Differential diagnosis of chorionepithelioma of the uterus and hydatidiform mole by an immunologic test

Polysaccharide complexes obtained by Westphal's method in the modification of L. A. Zil'ber et al. from tissues of the primary tumor node and distant metastases (lungs) of a chorionepithelioma of the uterus were used for the differential diagnosis between chorionepithelioma and hydatidiform mole. The reaction to intradermal injection of polysaccharide complexes obtained from distant metastases (lungs) of the uterine chorionepithelioma possess high specificity and sensitivity: a positive reaction developed only in patients with chorionepithelioma of the uterus and it was negative in patients with hydatidiform mole. During a marked decrease in size of the metastases in the lungs in the course of chemotherapy, when the immunologic reaction for chorionic gonadotropin fell to 300–100 i.u./liter urine, the reaction to intradermal injection of the polysaccharide complexes from the metastases of the uterine chorionepithelioma still remained positive.Laboratory of Experimental Endocrinology, Department of Gynecology, Institute of Experimental and Clinical Oncology, Academy of Medical Sciences of the USSR, Moscow. Translated from Byulleten' Éksperimental'noi Biologii i Meditsiny, Vol. 79, No. 1, pp. 60–63, January, 1975.     

Molecular diagnosis in breast cancer

Breast cancer is a complex and heterogeneous disease, encompassing a plethora of entities with distinct biological features and clinical behaviour. The advent of high throughput molecular methods has allowed a systematic characterization of the genomic landscape of breast cancer, revealing a profound heterogeneity in this disease. These methods are having a profound effect on the understanding of breast cancer. Some have already been incorporated in clinical practice, such as the prognostic ‘gene signatures’ that allow the tailoring of therapy in the subgroup of patients with oestrogen receptor (ER)-positive and HER2-negative breast cancer. In this review, we discuss the contribution of the main molecular methods in breast cancer research and how this information is changing our approaches to the diagnosis and management of this disease. We also address novel developments in the diagnosis and management of HER2-positive breast carcinomas and familial breast cancer.     

Role of mammography in diagnosis of breast cancer in an inner-city hospital

Mammography continues to play a strategic role in breast cancer diagnosis. Its place in the urban inner-city population among individuals in lower socioeconomic groups has been shown to differ from contemporary trends. A retrospective review of all women diagnosed with breast cancer over a 5-year period (1993 to 1997) in an inner-city hospital was undertaken. Primary cancers (128) were diagnosed in 123 patients during this period. Only 17 patients (12%) had their disease diagnosed with the help of mammography. All other 111 patients were diagnosed clinically. All 17 patients diagnosed by mammogram evaluation had Stage II carcinoma or earlier in contrast with three-fourths of the clinically detected group of patients. Twelve percent of the black women were diagnosed by mammography, whereas 21% of white patients were diagnosed by the same modality. All these proportions are lower than those cited in the regular literature. Better utilization of mammography needs to be applied in inner-city populations to improve early detection of breast cancer.     

Predictive diagnosis of breast cancer

Detection of selected predictive markers is currently included in the standard diagnostic algorithm of breast carcinoma specimens. Despite this fact we are facing several unresolved questions and issues. Probably the most frequently discussed predictive marker in breast carcinoma is HER-2/neu. The change of criteria of positivity in 2007 brought several confusions regarding the selection of patients eligible for anti-HER2 treatment. There is a deficiency of knowledge in tumors with the discordant phenotype (a discrepancy between the results of immunohistochemistry and in situ hybridization). Even in selected HER2 positive patients is the anti-HER2 treatment effective in only 30 % of cases. Thus, we evidently have to search for new markers which would help to more precisely select the optimal treatment for breast cancer patients.     

应关注乳腺癌病理诊断中的新问题

随着乳腺癌临床诊治技术的迅速发展,乳腺临床专科医师已经开始呼吁,改进病理诊断的模式,建立乳腺专科病理诊断机制[1].目前国内乳腺癌的病理诊断和临床要求相比,明显处于滞后状态,亟待改进和规范.在新形势下,病理工作者应当密切关注下述乳腺癌病理诊断中的问题.     

Use of a multiseparation fiber optic probe for the optical diagnosis of breast cancer

We explore the effects of the illumination and collection geometry on optical spectroscopic diagnosis of breast cancer. Fluorescence and diffuse reflectance spectroscopy in the UV-visible spectral range are made with a multiseparation probe at three illumination-collection separations of 735, 980, and 1225 microm, respectively, from 13 malignant and 34 nonmalignant breast tissues. Statistical analysis is carried out on two types of data inputs: (1) the fluorescence and diffuse reflectance spectra recorded at each of the three illumination-collection separations and (2) the integrated fluorescence (at each excitation wavelength) or diffuse reflectance over the entire spectrum at all three illumination-collection separations. The results show that using the integrated fluorescence intensities recorded at a single excitation wavelength at all three illumination-collection separations can discriminate malignant from nonmalignant breast tissues with similar classification accuracy to that using spectral data measured at several excitation wavelengths with a single illumination-collection separation. These findings have significant implications with respect to the design of an optical system for breast cancer diagnosis. Examining the intensity attenuation at a single wavelength rather than spectral intensities at multiple wavelengths can significantly reduce the measurement and data processing time in a clinical setting as well as the cost and complexity of the optical system.     

当前乳腺癌诊治中的病理学新发展

乳腺癌是我国女性常见的一种恶性肿瘤 ,其死亡率仅次于肺癌而位居第二位 ,且发病率呈直线上升趋势。据上海市统计 ,乳腺癌发病率已从 1972年的 17/ 10万上升至 1993年的 37/ 10万。近年来 ,在有关乳腺癌的病因、诊断、治疗、预后判断及乳腺癌发生、发展过程中的分子生物学变化等的研究出现了许多新的进展。一、关于乳腺癌的早期诊断乳腺癌的早期诊断需要病理科、外科和放射科医师的紧密协作 :以往的早期乳腺癌病人多因能触及肿块 ,而肿块较小 ,被认为尚处于临床早期 ,实际上这并非真正意义上的早期诊断。早期诊断应是针对在临床上触及不到肿…     

Use of immunohistochemistry in diagnosis of breast epithelial lesions

In recent years, the use of immunohistochemistry (IHC) in breast pathology has increased tremendously. It is not because the new genre of breast pathologists are less well trained than their "experienced" counterparts; it is mainly because of the demands of more accurate and precise diagnoses, identification of new entities and availability of novel antibodies. The main purpose of this review is to discuss the use of best available antibodies in diagnoses of breast epithelial lesions. The following items are discussed: assessment of invasion, IHC in papillary lesions, identification of breast tumor subtypes, IHC in proliferative breast lesions, assessment of lymphatic space invasion, diagnosis of metaplastic breast carcinoma, IHC in Paget disease, use of cytokeratins in sentinel lymph node assessment, and diagnosis of breast carcinoma at metastatic sites. Because the main focus of this review is on diagnosis, receptor studies on breast carcinoma are briefly discussed and only a few general comments are made.     

当代乳腺癌诊断和治疗理念的变化趋势

与传统模式相比,当代乳腺癌的诊断治疗理念和方法已经发生了巨大的变化。保留乳房治疗、前哨淋巴结活检、新辅助治疗、分子靶向治疗等新技术新方法充实了乳腺癌的治疗内容,对乳腺癌生物学行为的进一步理解使辅助治疗的决策方式发生变化,乳腺癌的确诊方式也发生了改变。理念的进步与技术手段的丰富对临床医师提出了更高的要求,作为临床医师最重要的合作伙伴,病理医师同样面临挑战。     

HER-2/neu protein-receptor-positive breast carcinoma: an immunologic perspective

Immunotherapy using a monoclonal antibody against the human epidermal growth factor receptor 2 protein, HER-2/neu, has proven to be clinically efficacious in about one-half of breast cancer patients who exhibit strong (3+) plasmalemmal immunoreactivity for this protein. The tumoricidal effect of this antibody relies in part upon antibody-dependent cell-mediated cytotoxicity. This report provides observations on certain factors or circumstances which could have an impact on this aspect of the therapeutic approach. These include: (1) concurrent medications; (2) the composition (immunophenotype) of peritumoral lymphocytes and the generally limited numbers of intratumoral T-lymphocytes/natural killer (NK) cells, monocytes, and neutrophilic granulocytes; (3) the presence of circulating HER-2/neu antigens which might bind the exogenous antibody and lead to immune complex formation; (4) the variable co-expression in the tumor of cytokines known to downregulate NK cell function (ie, transforming growth factor-beta1 [TGF-beta1] and platelet-derived growth factor [PDGF]-AB); and (5) the tumoral and/or stromal immunoreactivity for angiotensin-converting enzyme, which forms a part of one of the pathways for the activation of latent TGF-beta1 and for the biosynthesis of PDGF-AB. These observations provide an immunologic perspective for the use of monoclonal antibody therapy in HER-2/neu protein-receptor-positive breast carcinoma and suggest a role for the clinical laboratory in identifying potential avenues for additional manipulations of the immune system in individual cases in order to enhance the therapeutic response.     

Current methods of immunologic diagnosis in parasitology

This review of the immunological diagnosis of parasitic diseases defines the various indications, the means of collection and preparation, the various levels of specificity and the choice of parasitic antigen which should be used for immuno-diagnosis. The detection and assay of circulating antibodies relies on the techniques of immuno-precipitation (immunodiffusion, immunoelectrophoresis, electrosyneresis), indirect agglutination (latex and haemagglutination) or the use of labelled compounds (immunofluorescence, enzymo-immunoassay, radio-immunoassay). Their respective advantages and disadvantages are discussed. The detection and assay of circulating antigens involve the use of agglutination techniques (mycoses), radio-immunoassay or enzymo-immunoassay (protozooses and helminthiases). The authors review the applications of immunological diagnosis for the helminthiases (Trichinosis, Toxocarosis, Filariasis, Anguillosis, Ascaridiasis, Echinococcosis, Taeniasis and Cysticercosis, Distomatosis and Schistosomiasis), the protozoan infections (malaria, Toxoplasmosis, Amebiasis, Trypanosomiasis, Leishmaniasis) and the mycoses (Aspergillosis, Candidiasis, Cryptococcosis). They also discuss the prospects for the development of immunological diagnosis by identification, purification and standardization of parasitic antigens and the study of circulating antigens and idiotypic anti-parasitic antibodies. Finally, they outline the respective responsibilities of the biologist and the prescribing doctor for the proper use of immunological diagnosis of parasitic diseases.     

Evaluation of digital mammography in diagnosis of breast cancer

Mammography has been digitized in all cases at our hospital. Digital mammography (MMG) of our hospital and its diagnostic accuracy were described in this report. Fuji Computed Radiography (FCR; Fuji Medical Systems, Tokyo, Japan) imaging plate was used and imaging data were processed with FCR 7000 or FCR 9000. Each image was output to a single hard copy. Sampling pitches for reading and output were 0.1 mm. The rate of breast cancer diagnosis by digital MMG was 67%, 95%, 94%, and 100% for unpalpable tumor, tumor less than ϕ 2 cm, tumor of ϕ 2 to 5 cm, and tumor greater than ϕ 5 cm, respectively, being 94% overall. Digital MMG enables us to establish goal-oriented image-processing conditions. The use of digital MMG, which provides an excellent diagnostic rate similar to that of screen-film MMG, is expected to became wide-spread in the near future.