histological grading (P = 0.03), ER (P = 0.03), PR (P = 0.02) and LI (P = 0.01). Multivariate analysis using the Cox regression model selected the LI as the single significant prognostic factor with regard to RFS (P = 0.037). These results emphasize the important role of cell proliferation kinetics in defining node-negative breast cancer patients with a high risk of relapse.

Extraretroperitoneal abdominal malignant fibrous histiocytoma.

Seven cases of extraretroperitoneal abdominal malignant fibrous histiocytoma (MFH) are reported. The anatomic distribution was as follows: liver (2 cases), spleen with gastric and pancreatic involvement (1 case), mesentery (1 case), right mesocolon (1 case), left mesocolon (1 case), and urachus (1 case). These bulky lesions were often extensively necrotic; calcifications were seen in 2 cases. All 7 cases were investigated by ultrasonography (US) and computed tomography (CT). Barium studies were performed in 4 cases, and angiography in 3 cases.

[Breast cancer: the role of scintigraphy in the initial evaluation and follow-up of patients with small tumors (T less than or equal to 3 cm)]. / Cancer du sein: place de la scintigraphie dans le bilan initial et le suivi de patients porteuses de petites tumeurs (T less than or equal to 3 cm).

To evaluate the utility of bone scans for the follow-up of patients with small breast cancers (T less than or equal to 3 cm), the files for 133 patients whose disease was diagnosed between Jan. 1, 1979 and Dec. 31, 1980 were reviewed. At initial presentation, two of these patients already had bone metastases. During their disease course, 30 patients developed metastases and 16 of them had at least one bone metastasis. In 7 of these 16 cases, the bone metastasis was solitary; in 4 cases bone lesions were symptomatic. A total of 178 bone scans were performed during the follow-up of these 133 patients; 16 of these scans were positive, but only 4 examinations allowed the diagnosis of bone metastasis. Despite the slight prognostic value of initial bone scanning in this series, the technique is of little value unless it is combined with clinical examinations aimed at early detection of disease recurrence or metastasis. Except as part of clinical trial protocols, systematic bone scans appear unnecessary for the staging and follow-up of patients with small breast cancers.

[Conservative treatment of cancer of the breast. Apropos of 108 cases]. / Traitement conservateur du cancer du sein. A propos de 108 cas.

Between 1975 and 1980, 108 cancers of the breast (T1 and small T2) were treated by associated conservative surgery and radiotherapy. Axillary glands were curetted in 92 patients; 17% showed lymph node invasion. Radiotherapy was by telecobalt: 45 grays to the whole breast and 60 grays to the tumor bed. Esthetic results were satisfactory. Intramammary recurrence was rare (6%) and was independent of site or size of tumor and of degree of lymph node involvement. Metastases not associated with local recurrence were very rarely observed (4% of cases) and were present only in patients without glandular involvement. The 5-year actuarial survival rate was 95%.

Conservative treatment of breast cancer: a report on 108 patients.

Between 1975 and 1980, 108 breast cancers (T1 and small T2) were treated at the Centre Antoine-Lacassagne (Nice, France) by a combination of conservative surgery and irradiation. Ninety-two of these patients underwent axillary node dissection; 17% of them presented with nodal involvement. All irradiation was given by telecobalt: 45 Gy to the entire breast, 60 Gy to the site of the tumor. All cosmetic results were acceptable. Intramammary recurrences were rare (6%) and independent of the tumor site or size or of any nodal involvement. Solitary metastases (not associated with a local recurrence) were extremely rare (4%) and were observed in patients who had had no nodal involvement. The actuarial survival rate at 5 years is 90%.

[Lymphangiosarcoma on a chronic edema of the lower limb. Radiologic study apropos of a case]. / Lymphangiosarcome sur oedème chronique du membre inférieur. Etude radiologique à propos d'un cas.

Lymphangiosarcoma is a rare tumor of the soft tissues, in particular outside of cases where the etiology is represented by chronic edema following mastectomy for breast cancer (Stewart-Treves syndrome). In the case reported, the patient experienced chronic edema of the lower limbs, with diffuse involvement of the right leg. The sonographic appearance revealing thickening of the dermis, with localized infiltration of the aponeurosis, and especially the angiographic findings showing hypervascularization with early venous return are discussed.

[Leiomyosarcoma of the renal capsule: ultrasonographic and angiographic appearances: a case report (author's transl)]. / Léiomyosarcome de la capsule rénale. Aspects échographique et angiographique. A propos d'un cas.

A 70-year-old patient presented with general ill-health, and a mass in the right hypochondrium which was found to be a leiomyosarcoma of the renal capsule. Ultrasonography demonstrated the retroperitoneal origin of the tumor and its lack of relation with the right kidney. Arteriography showed the right renal capsule origin of the mass, with partial invasion of the inferior vena cava. Operation confirmed the angiographic findings, particularly the independent nature of the mass i relation to the kidney and the excretory pathways.