Pemphigus vulgaris mimicking Paget's disease of the breast.

We report the development of an ulcerative skin lesion involving the areola of a 37-year-old woman. Clinically the lesion was compatible with Paget's disease, however, histologic evaluation identified pemphigus vulgaris. Differences in the presentation and treatment of these two entities are highlighted. The underlying role of plasminogen activator in the molecular pathology of both diseases is discussed.

Oncologic mathematics: evolution of a new specialty.

HYPOTHESIS: Mathematical methods and their derivatives have practical applications to oncology. They can be used to describe fundamental aspects of tumor behavior, such as loss of genetic stability, tumor growth, immunologic identity, genesis of diversity, and methods of prognosticating cancer. DATA SOURCES: Descriptive models and published literature in the fields of oncology and applied mathematics. DATA SYNTHESIS: Cancer does not conform to simple mathematical principles. Its irregular mode of carcinogenesis, erratic tumor growth, variable response to tumoricidal agents, and poorly understood metastatic patterns constitute highly variable clinical behavior. Defining this process requires an accurate understanding of the interactions between tumor cells and host tissues and ultimately determines prognosis. Applying time-tested and evolving mathematical methods to oncology may provide new tools with inherent advantages for the description of tumor behavior, selection of therapeutic modes, prediction of metastatic patterns, and providing an inclusive basis for prognostication. We term this combined field of research "oncologic mathematics." As surgeons, we have the unique opportunity to be active participants and assume leadership in research that affects selection of the optimal anticancer treatment for our patients. Mathematicians describe equations that define tumor growth and behavior, whereas surgeons actively deal with biological processes. Oncologic mathematics applies these principles to clinical settings. CONCLUSION: Experimentally testable, oncologic mathematics may provide a framework to determine clinical outcome on a patient-specific basis and increase the growing awareness that mathematical models help simplify seemingly complex and random tumor behavior.

Urokinase Plasminogen Activator Receptor (uPAR): A Potential Indicator of Invasion for In Situ Breast Cancer.

Urokinase plasminogen activator (uPA) and its cellular receptor (uPAR) are important mediators in the cellular process of cancer invasion and metastasis. Ductal carcinoma in situ (DCIS) is classified by lack of invasion into the adjacent stroma, yet definitive histologic features have not been identified to indicate the propensity for cellular invasion. Therapy for DCIS remains controversial because of the probability for recurrence. We hypothesized that uPA and uPAR may represent new predictors for recurrence of DCIS. Tissue specimens were obtained from 10 normal, 10 hyperplasia, and 70 patients with DCIS. Representative sections of the regions were mounted and stained by immunohistologic techniques using mouse anti-human uPA and uPAR antibodies. Stain intensities were assessed by densitometry image analysis. Gray scale values for in situ patients were compared to normal averages to determine whether staining intensities were normal or significantly higher (p < 0.05) than normal. DCIS tissues were heterogeneous for stain intensities of uPA and uPAR. Patients with high stain intensities for uPAR (28/70 = 40%) correlated with a higher recurrence rate (15/28 = 54%) than with patients having high stains for uPA (19/70 = 28% with 17/50 = 34% recurrence). In addition, patients with combined high stains for uPA and uPAR (11/19 = 60%) showed a recurrence rate of 55% compared to high uPA/normal uPAR with 0% recurrence. Immunohistologic evaluation of DCIS for uPAR, alone and in combination with uPA, significantly correlates with recurrence of invasive breast carcinoma. Evaluation of uPAR among DCIS lesions may provide a new prognostic indicator for recurrence of breast carcinoma.