Sentinel Lymph Node Involvement by Epithelial Inclusions Mimicking Metastatic Carcinoma: A Diagnostic Pitfall

Objective: Background: Rare disease An epithelial inclusion cyst within a lymph node denotes a heterotopic phenomenon. Nodal epithelial inclusion cysts have been reported in a variety of anatomical locations including pelvic, abdominal, mediastinal, and axillary regions. While nodal melanocytic nevus (also known as nevus cell aggregates) is the most common heterotopic phenomena involving the axillary lymph nodes, the presence of benign epithelial inclusion cysts in axillary lymph nodes is a rare but well-reported finding. Such documentation is in part due to assessment of sentinel lymph nodes in breast cancer becoming standard of care. These epithelial inclusion cysts offer a diagnostic pitfall in evaluation of sentinel lymph node in the setting of breast carcinoma. They also complicate assessment of sentinel lymph node during intraoperative frozen sections analysis. Case Report: We report a case of co-existent of benign squamous-type and glandular-type epithelial inclusions cysts in 2 sentinel lymph nodes in a patient with grade III invasive ductal carcinoma involving the left breast. There have been at least 4 cases reported in literature in which benign epithelial inclusion cysts in sentinel lymph nodes were first mistakenly diagnosed as metastatic carcinoma both during intraoperative frozen section analysis and during review of permanent sections. The missed diagnosis could potentially occur intraoperatively during frozen section sentinel lymph node analysis secondarily due to lack of availability of the primary tumor for comparison and inability to use immunohistochemical stains. Conclusions: Pathologists should be aware of this pitfall especially in frozen section analysis of sentinel lymph node to avoid misdiagnosis and its associated potential grave consequences

Technique for achieving optimum balance of three critical barriers to human error

Thesis (M.Eng.)--Massachusetts Institute of Technology, Dept. of Nuclear Engineering, 1998.Includes bibliographical references (leaves 51-52).After thirty years of commercial nuclear plant operation, the nuclear industry has achieved dramatic improvements in the safe and reliable operation of its electrical generating stations. Recent indications, however, are that the rate of improvement may be slowing, particularly in the area of human performance. The nuclear industry has been and will be heavily dependent on rigid structure and centralized organization. Defense- in- depth is a key element in the prevention of human error or equipment malfunction and will continue to be so. The accident at Three Mile Island significantly increased the emphasis placed on procedures as a means of preventing human error. However, current reductions in the rate of human performance improvement have prompted reevaluation of the ability of improvement techniques, which have unquestionably achieved noteworthy success in the past, to enjoy similar success in the future. Years of adding more and more detail to procedures may in fact be becoming counterproductive. The majority of work on procedure use and procedure violations that has been performed to date deals primarily with the psychological aspects of human behavior. The ability of the procedure user to follow the procedure without becoming confused, however, has been left relatively unanalyzed. This paper attempts to characterize the recent slowdown in human performance improvement and the dynamics associated with human performance, to ascertain the significance of procedure complexity, and to put forward a technique to achieve an optimum balance of the critical factors that constitute human error defense-indepth. The embodiment of the technique, referred to as the A + B + C Method, is a mnemonic to allow workers and supervisors to balance the level of procedure detail, the worker's level of knowledge, and the amount of supervisory involvement required when executing work tasks.by Alan B. Smith.M.Eng

Life-course body size and perimenopausal mammographic parenchymal patterns in the MRC 1946 British birth cohort

Dense mammographic parenchymal patterns are associated with an increased risk of breast cancer. Certain features of body size have been found to be associated with breast cancer risk, but less is known about their relation to breast density. We investigated the association of birth size, childhood growth and life-course changes in body size with Wolfe grade in 1298 perimenopausal women from a British cohort of women born in 1946. The cohort benefits from repeated measures of body size in childhood and adulthood. We obtained mammograms for 90% of women who at age 53 years reported having previously had a mammogram. We found no associations with birth weight or maximum attained height. Body mass index (BMI) at age 53 years and breast size were independently and inversely associated with Wolfe grade (P-value for trend <0.001 for both). Women who reached puberty later were at a greater odds of a higher Wolfe grade than women who had an earlier puberty (odds ratio associated with a 1 year delay in menarche 1.14, 95% CI: 1.01-1.27, adjusted for BMI and breast size at mammography). A higher BMI at any age during childhood or adult life was associated with a reduction in the odds of a higher Wolfe grade, after controlling for breast size and BMI at mammography, for example, standardised odds ratio for height at age 7 was 0.72 (95% CI: 0.64, 0.81). These findings reveal the importance of taking life-course changes in body size, and not just contemporaneous measures, into account when using mammographic density as an intermediate marker for risk of breast cancer

Mammographic density, lobular involution, and risk of breast cancer

In this review, we propose that age-related changes in mammographic density and breast tissue involution are closely related phenomena, and consider their potential relevance to the aetiology of breast cancer. We propose that the reduction in mammographic density that occurs with increasing age, parity and menopause reflects the involution of breast tissue. We further propose that age-related changes in both mammographic density and breast tissue composition are observable and measurable phenomena that resemble Pike's theoretical construct of ‘breast tissue ageing'. Extensive mammographic density and delayed breast involution are both associated with an increased risk of breast cancer and are consistent with the hypothesis of the Pike model that cumulative exposure of breast tissue to hormones and growth factors that stimulate cell division, as well as the accumulation of genetic damage in breast cells, are major determinants of breast cancer incidence

Mapping Meisner – how Stanislavski’s system influenced Meisner’s process and why it matters to British Drama School training today

As the Meisner technique has increased in popularity in UK Drama schools over the last decade, it is important to understand its origin and where Meisner drew his own inspiration from during the development of his technique, especially when questioning its place within British conservatoire training. This article will give a brief outline of Meisner’s foundational training, such as the Repetition and Activity exercises, however the main purpose is to highlight the ideas behind the technique. This will include the training Meisner received within the Group Theatre, the inspiration he took from the Russian scholars and the areas of Stanislavsky’s system that were utilised as he developed his technique. The article also acknowledges the argument that the Meisner technique’s introduction outside the US has been subject to aform of misrepresentation as large parts of Meisner’s more analytical training have often not been adequately represented, and in some cases ignored entirely

Matrix Metalloproteinase-Induced Epithelial-Mesenchymal Transition in Breast Cancer

Matrix metalloproteinases (MMPs) degrade and modify the extracellular matrix (ECM) as well as cell-ECM and cell-cell contacts, facilitating detachment of epithelial cells from the surrounding tissue. MMPs play key functions in embryonic development and mammary gland branching morphogenesis, but they are also upregulated in breast cancer, where they stimulate tumorigenesis, cancer cell invasion and metastasis. MMPs have been investigated as potential targets for cancer therapy, but clinical trials using broad-spectrum MMP inhibitors yielded disappointing results, due in part to lack of specificity toward individual MMPs and specific stages of tumor development. Epithelial-mesenchymal transition (EMT) is a developmental process in which epithelial cells take on the characteristics of invasive mesenchymal cells, and activation of EMT has been implicated in tumor progression. Recent findings have implicated MMPs as promoters and mediators of developmental and pathogenic EMT processes in the breast. In this review, we will summarize recent studies showing how MMPs activate EMT in mammary gland development and in breast cancer, and how MMPs mediate breast cancer cell motility, invasion, and EMT-driven breast cancer progression. We also suggest approaches to inhibit these MMP-mediated malignant processes for therapeutic benefit

Mammographic density and breast cancer risk: current understanding and future prospects

Variations in percent mammographic density (PMD) reflect variations in the amounts of collagen and number of epithelial and non-epithelial cells in the breast. Extensive PMD is associated with a markedly increased risk of invasive breast cancer. The PMD phenotype is important in the context of breast cancer prevention because extensive PMD is common in the population, is strongly associated with risk of the disease, and, unlike most breast cancer risk factors, can be changed. Work now in progress makes it likely that measurement of PMD will be improved in the near future and that understanding of the genetics and biological basis of the association of PMD with breast cancer risk will also improve. Future prospects for the application of PMD include mammographic screening, risk prediction in individuals, breast cancer prevention research, and clinical decision making