D2-40在原发性胃腺癌淋巴管浸润中的标记及临床病理意义

目的探讨一种新的淋巴管特异标记物D2-40在判断原发性胃腺癌淋巴管浸润中的作用及其临床病理意义。方法应用单克隆抗体D2-40检测74例原发性胃腺癌淋巴管浸润的情况，并分析其和临床病理参数之间及和癌周淋巴结微转移之间的关系。结果D2-40选择性地表达在CD31染色阴性的淋巴管内皮细胞。HE染色和D2-40染色判断肿瘤淋巴管浸润的阳性率分别是16．2％（12／74）和52．7％（39／74），两者间差异有统计学意义（P〈0．001）。统计学相关分析显示借助D2-40（r=0．641）和HE（r=0．415）方法判断淋巴管浸润均相关于淋巴结微转移，但两者间差异有统计学意义（P〈0．01），提示采用D2-40标记判断淋巴管浸润来预测淋巴结微转移是一种更可靠的手段。结论D2-40抗体的应用较HE染色方法更敏感和特异地检测出肿瘤的淋巴管浸润，并且在预测淋巴结微转移方面有更高的可靠性，因此具有良好的临床病理应用价值。     

转录因子Snail及黏附分子E-cadherin在胃癌中的表达及意义

目的探讨转录因子Snail及黏附分子E—cadherin在胃癌中的表达及意义。方法采用免疫组化sP法检测96例胃癌组织和80例癌旁组织中Snail、E—cadherin的表达，分析两者在不同组织类型与分化程度胃癌中的表达，以及与临床病理因素之间的关系。结果胃癌组织E—cadherin的阳性率（37．5％）显著低于癌旁组织（100％）（P〈0．05），E—cadherin的表达与胃癌不同分化程度、组织学类型、浸润深度、淋巴结转移、临床分期及远处转移有关（P〈0．05）。胃癌组织Snail阳性率（83．3％）显著高于癌旁组织（41．25％）（P〈0．05），Snail的表达与胃癌不同分化程度、组织学类型、浸润深度、淋巴结转移及远处转移有关（P〈0．05）。胃癌组织中E—cadherin与Snail的表达呈负相关（P〈0．05）。结论E—cadherin蛋白低表达与Snail蛋白高表达可能是胃黏膜恶性转变以及胃癌发生浸润转移的重要生物学标志。联合检测E—cadherin及Snail对预测胃癌浸润转移有重要意义。     

非小细胞肺癌组织中MMP12、HMGB1的表达及其临床意义

目的：研究非小细胞肺癌中人巨噬细胞金属弹性蛋白酶（humanmacrophagemetalloelas-tase,HME,namelyMMP12）、高迁移率族蛋白B1（highmobilitygroupbox—B1,HMGB1）蛋白表达并探讨其与病理学分级、淋巴结转移等的关系,以及两者的相关性。方法：用免疫组化sP法分别检测53例非小细胞肺癌组织（其中肺鳞状细胞癌30例、肺腺癌23例）和20例癌旁组织中MMP12、HMGB1蛋白表达。结果：MMP12和HMGB1在非小细胞肺癌组织的阳性表达率分别为69．8％和5．4％,在癌旁组织中分别为15％和20％（P〈0．01）;肺鳞癌中MMP12阳性表达率86．6％高于腺癌组47．8％;MMP12和HMGB1表达在非小细胞肺癌中与淋巴结转移呈正相关（P〈0．05）;MMP12和HMGB1在非小细胞肺癌组织中表达成正相关（P〈0．01）。结论：MMP12和HMGB1可能在非小细胞肺癌患者的浸润、转移中起作用,联合检测有利于预后判断。     

食管癌组织中KAI1、EphA2蛋白的表达及其意义

目的探讨KAI1蛋白和EphA2蛋白的表达与食管癌发生及浸润转移的关系以及两者表达的相关性。方法采用免疫组化方法，检测160例食管癌组织及其150例正常黏膜中KAI1和EphA2蛋白的表达。结果KAI1蛋白在癌组织中的表达明显低于其正常黏膜（P〈0．05），在有淋巴结转移病例中的表达明显低于无淋巴结转移病例（P〈0．05），KAI1蛋白的表达与肿瘤的分化程度、浸润深度无关（P〉0．05）。EphA2蛋白在食管癌组织中的表达明显高于其正常黏膜（P〈0．05），在深层浸润组的表达明显高于浅层浸润组（P〈0．05），在有淋巴结转移组中的表达明显高于无淋巴结转移组（P〈0．05），EphA2蛋白的表达与肿瘤的分化程度无关（P〉0．05）。KAI1蛋白和EphA2蛋白的表达在有淋巴结转移的病例中有显著负相关（P〈0．05）。结论 KAI1蛋白的低表达和EphA2蛋白的高表达与食管癌的癌变及转移的发生有关，两者对于食管癌的淋巴结转移具有负向调节作用。     

伴有浸润性微乳头状癌结构乳腺癌的诊断和预后研究

目的探讨伴有浸润性微乳头状癌（IMPC）结构乳腺癌的临床病理特征和诊断标准及其与预后相关因素的关系。方法复习1989—2001年间乳腺癌存档切片,按2003年WHO乳腺病理学标准诊断含有IMPC结构的乳腺癌100例,98例获得随访结果。结果100例具有IMPC结构乳腺癌中,淋巴管侵犯率69％（69／100）,淋巴结转移率84．8％（84／99）;98例平均随访60．1个月。结果显示,11．2％（11／98）局部复发（术后平均存活26．4个月）,38．8％（38／98）远位转移（术后平均存活36．0个月）,36．7％（36／98）死于肿瘤,术后5年生存率59％,10年生存率48％;单因素及多因素生存分析均显示有肿瘤家族史及淋巴管侵犯的患者预后差,内分泌治疗可降低患者死亡的风险,单因素生存分析显示术后化疗可提高患者生存率。结论伴有IMPC结构的乳腺癌是一种预后极差的恶性肿瘤,无论肿瘤中IMPC结构比例占多少都应引起重视,预后与肿瘤家族史、淋巴管侵犯有关,内分泌治疗及个体性化疗可能是提高生存率的有效方法。     

子宫内膜癌临床病理学研究

目的 了解子宫内膜癌的主要临床病理特点、肿瘤的浸润和扩散，以期对临床手术方式选择有所裨益。方法 对126例子宫内膜癌患者，重新光镜观察人膜癌病理、浸润及扩散情况并进行病理分类、病理分级和临床分期。结果 本组中有异常子宫出血124例（98．4％），子宫内膜样腺癌最多（86．5％），临床Ⅰ期占82．1％，G3淋巴结转移率（43．7％）明显高于G2（12．2％）和G1（2．7％），深肌层浸润的淋巴结转移率（43．7％）明显高于浅肌层浸润层（3．2％）。结论 子宫内膜癌最突出的症状是子宫出血，几乎绝大多数是腺癌。手术时要根据大体观察、术前诊断、术中冰冻等结果，对其组织亚型、病理分级、临床分期、肌层浸润程度等进行综合分析，以选择合适的手术方式。     

乳腺伴大汗腺分化的癌临床病理特征及预后分析

目的：探讨乳腺伴大汗腺分化的癌临床病理特点及影响其预后的因素。方法收集乳腺伴大汗腺分化的癌标本70例和同期诊断为非特殊型浸润性癌283例患者的临床病理资料,比较两组预后差异,并对患者年龄、肿瘤大小、淋巴结转移、组织学分级、分期、免疫组化等因素与预后的关系进行统计学分析。结果乳腺伴大汗腺分化的癌平均发病年龄(56．17±12．41岁)比非特殊型浸润性癌(52.77±11．07岁)高(P=0．039);与非特殊型浸润性癌相比,乳腺伴大汗腺分化的癌具有更低的腋窝淋巴结转移率,较低的ER、PR阳性率(P<0．05);乳腺伴大汗腺分化的癌患者与非特殊型浸润性癌患者相比,5年总生存率(P=0．221)和无病生存率(P=0．378)差异无统计学意义;单因素生存分析显示肿瘤大小、淋巴结转移、病理学分期、淋巴结外软组织浸润与乳腺伴大汗腺分化的癌患者预后有关(P<0．05),Cox多因素分析结果显示,淋巴结转移与乳腺伴大汗腺分化的癌患者不良预后有关(P<0．05)。结论乳腺伴大汗腺分化的癌与浸润性癌临床病理特征不同,但预后无统计学意义。淋巴结转移可作为乳腺伴大汗腺分化的癌患者预后不良的指标,早诊断、早治疗是改善其预后的关键。     

p53过表达与胃癌患者淋巴结转移的关系

应用Ｓ－Ｐ免疫组化方法，研究ｐ~（５３）在８８例原发性胃癌患者的表达变化与肿瘤细胞增殖和浸润深度及淋巴结转移的关系。发现ｐ~（５３）阳性染色率为４８．９％，ｐ~（５３）阳性染色与肿瘤浸润深度及癌细胞增殖活性呈正相关，ｐ~（５３）阳性肿瘤的淋巴结转移率（９３％）明显高于ｐ~（５３）阴性的肿瘤（６０％，Ｐ＜０．０５）。提示ｐ~（５３）过表达在胃癌淋巴结转移和肿瘤浸润及增殖中起重要作用。     

凋亡调节蛋白FasL，Fas和P53在乳腺癌的表达及其意义

目的 观察人乳腺癌组织、癌旁相对正常乳腺组织中凋亡调节蛋白FasL，Fas、P53的表达，探讨FasL，Fas及P53与乳腺癌发生发展的关系。方法 收集手术切除的人乳腺癌组织和癌周相对正常乳腺组织，用免疫组织化学方法对21例乳腺癌标本进行检测。结果 乳腺癌组织中Fas蛋白表达的阳性率明显低于癌周正常乳腺组织（P〈0．01），有淋巴结转移者明显低于无淋巴结转移者（P〈0．05）。乳腺癌组织中FasL、P53蛋白表达的阳性率均明显高于癌周正常乳腺组织（P〈0．01），有淋巴结转移者明显高于无淋巴结转移者（P〈0．05）。结论 乳腺癌组织中Fas／FasL表达异常使肿瘤逃脱机体自身免疫攻击，促使肿瘤的发生发展，对预测乳腺癌的预后有重要参考价值。突变型P53在乳腺癌中过表达，可能抑制肿瘤凋亡的发生，促进肿瘤生长。     

甲状腺乳头状癌 ALDH1A1表达与淋巴结转移的相关性

目的探讨甲状腺乳头状癌（ PTC）中ALDH1A1的表达情况及与淋巴结转移的相关性。方法收集首都医科大学附属北京同仁医院病理科2006年1月至2013年12月间PTC腺叶切除＋淋巴结清扫标本153例,在HE染色下观察其一般临床病理学特点（肿物直径、双侧、多灶、肿瘤边界、腺叶外浸润）,并采用免疫组织化学染色EnVision法,检测癌及癌旁组织中ALDH1A1的表达情况,分析ALDH1A1表达与淋巴结转移的关系。结果在153例PTC中,84例（54.9％）发生淋巴结内癌转移,126例癌组织高表达ALDH1A1,112例癌旁组织高表达ALDH1A1。通过单因素分析,发现年龄＜45岁、肿物直径＞10 mm、浸润性边缘及癌组织 ALDH1A1高表达与淋巴结转移明显相关（P＜0.05）。而性别、双侧、多灶、腺叶外浸润、癌旁组织ALDH1A1与淋巴结转移无关（P＞0.05）。进一步多因素分析发现浸润性边界和癌组织ALDH1A1高表达是PTC淋巴结转移的独立危险因素（P＜0.05）。在随访的82例PTC中,局部肿瘤复发4例,5年局部复发率为4.88％,包括淋巴结肿瘤复发3例和甲状腺肿瘤复发1例,无远处转移及疾病相关死亡病例。复发病例肿瘤组织ALDH1A1均为高表达。结论 ALDH1 A1在PTC癌组织内高表达与淋巴结转移明显相关,可作为PTC淋巴结转移的有效预测因子,有利于改善PTC患者治疗方法及随访方案。     

Clinicopathologic analysis of microscopically invasive breast carcinoma

Breast biopsy or mastectomy cases having diagnoses of carcinoma in situ with “microinvasion,” “minimal invasion,” “focal invasion,” or “suggestive of invasion” were reviewed and all histologically identified foci of invasive disease from each case were measured using an ocular micrometer. Cases in which any single focus of invasion was greater than 5 mm or the added size of separate invasive foci exceeded 10 mm were excluded, resulting in a study group of 75 patients. Invasive neoplasm was present in the initial biopsy in 69 of 75 cases (92%); however, residual invasive neoplasm was found in the subsequent lumpectomy/mastectomy from 14 of these (20%). In 59% of cases, two or more histologically separate foci of invasion were identified. Invasive foci consisted of isolated cells or cell clusters, each less than 1 mm (microfocal invasion), in 33% of cases. In 12 cases, the sum of individual invasive foci was 5 to 10 mm. Axillary lymph nodes (LN) from 5 of 69 patients (7%) contained metastatic carcinoma (four cases, one LN positive; one case, two LN positive). The cumulative sizes of all invasive foci in the LN-positive group were microfocal invasion (one case), 0.6 mm (one case), 1.1 mm, 2.5 mm, and 5.8 mm. The difference in frequency of axillary node metastasis between tumors with microfocal and measurable invasion (4.3% v 8.6%) was not statistically significant. Follow-up data were available on 55 cases (mean interval, 66.1 months). One (node-negative) patient had duct carcinoma in situ recurrence in the same breast 4 years after initial treatment. Another (with unknown node status) developed an axillary lymph node metastasis 13 months after initial treatment (96% disease-free survival). We conclude that microscopic stromal invasion in breast carcinoma, at least in the setting of significant in situ component, is often initiated from multiple foci. Patients with microscopically invasive breast carcinoma have a small but significant risk of axillary metastases, although a highly favorable survival.     

Large paraffin sections and chemical clearance of axillary tissues as a routine procedure in the pathological examination of the breast

The technique of large paraffin sections of the breast and lymph node dissection of axillary tissues after chemical clearance as used in a routine histology laboratory is described and discussed. The findings in 155 cases of breast malignancy derived from routine surgical patients and also from the breast screening clinic are described and analysed. There were 21 cases of in-situ carcinoma alone and an additional 17 cases with minimal invasive carcinoma (MIC). The maximum area of each lesion in one plane was measured and the size varied between less than 1 cm2 and 30 cm2, with an average of 7 cm2. The large lesions had the highest incidence of MIC. There were 117 palpable invasive carcinomas and they were divided into two groups, namely single quadrant (80%) and multiquadrant malignancy (20%). The clinical implications of this are discussed. Lymph node metastases were found in 36 (27%) of all invasive carcinomas but no metastases were found in either in-situ carcinoma alone or when combined with MIC in the eight cases which had a radical operation.     

Towards reasonable workload in diagnosis of sentinel lymph nodes: comparison of two frozen section methods

AIMS: To compare two methods of histological assessment with intraoperative diagnosis of sentinel node metastases in breast cancer. METHODS AND RESULTS: A total of 204 consecutive breast cancer cases with lymphatic mapping, sentinel node biopsy and intraoperative diagnosis were included. The sentinel nodes in the first 102 cases (method A) were bisected and serially sectioned. In the other 102 cases (method B) the nodes were sliced thinly with a razor blade. All 1-1.5 mm thick slices were mounted on prechilled mounting medium on frozen section buttons. Cytological imprints were also made of the attached tissue slices. Postoperative diagnosis of sentinel lymph node metatases was taken as gold standard. Sentinel node metastases were found in 28 (27%) cases in group A and in 42 (40%) cases in group B (P = 0.05). The median size of the sentinel node metastases was 4.3 mm in group A and 3.3 mm in group B (P < 0.05). CONCLUSION: Method B finds more and smaller metastases and takes less time and effort in the laboratory. When using method A, many small metastases are not detected at all.     

Invasive micropapillary carcinoma of the breast: high incidence of lymph node metastasis with extranodal extension and its immunohistochemical profile compared with invasive ductal carcinoma

AIMS: Invasive micropapillary carcinoma of the breast is an aggressive and distinctive variant of breast cancer. These tumours have a characteristic histological appearance and have been associated with a high incidence of axillary lymph node metastases and a poor clinical outcome. The aims of this study were to investigate the immunohistochemical profile of invasive micropapillary carcinoma of the breast, to compare it with invasive ductal carcinoma, and to identify the morphological parameters which predict its poor outcome. METHODS AND RESULTS: Fifty-three (2.6%) invasive micropapillary carcinomas of the breast from 2022 cases of infiltrating breast carcinomas were identified by retrospective review. The patient age at presentation ranged from 33 to 78 years (mean 52.5 years). The tumour size ranged from 5 to 70 mm (mean 27 mm). Eighty-two percent (43 of 53) were of high histological grade; 69% (33 of 48) of cases with axillary lymph node dissections had positive lymph nodes; and 75.5% (40 of 53) had lymphatic invasion: 46% (22 of 48) of cases had extranodal extension. Of lymph node-positive cases, 61% had four or more metastatic lymph nodes. Of tumours with tumour size >10 mm, 77% had positive lymph nodes. The percentages of cases positive for oestrogen receptor (ER) and progesterone receptor (PR) were 68% and 61%, respectively. These values were significantly higher than the values for invasive ductal carcinomas. p53 and c-erbB-2 were detected in 48% and 54% of cases, respectively. The mean value of Ki67 was 26%. Follow-up was available in 36 patients. Eight patients had local recurrences, nine patients had distant metastases, and 10 patients died of disease within a follow-up period of 9 years. CONCLUSION: Lymphotropism and an unfavourable prognosis are the hallmarks of this distinct entity. Prognostic markers such as ER, PR, p53, and c-erbB-2 failed to provide new criteria to allow discrimination of these tumours from other breast cancers.     

The value of cytokeratin immunohistochemistry in the evaluation of axillary sentinel lymph nodes in patients with lobular breast carcinoma

BACKGROUND: Cytokeratin immunohistochemistry (IHC) reveals a higher rate of occult lymph node metastases among lobular carcinomas than among ductal breast cancers. IHC is widely used but is seldom recommended for the evaluation of sentinel lymph nodes in breast cancer patients. Objective: To assess the value of cytokeratin IHC for the detection of metastases in sentinel lymph nodes of patients with invasive lobular carcinoma. METHODS: The value of IHC, the types of metastasis found by this method, and the involvement of non-sentinel lymph nodes were analysed in a multi-institutional cohort of 449 patients with lobular breast carcinoma, staged by sentinel lymph node biopsy and routine assessment of the sentinel lymph nodes by IHC when multilevel haematoxylin and eosin staining revealed no metastasis. RESULTS: 189 patients (42%) had some type of sentinel node involvement, the frequency of this increasing with increasing tumour size. IHC was needed for identification of 65 of these cases: 17 of 19 isolated tumour cells, 40 of 64 micrometastases, and 8 of 106 larger metastases were detected by this means. Non-sentinel-node involvement was noted in 66 of 161 cases undergoing axillary dissection. Although isolated tumour cells were not associated with further lymph node involvement, sentinel node positivity detected by IHC was associated with further nodal metastases in 12 of 50 cases (0.24), a proportion that is higher than previously reported for breast cancer in general. CONCLUSIONS: IHC is recommended for the evaluation of sentinel nodes from patients with lobular breast carcinoma, as the micrometastases or larger metastases demonstrated by this method are often associated with a further metastatic nodal load.     

Breast cancer in young women: clinicopathologic correlation.

It has been suggested that early-onset breast carcinomas may be different from those that occur in older women. The clinicopathologic characteristics of 191 young female patients (under 40 years of age) diagnosed with breast carcinoma (BC) were studied. Clinical history, staging, treatment and outcome were reviewed. Histology was assessed for tumor subtypes, invasive and in situ components, nuclear and histologic grades and lymph node status. Adjacent nontumoral breast tissue was evaluated. Clinically, 11 patients were stage 0, 21 stage I, 94 stage II, 38 stage III, 6 stage IV, and in 21 no information was obtained. Sixty five percent of patients had positive lymph nodes at diagnosis; 102 patients (54%) relapsed at a median of 29 months after diagnosis. Histologically, 180 cases were infiltrating BC, 150 ductal (83%), 19 lobular (11%) and 11 of special types (6%); 11 cases were ductal carcinoma in situ. We found no cases of medullary carcinoma. High nuclear grade and vascular invasions were frequent (68% and 67%, respectively) even in patients who remained disease-free at least 5 years after diagnosis (61% and 60%, respectively). Our study demonstrates that the histologic types of early-onset breast cancer are not different from other BC. However, BC in young women is often associated with histologic features of high-grade malignancy even in patients with better survival. Our results suggest that BCs in young women are different from those that occur in older women.     

PLK1在乳腺癌分子亚型中的表达及其与基底细胞样型乳腺癌的关系

目的:探讨乳腺癌各分子亚型中PLK1的表达及其与基底细胞样型乳腺癌的关系.方法:回顾性分析803例乳腺浸润性导管癌的临床病理资料,按照Nielsen标准将乳腺浸润性导管癌分成腺腔A型、腺腔B型、HER-2过表达型、基底细胞样型和普通乳腺样型.检测PLK1在5种不同乳腺癌亚型中的表达水平并分析其与基底细胞样型乳腺癌的关系.结果:PLK1在基底细胞样型、普通乳腺样型、HER-2过表达型、腺腔A型及腺腔B型乳腺癌中的阳性表达率分别为58.94%(56/95),39.39%(65/165),33.33%(22/66),17.91%(79/441)及5.56%(2/36).PLK1在ER阴性的乳腺癌分子亚型中的表达显著高于其在ER阳性的乳腺癌分子亚型中的表达,差异具有统计学意义(P<0.05);PLK1的表达与ER呈负相关,与Ki-67表达呈正相关(P<0.01),与HER-2无显著相关性.ER阴性乳腺癌中,PLK1在基底细胞样型乳腺癌中的阳性表达率最高,显著高于其在HER-2过表达型及普通乳腺样型乳腺癌中的表达,差异有统计学意义(P<0.05).而HER-2过表达型与普通乳腺样型中相比,PLK1的表达差异无统计学意义(P=0.390).PLK1的表达与基底细胞样型乳腺癌的淋巴结转移及临床分期相关,而与肿瘤大小及患者年龄无关.结论:PLK1过表达可能与ER阴性的基底细胞样型乳腺癌关系更密切,并在基底细胞样型乳腺的浸润、转移中起重要作用.     

Carcinoma cuniculatum of the esophagus

AIMS: Extremely well-differentiated squamous cell carcinoma with the features of so-called carcinoma cuniculatum (CC) is a rare neoplasm. We describe the clinicopathologic findings of the first 2 cases of CC of the esophagus. METHODS AND RESULTS: Two elderly men presented with symptoms and clinical signs of esophageal malignancy. Repeated endoscopic biopsies of their esophageal tumors were inconclusive. Resection revealed CC of the esophagogastric junction in both cases. The tumors extended into the adventitia but no lymph node metastases were present. In situ hybridization for human papillomavirus HPV subtypes was negative. CONCLUSION: Carcinoma cuniculatum is reported for the first time in the esophagus. The diagnosis of this tumor variant is difficult by means of cytological examination or by endoscopic biopsies alone. Carcinoma cuniculatum in this location shows biologic features similar to verrucous carcinoma (deep penetration, no lymph nodes metastases, and location at one end of the esophagus). No evidence of human papillomavirus could be demonstrated.     

乳腺典型髓样癌与不典型髓样癌临床病理分析

目的探讨乳腺典型与不典型髓样癌的临床病理特征和生物学行为差异。方法对乳腺典型髓样癌及不典型髓样癌各20例临床病理资料进行分析,并采用S-P法检测nm23、E-cad、p53、ER、PR、c—erbB—2、CD45RO和CD20的表达。结果典型髓样癌组,癌细胞合体性结构〉75％,无腺管结构,间质见弥漫性淋巴细胞浸润;不典型髓样癌组,可见腺管结构,间质无或少量淋巴细胞浸润。免疫组化检测典型髓样癌nm23、E—cad阳性表达均高于不典型髓样癌。典型组随访12～84月（平均37个月）,均无腋下淋巴结转移,均健在;不典型组随访9～84月（平均29．5个月）,腋下淋巴结转移4／20例,其中4例分别于术后1—3年内死亡。结论①要严格掌握乳腺典型髓样癌与不典型髓样癌的病理诊断标准。②不典型髓样癌不完全等同“乳腺浸润性导管癌伴髓样特点。”③乳腺典型与不典型髓样癌的预后不同,前者明显优于后者。     

Invasive micropapillary carcinoma of the breast: clinicopathological and immunohistochemical study

Invasive micropapillary carcinoma (IMPCa) of the breast refers to a unique variant of invasive ductal carcinoma, but its biological behavior has not been elucidated well. We analyzed 16 IMPCa cases (10 pure type, six mixed type). The incidence of IMPCa was 1.0% of all primary breast carcinoma. High nuclear grade (75.0%), as well as poorly differentiated histological grade (81.3%), was frequently seen. Lymph node metastases were evident in 92.9% of the examined cases, and about half of them showed more than 10 positive nodes. Comparison between serially experienced invasive ductal carcinoma, not otherwise specified (IDC-NOS), revealed that both high nuclear grade and poor histological grade were significantly more frequent ( P  < 0001), there was a lower frequency of positive estrogen receptor/progesterone receptor ( P  < 0.05, P  < 0.01), a higher frequency of HER-2 overexpression ( P  < 0.025), and more frequent lymph node metastases ( P  < 0.05) in IMPCa. The comparison between lymph node positive IDC-NOS did not show any statistically significant differences in frequency for positive p53, matrix metalloproteinase protein-2 (MMP-2), vascular endothelial growth factor (VEGF) or E-cadherin. However, IMPCa showed a significantly increased number of blood vessels counted by CD34 immunostains ( P  < 0.05). These results suggest that IMPCa is, at least, the same or more aggressive than lymph node positive cases of IDC-NOS. Hence, not only the high incidence of lymph node metastases but also distant, blood-borne metastases may be important.