Predictive value of pathological and immunohistochemical parameters for axillary lymph node metastasis in breast carcinoma

<p>Abstract</p> <p>Background/Objective</p> <p>While several prognostic factors have been identified in breast carcinoma, the clinical outcome remains hard to predict for individual patients. Better predictive markers are needed to help guide difficult treatment decisions. Axillary lymph node metastasis (ALNM) is one of the most important prognostic determinants in breast carcinoma; however, the reasons why tumors vary in their capability to result in axillary metastasis remain unclear. Identifying breast carcinoma patients at risk for ALNM would improve treatment planning. This study aimed to identify the factors associated with ALNM in breast carcinoma, with particular emphasis on basal-like phenotype.</p> <p>Methods</p> <p>Breast carcinoma patients (n = 210) who underwent breast conserving surgery and axillary lymph node dissection (ALND) (level I and II) or modified radical mastectomy were included in this study. Pathological and immunohistochemical data including individual receptor/gene status was collected for analysis. The basal phenotype status was ascertained using the basal cytokeratin markers CK5, CK14, CK17 and EGFR.</p> <p>Results</p> <p>ALNM was found in 55% (n = 116) of the patients. On univariate analysis, multicentric disease, large tumor size (>2 cm), vascular and lymphatic invasion, epithelial hyperplasia, necrosis, in situ carcinoma and perineural invasion were associated with higher risk for ALNM, whereas CK5, CK14, EGFR positivity and basal-like tumor type were associated with lower risk. On multivariate analysis, CK5 positivity (OR 0.003, 95%CI 0.000-0.23, p = 0.009) and lymphatic/vascular invasion (OR 17.94, 95%CI 4.78-67.30, p < 0.001) were found to be independent predictors.</p> <p>Conclusions</p> <p>Although the value of complete ALND has been questioned in invasive breast cancer patients, treatment decisions for breast carcinoma have been influenced by many parameters, including lymph node status. Since histopathologic characteristics and expression of biological markers varies among the same histologic subtypes of breast carcinoma, specific clinical and histopathologic features of the primary tumor and ALN status like sentinel node might be used to tailor the loco-regional and systemic treatment in different clinical settings.</p

Mediator complex (MED) 7: a biomarker associated with good prognosis in invasive breast cancer, especially ER+ luminal subtypes

Background: Mediator complex (MED) proteins have a key role in transcriptional regulation, some interacting with the oestrogen receptor (ER). Interrogation of the METABRIC cohort suggested that MED7 may regulate lymphovascular invasion (LVI). Thus MED7 expression was assessed in large breast cancer (BC) cohorts to determine clinicopathological significance. Methods: MED7 gene expression was investigated in the METABRIC cohort (n = 1980) and externally validated using bc-GenExMiner v4.0. Immunohistochemical expression was assessed in the Nottingham primary BC series (n = 1280). Associations with clinicopathological variables and patient outcome were evaluated. Results: High MED7 mRNA and protein expression was associated with good prognostic factors: low grade, smaller tumour size, good NPI, positive hormone receptor status (p < 0.001), and negative LVI (p = 0.04) status. Higher MED7 protein expression was associated with improved BC-specific survival within the whole cohort and ER+/luminal subgroup. Pooled MED7 gene expression data in the external validation cohort confirmed association with better survival, corroborating with the protein expression. On multivariate analysis, MED7 protein was independently predictive of longer BC-specific survival in the whole cohort and Luminal A subtype (p < 0.001). Conclusions: MED7 is an important prognostic marker in BC, particularly in ER+luminal subtypes, associated with improved survival and warrants future functional analysis

Two foreign body reactions caused by suture materials: mammograms mimic cancer as a speculated lesion.

A spiculated breast lesion on mammogram is highly suggestive of malignancy. However, it can be seen on rare occasions in benign conditions including foreign body associated granuloma. We describe two foreign body reactions in the breast caused by suture materials and describe the clinical, radiological and pathological features

Corneal melanosis successfully treated using topical mitomycin-C and alcohol corneal epitheliectomy: A 3-year follow-up case report

We report a case of primary acquired corneal melanosis without atypia associated with corneal haze in a patient with a history of limbal malignant melanoma and the effect of mitomycin-C. A 75-year-old woman with a history of limbal malignant melanoma presented with loss of vision in right eye. Corneal examination showed a patchy melanotic pigmentation with a central haze. Topical mitomycin-C improved visual acuity and corneal haze. However, the pigmented lesions persisted, and they were removed with alcohol corneal epitheliectomy. Histopathological examination demonstrated primary acquired melanosis without atypia. The lesions were successfully removed, and there were no recurrences during the follow-up period of 36 months. The association of conjunctival and corneal melanosis without atypia is a rare condition. In addition, co-existence of central corneal haze and melanosis may decrease visual acuity. Topical mitomycin-C and alcohol corneal epitheliectomy can be useful treatments in this condition

The effect of non-ionizing radiation on the ovarian reserves of female rats

Objective: The authors aimed to investigate whether there was any effect of 1800 MHz GSM-modulated radio frequency radiation (RFR) as a source of non-ionizing radiation on the ovarian reserves of female rats by hematoxylin eosin staining under a light microscope, and also to evaluate the effect on the anti-Mulllerian hormone (AMH) level of rats. Design: A prospective observational study. Materials and Methods: A total of 12 age-matched young adult female Wistar albino rats were divided into two groups. Group 1 (n=6) constituted the controls; group 2 (n=6) constituted the 1800 MHz exposed animals. RFR exposed group were kept ten cm away from the horn antenna to satisfy the near field condition. The control group was kept in the same setting without any RFR exposure. The exposure period was 20 minutes for five days/week for one month. Results: The results of this study showed that 1800 MHz RFR did not have a significant effect on the ratios of atretic follicles in rat ovary tissues when compared with the control group (p>0.05). However, the authors detected statistically significantly higher AMH levels in RFR exposed groups (p<0.005). Conclusions: 1800 MHz GSM modulated RFR exposure in rats was found to have no adverse effect on ovarian reserves or follicles. The present authors' failure to detect any changes could be due to the limited duration of the RFR exposure or the limited number of subjects used in the study. AMH levels were significantly higher, which might be due to the aforementioned limitations in this study. There is a need for further experimental studies in which the effects of RFR emitted by cellular phones can be studied