Prognostic significance of scoring system based on histological heterogeneity of invasive ductal carcinoma for node-negative breast cancer patients.

This study aimed to determine the prognostic significance of histological scoring system based on heterogeneity of invasive ductal carcinoma, for node-negative breast cancer patients. We studied 108 patients of node-negative invasive ductal carcinoma with invasive tumor >5 mm. Histological score of each patient was evaluated based on histological subtype of invasive ductal carcinoma and pattern of its heterogeneity. Score of each subtype was defined as follows; papillotubular carcinoma: score 1, solid-tubular carcinoma: score 2 and scirrhous carcinoma: score 3. The existence of histological heterogeneity was examined, and corresponding score was doubled in a pure case and scores of two dominant subtypes were summed in a composite case. Overall survival curves defined by sores were drawn by Kaplan-Meier method and the difference in survival rate was evaluated by log-rank test. The most significant difference of overall survival was recognized between low score group (scores 2, 3 and 4) and high score group (scores 5 and 6) (p<0.001). In addition, multivariate analysis confirmed that only histological score was an independent prognostic factor. These results suggested that assessment of histological heterogeneity of invasive ductal carcinoma could serve as independent potent prognostic factor for node-negative invasive ductal carcinoma of the breast, and this method might be useful to decide indication of postoperative adjuvant chemotherapy.

Scirrhous changes in dysplastic nodules do not indicate high-grade status.

BACKGROUND AND AIMS: Dysplastic nodules (DN) may be divided into high-grade and low-grade, and the former has been known as a precancerous or borderline lesion. Recently many morphological characteristics concerning these types of DN have been reported. In the present study we attempted to evaluate the scirrhous change in DN as an indicative feature of high-grade DN, based on the morphological and cell-kinetic analyses using immunohistochemical stains for Ki-67. METHODS: We reviewed 35 livers with DN and selected 15 DN with scirrhous change. We stained DN-bearing sections of each case with hematoxylin and eosin, trichrome, reticulin and Perls' stain. We tried to subclassify and characterize the scirrhous change according to the fibrosis pattern. We also stained with Ki-67 immunohistochemically to assess the proliferative activity of DN with scirrhous change. RESULTS: We found two types of scirrhous change, that is, pericellular and stellate. The pericellular type was related to the Mallory body-forming cholestatic degeneration, whereas the stellate type was associated with extensive portal fibrosis probably induced by ischemic damage. Among DN with scirrhous change, high-grade DN comprised five nodules (33%) and there were 10 (67%) low-grade nodules. There was no significant relationship between the presence or the types of scirrhous change and the grade of DN. The significant differences of Ki-67 labeling indices between types of scirrhous change were not shown in this study. We also could not find the differences between Ki-67 labeling indices of scirrhous DN (high and low grades) and those of surrounding regenerative nodules. CONCLUSIONS: This evidence indicated that the scirrhous change in DN was not a specific feature of high-grade DN. We also found that scirrhous DN have two morphological varieties that may represent biologically different processes, that is, pericellular scirrhous type and stellate scirrhous type.

Borrmann's type IV gastric cancer: clinicopathologic analysis.

OBJECTIVE: To determine whether there is a specific pattern of clinicopathological features that could distinguish Borrmann's type IV gastric cancer from other types of gastric cancer. DESIGN: A retrospective study of patients with advanced gastric cancer treated between 1985 and 1995. SETTING: The Department of Surgery, Sendai National Hospital, a 716-bed teaching hospital. PATIENTS: The clinicopathologic features of 88 patients with Borrmann's type IV carcinoma of the stomach were reviewed from the database of gastric cancer. The results were compared with those of 309 patients with other types of gastric carcinoma. MAIN OUTCOME MEASURES: Gender, age, tumour size, depth of invasion, histologic type, cancer-stromal relationship, histologic growth pattern, nodal involvement, lymphatic and vascular invasion, type of operation, cause of death and 5-year survival. RESULTS: Women were afflicted as commonly as men in the Borrmann's type IV group. These patients tended to be younger and to have larger tumours involving the entire stomach than patients with other types of cancer. Histologic type was commonly diffuse and scirrhous, and serosal invasion was prominent with infiltrative growth. Nodal involvement and lymphatic invasion were more common in patients with Borrmann's type IV than in those with other types of gastric cancer. The disease was advanced in most instances and a total gastrectomy was performed in 55% of the patients. The survival rate of patients with Borrmann's type IV tumour was lower than for patients with other types of gastric cancer (p < 0.005, log-rank test). CONCLUSIONS: In Borrmann's type IV gastric cancer, early detection and curative resection are crucial to extend the patient's survival. Aggressive postoperative chemotherapy is recommended when a noncurative resection is performed.

[Potentialities of ultrasound examination in differential diagnosis of benign nodules and breast cancer]. / Vozmozhnosti ul'trazvukovogo issledovaniia v differentsial'noí diagnostike dobrokachestvennykh uzlovykh obrazovanií i raka molochnoí zhelezy.

The results of examination of 410 patients with nodular masses of the breast are analysed. Benign tumors were present in 314 (76.6%) of the patients, cancer of the mammary gland--in 96 (23.4%) of the patients. The tumors were classified into 3 types, depending on the intensity of the ultrasound wave behind the tumor. Based on the clinical and morphological analyses it was demonstrated that the presence of the acoustic wave behind the tumor is typical for the invasive cancer of the duct, scirrous carcinoma and lobular cancer. In medullar and mucosous cancer the intensity of the ultrasound wave does not change. In case of intracystic cancer the symptom of "back magnification" is present. The sensitivity of the ultrasound in detection of mammary gland cancer is 88.5%, specificity--96.5%. The analogous parameters of mammography are: 91.0% and 97.8%. In the use of ultrasound control in fine needle aspiration biopsy (FNAB) the sensitivity and specificity of the method increases from 88.5% to 92.7%. If the diagnosis of mammary gland cancer was established with the use of ultrasound and FNAB the additional use of mammography is not obligatory.

[Scirrhous gastric carcinoma: utility of computed tomographic diagnosis].

Fifty gastric carcinoma lesions were classified into three groups depending on their morphologic characteristics on incremental dynamic computed tomography (CT). Two-layered tumors (23 cases) showed both an outer layer of low attenuation and a thick inner layer of high attenuation. Furthermore, they were classified into two subgroups depending on the thickness of the outer layer. Two-layered tumors showing a thick outer layer (13 cases) were all scirrhous carcinomas. The mean thickness was 11.05 +/- 3.38 mm for the outer layer, and 4.40 +/- 1.92 mm for the inner layer. The thick outer layer corresponded histopathologically to the layer submucosal to the serosa, and the thick inner layer, to the mucosal layer. Two-layered tumors showing the thin outer layer (10 cases) were all non-scirrhous carcinomas. The mean thickness was 1.62 +/- 0.47 mm for the outer layer, and 12.34 +/- 8.68 mm for the inner layer. Tumors of high attenuation (12 cases) and tumors of low attenuation (15 cases) were also nonscirrhous carcinomas. In conclusion, all scirrhous carcinomas showed both a thick outer layer and a thick inner layer, whereas non-scirrhous carcinomas did not have appearance. This new classification can serve as a guideline for predicting scirrhous carcinoma on the basis of CT findings.

[Radiological findings of gastric scirrhous cancer].

Gastric scirrhous cancer was classified from the radiological findings into three phases (typical, latent and early phases) by cancerous involvement in the gastric wall. Radiological findings in the typical phase were divided into a giant-fold type and a no giant-fold type. We made a differential diagnosis for scirrhous cancer and other diseases. Radiological findings in the typical phase of scirrhous cancer were characteristic stiffness and rigidity of the gastric wall; in the latent phase, they were swelling and winding of mucosal folds in appropriate distended stomach; and in the early phase, interrupted folds around barium fleck. The effect of chemotherapy against a gastric scirrhous cancer is decided by distensibility of the gastric wall in radiological findings.

[Reevaluation of the histological classification of breast cancer--a presentation of a new histological classification considering the relationship between scirrhous tendency and postoperative prognosis].

The present study was designed to evaluate the correlation between the histology and the prognosis of the patients with breast cancer. In this study, 1271 cases with breast cancer were retrospectively studied and an attempt of a new histological classification was presented, which was intended to reflect the prognosis more exactly than the ordinarily used classification by Japan Mammary Cancer Society. Japan Mammary Cancer Society classifies infiltrating carcinoma into 3 types; papillotubular, medullary tubular and scirrhous carcinoma. In this study, when scirrhous interstitial infiltration was observed in papillotubular or medullary tubular carcinoma, even if scirrhous tendency was observed only in small part, the patients' prognosis was as poor as scirrhous carcinoma. The prognosis of common type of infiltrating carcinoma with scirrhous tendency corresponded to that of one grade advanced stage without scirrhous tendency. Considering these results and clinical usefulness, common type of infiltrating carcinoma should be classified to 2 types, namely with or without scirrhous tendency in order to reflect the prognosis and to correspond to WHO classification.

[Pathology and histogenesis of gastric scirrhous carcinoma].

Gastric scirrhous carcinoma can be tentatively defined as the following. Histologically, poorly differentiated adenocarcinoma, scirrhous type, according to histological classification by Japanese Research Society for Gastric Cancer. Grossly, Borrmann IV type (diffusely infiltrating without ulceration or mass formation). Extensive infiltration of the stomach. Gastric scirrhous cancers were classified as follows. Pyloric stenotic type (6 cases). Cancers were located at the distal pyloric portion, causing stenosis, and considered to originate from the pyloric gland. IIc-erosive type (6 cases). Cancers were located about at the border between pyloric and fundic areas, and considered to arise from the intermediate (or transitional) zone. Rugal type (or Linitis plastica type) (9 cases). Cancers were located at the gastric corpus, causing giant rugae in the fundic region, and considered to originate from the fundic gland. Gastric scirrhous cancers must start at the gastric mucosa as intramucosal cancers, whose histology shows adenocarcinoma mucocellular (signet-ring cell carcinoma). Signet-ring shaped cells in adenocarcinoma mucocellulare disclosed at least three types as follows.

[Histological and cytological criteria for classification of primary liver cell carcinoma (author's transl)]. / Histologische und zytologische Kriterien zur Klassifikation der primären Leberzellkarzinome.

23 cases of liver cell carcinoma were reclassified according to the WHO classification schema. Appropriate cases could be classified without any difficulty into the trabecular, compact and acinar type groups; there was more difficulty to classify the scirrhous type of carcinoma. Carcinoma composed by clear cells, and inacrocellular eosinophilic carcinoma with lamellar fibrosis have a lower incidence of mitoses than the other carcinoma types. AFP could be demonstrated in tumor tissue by immune histochemistry in one case only; HBs-Ag could never been shown by the aldehyd-thionin method. The ratio mitoses/apoptoses was approx. 2:1.