Isolated avulsion fracture of the lesser tuberosity of the humerus.

Six cases of isolated avulsions of the lesser tuberosity of the humerus were encountered within a short period of time. Although it seldom has been described in the literature, it might be a more common fracture than suspected. Physical examination revealed a painful shoulder with limited function in all six patients. In retrospect, all diagnoses could have been made on the primary plain roentgenograms. However, the fragment of the lesser tuberosity was easily misdiagnosed. An axillary view showed the fragment clearly in all cases. Computed tomography is useful for making an accurate diagnosis because it establishes the size and displacement of the fragment and determines additional injuries, such as a ruptured biceps tendon. Five patients with displacement of the lesser tuberosity were operated on after several weeks or months. The lesser tuberosity was reattached in all cases. After 6 months three patients had slight impairment of elevation and external rotation, and one of them suffered from pain during movements of the arm. The patient with no fracture displacement was treated conservatively with a good result. In conclusion, we recommended an axillary roentgenogram as part of the posttrauma radiologic series of the shoulder. A nondisplaced avulsion fracture of the lesser tuberosity of the humerus can be treated conservatively. We recommend reattachment of displaced fractures.

Ki-67 staining in histological subtypes of breast carcinoma and fine needle aspiration smears.

Thirty four cases of invasive breast carcinoma were analysed for heterogeneity of Ki-67 reactivity in a tumour, and proliferative activity in various histological subtypes was compared. The growth factions determined in areas of central and peripheral tumour were the same. Mucinous and lobular carcinoma showed lower Ki-67 activity than ductal carcinomas. When ductal carcinomas were subdivided according to their dominant growth pattern, the carcinomas with a solid or comedo growth pattern showed the highest proliferative activity. These results largely confirm data from previous cell kinetic studies on the incorporation of radioactively labelled thymidine. A correlation between the growth fraction determined by Ki-67 in fine needle aspiration smears and cryostat sections of corresponding tumours was shown, implying that the immunostaining of cytological smears gives a reliable impression of the growth fraction of a tumour and may therefore be used in prospective studies.

Neuroendocrine carcinoid tumours of the breast: a variant of carcinoma with neuroendocrine differentiation.

Carcinoid tumours most frequently develop in the gastrointestinal tract but have been described in many organs of the body. In 1977 the first cases were reported in the mamma, followed by descriptions of argyrophilic carcinoid-like, neuroendocrine mammary tumours by many investigators who performed immunohistochemical and ultrastructural examinations. The existence of true carcinoids in the mamma is still a controversial issue. Eight mammary neoplasms with monomorphous cytonuclear features, five of the small cell carcinoid-like variety and three composed of larger cells, were examined by immunohistochemical and ultrastructural examination. We believe this kind of tumours are ductal or lobular carcinomas with focal or more extensive neuroendocrine features and are the result of a dual differentiation of neoplastic precursor stem cells along epithelial and endocrine lines. Consequently, we consider that treatment of such cases should not be different from that of the ordinary type of mammary carcinomas.