Breast carcinoma developing in patients on hormone replacement therapy: a histological and immunohistological study.

AIM: To study the histopathological features of breast carcinoma developing in postmenopausal patients on hormone replacement therapy (HRT). METHODS: The sample comprised 60 patients with invasive breast carcinoma including 31 who had received HRT at or shortly before presentation, and 29 who had not. Details concerning their tumour size, histological type and grade, lymph node status, and oestrogen and progesterone receptor status were compared. Immunoperoxidase staining for Bcl-2, p53, and E-cadherin was carried out on paraffin sections of all 60 patients. The results were then statistically analysed. RESULTS: Tumours detected in HRT patients were significantly smaller (mean 17 mm v 25 mm; p = 0.0156) and of a lower histological grade (p = 0.0414) than those detected in non-HRT patients. The incidence of invasive lobular carcinoma was slightly higher in HRT patients (19% v 14%). Immunohistologically, 87% of HRT tumours were Bcl-2 positive (compared with 79% in the control group), 29% were p53 positive (45% in the control), and 48% were E-cadherin positive (72% in the control group). Although the differences were not statistically significant there was a trend towards higher incidence of p53 negative and E-cadherin negative tumours in HRT patients. CONCLUSIONS: Breast carcinomas detected in patients on HRT have a significantly higher incidence of two favourable prognostic features (small size and a low histological grade). They also show a trend, statistically not significant, of being p53 negative and E-cadherin negative; this may be related to the slightly higher incidence of invasive lobular tumours in these patients.

Polypoid rhinosinusitis in patients with host defence deficiencies: cellular infiltration and disease severity.

Polypoid rhinosinusitis is a chronic inflammatory, mucosal disease. Eosinophils may play a key role in driving and maintaining this inflammation. Polyps in conditions associated with chronic infective rhinosinusitis--such as cystic fibrosis (CF) and primary ciliary dyskinesia--however have been described as neutrophilic. We compared cell counts in polyps from 55 patients with host-defence deficiencies (HDD) to polyps from 50 patients without HDD. The CT-scan appearance was also compared to the cell counts in the HDD group. No difference was detected in the percentage of patients with eosinophils from either group. Significantly more patients in the HDD group had polyp neutrophils (p < 0.001). Non-HDD-patient polyps contain more eosinophils (p < 0.000) whilst HDD-patient polyps contained more neutrophils (p = 0.005) and plasma cells (p = 0.05). Significant correlation was found between the neutrophil count and the CT score (p = 0.012) and the mast-cell count and the CT score (p = 0.02). Eosinophils are present in HDD and non-HDD polyps. Whilst the degree of cellular infiltration may vary, to classify polyps as eosinophilic or neutrophilic may be a false distinction.

Polypoidal rhinosinusitis in cystic fibrosis: a clinical and histopathological study.

The eosinophil may play a key role in the pathogenesis of nasal polyposis. Polyps in cystic fibrosis, however, have been described as neutrophilic. We compared the cell counts in polyps from 44 patients with cystic fibrosis to polyps from 50 patients without cystic fibrosis. The clinical profile, CT-scan and time to polyp recurrence were also compared with the cell counts in the patients with cystic fibrosis. No significant difference was detected in the number of patients with eosinophils (P > 0.25). Significantly more patients in the group with cystic fibrosis had polyp neutrophils (P < 0.01). Polyps from patients without cystic fibrosis contained more eosinophils (P < 0.001) whilst polyps from patients with cystic fibrosis contained more neutrophils (P = 0.001) and plasma cells (P = 0.038). Significant correlation was found between the neutrophil count and the CT score (P = 0.025) and between the recurrence time of polyps and the macrophage count (P = 0.01). Eosinophils are present in varying degrees in polyps from patients with and without cystic fibrosis and to classify polyps as eosinophilic or neutrophilic may be a false distinction.

Smoking, hypertension, and colonic anastomotic healing; a combined clinical and histopathological study.

BACKGROUND: Large bowel anastomotic breakdown occurs as a result of perianastomotic ischaemia. Preservation of the macroscopic arterial supply to the perianastomotic tissues is vital, but little is known about the influence of microvascular disease on anastomotic healing. AIMS: To study the associations between risk factors for macrovascular disease, the presence of colonic microvascular disease, and the incidence of anastomotic dehiscence. PATIENTS: 147 consecutive colonic surgery patients. METHODS: The prevalence of smoking, hypertension, diabetes, and ischaemic heart disease were established retrospectively from patient notes. These risk factors were correlated with histopathological assessment of resection margin vasculature and clinical follow up. RESULTS: Smoking and hypertension were significantly associated with an increased incidence of anastomotic dehiscence and microvascular disease. Microvascular disease was positively correlated with an increased incidence of anastomotic dehiscence. CONCLUSIONS: Microvascular disease predisposes to anastomotic breakdown. This effect may in part be due to vasospasm in the diseased vessels, which are hypersensitive to serotonin, a vasoactive amine known to be present in increased quantities in the serum of smokers, hypertensives, and after surgery. Treatment with serotonin antagonists in the perioperative period may be beneficial to anastomotic healing, helping to maintain microvascular flow.