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.     

VEGFR-3与肿瘤淋巴转移的研究进展

肿瘤转移通常是人类癌症致死的主要原因之一.淋巴转移是肿瘤特别是癌的常见转移途径,肿瘤细胞转移至淋巴结通常作为肿瘤转移的信号,同时也是患者预后的重要指标.在肿瘤转移过程中,血管内皮生长因子及其受体家族发挥了重要的作用.尤其是淋巴内皮特异性的受体--血管内皮生长因子受体3(VEGFR-3)及其配体VEGF-C/D在促进淋巴管生长具有关键的作用.本文就VEGFR-3与肿瘤淋巴转移的研究进展进行综述.     

Collective invasion in ductal and lobular breast cancer associates with distant metastasis

Breast cancer undergoes collective tissue invasion and, in experimental models, can collectively metastasize. The prevalence of collective invasion and its contribution to distant metastasis in clinical disease, however, remains poorly defined. We here scored the adipose tissue invasion of primary invasive ductal carcinoma (IDC), expressing E-cadherin, and E-cadherin negative invasive lobular carcinoma (ILC) and identified predominantly collective invasion patterns (86/86 samples) in both carcinoma types. Whereas collective invasion in IDC lesions retained adherens junctions, multicellular clusters and “Indian files” in ILC, despite the absence of adherens junctions (AJ) proteins E-cadherin and β-catenin, retained CD44 at cell–cell contacts. By histomorphological scoring and semi-automated image analysis, we show that the extent of collective invasion into the adipose tissue correlated with decreased distant metastasis-free survival (5-year follow-up; hazard ratio: 2.32 and 2.29, respectively). Thus, collective invasion represents the predominant invasion mode in breast cancer, develops distinct junctional subtypes in IDC and ILC, and associates with distant metastasis, suggesting a critical role in systemic dissemination.     

SELDI-MS-based expression profiling of ductal invasive and lobular invasive human breast carcinomas

Expression profiling using proteomic techniques has a great potential to identify new biomarkers that might help to better diagnose and treat diseases such as breast cancer, which is one of the leading causes of cancer death in women. Surface-enhanced laser desorption ionization mass spectrometry (SELDI-MS) combines chromatographic separation of peptides and proteins with mass spectrometry and is a fast, user-friendly tool to analyze protein and peptide profiles. SELDI-MS was employed for a comparative analysis of lobular invasive versus ductal invasive breast tumors to find differentially expressed proteins and peptides, and to validate this technique for biomarker identification using complex samples such as tissue. After optimization of sample preparation using HMEC and MCF-7 cell lines, 20 breast tumors were analyzed, and about 550 mass signals corresponding to an estimated 140 native peptides and proteins were detected in each tumor. Only 14% of the mass signals were present in more than six tumors of one subgroup or in more than 12 tumors of both groups showing a great overall heterogeneity of the peptide and protein profiles obtained. Peptide mass signals specific for each of the analyzed groups were identified. In addition, we detected peptides from laser-microdissected ductal invasive and intraductal tumor parts corresponding to peptides present in whole tumors. The low amount of identified peptides and proteins and the observed heterogeneity suggest that SELDI-MS is not well suited for biomarker identification of and profiling experiments on complex samples such as tumor tissue.     

Simultaneous loss of E-cadherin and catenins in invasive lobular breast cancer and lobular carcinoma in situ

Loss of expression of the intercellular adhesion molecule E-cadherin frequently occurs in invasive lobular breast carcinomas as a result of mutational inactivation. Expression patterns of E-cadherin and the molecules comprising the cytoplasmic complex of adherens junctions, α-, β- and γ-catenin, were studied in a series of 38 lobular breast carcinomas with known E-cadherin mutation status. The effect of loss of E-cadherin by mutational inactivation (or other mechanisms) on the expression of catenins was investigated. Complete loss of plasma membrane-associated E-cadherin expression was observed in 32 out of 38 invasive lobular carcinomas, for which in 21 cases a mutation was found in the extracellular domain of E-cadherin. In total, 15 frameshift mutations of small deletions or insertions, ranging from 1 to 41 bp, three non-sense mutations, and three splice mutations were identified. Mutations were scattered over the whole coding region and no hot spots could be detected. In all cases, simultaneous loss of E-cadherin and α- and β-catenin expression was found; in 50 per cent of these cases, additional loss of γ-catenin was observed. In six invasive lobular carcinomas, expression of both E-cadherin and catenins was retained. In none of these carcinomas was an E-cadherin mutation detected. Lobular carcinoma in situ adjacent to invasive lobular carcinoma showed simultaneous loss of E-cadherin and catenins in all the cases studied—remarkably, also, in four cases positive for E-cadherin and catenin expression in the invasive component. These results indicate that simultaneous loss of E-cadherin and α-, β- and γ-catenin may be an important step in the formation of lobular carcinoma in situ, as a precursor of invasive lobular breast cancer. Events additional to E-cadherin inactivation must be involved in the transition of lobular carcinoma in situ to invasive lobular carcinoma. © 1997 John Wiley & Sons, Ltd.     

Cytological characteristics of invasive lobular carcinoma of the human breast

In contrast to invasive ductal carcinoma, invasive lobular carcinoma (ILC) of the breast is characterized by multiple ipsilateral occurrences and a higher incidence in the contralateral breast. It is therefore necessary to examine thoroughly whether there is any other carcinoma present before any breast-conserving surgery is carried out. We cytologically, histologically, and ultrastructurally investigated ILC and pure scirrhous carcinoma (PSC), a subtype of invasive ductal carcinoma, to establish cytological diagnostic criteria for the differential diagnosis of these two types of carcinoma that have high histological similarity. Cytologically, ILC cells showed linear or isolated cell arrangements and had small nuclei with round homogeneously distributed fine granular chromatin. The cytoplasm was light, and individual cells lacked cohesion. The carcinoma showed a rosary-like configuration. PSC cells, however, showed linear or cordlike arrangements. Individual cells showed a vertical arrangement. PSC cells had a linear cytoplasmic edge and were characterized by nuclear molding with coarse granular chromatin. These cytological findings were supported by histological and ultrastructural findings. These findings may contribute to histological estimation of ILC in preoperative cytological diagnosis.     

Stanniocalcin-1 promotes metastasis in a human breast cancer cell line through activation of PI3K

Stanniocalcin-l (STC-1) is a secreted glycoprotein hormone that regulates calcium and phosphate homeostasis. STC-1 expression is upregulated in several cancers including breast cancer, and has been shown to be prognostic. Although these clinical observations implicate STC-1 as a potential tumor marker, it is still unclear whether STC-1 confers a malignant phenotype. In this study, this question was addressed by overexpressing STC-1 in the human breast cancer cell line MDA-MB-231 and examining the resultant phenotype in vitro and in vivo. Overexpression of STC-1 enhanced invasiveness of MDA-MB-231 cells in vitro and promoted their lung metastasis in vivo, while having no effect on proliferation, adhesion, or proteinase activity. The addition of soluble STC-1 to MDA-MB-231 cultures resulted in the activation of the phosphoinositide 3-kinase (PI3K)/Akt signaling pathway, suggesting a mechanistic basis for the observed increases in cell motility and metastasis. Taken together, it was indicated that secreted STC-1 promotes metastatic potential of breast cancer cells via activation of PI3K/AKT.     

血管内皮生长因子C、D和受体3在人胰腺癌组织中的表达

目的:通过观察不同临床指标的人胰腺癌组织VEGF-C、VEGF-D、VEGFR-3的表达,来探讨VEGF-C和VEGF-D对人胰腺癌转移的影响,为癌组织中淋巴管的生成机制以及癌的淋巴道转移机制提供理论依据。方法:取人胰腺癌标本33例及癌旁正常胰腺组织15例,用免疫组化的方法观察VEGF-C、VEGF-D及VEGFR-3在人胰腺癌和癌旁正常胰腺组织中的表达。结果:VEGF-C、VEGF-D和VEGFR-3在胰腺癌组织中的表达比例较在癌旁正常胰腺组织中的表达比例明显增高,并且VEGFR-3的表达与VEGF-D的表达具有显著相关性(P<0.01),与VEGF-C的表达不具有相关性(P>0.05)。胰腺癌组织中VEGF-C和VEGF-D的表达与患者的年龄、性别、远处转移无关(P>0.05)。结论:VEGF-C、VEGF-D在胰腺癌组织中的表达明显增高,并有可能通过与VEGFR-3的结合促进了癌组织中淋巴管的生成,从而对癌的淋巴道转移起促进作用。     

A comparative morphometric analysis of cytograms of invasive ductal and invasive lobular breast cancer

The most informative for differential diagnosis parameters (surface and nucleus polarization) were determined on the basis of morphometric analysis of 42 cytograms of invasive duct cancer (IDC) and 39 cytograms of invasive lobular breast cancer (ILC) using the computer analyzer MEKOC-C. Combination of these two parameters allowed the authors to elaborate a decisive rule for differential diagnosis of these two cancers (the mistake is reduced to 8.6%). The analysis of 8 informative morphometric nuclear parameters has shown that in ILC the nuclei are more monomorphic, less in square and perimeter, nucleoli are less numerous than in IDC. The study gives objective criteria for preoperative differential cytological diagnosis between IDC and ILC.     

Cadherins as predictive markers of nodal metastasis in breast cancer.

Adhesion molecules, particularly cadherins play a pivotal role in cancer invasion and metastasis. Because the therapeutic management of tumors with and without nodal metastasis differs considerably, our idea was to identify tumors with metastatic potential. We studied the expression of E-cadherin and P-cadherin immunohistochemically in 51 cases of breast cancer that included 29 node-negative and 22 node-positive cases. Expression of the cadherins was mainly membranous, with cytoplasmic staining in a few lesions. Both E-cadherin and P-cadherin showed significant down-regulation of their expression in node-positive tumors in comparison to node-negative tumors. Logistic regression analysis revealed that the positive expression of E-cadherin and P-cadherin showed low odds ratios of 0.1 and 0.2, respectively, and were statistically significant. On multivariate analysis, both the cadherins were found to be of independent prognostic value. This suggests that cadherin expression could be a marker of nodal metastasis. An observation of interest was that the expression of E-cadherin and P-cadherin were highly correlated (correlation coefficient = 0.5873), which requires further evaluation for confirmation of a common regulatory pathway that could be activated in the early onset of nodal metastasis.     

乳腺微钙化促进乳腺癌骨转移的研究进展

乳腺癌是女性发病率最高的癌症,在过去的十年中,全球发病率持续上升,死亡率高居不下.最新的统计学研究表明,仅2018年,全球范围内检测出约210万乳腺癌病例,其中近63万患者死亡,因而也是女性死亡率最高的癌症[1].然而,许多癌症患者的死亡并非由于肿瘤在原发部位生长,而是在于肿瘤侵袭或转移至其他部位,其中乳腺癌最容易发生...     

Malignant adenomyoepithelioma of the breast combined with invasive lobular carcinoma

Presented herein is the first case of malignant adenomyoepithelioma (malignant AME) of the breast combined with invasive lobular carcinoma (ILC) in a 53-year-old woman. Histologically, the tumor was composed of nodular proliferation of biphasic epithelial and myoepithelial carcinoma, partially surrounded by ILC. Interestingly, ILC metastasized to the axillary lymph nodes, while biphasic epithelial and myoepithelial carcinoma hematogenously metastasized to the lung and the kidney. On immunohistochemistry the biphasic carcinoma consisted of cytokeratin (CK) 8/18-positive/CK5/6-positive/smooth muscle actin (SMA)-negative inner carcinoma cells and CK8/18-positive/CK5/6-positive/SMA-positive outer carcinoma cells. The monophasic ILC cells had a CK8/18-positive/CK5/6-negative/SMA-negative staining pattern. Although it is unclear whether both ILC and biphasic epithelial and myoepithelial carcinoma originated from AME or whether ILC occurred independently of malignant AME, this is an exceptionally rare case, which might give rise to a special consideration of the histogenesis of breast cancer.     

RANK expression on breast cancer cells promotes skeletal metastasis

RANK ligand (RANKL), acting through its cognate receptor RANK, is a key factor for bone remodeling and metastasis by regulating the differentiation, survival and activation of osteoclasts. RANKL is also crucial for the development of mouse mammary glands during pregnancy and has been recently linked to the etiology of breast cancer via its direct activity on RANK-expressing normal or transformed breast epithelial cells, leading to increased mitogenesis, enhanced regenerative potential of mammary stem cells, and increased invasion and migration. We demonstrate that higher RANK expression in MDA-MB-231 breast cancer cells (MDA-231-RANK cells) is sufficient to confer a significantly greater metastatic growth rate in the bone compared with MDA-MB-231 cells which do not express high levels of RANK. Blockade of osteoclastic bone resorption, achieved with treatment by either RANKL inhibition or zoledronic acid, did reduce skeletal tumor progression of MDA-231-RANK cells suggesting that the vicious cycle contributes to metastatic growth. However, RANKL inhibition reduced skeletal growth of MDA-231-RANK tumors to a significantly greater extent than zoledronic acid, indicating that skeletal growth of RANK-positive tumors is also driven by direct RANKL effects. RANKL stimulated the expression of multiple genes associated with cell invasive behavior, including several matrix metalloproteinases and other genes previously defined as part of a bone metastasis gene signature. These data indicate that RANKL provokes breast cancer bone metastases via two distinct, but potentially overlapping mechanisms: stimulation of tumor-associated osteoclastogenesis and stimulation of RANK-expressing tumor cells.     

Oncogenic PIK3CA mutations in lobular breast cancer progression

Infiltrating lobular breast cancer (ILBC) is a tumor‐biologically distinct breast cancer subtype. A high frequency of oncogenic PIK3CA mutations has been reported in ILBC, which may allow for targeted therapy with newly developed PI3K inhibitors. This is of particular clinical relevance for ILBC patients, who have failed to respond to current treatment regimes and suffer from tumor recurrence or dissemination. In anticipation of this therapeutic strategy, we investigated PIK3CA mutations in ILBC with special reference to late stage tumor progression. A total of 88 ILBCs from 73 patients, including primary tumors (PTs, n = 43), ipsilateral locally recurrent tumors (LRTs, n = 15), and distant organ metastases (DOMs, n = 30), were compiled on tissue microarrays. Established ILBC marker proteins were evaluated by immunohistochemistry and PIK3CA hot spot mutations in exons 9 and 20 by direct sequencing. Matched PT/LRT, PT/DOM, and DOM/DOM cases were characterized on a patient‐by‐patient basis. Following correction for redundant patient representations, mutation frequencies were compared in PTs versus LRTs or DOMs. Nearly all specimens were E‐cadherin‐negative (99%), estrogen receptor (ER)‐positive (91%), and lacked basal epithelial markers (100%), demonstrating correct ILBC classification. PIK3CA mutations were detected in 32/88 (36%) specimens. The mutation rate was similar in PTs (33%) and DOMs (26%, P = 0.769), but approximately two‐fold increased in LRTs (69%, P = 0.022). Consistently, matched PT/LRT and LRT/DOM cases showed additional PIK3CA mutations in LRTs. Intriguingly, these findings imply that PIK3CA mutations are positively selected for during ILBC progression to local recurrence but not distant metastasis, which may have clinical implications for PI3K inhibitor‐based therapy. © 2012 Wiley Periodicals, Inc.     

Non-receptor tyrosine kinase 2 reaches its lowest expression levels in human breast cancer during regional nodal metastasis

Almost half of breast Ductal Carcinoma in situ are likely to remain non threatening in situ lesions with no invasion to the surrounding stroma and no metastases. The majority of focal disruptions in myoepithelial (ME) cell layers indicative of invasion onset were found to be overlying epithelial cell clusters with no or substantially reduced estrogen receptor α (ERα) expression. Here we report the down-regulation of tyrosine kinase-2 (TYK2) and up-regulation of strumpellin expression, among other proteins in ERα(−) cells located at disrupted ME layers compared to adjacent ERα(+) cells overlying an intact myoepithelial layer. ERα(+) and ERα(−) cells were microdissected from the same in vivo human breast cancer tissues, proteins were extracted and separated utilizing Differential in-Gel Electrophoresis followed by trypsin digestion, MALDI-TOF analysis, and protein identification. Proteins expressed by ERα(−) cell clusters were found to express higher levels of strumpellin that binds to valosin-containing protein (VCP) to slow-down wound closure and promote growth; and lower levels of TYK2, a jak protein necessary for lineage specific differentiation. TYK2 levels were further analyzed by immunohistochemistry in a cohort composed of 70 patients with broad clinical characteristics. TYK2 levels were minimal in TxN1M0 breast cancers which is the stage where the initial regional lymph node metastasis is observed. Our data highlight the role of TYK2 downregulation in breast cancer cell de-differentitation and initiation of regional metastasis. In addition, the aggressiveness of the ERα(−) cell clusters compared to ERα(+) ones present in the same duct of the same patient was confirmed.     

Maspin expression in invasive breast cancer: association with other prognostic factors

Maspin is a unique serine protease inhibitor with a molecular weight of 42 kDa. It has been shown to inhibit tumour cell motility and invasion in cell culture, and tumour growth and metastasis in animal models. There is very limited data on the prognostic utility of maspin in human breast cancer. We performed a preliminary study to assess the associations of maspin with other established prognostic factors in invasive breast cancer (IBC). 1068 paraffin-embedded IBCs were immunohistochemically stained with a monoclonal antibody to maspin. A nuclear signal was present in 96% and a cytoplasmic signal in 35% of the cases. Nuclear staining was related to oestrogen (ER) and progesterone receptor (PR) positivity (p < 0.0001), but not to S-phase fraction (SPF) or ploidy. Cytoplasmic staining was related to ER and PR negativity (p < 0.0001), high SPF (p < 0.0001), and aneuploidy (p = 0.003). Thus, maspin nuclear staining was significantly associated with good prognostic factors, while cytoplasmic staining was associated with poor prognostic markers. These findings suggest that the presence of maspin in two different compartments of the cell may have different biological and clinical implications. Additional studies are needed to evaluate further this expression profile of maspin in breast cancer.     

Paucity of fibronectin in invasive lobular carcinoma of breast

Fifty-four cases of invasive carcinoma of breast were immunostained for fibronectin and laminin. They included 36 cases of invasive ductal carcinoma and 18 cases of invasive lobular carcinoma. Although there was some heterogeneity within tumours, it was found that whilst the majority of ductal carcinomas (31/36) had abundant fibronectin at cell/stroma boundaries or diffusely throughout stroma, a substantial proportion of lobular carcinomas (12/18) had very little (P less than 0.001). This difference could not be related to differences in laminin immunoreactivity, which was most commonly scanty or absent in both tumour types. It is postulated that the characteristic infiltration pattern of lobular carcinoma may be attributed in part to paucity of stromal fibronectin.     

浸润性乳腺癌的细胞学分级:与临床病理指标的关系及其预测淋巴结转移的价值

由于辅助治疗越来越多地成为乳腺癌的最初治疗方法 ,术前的细针穿刺细胞学 (ＦＮＡＣ)对乳腺癌进行分级就倍受关注了。该文提出了一种基于ＦＮＡＣ的浸润性导管癌的半定量分级系统 ,并与已知的预后因子进行了比较。10 4例术前乳腺癌细针穿刺细胞学涂片档案材料均经术后组织病理学证实 ,涂片经常规巴氏染色观察。半定量打分系统由以下 7项参数组成 :坏死、细胞大小、核质比例、核异型性、核仁、染色质颗粒及染色质密度。 1、坏死 :无 (0分 )、有 (1分 )。 2、细胞大小 :<3个红细胞 (1)、3～ 4个红细胞 (2 )、>4个红细胞 (3)。 3、核质比例 :<…