Inflammatory breast cancer: An overview about the histo-pathological aspect and diagnosis.

Inflammatory Breast Cancer (IBC) is a rare and aggressive form of locally advanced breast cancer, classified as stage T4d according to the tumor-node-metastasis staging criteria. This subtype of breast cancer is known for its rapid progression and significantly lower survival rates compared to other forms of breast cancer. Despite its distinctive clinical features outlined by the World Health Organization, the histopathological characteristics of IBC remain not fully elucidated, presenting challenges in its diagnosis and treatment. Histologically, IBC tumors often exhibit a ductal phenotype, characterized by emboli composed of pleomorphic cells with a high nuclear grade. These emboli are predominantly found in the papillary and reticular dermis of the skin overlaying the breast, suggesting a primary involvement of the lymphatic vessels. The tumor microenvironment in IBC is a complex network involving various cells such as macrophages, monocytes, and predominantly T CD8+ lymphocytes, and elements including blood vessels and extracellular matrix molecules, which play a pivotal role in the aggressive nature of IBC. A significant aspect of IBC is the frequent loss of expression of hormone receptors like estrogen and progesterone receptors, a phenomenon that is still under active investigation. Moreover, the overexpression of ERBB2/HER2 and TP53 in IBC cases is a topic of ongoing debate, with studies indicating a higher prevalence in IBC compared to non-inflammatory breast cancer. This overview seeks to provide a comprehensive understanding of the histopathological features and diagnostic approaches to IBC, emphasizing the critical areas that require further research.

Prognostic value of tumor-infiltrating lymphocytes (TILS) and their association with clinicopathological features in breast cancer: A retrospective study involving 53 cases / Valor pronóstico de los linfocitos infiltrantes de tumores (TIL) y su asociación con características clínico-patológicas en el cáncer de mama: un estudio retrospectivo de 53 casos

Objective: Quantitative analysis of tumor-infiltrating lymphocytes (TILs) is currently considered as a prognostic factor in several malignant tumors. The aim of our study was to assess the prognostic value of TILs in breast cancers and its association with other clinicopathological prognostic factors in non-specific type (NST) breast carcinoma in Tunisian population.MethodsRetrospective study included 53 women with NST breast carcinoma. The data were collected over a period of 13 months with a follow-up of 40 months for all the patients. The TILs were evaluated according to the 2014 recommendations of the international working group on TILs.ResultsTILs level was between 3% and 60% with mean of 21%. Ten patients had lymphocyte predominant breast cancer (LPBC). Statistical analysis had shown that the TILs level ≤50% was associated with the presence of vascular emboli and the absence of HER2 amplification. Inflammatory-type carcinoma and HER2 amplification significantly worsened OS. Presence of vascular emboli, lymph node metastases, inflammatory type of carcinoma, TILs ≤50%, and absence of estrogen receptors (ER) were associated with reduced RFS. In multivariate analysis, the presence of vascular emboli was an independent factor for OS. TILs ≤50%, inflammatory type of carcinoma and presence of vascular emboli were independent risk factors for RFS.ConclusionThis Tunisian pilot study showed higher level of TILs in NST breast carcinomas is associated with improved RFS. The therapeutic implications will benefit from multiple research studies including ours on the predictive value of TILs for neoadjuvant or adjuvant treatment. (AU)

Objetivo: El análisis cuantitativo de los linfocitos infiltrantes de tumor (TIL) se considera actualmente como un factor pronóstico en varios tumores malignos. El objetivo de nuestro estudio fue evaluar el valor pronóstico de los TIL en los cánceres de mama y su asociación con otros factores pronósticos clinicopatológicos en el carcinoma de mama de tipo no específico (NST) en la población tunecina.MétodosEn un estudio retrospectivo se incluyó a 53 mujeres con carcinoma de mama NST. Los datos se recogieron durante un período de 13 meses, con un seguimiento de 40 meses para todas las pacientes. Los TIL se evaluaron según las recomendaciones de 2014 del grupo de trabajo internacional sobre TIL.ResultadosEl nivel de TIL estuvo entre el 3% y el 60% con una media del 21%. Tenían cáncer de mama con predominio de linfocitos (LPBC) 10 pacientes. El análisis estadístico mostró que el nivel de TIL ≤ 50% se asociaba a la presencia de émbolos vasculares y a la ausencia de amplificación de HER2. El carcinoma de tipo inflamatorio y la amplificación de HER2 empeoraron significativamente la SG. La presencia de émbolos vasculares, las metástasis en los ganglios linfáticos, el carcinoma de tipo inflamatorio, los TIL ≤ 50% y la ausencia de receptores de estrógeno se asociaron a una menor SSR. En el análisis multivariante, la presencia de émbolos vasculares fue un factor independiente para la SG. Los TIL ≤ 50%, el tipo de carcinoma inflamatorio y la presencia de émbolos vasculares fueron factores de riesgo independientes para la RFS.ConclusiónEste estudio piloto tunecino mostró que un mayor nivel de TIL en los carcinomas de mama NST se asocia a una mejor RFS. Las implicaciones terapéuticas se beneficiarán de múltiples estudios de investigación, incluido el nuestro, sobre el valor predictivo de los TIL para el tratamiento neoadyuvante o adyuvante. (AU)

Characteristics and distribution of obesity in the Arab-American population of southeastern Michigan.

BACKGROUND: Arab-Americans constitute ~ 5% of Michigan's population. Estimates of obesity in Arab-Americans are not up-to-date. We aim to describe the distribution of and factors associated with obesity in an Arab-American population in Southeastern Michigan (SE MI). METHODS: Retrospective medical record review identified n = 2363 Arab-American patients seeking care at an Arab-American serving clinic in SE MI, located in a city which is home to a large proportion of Arab-Americans in the United States (US). Body mass index (BMI) was the primary outcome of interest. Distribution of BMI was described using percentages, and logistic regression models were constructed to examine the association between obesity, other comorbid conditions and health behaviors. This cohort was compared to Michigan's Behavioral Risk Factor Surveillance System (BRFSS) data from 2018 (n = 9589) and to a cohort seeking care between 2013 and 2019 from a free clinic (FC) located in another city in SE MI (n = 1033). RESULTS: Of the 2363 Arab-American patients, those who were older or with HTN, DM or HLD had a higher prevalence of obesity than patients who were younger or without these comorbidities (all p-value < 0.001). Patients with HTN were 3 times as likely to be obese than those without HTN (95% CI: 2.41-3.93; p < 0.001). Similarly, the odds of being obese were 2.5 times higher if the patient was diabetic (95% CI: 1.92-3.16; p < 0.001) and 2.2 times higher if the patient had HLD (95% CI: 1.75-2.83; p < 0.001). There was no significant difference in obesity rates between Arab-Americans (31%) and the BRFSS population (32.6%). Compared to Arab-Americans, patients seen at the FC had a higher obesity rate (52.6%; p < 0.001) as well as significantly higher rates of HTN, DM and HLD (all p < 0.001). CONCLUSION: Overall obesity rates in Arab-Americans were comparable to the population-based BRFSS rates, and lower than the patients seen at the FC. Further studies are required to understand the impact of obesity and the association of comorbidities in Arab-Americans.