Expression and prognostic significance of metalloproteases and their inhibitors in luminal A and basal-like phenotypes of breast carcinoma

To analyze the expression and prognostic value of matrix metalloproteases and their tissue inhibitors in luminal A and basal-like breast carcinomas, an immunohistochemical study was performed on cancer specimens from 93 randomly selected patients with invasive primary ductal tumors of the breast (46 with and 47 without distant metastasis) and with luminal A (n = 48) (ER+, HER2−) or basal-like (HER2−, ER−, PgR−) (n = 45) lesions. Luminal B cases were too few to analyze. Specimens were also studied using tissue microarrays and specific antibodies against matrix metalloproteases 1, 2, 7, 9, 11, 13, and 14 and tissue inhibitors 1, 2, and 3. There were no significant differences in matrix metalloprotease or tissue inhibitor expression in the 2 phenotypes of tumors. In basal-like carcinomas, high scores for matrix metalloproteases 9 and 11 were significantly associated with a high distant metastasis rate. Likewise, data showed associations between matrix metalloprotease/tissue inhibitor expression by either stromal fibroblasts or mononuclear inflammatory cells and distant relapse-free survival in both tumor phenotypes. In addition, in infiltrating luminal A and basal-like tumors, we identified a prometastatic phenotype of mononuclear inflammatory cells, showing a high matrix metalloprotease/tissue inhibitor molecular profile. Expression of matrix metalloproteases and tissue inhibitors is related to the characteristics of breast tumor cells. As prognostic factors in breast carcinomas of both luminal A and basal-like phenotypes, our results point to the importance of the expression of matrix metalloproteases and tissue inhibitors by the stromal cells.     

Comparative analysis and clinical value of the expression of metalloproteases and their inhibitors by intratumour stromal mononuclear inflammatory cells and those at the invasive front of breast carcinomas

González L O, González‐Reyes S, Marín L, González L, González J M, Lamelas M L, Merino A M, Rodríguez E, Pidal I, del Casar J M, Andicoechea A & Vizoso F
(2010) Histopathology 57, 862–876 Comparative analysis and clinical value of the expression of metalloproteases and their inhibitors by intratumour stromal mononuclear inflammatory cells and those at the invasive front of breast carcinomas Aims: Matrix metalloproteases (MMPs) and their inhibitors (TIMPs) play an essential role in the degradation of stromal connective tissue and basement membrane components. The aim of this study was to determine whether the dynamic analysis of these components can help to predict tumour aggressiveness. Methods and results: An immunohistochemical study was performed using tissue arrays and specific antibodies against MMPs ‐1, ‐2, ‐7, ‐9, ‐11, ‐13 and ‐14 and TIMPs ‐1, ‐2 and ‐3. More than 5000 determinations on cancer specimens from 124 patients with invasive breast cancer were performed on the tumour centre core as well as on the invasive front. Immunostaining for MMPs/TIMPs on mononuclear inflammatory cells (MICs) was evaluated. To identify specific groups of tumours with distinct expression profiles, data obtained from both MICs populations were analysed by unsupervised hierarchical cluster analysis. When compared with MICs at the invasive front, intratumour MICs more frequently showed expression of MMP‐7 and ‐1 and TIMP‐3, but less frequently expression of MMP‐9 and ‐11 and TIMP‐2. Conclusions: Our data led us to consider the need of further studies in order to identify subsets of MICs and other protein elements of the microenvironment as attractive targets for new therapeutic strategies against cancer.     

乳腺原发癌和淋巴结转移癌干细胞Hedgehog信号通路相关基因的比较

目的:探讨Hedgehog信号通路相关基因在乳腺原发癌干细胞与其相应的淋巴结转移癌干细胞中的表达及意义。方法:收集新鲜的乳腺癌标本,经快速病理诊断为乳腺浸润性导管癌,且伴有腋窝淋巴结的转移,采用免疫磁珠分选法分别提取乳腺原发癌与淋巴结转移癌干细胞,采用Real-time PCR检测Hedgehog信号通路相关基因Shh、Ptch、Smo和Gli-1在乳腺原发癌干细胞与相应转移癌干细胞中的表达。结果:Shh在乳腺原发癌干细胞和相应淋巴结转移癌干细胞中的表达没有统计学意义;Ptch在乳腺原发癌干细胞的表达明显高于转移癌干细胞,而Smo、Gli-1在乳腺原发癌干细胞的表达明显低于转移癌干细胞。结论:与乳腺原发癌干细胞相比,转移癌干细胞Hedgehog信号通路处于更高的活化状态,从而具有更强的侵袭和转移能力,有可能成为新的治疗靶点。     

Study of matrix metalloproteinases and their tissue inhibitors in ductal in situ carcinomas of the breast

Aims: To analyse the expression of metalloproteinases (MMPs) and their inhibitors (TIMPs) in ductal carcinoma in situ of the breast (DCIS). Methods and results: An immunohistochemical study was performed in 56 patients with pure DCIS, in 39 with DCIS adjacent to invasive carcinoma (IDC) and 63 patients with T1 IDC, using tissue microarrays and specific antibodies against MMPs and TIMPs. Immunohistochemical results were categorized using a specific software program. The data were analysed by unsupervised hierarchical cluster analysis by each cellular type. IDC showed a higher expression rate of MMP‐7 and TIMP‐1 than pure DCIS, as well as a higher expression rate of MMP‐9 and TIMP‐3 than the DCIS component of mixed cases, whereas pure DCIS showed a higher rate of expression of MMP‐9 and ‐11 and TIMP‐3 than in the DCIS component of mixed cases. Pure DCIS with a periductal inflammatory infiltrate showed significantly higher MMP‐2, ‐14 and TIMP‐1. Dendograms identified two cluster groups with distinct MMP/TIMP expression profiles in neoplastic cells and fibroblastic or mononuclear inflammatory cells surrounding the neoplastic ducts of pure DCIS. Conclusions: The results indicate the distinct variability in MMP/TIMP expression by DCIS, which may be of potential biological and clinical interest in breast cancer.     

影响乳腺癌前哨淋巴结数目的临床病理特征分析

目的分析影响乳腺癌前哨淋巴结数目的相关因素,探讨最佳的前哨淋巴结活检值。方法回顾性分析2007年1月-2011年12月中国医学科学院肿瘤医院乳腺癌前哨淋巴结活检病例578例。采用Logistic回归模型分析前哨淋巴结数目与临床病理特征的相关性。结果全组女性,平均年龄49.9(21～90)岁。总共获得2 222枚前哨淋巴结,平均每例3.8枚(1～15)。淋巴结转移率17.8%(103/578),转移组和无转移组淋巴结数目无差异。单因素分析显示,术式、显像方法和体质指数影响前哨淋巴结数目(P<0.05)。多因素分析中,单纯乳房切除、联合显像、BMI≤30者前哨淋巴结较多(P<0.05)。前哨淋巴结限于5枚时,转移病例检出率100%。18.7%(108/578)病例不必继续送检淋巴结,298枚淋巴结免于切除。结论乳腺癌前哨淋巴结活检数量受到显像方法、乳腺术式和体质指数的影响,5枚前哨淋巴结可能是一个比较合适的参考标准。     

Expression of matrix metalloproteinases and their tissue inhibitors in the serum and cerebrospinal fluid of patients with meningitis

Meningitis is associated with an imbalance between matrix metalloproteinases (MMPs) and endogenous tissue inhibitors of MMP (TIMPs). Serum and CSF were collected prospectively from all patients with meningitis between January 2008 and December 2008 to measure the concentrations of MMP/TIMP in those patients who underwent a lumbar puncture for a presumptive diagnosis of meningitis. A total of 199 patients were enrolled into the study. The concentrations of CSF MMP‐9 and TIMP‐1 were significantly higher in the meningitis group compared with the control group (p 0.032 and p <0.001, respectively). However, the CSF TIMP‐4 levels were significantly lower in the meningitis groups compared with the control groups (p <0.001). Patients with bacterial meningitis had higher CSF MMP‐9 and TIMP‐1 levels than those who had aseptic meningitis and controls. Patients with various infectious meningitis etiologies tended to have higher CSF MMP‐9 expression by gelatin zymography when compared with the controls. In conclusion, MMP/TIMP system dysregulation was found in patients with meningitis, and CSF MMP and TIMP might act as novel indicators in patients with meningitis.     

乳腺癌患者妊娠次数与腋窝淋巴结转移的关系研究

目的探讨乳腺癌患者妊娠次数与腋窝淋巴结转移之间的关系。方法171例乳腺癌患者按妊娠次数分为妊娠1次，2次及2次以上共3组。统计该3组患者各自发生腋窝淋巴结转移的患者比例及发生转移的腋窝淋巴结在所检测的淋巴结中的比例，应用X2检验分析不同组别间腋窝淋巴结转移阳性患者比例的差异，阳性转移淋巴结比例之间的差异，从而探讨乳腺癌患者的妊娠次数与其腋窝淋巴结转移例数及转移个数之间的关系。结果妊娠1次、妊娠2次及妊娠2次以上组发生腋窝淋巴结转移的比例分别为34．78％、50％、64．10％。随妊娠次数增加，发生腋窝淋巴结转移的比例逐渐增高。其中妊娠2次以上患者组发生腋窝淋巴结转移的比例明显高于妊娠1次患者组发生腋窝淋巴结转移的比例（64．10％掷34．78％），2者相比差异有显著性（P：0．012）。妊娠1次、妊娠2次及妊娠2次以上组腋窝淋巴结发生转移的比例分别为44．58％、44．18％、52．97％。妊娠2次以上患者组腋窝淋巴结发生转移的比例明显高于妊娠2次患者组腋窝淋巴结发生转移的比例（52．97％协44．18％），2者相比差异有显著性（P=0．025）。但妊娠1次组腋窝淋巴结发生转移的比例与妊娠2次组及妊娠2次以上组相比，差异均无显著性（P=0．948，P=0．167）。结论妊娠次数较少的患者组发生腋窝淋巴结转移的比例相对较小，发生转移的腋窝淋巴结数目也相对较少。乳腺癌患者的妊娠次数与乳腺癌的腋窝淋巴结转移有关。乳腺癌患者的妊娠次数对判断乳腺癌患者的腋窝淋巴结转移有一定的意义。     

Development of the lymph nodes in the very young, and their evolution in the mature, nude rat

We recently revised the concepts on the morphology of the lymph nodes of the young adult athymic nude rat. The present work studied the postnatal development of its nodal structures and their evolution with aging. The structural development of the deep cortex "units" was found to progress as usual. However, while the concentration of lymphocytes appeared to develop normally in the periphery of a unit, the center of the unit remained lymphocyte-depleted. Further, the peripheral cortex failed to develop over the middle part of a unit center. With aging, the peripheral cortex over the remainder of a unit center could atrophy and disappear completely. The present findings did not yield information as to whether thymic elements are necessary to trigger the development of a unit, but they revealed that its further development is determined by stimuli. It was concluded that, in the absence of T-cells, stimuli for cellular immune responses provoke the proliferation of the reticular or interdigitating cells of a unit center. On the other hand, an increase of these stimuli was concluded to cause the peripheral cortex to fail to develop over part of a unit center and, later, to atrophy over the remainder of the unit center. The mechanisms of the phenomena are discussed.     

Comparison of molecular determinants of angiogenesis and lymphangiogenesis in lymph node metastases and in primary tumours of patients with breast cancer

Angiogenesis and lymphangiogenesis are complex processes, driven by multiple factors. In primary breast tumours (PTs), VEGFA, -C and -D are the most important (lymph)angiogenic factors. The induction of lymphangiogenesis in axillary lymph node (LN) metastases of patients with breast cancer was described recently. To compare the molecular determinants of (lymph)angiogenesis in LN metastases and PTs of breast cancer patients, RNA was isolated from formalin-fixed, paraffin-embedded tissue sections of a metastatically involved and uninvolved LN and the PT from 26 lymph node-positive patients. The expression of 12 (lymph)angiogenic markers was measured by qRT-PCR. Expression was correlated with tumour cell proliferation, angiogenesis and lymphangiogenesis, quantified by tumour cell proliferation fraction (TCP%) and (lymphatic) endothelial cell proliferation fraction [(L)ECP%]. TCP%, ECP% and LECP% were assessed on immunohistochemical double stains for CD34/Ki-67 and D2-40/Ki-67, respectively. In involved LNs, the relative gene expression levels of PROX1 (p < 0.001) and FGF2 (p = 0.008) were decreased and the expression levels of VEGFA (p = 0.01) and PDGFB (p = 0.002) were increased compared to uninvolved LNs. The expression of most markers was increased in PTs compared to involved LNs. In metastatically involved LNs, the expression of VEGFA correlated with ECP% (r = 0.54, p = 0.009) and LECP% (r = 0.76, p < 0.001). In PTs, VEGFA correlated only with ECP% (r = 0.74, p < 0.001). VEGFD correlated with peritumoural LECP% (r = 0.61, p = 0.001) and with VEGFC (r = 0.78, p < 0.001). Linear regression analysis confirmed the expression of VEGFA as an independent predictor of ECP% in both PTs and LN metastases and of LECP% in LN metastases. The expression of VEGFD, but not of VEGFA, independently predicted peritumoural LECP% in PTs. Our results confirm existing data that, in PTs, angiogenesis and lymphangiogenesis are respectively driven by VEGFA and VEGFD. In contrast, in LN metastases, both processes seem to be driven by VEGFA. Lymphangiogenesis in PTs and in LN metastases might thus be driven by different factors.     

乳腺癌前哨淋巴结不同转移状态下局部淋巴结成熟树突状细胞的研究

目的：研究乳腺癌前哨淋巴结不同转移状态 下前哨淋巴结与非前哨淋巴结成熟树突状细胞密度的改变。方法:回顾 性分析79例符合研究标准的女性乳腺癌患者。根据前哨淋巴结的转移状况分为3组：A组（2 8例），所有淋巴结转移阴性；B组（25例），仅微小肿瘤出现于前哨淋巴结，包括B1组（16 例），仅游离肿瘤细胞出现于前哨淋巴结；B2组（9例），仅微转移出现于前哨淋巴结；C组 （26例），转移出现于前哨淋巴结，非前哨淋巴结有或无转移。所有前哨淋巴结及非前哨淋 巴结蜡块切片均行与DC-LAMP抗体免疫反应的免疫组织学检查以确认成熟树突状细胞。蔡司 图像分析系统定量分析每个淋巴结DC-LAMP阳性细胞的相对密度（DC-LAMP阳性细胞面积/淋 巴结面积）。Wicoxon检验和Mann-Whitney检验分别用于DC-LAMP阳性细胞的相对密度的组内 和组间比较。结果:DC-LAMP阳性细胞密度的组内比较显示A组和B组前哨 淋巴结DC-LAMP阳性细胞平均密度较非前哨淋巴结高（P<0.05，P<0.01）；C组前哨淋 巴结DC-LAMP阳性细胞平均密度与非前哨淋巴结比较无明显差异（P>0.05）。组间比较 显示各组前哨淋巴结DC-LAMP阳性细胞平均密度无显著差异；而B组(尤其B2组)非前哨淋巴结 DC-LAMP阳性细胞密度较A组和C组显著升高（P<0.05，P<0.01）。结论： 前哨淋巴结和非前哨淋巴结DC-LAMP阳性细胞平均密度在淋巴结肿瘤转移形成过程发生改变,揭示前哨淋巴结在肿瘤与引流淋巴结间相互作用中起重要作用。     

结直肠癌原发灶及淋巴结转移灶中SATB2表达及意义

目的：探讨富含AT序列特异性结合蛋白2(special AT-rich sequence-binding protein 2, SATB2)在结直肠癌组织及对应淋巴结转移灶中的表达,并分析其与临床病理特征的关系。方法应用免疫组化EnVision法检测200例结直肠癌原发灶及80例淋巴结转移灶中SATB2蛋白表达。结果结直肠癌原发灶中SATB2高表达率为25．0%(50/200),中等强度表达率为36．0%(72/200),阴性率为39．0%(78/200)。对应淋巴结转移灶中SATB2高表达率为15．0%(12/80),中等强度表达率为28．8%(23/80),阴性率为56．2%(45/80)。 SATB2在结直肠癌原发灶中的表达与肿瘤大小、分化程度,浸润深度、淋巴结转移以及TNM分期显著相关(P<0．05),与患者年龄、性别及远处转移无相关性。 SATB2在结直肠癌淋巴结转移灶中表达显著低于原发灶(P<0．05),其在转移灶中的表达与临床病理因素无明显相关性。结论 SATB2低表达与结直肠癌的发生、发展相关,在肿瘤转移过程中表达明显降低,有望成为新型的结直肠癌分子靶标。     

Involvement of Matrix Metalloproteinases and their Inhibitors in Bovine Cystic Ovarian Disease

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Matrix metalloproteinases 7 and 9 and their types 1 and 4 tissue inhibitors in tumors and plasma of patients with colorectal cancer

Enzyme immunoassays showed significantly elevated content of matrix metalloproteinase 7 and type 1 tissue inhibitor of metalloproteinases in tumors compared to adjacent histologically unchanged mucosa of patients with colorectal cancer; the levels of metalloproteinase 9 and type 4 tissue inhibitor of metalloproteinases were virtually the same in the tumors and mucosa. Plasma concentrations of the studied proteins did not correlate with their levels in the tumor, did not surpass the normal, and did not decease after removal of the primary tumor in the majority of patients. __________ Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 143, No. 4, pp. 438–441, April, 2007     

Eight-year experience with the intraoperative frozen section examination of sentinel lymph node biopsy for breast cancer in a North-Italian university center

Sentinel lymph node biopsy (SLNB) completely changed the impact of breast surgery on patients psycho-physical wellness, reducing morbidity associated with complete axillary lymph node dissection (CALND) while granting an adequate breast cancer staging. We reviewed our experience with the SLNB in a University Clinic. We collected data about all breast cancer patients submitted to SLNB from 2002 to 2010, and analyzed them with R (version 2.15.2), considering significant p<0.05. We performed 615 SLNBs on 607 patients, with a mean age of 59.86 (±10.76). Sentinel node detection rate resulted 99,7%, with a mean number of biopsied nodes of 1.64 (±0.67), axillary localization in 98% of cases, and negative intraoperative histological finding in the 86.2% of cases. Prevalence of ITCs, micrometastasis, macrometastasis and pericapsular metastasis resulted respectively 0.6%, 4.9%, 7.5% and 8.8%. Among women who received CALND, mean number of examined nodes was 16.36 (±6.19) and mean number of metastatic non-sentinel nodes was 0.97 in case of micrometastasis, 2.65 in case of macrometastasis, and up to 9.88 when pericapsular invasion was described. To conclude, our data confirm the role of nodal metastasis size in the prediction of non-sentinel node involvement, but further studies are required in order to better assess the role of ITCs and micrometastasis in the diagnostic and therapeutic management of breast cancer, with the final aim to reduce the surgical complications of axilla demolition when unnecessary.     

p16 expression in sentinel nodes with metastatic breast carcinoma: evaluation of its role in developing triaging strategies for axillary node dissection and a marker of poor prognosis

Not all patients with metastatic breast carcinoma (MBC) in a sentinel lymph node (SLN) have metastasis in additional axillary nodes (ANs). A biological marker that can predict this occurrence may be beneficial in triaging only appropriate patients for AN dissection (AND). Our aim was to study p16 expression in SLNs and to determine whether it is a predictor of metastases to additional ANs and a marker of poor prognosis. We correlated p16 expression in SLNs and ANs of 54 patients with MBC with clinicopathologic features and the nodal proliferative index (PI). We sequenced p16 from DNA in 7 cases. We found that 35 of 54 cases (65%) had p16-positive tumor cells. Nine of 17 (53%) cases in which both SLN and AND were done had MBC in additional ANs. The SLNs of 8 of 9 cases (89%) were p16 positive (73% positive predictive value). Eight of 17 (47%) cases had no metastases in ANs even though their SLNs had metastases. The SLNs of 5 of 8 (62.5%) of these cases were p16 negative (83% negative predictive value). Ductal MBCs were p16 positive in 27 of 37 cases (73%). Carcinomas with a lobular component were p16 negative in 9 of 11 cases (82%). Nine of 12 (75%) p16-negative ductal carcinomas were estrogen receptor (ER) positive. Some 75% of T2 and T3 tumors were p16 positive, compared with 50% of T1 tumors. The highest PI (defined as > or =50%) was seen in p16-positive SLNs (5 of 6 cases). The p16 DNA sequence was normal, and no mutations were found. Our findings indicate that p16 expression in SLNs with MBC predicts (1) increased likelihood of metastasis in additional ANS, and its expression along with other markers and clinicopathologic parameters may serve as an indicator for proceeding to a formal AND; (2) poor prognosis and is associated with larger primary tumors with a high nodal PI and ER-negative status; and (3) histological subtypes. Gene mutations were not responsible for the expression of p16 in our cases.     

Reliability of intraoperative frozen section and imprint cytological investigation of sentinel lymph nodes in breast cancer

AIMS: The sentinel lymph node procedure enables selective targeting of the first draining lymph node, where the initial metastases will form. A negative sentinel node (SN) predicts the absence of tumour metastases in the other regional lymph nodes with high accuracy. This means that in the case of a negative SN, regional lymph node dissection is no longer necessary. Besides saving costs, this will prevent many side-effects of lymph node dissection. The aim of this study was to evaluate the reliability of intraoperative cytological and frozen section investigation of the SN to detect metastases. This would allow the axillary lymph node dissection to be performed in the same session as the SN procedure and the excision of the primary tumour in case of a positive SN. METHODS AND RESULTS: Seventy-four SNs were detected by gamma probe detection of nanocolloid and visual localization of Patent Blue accumulations in 54 women with stage T1-2N0M0 invasive breast cancer. The identified SN were immediately investigated by frozen section and imprint cytological investigation. Diagnoses were confirmed on the paraffin material, and in case of negative frozen section and paraffin haematoxylin and eosin sections, skip sections and immunohistochemistry were performed. Thirty-one SNs (42%) contained metastases, of which 27 were detected by the frozen section procedure (sensitivity 87%). There were no false positives (specificity 100%). The sensitivity of the imprints was 62% with a specificity of 100%. When evaluating the data per patient, for the frozen section procedure the sensitivity was 91% and the specificity 100%, and for the imprints, the sensitivity was 63% and the specificity 100%. There were no SNs in which the imprints showed metastases and the frozen section did not. CONCLUSIONS: Intraoperative frozen section analysis is a reliable procedure by which a high percentage of sentinel lymph node metastases can be detected in breast cancer patients without false positive results. This allows the surgeon to perform an immediate axillary lymph node dissection in case of positive SNs. In up to 10% of cases, the final paraffin sections will reveal micrometastases that were not detected by the frozen section, and in these patients axillary lymph node dissection will have to be performed in a second session. The imprint method is significantly less sensitive than the frozen section but may be used as an alternative when frozen section is not possible.