Giant fibro-adenomas in black and Indian adolescents.

Over a 5-year period, 47 giant fibro-adenomas were managed in the benign breast clinic at King Edward VIII Hospital, Durban. These tumours usually present in the perimenarchal period with gross breast asymmetry; smaller fibro-adenomas are present in 10% of these patients. A hormonal basis for their development is likely. Local excision with preservation of the breast tissue is recommended.

Late presentation of small-bowel injury--hypoproteinaemia, anaemia and obstruction. A report of 2 cases.

In contrast with traumatic intestinal perforation, the late sequelae of lesser small-bowel injury are not readily recognised. A protracted course of protein-losing enteropathy as an intermediate result of traumatic segmental small-intestinal ischaemia, and a fibrotic stricture with anaemia, intestinal obstruction and bezoar formation as a late result, are illustrated.

Estrogen and progesterone receptors in breast cancer among women of different racial groups.

No differences in steroid hormone receptor status were detected in premenopausal breast cancer patients of different races. In postmenopausal women, 65% of Whites were found to have tumors positive for cytoplasmic estrogen receptors (CER) compared with 58, 52, and 41% in women of mixed race, Blacks, and Asians, respectively. The proportions of tumors which contained a full complement of receptors (CER, nuclear estrogen receptors, and cytoplasmic progesterone receptors) were similar in Blacks, Whites, and Asians in each menopausal group. In postmenopausal patients, significantly fewer White women had tumors devoid of all receptors, while having a higher incidence of tumors with an abnormal or defective receptor distribution. Neither the stage of the disease nor the degree of nodal involvement appeared to affect receptor status in any population group, but very large tumors had fewer receptors. White patients with large neoplasms had a significantly higher incidence of CER than Blacks or Asians. Similar observations were made for White patients presenting with Stage III disease, whose tumors were greater of histological Grade I tumors were positive for CER, compared with Grade III neoplasms. Indications are that receptor status is inherent to the natural history of the disease and is not influenced by clinical features.

Breast cancer prognosis in three different racial groups in relation to steroid hormone receptor status.

Follow-up studies on 466 patients over a 5-year period showed Whites to have an overall significantly longer disease-free interval and survival than Blacks and Asians. No racial differences in prognosis were seen in patients with Stage II disease (p greater than 0.2) but in Stage III, White patients had significantly longer disease-free periods than Blacks or Asians; the same was not true of survival. Whites had a 67% incidence of cytoplasmic estrogen receptor (CER) positive tumors compared with only 49% in Blacks and 41% in Asians. When tumors were assayed for CER, nuclear estrogen receptor (NER), and cytoplasmic progesterone receptor (CPR), there were no racial differences in the proportions of tumors containing all 3 receptors, but significant variations were found in neoplasms with no receptors and in those with apparently defective receptors. In White patients receptor status had no influence on prognosis (p greater than 0.3). Black patients whose tumors contained both CER and NER had a significantly better time to recurrence than those whose tumors lacked these receptors, while in Asian women the presence of CER alone, or CER together with NER, or CER, NER, and CPR, was indicative of a significantly longer disease-free period.

Clinical patterns of presentation of breast cancer in women of different racial groups in South Africa.

The ages at presentation of white patients with breast cancer were found to be significantly higher than those of blacks, Indians and coloureds; 73% of white women fell into the postmenopausal group, in marked contrast to only 35% of Indians, while blacks and coloureds had similar proportions of pre- and post-menopausal patients. A significantly higher incidence of poorly differentiated tumours was seen in Indian and black patients. Blacks showed a significant tendency to present with more advanced disease, while whites were generally diagnosed at a much earlier stage.

The sex hormone profile of male patients with breast cancer.

The mean total serum oestradiol level was found to be significantly increased in 8 patients with carcinoma of the breast when compared with 8 healthy reference subjects matched for race, sex and age. The calculated mean free oestradiol index was also higher in these patients. There were no significant differences, however, between the levels of LH, FSH, prolactin. DHEA-S, testosterone and SHGB in the 2 groups. The patients showed a significantly increased LH response to GnRH while there was no difference in the FSH response. Only 1/7 patients had a tumour devoid of steroid hormone receptors. It may be that an increased level of circulating oestradiol-17 beta is an important factor in the aetiology of hormone-dependent male breast cancer.

Cytoplasmic and nuclear estrogen and progesterone receptors in male breast cancer.

Cytoplasmic estrogen receptors were detected in 12 of 13 male breast cancer tumors. There was no significant correlation of receptor levels with the age of the patient, size and histological grading of the tumor, and stage and nodal involvement of the disease. Nuclear estrogen receptors were found in eight of 10 tumors and six of nine patients had tumors positive for cytoplasmic progesterone receptors, two of which were also found to contain nuclear progesterone receptors. The presence of cytoplasmic progesterone receptors, in addition to cytoplasmic and nuclear estrogen receptors, may be indicative of truly hormone-dependent tumors in male breast cancer. Treatment offered to patients included surgery, X-ray therapy, chemotherapy, and orchiectomy, but as yet, no general conclusions of the efficacy of the therapeutic regime can be drawn.

Nuclear and cytoplasmic oestrogen receptors in human mammary carcinoma.

Methods for the measurement of cytoplasmic and nuclear oestrogen receptors (CER and NER) are described. CERs and NERs were found to be labile at ambient temperatures; the receptors are stable for up to 1 year when stored in liquid nitrogen. Over a period of 5 years, 51% of the breast adenocarcinomas examined in women proved to be positive for CER; four adenocarcinomas of the breast obtained from men were all positive for CER; in those tumours examined for both CER and NER, 46% proved positive for CER and 30% positive for NER; no tumour was found to be positive for NER and negative for CER. In older female patients, the percentage of patients positive for oestrogen receptors increased and they were present in higher concentrations; in younger Indian women the same tendency was observed. The percentages of receptor-positive tumours in Indians, Blacks and Whites are similar. Neither the stage of the tumour nor the presence of nodal metastases influenced receptor positivity; there was no significant difference in the time to recurrence between receptor-positive and receptor-negative patients in the small number with reliable follow-up data.

Traumatic haemobilia: case reports.

Injury to the liver may result in traumatic haemobilia. Three cases are reported, with differing clinical presentation resulting from different forms of injury. Haemobilia may present difficulties in diagnosis, particularly if there has been a long delay between injury and presentation. The use of selective hepatic arteriography as a diagnostic aid and treatment by hepatic artery ligation are outlined.