Epithelial atypia in biopsies performed for microcalcifications. Practical considerations about 2,833 serially sectioned surgical biopsies with a long follow-up

This study analyzes the occurrence of epithelial atypia in 2,833 serially sectioned surgical breast biopsies (SB) performed for microcalcifications (median number of blocks per SB:26) and the occurrence of subsequent cancer after an initial diagnosis of epithelial atypia (median follow-up 160 months). Epithelial atypia (flat epithelial atypia, atypical ductal hyperplasia, and lobular neoplasia) were found in 971 SB, with and without a concomitant cancer in 301 (31%) and 670 (69%) SB, respectively. Thus, isolated epithelial atypia were found in 670 out of the 2,833 SB (23%). Concomitant cancers corresponded to ductal carcinomas in situ and micro-invasive (77%), invasive ductal carcinomas not otherwise specified (15%), invasive lobular carcinomas (4%), and tubular carcinomas (4%). Fifteen out of the 443 patients with isolated epithelial atypia developed a subsequent ipsilateral (n = 14) and contralateral (n = 1) invasive cancer. The high slide rating might explain the high percentages of epithelial atypia and concomitant cancers and the low percentage of subsequent cancer after a diagnosis of epithelial atypia as a single lesion. Epithelial atypia could be more a risk marker of concomitant than subsequent cancer

Molecular apocrine differentiation is a common feature of breast cancer in patients with germline PTEN mutations

International audienceINTRODUCTION: Breast carcinoma is the main malignant tumor occurring in patients with Cowden disease, a cancer-prone syndrome caused by germline mutation of the tumor suppressor gene PTEN characterized by the occurrence throughout life of hyperplastic, hamartomatous and malignant growths affecting various organs. The absence of known histological features for breast cancer arising in a PTEN-mutant background prompted us to explore them for potential new markers. METHODS: We first performed a microarray study of three tumors from patients with Cowden disease in the context of a transcriptomic study of 74 familial breast cancers. A subsequent histological and immunohistochemical study including 12 additional cases of Cowden disease breast carcinomas was performed to confirm the microarray data. RESULTS: Unsupervised clustering of the 74 familial tumors followed the intrinsic gene classification of breast cancer except for a group of five tumors that included the three Cowden tumors. The gene expression profile of the Cowden tumors shows considerable overlap with that of a breast cancer subgroup known as molecular apocrine breast carcinoma, which is suspected to have increased androgenic signaling and shows frequent ERBB2 amplification in sporadic tumors. The histological and immunohistochemical study showed that several cases had apocrine histological features and expressed GGT1, which is a potential new marker for apocrine breast carcinoma. CONCLUSIONS: These data suggest that activation of the ERBB2-PI3K-AKT pathway by loss of PTEN at early stages of tumorigenesis promotes the formation of breast tumors with apocrine features

Cancer du sein (reprise d'exérèse pour berge envahie)

Objectif : le traitement conservateur du cancer du sein expose à un risque de récidive locale dont un des paramètres reconnu est l'état des marges d'exérèses. On se propose de trouver des facteurs prédictifs de reprise d'exérèse positive (cacinome infiltrant ou in situ dans la deuxième exérèse) dans le cas d'un traitement conservateur initial. Méthode : Nous avons étudié une série de 109 patientes ayant bénéficié d'un traitement conservateur pour cancer mammaire infiltrant à l'Institut Bergonié de Bordeaux entre 1990 et 2003. Les patientes présentaient des berges d'exérèses envahies et ont bénéficié d'une deuxième exérèse qui a consisté en 96 traitements conservateurs et 13 mastectomies secondaires. La population étudiée se compose de 59 T0, 25 T1, 18 T2 et 7 autres stades T. Le taux de reprise positive est de 66 %. Résultats : la pratique ou non de recoupes chirurgicales ne permet pas de mieux estimer un résidu tumoral dans le lit de la première exérèse, il en est de même pour la pratique d'un repérage radiologique. Les carcinomes canalaires micro-invasifs et lobulaires infiltrants sont liés à une reprise chirurgicale positive avec un p respectivement égal à 0,04 et 0,017. Le pourcentage de blocs d'histologie envahis dans les berges d'exérèse croît avec le pourcentage de reprise positive sans être significatif. Conclusion : nous n'avons pas mis en évidence de paramètres permettant de se dispenser d'une reprise chirurgicale en cas de traitement conservateur avec marges envahies. On peut par contre discuter l'indication d'une mastectomie pur les carcinomes canalaires micro-invasifs et lobulaires infiltrants.FORT-DE-FRANCE-CHRU-BU (972332102) / SudocBORDEAUX2-BU Santé (330632101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Splenic marginal zone lymphomas and lymphoplasmacytic lymphomas originate from B-cell compartments with two different antigen-exposure histories.

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