ki67在三阴性乳腺癌中的临床病理意义

目的 通过检测三阴性乳腺癌中细胞增殖抗原ki67的表达情况,分析其与临床病理特征及预后的关系,明确ki67是否可以作为判断三阴性乳腺癌的预后指标.方法 应用免疫组织化学方法检测ki67在三阴性乳腺癌组织中的表达,分析ki67表达与三阴性乳腺癌患者临床病理特征的相关性及与预后的关系.结果 ki67在三阴性乳腺癌组织中的表达与肿瘤大小、TNM分期、组织学分级和淋巴结转移有关(x2=10.536、16.824、11.020、7.180、P＜0.05).单因素生存分析结果显示:肿瘤大小、临床分期、组织学分级、淋巴结转移和ki67与患者总生存均相关(OR=4.211、3.800、0.288、3.502、2.612,P＜0.05).Cox多因素生存分析显示,淋巴结转移与总生存有一定的相关性(OR=2.768,P＜0.05).结论 ki67表达与三阴性乳腺癌中肿瘤大小、TNM分期、组织学分级和淋巴结转移有关,对于三阴性乳腺癌的预后评估具有一定的价值,可作为评价三阴性乳腺癌预后的候选指标.通过Cox多因素生存分析,淋巴结转移可作为与总生存相关的独立预后因素.     

乳腺癌细胞核形态与预后关系的定量研究

应用图象分析技术测定５７例乳腺癌细胞核形态参数，观察它们在不同临床病理状况下与预后的关系。结果显示，雌激素受体阴性、淋巴结有转移的、低分化单纯癌及５０岁以下患者，细胞核大则生存期较短；而无淋巴结转移、高分化导管浸润癌及５０岁以上患者，大核乳腺癌术后５年生存率较高。生存组细胞核形状因子较大，且与各临床病理因素无明显相关。     

Notch1受体在乳腺癌组织中的表达及其与临床病理特征的关系

目的 探讨Notch1受体与乳腺癌患者的临床病理特征及预后的关系.方法 应用免疫组化技术检测106例乳腺癌组织中Notch1受体、ER、PR、CerbB-2受体表达情况,分析其与临床病理特征及预后的相关性.结果 乳腺癌组织中Notch1受体表达明显高于癌旁正常组织(P＜0.05);Notch1受体表达与CerbB-2具有相关性(P＜0.05),与ER、PR无显著相关性(P＞0.05);Notch1受体高表达组5年生存率低于低表达组(P＜0.05).结论 乳腺癌组织中Notch1受体表达明显高于癌旁正常组织;Notch1受体表达与CerbB-2具有相关性,推测Notch1受体可能与CerbB-2存在交互作用;Notch1受体高表达与预后不良有关.     

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…     

The prognostic value of tumor budding in invasive breast cancer

We investigated the prognostic value of tumor budding in 160 cases of operable invasive ductal carcinoma, not otherwise specified (IDC-NOS). The number of buds was counted in H&E slides with a maximal invasive margin in a 0.950 mm² field of vision (200×). According to a cut-off score selected by ROC analysis, the cohort was dichotomized into a low (0–7 budding foci, 107 cases, 66.9%) and a high-grade budding group (8 or more budding foci, 53 cases, 33.1%). The inter-observer test showed a good reproducibility with 0.717 as the К value. High-grade budding was significantly associated with the presence of lymphovascular invasion (LVI) (P = 0.001), larger tumor size (P = 0.014), and worse clinical outcome (P < 0.001). By immunohistochemical staining, budded cells at the margin displayed epithelial mesenchymal transition (EMT)-like molecular phenotype and decreased proliferative activity. Survival analyses revealed that tumor budding (HR 4.275, P < 0.001) together with tumor size (HR 2.468, P = 0.002), node status (HR 2.362, P < 0.001), and LVI status (HR 1.910, P = 0.035) was the independent prognostic factor in IDC-NOS. In conclusion, tumor budding is a reproducible, significant, and independent histopathological prognostic factor in IDC-NOS.     

Tubulolobular invasive breast cancer: A variant of lobular invasive cancer

Attention is directed to an apparently unique form of invasive breast cancer designated as tubulolobular invasive cancer. These neoplasms exhibit small tubules as well as cords of neoplastic cells in a lobular configuration reminiscent of lobular invasive carcinoma. The clinical and pathologic characteristics encountered in 24 examples were statistically compared with those of infiltrating ductal carcinomas without special specific features, pure tubular, and pure lobular invasive cancer. The results of these analyses as well as the morphologic characteristics of these lesions prompt the conclusion that this lesion represents a tubular variant of lobular invasive carcinoma. Short term treatment failure rates in patients with tubulolobular invasive carcinoma are intermediate between those of pure tubular cancer and lobular invasive carcinoma.     

Lymphoreticular infiltrates in invasive ductal breast cancer

Summary Fifty-two invasive ductal breast cancers were investigated histologically and immunohistologically to assess localization and composition of the lymphoreticular infiltrates. The tumour-infiltrating cells were mainly located in the intervening stroma, whereas tumour foci often exhibited lower numbers of lymphoreticular cells. Macrophages (Mono 1+ and KiM 6+) and helper/inducer cells bearing the T4 surface antigen (Leu-3a+) regularly constituted the majority of the tumour-infiltrating lymphoreticular cells. In more than 80% of cases large numbers of macrophages were found, and many T4 cells occured in about 60%. Next in frequency were the T lymphocytes (Leu-1+) which were mostly observed in high (46%), or in moderate (39%) numbers. In about 2/3 of the cases moderate numbers of T8 (suppressor/cytotoxic) lymphocytes (Leu-2a+) were detected. B lymphocytes (T0 15+) and natural killer cells (Leu-7+) were generally encountered in very low numbers, while eosinophilic granulocytes were virtually absent from the lymphoreticular infiltrates. Tissue mast cells and plasma cells were present in very low numbers in about one half of the tumours but cases with low, moderate or - rarely - even high numbers of infiltrating cells also occured. It must be emphasized that an in situ histomorphological analysis of the cellular part of the stromal reaction of invasive ductal breast cancers allows only limited conclusions concerning the functional properties of the tumour-infiltrating lymphoreticular cells. From the present study, macrophages and T4 cells but also T8 lymphocytes might be of significance in immunooncological reactions against clinically detectable stages of invasive breast cancer.This work is dedicated to Prof. Dr.Dr.h.c. K. Lennert in honor of his 65. birthday.Supported by the Schleswig-Holsteinische Krebsgesellschaft e.V. and the Tumorzentrum Kiel e.V.     

Molecular comparison of interval and screen-detected breast cancers

Breast cancer (BC) diagnosed after a negative mammogram but prior to the next screening episode is termed an 'interval BC' (IBC). Understanding the molecular differences between IBC and screen-detected BCs (SDBC) could improve mammographic screening and management options. Therefore, we assessed both germline and somatic genomic aberrations in a prospective cohort. Utilising the Lifepool cohort of >54 000 women attending mammographic screening programs, 930 BC cases with screening status were identified (726 SDBC and 204 IBC). Clinico-pathological and family history information were recorded. Germline and tumour DNA were collected where available and sequenced for BC predisposition and driver gene mutations. Compared to SDBC, IBCs were significantly associated with a younger age at diagnosis and tumour characteristics associated with worse prognosis. Germline DNA assessment of BC cases that developed post-enrolment (276 SDBCs and 77 IBCs) for pathogenic mutations in 12 hereditary BC predisposition genes identified 8 carriers (2.27%). The germline mutation frequency was higher in IBC versus SDBC, although not statistically significant (3.90% versus 1.81%, p = 0.174). Comparing somatic genetic features of IBC and SDBC matched for grade, histological subtype and hormone receptor revealed no significant differences, with the exception of higher homologous recombination deficiency scores in IBC, and copy number changes on chromosome Xq in triple negative SDBCs. Our data demonstrates that while IBCs are clinically more aggressive than SDBC, when matched for confounding clinico-pathological features they do not represent a unique molecular class of invasive BC, but could be a consequence of timing of tumour initiation and mammographic screening. Copyright © 2019 Pathological Society of Great Britain and Ireland. Published by John Wiley & Sons, Ltd.     

DAPK1基因启动子甲基化与乳腺癌临床病理特征的关系

目的：研究乳腺癌组织中死亡相关蛋白激酶（death-associated protein kinase 1,DAPK1）启动子甲基化状态及其与临床病理特征之间的关系,并探讨该甲基化状态与DAPK1 mRNA表达的相关性。方法：应用甲基化特异性PCR法检测人乳腺癌组织和相应癌旁正常乳腺组织中DAPK1启动子甲基化状态,分析其与患者临床病理特征的关系,并结合半定量RT-PCR法的检测结果加以分析。结果：43例乳腺癌标本中DAPK1启动子甲基化阳性率为44.1%（20/43）,DAPK1启动子甲基化状态与年龄、肿瘤大小、组织学分级、TNM分期、ER状态、PR状态、Her2状态无关（P〉0.05）,而与有无淋巴结转移、P53是否阳性有关（P〈0.05）。DAPK1启动子甲基化标本中的DAPK1mRNA表达水平低于未甲基化标本,两者差异具有统计学意义（P〈0.05）。结论：乳腺癌中DAPK1基因启动子区高甲基化与其mRNA失表达有关,在乳腺癌发生、发展中可能起重要作用,有可能作为乳腺癌诊断和预后分析的检测指标之一。     

Predictive and prognostic biomarker testing in invasive breast cancer

Surgical pathologists play an important role in ordering and interpreting biomarker testing for prognostic and predictive purposes. In invasive breast cancer, these biomarkers include hormone receptors, HER2 expression, multi-gene expression assays, checkpoint inhibitor staining, single gene mutation status, and genomic findings. Additionally, there are tests that predict response to “tumor-agnostic” drugs targeting gene-specific alterations or protein expression changes, regardless of tumor type. The assays employed to assess these biomarkers range from immunohistochemistry to RNA expression to next-generation sequencing. Each assay has specific indications and technical pitfalls. The pathologist must select the correct specimen, choose the area for microdissection, and consider cellularity and tissue adequacy. Often, the pathologist will also provide interpretation of the results. This review will provide an overview of these biomarker tests in breast cancer, describe their indications and utilization, and list some of their challenges. It will serve as a practical reference for pathologists in their integral role in patient care.     

Prevalence of thyroid cancer at a medical screening center: pathological features of screen-detected thyroid carcinomas

Purpose

To assess the incidence of thyroid malignancy in an adult population screened by high-resolution ultrasonography at a medical screening center and to compare the clinical and pathological features of screen-detected thyroid carcinomas to symptomatic overt thyroid carcinomas.

Materials and Methods

We calculated the prevalence of screen-detected thyroid cancer at a medical screening center using high-resolution ultrasonography and fine needle aspiration. We then compared the clinical and pathological features of screen-detected thyroid cancers (n = 46) to clinical symptomatic thyroid cancers (n = 157). We evaluated age, gender, size, perithyroidal extension, lymphovascular extension, stage, histological lymph node metastasis, and the type of cancer. We also compared the above findings of micropapillary carcinomas to papillary thyroid carcinomas that were larger than 1 cm in diameter.

Results

Screen-detected thyroid nodule patients were 2,747 (37%) of 7,491 patients. Nodules selected for fine needle aspiration were 658 and cytology confirmed malignancy were 79 (12%) nodules. When screen-detected thyroid cancers (n = 46) were compared to symptomatic overt thyroid cancers (n = 157), only statistically significant factor was size (p = 0.002). Papillary thyroid carcinomas that were larger than 1 cm had more frequent capsular invasion (p = 0.000) and a higher stage (p = 0.027), and a higher prevalence of lymph node metastases (p = 0.002).

Conclusion

Screen-detected thyroid cancers should be managed as same as symptomatic thyroid cancers in respect to size, and an assessment should strictly be based on the ultrasound features and fine needle aspiration biopsy findings.     

Macrophages define the invasive microenvironment in breast cancer

In many human cancers, the abundance of macrophages in the tumor microenvironment is correlated with poor prognosis. Experimental evidence for the causal relationship between macrophages and poor prognosis came from mouse models of breast cancer in which genetic ablation of macrophages resulted in attenuation of tumor progression and metastasis, and premature recruitment to hyperplastic lesions accelerated these processes. Malignancy is defined by the invasion of tumor cells into the stroma, a process that allows escape of these cells into the circulation and dissemination to distant sites. In this review, I argue that macrophages are recruited to the invasive front by expression of tumor-derived chemotactic factors and in response to the disruption of the basement membrane. At this invasive site, macrophages enhance tumor cell migration and invasion through their secretion of chemotactic and chemokinetic factors including epidermal growth factor (EGF). They promote angiogenesis by the synthesis of angiogenic factors including vascular endothelial growth factor (VEGF), and they remodel the extracellular matrix and in particular, regulate collagen fibrillogenesis. A combination of these factors provides a triple-whammy, as the more mobile and invasive tumor cells track along collagen fibers that are also anchored to blood vessels, which are fabricated at sites of invasion and through which macrophages potentiate tumor cell intravasation. All of these activities suggest that macrophage functions are significant targets for the generation of novel therapeutics that should improve the current cytotoxic armamentarium.     

Predictive and prognostic markers for invasive breast cancer

Breast cancer is one of the most serious carcinomas among women worldwide, yet there are now encouraging signs that improvements in the mortality rate may be possible. The use of hormone therapy and chemotherapy has been widely accepted as treatment for breast cancer. Predictive factors can be used to predict response or lack of response to a particular therapy, and prognostic factors can be useful in making decisions about which patients should receive adjuvant therapy. Histopathology remains the universal basis of diagnosis, with the identification of new surrogate markers for potential new treatments. These are aimed at blocking tumor cell proliferation, neutralizing growth factors, stimulating apoptosis and blocking metastasis, and represent an integral part of new approaches for improving clinical management of patients with breast cancer. We review the standard predictive and prognostic factors that are routinely available today, and also describe some of the new, potential markers that are currently under investigation.     

Estrogen receptor beta expression in invasive breast cancer

The aim of this work was to determine the extent of estrogen receptor beta (ER-beta) expression in invasive breast cancer (BrCA) and whether ER-beta expression is correlated with response to adjuvant hormonal therapy with tamoxifen (AHTT). Immunohistochemical staining (IHC) for estrogen receptor alpha (ER-alpha) and ER-beta was performed on sections of formalin-fixed and paraffin-embedded tissue from 47 unselected invasive breast carcinomas (BrCA). IHC for ER-beta was also performed on sections of BrCA from 118 women who were treated with mastectomy and AHTT. Survival analysis was performed using the Kaplan-Meier method and the log-rank test. Of the 47 unselected BrCA, 17 (36%) were negative for ER-alpha and of these, 8 (47% of ER-alpha negative cases and 17% of all 47 patients) were ER-beta positive. Five of the 8 ER-alpha negative and ER-beta positive cases were positive for ER biochemically. There was no correlation between ER-beta positivity and overall survival in the unselected group. By contrast, in the group of women treated with AHTT, expression of ER-beta in more than 10% of cancer cells was associated with better survival (P = .0077), even in women with node-negative BrCA (P = .0069). In conclusion, our results show that a significant number of women with BrCA are positive for ER-beta only, and may be determined to be ER-negative when currently available IHC is used. ER-beta status is a significant predictor of response to AHTT in women with BrCA. Larger studies with multivariate analysis are needed to confirm these findings.     

乳腺癌中E-cadherin的表达及其临床病理意义

目的 探讨上皮钙黏附表（E-cadherin，E-cad）与乳腺癌临床病理和生物学行为的关系。方法 用免疫组化S-P法检测乳腺浸润性导管癌和浸润性小叶癌中E-cad的表达情况及其与淋巴结转移，ER-PR表达水平的相关性。结果 乳腺浸润性导管癌E-cad表达高于浸润性小叶瘤，有淋巴结转移者E-cad表达低于无转移者，E-cad高表达的乳腺浸润性导管癌及浸润性小肾癌中均与ER-PR表达水平成正相关。结论 E-cad中作为乳腺癌分类、转移潜能和预后判断的参考指标。