Positioning of necrotic lobular intraepithelial neoplasias (LIN,grade 3) within the sequence of breast carcinoma progression

Lobular intraepithelial neoplasia Grade 3 (LIN3) is a recently recognized variant of intraepithelial lobular neoplasia (LIN) of the breast composed of either uniform, generally small cells with massive lobular distension, pleomorphic cells, signet‐ring cells, or any cell type with necrosis. In contrast to classic forms of LIN, there is no consensus on therapeutic strategies for LIN3. In part this is due to the paucity of molecular data that could assist in defining the relationship of LIN3 to classic LIN and carcinomas. In this study we have employed array comparative genomic hybridization to determine the patterns of chromosomal aberrations in nine LIN3 lesions. By comparison to array CGH data of 13 classic LIN lesions, we demonstrate that classic LIN and LIN3 share several recurrent changes, in particular gains of 1q and losses of 16q. Both aberrations are known to appear early in tumorigenesis and to be associated with good prognosis. However, apart from this overlap, there were a number of karyotypic features that were observed exclusively in LIN3. Clearly, this lesion was characterized by a significantly higher number of DNA copy number changes (9 vs. 31 on average), a considerable complexity of chromosomal rearrangements with more than 16 breakpoints in one chromosome and overlapping high copy amplifications encompassing a number of known oncogenes. Our data suggest that, at the genetic level, LIN3 represents a highly advanced lesion with considerable resemblance to carcinomas and, therefore, might represent the transition state from an intraepithelial neoplasm to breast carcinoma. © 2010 Wiley‐Liss, Inc.     

Discrepancies in the diagnosis of intraductal proliferative lesions of the breast and its management implications: results of a multinational survey

To measure discrepancies in diagnoses and recommendations impacting management of proliferative lesions of the breast, a questionnaire of five problem scenarios was distributed among over 300 practicing pathologists. Of the 230 respondents, 56.5% considered a partial cribriform proliferation within a duct adjacent to unequivocal ductal carcinoma in situ (DCIS) as atypical ductal hyperplasia (ADH), 37.7% of whom recommended reexcision if it were at a resection margin. Of the 43.5% who diagnosed the partially involved duct as DCIS, 28.0% would not recommend reexcision if the lesion were at a margin. When only five ducts had a partial cribriform proliferation, 35.7% considered it as DCIS, while if ≥20 ducts were so involved, this figure rose to 60.4%. When one duct with a complete cribriform pattern measured 0.5, 1.5, or 4 mm, a diagnosis of DCIS was made by 22.6, 31.3, and 94.8%, respectively. When multiple ducts with flat epithelial atypia were at a margin, 20.9% recommended reexcision. Much of these discrepancies arise from the artificial separation of ADH and low-grade DCIS and emphasize the need for combining these two under the umbrella designation of ductal intraepithelial neoplasia grade 1 (DIN 1) to diminish the impact of different terminologies applied to biologically similar lesions.     

Anemia of spaceflight

A consistent deficit in the red cell mass has been observed during both the American and Soviet orbital space flights and is sometimes referred to as "astronaut anemia." This may be associated with a reduction in plasma volume so that the hematocrit and the hemoglobin concentration remain unchanged. During the Gemini program, the hypobaric hyperoxic atmosphere of the spacecraft led to oxidative injury to the red cells, causing hemolysis. Thus, the atmosphere proved to be, in part, responsible for the deficit. However, a similar deficit of a lesser magnitude was again observed in subsequent flights with normal ambient PO2 as well as in the Soviet flights in which an atmosphere essentially of see level air is used. The cause of this deficit seems to be suppression of erythropoiesis, as indicated by reticulocytopenia and erythroid hypoplasia of the marrow. No suppression of erythropoiesis has been observed in ground-based experiments carried out under almost identical conditions. Thus, the suppression of erythropoiesis is thought to be related to weightlessness. The reason for the suppression is not known but may be related to total inhibition of bone formation.     

Social determinants and health‐related dimensions of quality of life in adult patients with haemophilia

The availability of safe and effective factor replacement therapies, in persons with haemophilia (PWH), has in some countries answered the basic need for treatment of these patients. The findings suggest that adult patients who have always been on prophylaxis reported significantly better physical functioning, and thus better quality of life. This study is designed to evaluate the QoL in adult PWH, by focusing on social determinants of QoL and their relationship with health‐related dimensions, in Tabriz, Iran. The survey instrument was a self‐report 36 items questionnaire, ‘A36 Hemofilia – QoL’, which is a disease‐specific questionnaire for the assessment of the health‐related QoL in adults living with haemophilia. A total of 100 haemophilia A and B patients, aged over 17 years participated in this study within 1 year. QoL total score was 71.88 (±26.89 SD). Patients who treat in our Hemophilia Treatment Center, had better QoL score (P = 0.000), and education has a significant impact on the social aspects of QoL (P = 0.18). The QoL was very poor in urban area in contrast to patients who lived in the city (54.45 vs. 74.21 respectively). Single patients have a better QoL than married patients (76.56 vs. 68.50 respectively). Our results showed that low education and lack of awareness of the diseases among PWH lead to reduce of QoL and more disease complications. More and wider treatment and psychological care for improving quality of life of these patients are seriously recommended.     

Absence of Tight Junctions in Endothelium of Marrow Sinuses: Possible Significance for Marrow Cell Egress

The nature of contact between endothelial cells in rat marrow sinuses was studied. Colloidal lanthanum permeated freely into the interendothelial space. Moreover, using freeze-fracture technique, we failed to show junctional structures where these endothelial cells came into contact. With thin sectioning electron microscopy, we observed occasional submembranous densities but the interendothelial distance measured 20 nm and no membrane fusion was seen. Absence of tight junctions between endothelial cells of marrow sinuses may serve a function in marrow cell egress by permitting these cells to slide over each other, thereby changing the luminal size. Within the fixed volume of marrow, an increase in luminal size results in displacement of haemopoietic cells into the lumen.     

Molecular basis of the recognition of intravenously transplanted hemopoietic cells by bone marrow.

Bone marrow transplantation is done by introducing a source of hemopoietic stem cells into general circulation in anticipation of their recognition and selective lodging into the bone marrow. We tested the hypothesis that the molecular basis of this recognition is by means of a lectin-carbohydrate interaction. We synthesized a number of neoglycoproteins by covalently binding pyranose derivatives of various monosaccharides to bovine serum albumin (BSA). These reagents and the galactosyl-terminating glycoprotein asialofetuin were used to inhibit engraftment of intravenously transplanted marrow cells into lethally irradiated mice. In splenectomized mice, in whom engraftment occurs only in the bone marrow, galactosyl-BSA, mannosyl-BSA, and asialofetuin but not fucosyl-BSA inhibited homing of transplanted cells. Both the survival and cellular content of marrow, including hemopoietic stem cells and granulocyte-macrophage progenitors, were reduced. In nonsplenectomized mice, in whom engraftment occurs in both spleen and marrow, the reagents did not inhibit splenic homing. Both the survival and cellular content of spleen, including hemopoietic stem cells and granulocyte-macrophage progenitors, were similar to those of the control group. But even in this group, marrow homing of transplanted cells was inhibited by these reagents. We conclude that the recognition and homing of intravenously transplanted hemopoietic cells by marrow, but not by spleen, occurs by means of a recognition system with galactosyl and mannosyl specificities.     

Brain metastasis from ovarian cancer: a systematic review

This topic review discusses the evolving clinical challenges associated with the implementation of electronic personal health records (PHR) that are fully integrated with electronic medical records (EMR). The benefits of facilitating patient access to the EMR through web-based, PHR-portals may be substantial; foremost is the potential to enhance the flow of information between patient and healthcare practitioner. The benefits of improved communication and transparency of care are presumed to be a reduction in clinical errors, increased quality of care, better patient-management of disease, and better disease and symptom comprehension. Yet PHR databases allow patients open access to newly-acquired clinical data without the benefit of concurrent expert clinical interpretation, and therefore may create the potential for greater patient distress and uncertainty. With specific attention to neuro-oncology patients, this review focuses on the developing conflicts and consequences associated with the use of a PHR that parallels data acquisition of the EMR in real-time. We conclude with a discussion of recommendations for implementing fully-integrated PHR for neuro-oncology patients.     

Structural analysis of hemopoiesis in S1/S1d anemic mice.

This study is an ultrastructural analysis of hemopoiesis in S1/S1d anemic mice. The anemia in this strain is caused by a defect in hemopoietic microenvironment which fails to support hemopoiesis. Marrow cellularity is reduced and vascular channels are dilated. Coverage of sinus endothelium by adventitial cells is nearly twice as in normal mice, suggesting a reduced rate of cell traffic into the circulation. Central macrophages are small with little or no interdigitation with erythroid cells and no crystalloid inclusions as seen in normal littermates. The findings suggest that a fundamental abnormality in the central macrophage may be responsible for the defect in hemopoietic microenvironment.     

Granular cell tumor. Clinical spectrum of the benign and malignant entity

The clinical records of all patients with granular cell tumor seen at our institution over a 20-year period were reviewed. Three patients with malignant, and 37 with benign tumor, were identified. Eleven patients had multiple benign lesions. Three had a history of familial occurrence. Clinical and pathologic features and the management of this nebulous entity, in both its benign and malignant forms, are reviewed and discussed.