Postoperative Prognosis of Breast Cancer Patients Predicted by p53 Gene Mutation in Cancer Cells Obtained by Aspiration Biopsy

The method of cytological examination by fine needle aspiration biopsy (FNAB) was developed clinically in breast cancer and enabled us to prepare cancer cell nuclei for the detection of p53 gene mutation. In the expectation that this method would improve the prediction of postoperative prognosis, the observation of 10 year survival for breast cancer patients with p53 gene mutations was done. The DNA of the aspirated cells was examined preoperatively for gene alterations in 53 patients with breast cancer. The p53 protein accumulation, DNA ploidy pattern, estrogen receptor (ER) , and clinicopathological factors were examined postoperatively The postoperative follow up was conducted over 10 years and evaluated the status of p53 gene mutation. In 26 patients (49.1%) , 29 p53 gene mutations were shown. p53 protein accumulations and DNA aneuploidy patterns were detected in 33 (62.3%) and 42 (79.2%) cases, respectively, and both significantly correlated with p53 gene mutations. With regard to the postoperative prognosis, in over 10 years of observation, the patients who showed p53 mutations had a significantly worse prognosis in both disease free survival and overall survival than those showing negative p53 mutation. A similar tendency was also seen in patients with histologic grade 3. Using FNAB, the usefulness of the preoperative detection of p53 gene mutation was revealed, suggesting its clinical benefits for predicting a patient\u27s prognosis

Latent adrenal Ewing sarcoma family of tumors: A case report

Ewing sarcoma family of tumors (ESFT) is derived from the neural crest, which originates from basal embryo cells in the primitive neural tube. ESFT often arises at the bone, chest wall, and soft tissues of the thoracic region. However, ESFT that arises from the adrenal gland is much rarer and it is usually revealed by clinical symptoms. We report an autopsy case of suicidal hanging, in which adrenal ESFT was incidentally revealed. To our knowledge, this is the first case of latent ESFT arising from the adrenal gland. Autopsy can sometimes reveal latent disease. Some of these latent diseases are very rare and we would not be able to detect them without a complete autopsy. As forensic pathologists, we should attempt to perform a complete autopsy and report new discoveries for the development of medicine

Characterization of p53 gene mutations in fine-needle aspirated breast cancer : correlation with clinicopathological features and short-term relapse

Mutations of the p53 gene play a key role in the development of common human malignancies. In the case of breast cancer patients, cancer cells can be obtained directly from the patient with minimal damage by fine-needle sampling. Thus, the method of aspiration biopsy cytology (ABC) by fine-needle aspiration biopsy (FNAB) was developed, enabling us to prepare cancer cell nuclei for detection of p53 gene mutation by polymerase chain reaction-single strand conformation polymorphism (PCR-SSCP) analysis. Fine-needle samplings were successfully performed and p53 gene mutations were disclosed in 25 advanced breast cancer patients. We investigated 27 mutations of the p53 gene in these 25 specimens, showing all point mutations including 10 CpG mutations and 3 double mutations in one allele. Of the 25 patients with p53 gene mutations, 16 patients were disease free (64.0%) but 9 had postoperative recurrence (36.0%) ; in detail, 7 patients (28.0%) experienced short-term relapse of disease, i. e. recurrence within 5 years after operation. In the study using FNAB, we further examined the correlation of p53 gene mutation in breast cancer with clinicopathological features, and especially with short-term relapse of disease. No significant correlation was found with respect to age, menopausal status, histological type, ER status, operative procedures, and postoperative adjuvant therapy in almost all tumors, however there was a significant relationship between p53 gene mutation and short-term relapse (P<0.01). Moreover, p53 gene mutation related closely with nuclear p53 protein accumulation (P<0.01) and with DNA aneuploidy pattern as well (P<0.001). Twelve p53 gene mutations were shown in 9 aspirated biopsy specimens. All were point mutations containing 8 transitions, 2 transversions, and 2 deletions ; the dominant mutations were transition at GC base pairs (G to A), constituting 41.7% of all mutations. Typical hot spot codons in the study were codon 175, 248, and 282.Mutations localizing at the CpG site of the gene were seen in 7 cases (58.3%). Additionally, there was a tendency of high recurrence of disease in advanced clinical stage IIIA and IIIB, lymph node metastatic estimation of N2/N3, and histologic grade 3. These results thus indicate that p53 gene mutations in aspirated breast cancer cells obtained by FNAB reflect the biological characteristics of breast cancer and may be a good indicator of short-term relapse of postoperative patients