An atypical course of breast cancer

U 46-letniej kobiety pojawił się guz w pasze lewej. Wycięto guz piersi lewej i wykonano limfadenektomię pachową lewostronną. Guz piersi miał charakter łagodny, a w węźle chłonnym obecny był przerzut gruczolakoraka, którego obraz nie pozwalał na określenie lokalizacji ogniska pierwotnego. Wykonano pozytonową emisyjną tomografię wraz z komputerową tomografią (PET-KT) i rozpoznano aktywną metabolicznie zmianę rozrostową w okolicy ogona Spence’a po lewej stronie. Ponownie stwierdzono guz piersi i wykonano tumorektomię oraz wycięto nawrotowy guz pachy lewej. Guz piersi był zmianą łagodną, a w węźle chłonnym pachy rozpoznano przerzuty gruczolakoraka, których obraz wskazywał na pochodzenie guza pierwotnego m.in. z płuca. W badaniach obrazowych uwidoczniono ognisko w płucu lewym oraz powiększone węzły chłonne śródpiersia. Rozpoznano niedrobnokomórkowego raka płuca z przerzutami do węzłów chłonnych pachowych. Podano 4 cykle chemioterapii cisplatyną i gemcytabiną, osiągając stabilizację w tomografii komputerowej. Po 4 miesiącach wykonano PET-KT, w której zobrazowano cechy aktywnego procesu nowotworowego w węźle chłonnym pachowym lewym. Chorą poddano radioterapii na obszar pachy. Po 4 miesiącach pacjentka zaobserwowała guz piersi lewej — wykonano amputację prostą piersi. Podczas konsultacji dostępnych preparatów pooperacyjnych histopatolog wskazał na pierś jako punkt wyjścia przerzutu do węzłów chłonnych pachy. Ustalono ostateczne rozpoznanie raka piersi z przerzutami do węzłów chłonnych pachowych, prawdopodobnie pojedynczym, nieaktywnym metabolicznie, przerzutem do płuca oraz powiększonymi węzłami chłonnymi śródpiersia o niepewnym charakterze. U chorej rozpoczęto chemioterapię doksorubicyną i cyklofosfamidem. Leczenie zakończono po podaniu 4 kursów ze względu na nietolerancję, uzyskując stabilizację choroby. W kontrolnym badaniu KT po 8 miesiącach uwidoczniono guz wnęki płuca i powiększone węzły chłonne śródpiersia. Po weryfikacji histopatologicznej rozpoczęto chemioterapię drugiego rzutu raka piersi.A 46-year old woman presented with a tumor in the left axilla. She had a resection of a breast tumor and an axillary lymph node dissection. The tumor of the breast was benign and in lymph node there was a metastasis of adenocarcinoma. In PET-CT there was a metabolically-active lesion nearby Spence’s tail area of the left breast. The woman had another resection of breast tumor and recurrent tumor in axilla. Breast tumor was benign but in lymph nodes metastases of adenocarcinoma probably from lung were found. In CT there were a single metastatic focus in a left lung and enlarged mediastinal lymph nodes. The diagnosis of non-small cell lung cancer stage IV was established. The patient received 4 cycles of cisplatin and gemcitabine with disease stabilization. Four months later she had PET-CT which showed a metabolically-active lesion in an axillary lymph node. The patient had radiotherapy on the area of armpit. Four months later she noticed a tumor of a left breast and underwent mastectomy. Microscopic sections were compared and a histopathologist indicated breast as a primary origin of lymph nodes metastases. The clinical diagnosis was changed to breast cancer metastatic to axillary lymph nodes and probably with single lung metastasis (metabolically-inactive) and suspected mediastinal lymph nodes. She received 4 cycles of doxorubicin with cyclophosphamide discontinued because of intolerance. Eight months later she had a CT scan which revealed a tumor of the hilus and enlarged mediastinal lymph nodes. Pathological examination confirmed metastasis from breast cancer and second-line chemotherapy was started

Abdominal Burkitt lymphoma mimicking the ovarian cancer. Case report and review of the literature

Summary Primary Burkitt lymphoma is a lymphoblastic B-cell malignant tumor with very aggressive course. Its abdominal form involving internal genital organs is very rare. Case: We report the case of 27-year-old woman treated for abdominal Burkitt lymphoma. The patient presented bilateral ovarian tumors with ascites, pain and elevated CA 125 over 900 IU/ml. During laparotomy an advanced neoplasmatic disease involving internal genital organs has been diagnosed. Bilateral salphingo-oophorectomy and omentectomy have been performed. Additionally, the neoplasmatic tumor from ileo-coecal region has been ressected in order to prevent ileus. Pathologic examination has revealed an abdominal Burkitt lymphoma. After surgery, polychemotherapy has been administered (COP followed by CODOX-M+IVAC). The patient, 36 months after surgical treatment, remains under the control of our Department. No signs of recurrence have been detected so far. Conclusions: The presence of primary abdominal Burkitt lymphoma may include clinical and laboratory findings suggesting the presence of ovarian cancer. Chemotherapy appears to be an essential therapeutic management for all forms of Burkitt lymphoma. Clinically advanced Burkitt lymphoma may be successfully managed with chemotherapy

Znaczenie ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych dla rokowania u chorych z gruczolakorakiem endometrialnym endometrium

Objectives: To assess the prognostic significance of Ki-67 expression in the tissue microarray method (TMA) for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC). Material and methods: The study examined 159 consecutive patients aged 37-86 (62.82±9.95) with EEC stages I-III according to FIGO, treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery, and constructed into the TMA recipient blocks. Using TMA method, the relationship between Ki-67 expression, DFS and OS was examined. DFS was defined as a period from primary surgery until relapse. OS was defined as a period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE; KE/1673/12). Results: The follow-up time varied between 3 - 60 months (51.42±15.87). In 31 patients (19.50%) the relapse of was diagnosed 1–59 months (24.97±16.08) after commencement of the treatment. During follow-up 32 patients (20.12%) died. DFS and OS were 80.50% and 79.88%, respectively. The lack of Ki-67 expression was found in 37 cases (23.27%) while in 122 patients (76.73%) the expression was present (p20% was present in 76 cases, 26 cases and 20 cases, respectively. Positive correlation between the expression of Ki-67 and staging was present (r=0.353; pCel pracy: Celem pracy była ocena znaczenia rokowniczego obecności i wielkości ekspresji antygenu Ki-67 ocenianej metodą mikromacierzy tkankowych (TMA) dla przeżycia wolnego od choroby (DFS) oraz przeżycia ogólnego (OS) chorych z gruczolakorakiem endometrialnym endometrium (GEE). Materiał i metody: Grupę badaną stanowiło 159 chorych. Wykorzystując metodę TMA, oceniono zależność między obecnością i wielkością ekspresji Ki-67 a DFS i OS. Wyniki: Okres obserwacji wynosił 3-60 miesięcy (51,42±15,87). DFS i OS wynosiły odpowiednio 80,50% i 79,88%. Brak ekspresji Ki-67 stwierdzono w 37 przypadkach (23,27%), a obecność ekspresji Ki-67 u 122 chorych (76,73%;

Effectiveness of tissue microarray technique for the assessment of estrogen and progesterone receptors expression in endometrioid endometrial cancer – preliminary report

Objectives: To assess the effectiveness of the donor-block biopsies with a 2 mm-size needle in endometrioid endometrial cancer (EEC) in the tissue microarray (TMA) technique and the application of the TMA for estrogen receptors (ER) and progesterone receptors (PR) expression in EEC. Material and methods: The study examined EEC tissues from 60 patients. Tissue cores, 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks and constructed into the TMA recipient block. The presence of EEC tissue in the TMAs was analyzed, and the ER and PR expressions were examined. Results: EEC tissue in TMAs was confirmed in 56 cases (93.33%). In 49 of them (81.67%), both cores presented with cancer tissues. In 4 cases (6.67%) EEC tissue was absent. All cases with ECC present on the TMA slides were appropriate for the ER and PR analysis. In 29 EEC cases (51.98%) both ER and PR were expressed. In 3 cases (5.36%) only ER was expressed, in 8 cases (14.29%) only PR was expressed, and in 16 cases (28.57%) ER and PR were assessed as negative. Conclusions: Two 2 mm-sized tissue cores from donor-block biopsies constructed into the TMA recipient block were sufficient to diagnose EEC and enabled the assessment of ER and PR expression in 93.3% of the cases. The use of the described TMA technique makes the immunohistochemical study of EEC easier and more timeefficient

Endometrioid endometrial cancer – the prognostic value of selected clinical and pathological parameters

Objectives: to assess the relationship between selected clinical and pathological factors and disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer patients. Material and methods: A retrospective review of 262 patients aged 37-86 (6.0±9.0) was performed. Selected clinical and pathological data were correlated with DFS and OS. Results: Follow-up was 8-123 months (64.9±27.1). In 4 patients (1.5%) clinical progression was diagnosed during the treatment. In 43 patients (16.4%) relapse was diagnosed 2-61 months (23.9±15.7) after commencing treatment. DFS and OS were 82.1% and 81.3% respectively. In univariate analysis worse DFS was related to older patients (p=0.007) and non-radical surgery (

Znaczenie ekspresji receptorów progesteronowych i estrogenowych ocenianej metodą mikromacierzy tkankowych dla rokowania u chorych z gruczolakorakiem endometrioidalnym endometrium

Objectives: To assess prognostic significance of progesterone receptors (PR) and estrogen receptors (ER) expression in the tissue microarray (TMA) technique for disease free survival (DFS) and overall survival (OS) in endometrioid endometrial cancer (EEC). Material and methods: The study included 151 consecutive patients, aged 37-86 years (62.80±9.99), with the EEC in stages I-III (FIGO), treated surgically at the Pirogow Memorial Hospital of Lodz between 2000 and 2007. Afterwards, they were subsequently treated and examined at the Regional Cancer Center, Copernicus Memorial Hospital of Lodz. Tissue cores 2 mm in size, in duplicate, were taken from the formalin-fixed and paraffin-embedded tissue donor blocks from surgery, and constructed into the TMA recipient blocks. Using TMAs, the expression of PR and ER was examined and presented as Total Score (TS). The TS was determined by adding the intensity and marker distribution scores in a given case. The relationship between PR and ER expression, DFS and OS was examined. DFS was defined as the period from primary surgery until relapse. OS was defined as the period from primary surgery until the end of the follow-up (60 months) or until the death of the patient. The study was approved by the Ethics Committee of the Medical University of Lodz (RNN/82/11/KE). Results: Lack of the PR and ER expression was found in 46 cases (30.46%) and 67 cases (44.37%), respectively. The expression of the PR and ER was weak in 24 cases (15.89%) and 22 cases (14.57%), respectively. Strong PR and ER expression was found in 81 patients (53.65%) and 62 patients (41.06%), respectively. Follow-up after surgery varied from 3 to 60 months (50.95±16.36). In 30 patients (19.87%) relapse was diagnosed 1–54 months (22.17±15.59) after surgery. During follow-ups, 29 patients (19.21%) died. In univariate analysis better DFS was related to the presence of PR (p=0.010), higher TS of PR (HR=0.81; 95% CI 0.71-0.94), the presence of ER (p=0.001) and higher TS of ER (HR=0.88; 95% CI 0.78-0.99). DFS differed significantly between the groups: without PR and ER expression (A), with presence of the PR but not ER expression (B), with the ER but not PR expression (C) and with the PR and ER expression (D) (p=0.004). In univariate analysis OS was not related to PR expression (p=0.110), TS of PR (HR= 0.89; 95% CI 0.80-1.02) and ER expression (p=0.070). TS of ER was connected to better OS (HR= 0.83; 95%CI 0.72-0.96). The OS differed between groups A, B, C and D (p=0.006). In multivariate analysis variants of PR/ER expression influenced the DFS (p=0.039) and OS (p=0.016). Conclusions: The expression of the PR and ER can significantly affect therapeutic decisions in selected patients with EEC. In EEC, common assessment of PR and ER expression is of higher prognostic value, than compared to single evaluation of PR and ER receptors.Cel pracy: Celem pracy była ocena znaczenia rokowniczego obecności i wielkości ekspresji receptorów estrogenowych (ER) i progesteronowych (PR) ocenianej metodą mikromacierzy tkankowych (TMA) dla przeżycia wolnego od choroby (DFS) oraz przeżycia ogólnego (OS) chorych z gruczolakorakiem endometrioidalnym endometrium (GEE). Materiał i metody: Grupę badaną stanowiło 151 chorych. Wykorzystując metodę TMA, oceniono zależność między obecnością i wielkością ekspresji ER i PR a DFS i OS. Wyniki: W analizie jednoczynnikowej stwierdzono zależność między wzrostem DFS a obecnością PR (p=0,010), wzrostem wskaźnika całkowitego (TS) ekspresji PR (HR=0,81; 95%CI 0,71-0,94), obecnością ER (p=0,001) i wzrostem TS ekspresji ER (HR=0,88; 95%CI 0,78-0,99). Stwierdzono występowanie różnic w DFS między grupami: bez ekspresji PR i ER (A), z ekspresją PR bez ekspresji ER (B), z ekspresją ER bez ekspresji PR(C), z ekspresją PR i ER (D) (p=0,004). Nie wykazano związku obecności PR (p=0,11), TS ekspresji PR (HR= 0,89; 95%CI 0,80-1,02) i ekspresji ER (p=0,07) z OS w analizie jednoczynnikowej. TS ekspresji ER było istotnym czynnikiem ochronnym, sprzyjającym dłuższemu OS (HR= 0,83; 95%CI 0,72-0,96). Stwierdzono różnice w OS między grupami: A, B, C i D (p=0,006). W analizie wieloczynnikowej kombinacje ekspresji PR/ER istotnie wpływały na DFS (p=0,039) i OS (p=0,016). Wnioski: Określenie ekspresji PR i ER może być istotnym elementem wpływającym na decyzje terapeutyczne u części chorych na GEE. Jednoczesna ocena ekspresji PR i ER ma większą wartość kliniczną od oceny tylko PRlub tylko ER

WWOX expression in colorectal cancer—a real-time quantitative RT-PCR study

The WWOX gene is a tumour suppressor gene affected in various types of malignancies. Numerous studies showed either loss or reduction of the WWOX expression in variety of tumours, including breast, ovary, liver, stomach and pancreas. Recent study demonstrated that breast cancer patients exhibiting higher WWOX expression showed significantly longer disease-free survival in contrast to the group with lower relative WWOX level. This work was undertaken to show whether similar phenomena take place in colon tumours and cell lines. To assess the correlation of WWOX gene expression with prognosis and cancer recurrence in 99 colorectal cancer patients, we performed qRT-PCR analysis. We also performed analysis of WWOX promoter methylation status using MethylScreen method and analysis of loss of heterozygosity (LOH) status at two WWOX-related loci, previously shown to be frequently deleted in various types of tumours. A significantly better disease-free survival was observed among patients with tumours exhibiting high level of WWOX (hazard ratio = 0.39; p = 0.0452; Mantel–Cox log-rank test), but in multivariate analysis it was not an independent prognostic factor. We also found that although in colorectal cancer WWOX expression varies among patients and correlates with DFS, the exact mode of decrease in this type of tumour was not found. We failed to find the evidence of LOH in WWOX region, or hypermethylation in promoter regions of this gene. Although we provide the evidence for tumour-suppressive role of WWOX gene expression in colon, we were unable to identify the molecular mechanism responsible for this