Radical Mastectomy Specimens Research Articles

EVALUATION OF ROTTER'S LYMPHNODE METASTASIS IN BREAST CANCER

The interpectoral lymph nodes (Rotter's nodes) have a therapeutic importance in radical mastectomy, because these nodes are not completely dissected unless the pectoral major muscle is sacrificed. In our institution, Rotter's nodes were disclosed by hand dissection in 71.4% of 35 recent, consecutive radical mastectomy specimens. The average number of dissected Rotter's nodes was 1.9 per specimen. In recent 109 cases of curative radical mastectomy, ten had metastases to Rotter's nodes, which accounted for 9.2% of all cases and 28.6% of those with axillary node metastasis respectively. In all cases with Rotter's node metastasis, the tumors were larger than 2.1 cm in size by palpation and located in the lateral half of the breast. Metastasis found only in Rotter's nodes occurred in one case (0.9% of all cases). But in the other 9 cases, more than 3 of the axillary lymphnodes were positive for metastasis, and their porgnoses were significantly poor. These reuslts suggest that the dissection of Rotter's nodes might be negligible in a case with a tumor smaller than 2.0cm in size, and that a case with swollen or hardened Rotter's nodes which denotes metastasis should not be a candidate for modified radical mastectomy that preserves the pectoral major muscle.

Signet Ring Cell Sinus Histiocytosis: A Previously Unrecognized Histologic Condition Mimicking Metastatic Adenocarcinoma in Lymph Nodes

The axillary lymph nodes in a radical mastectomy specimen from a 70-year-old insulin-dependent diabetic patient contained significantly vacuolated sinus histiocytes. The histologic picture closely resembled metastatic signet ring cell adenocarcinoma. The signet ring histiocytes did not stain with the mucicarmine or periodic acid-schiff stains or any of the immunohistochemical epithelial markers. The differential diagnosis and the possible origin of these vacuolated histiocytes are discussed.

Nevus Cells in Axillary Lymph Nodes from Radical Mastectomy Specimens

From 1977 to 1983, 44 cases with nevus cells in the capsule and trabeculae of axillary lymph node specimens from about 7000 mastectomies performed for primary breast cancer were found. This finding was therefore less than 1%. In 3 cases, the nevus cells were present in 2 nodes, whereas in 41 cases solitary nodes were involved. In 13 cases, nevus cells were present in nodes that also contained metastatic carcinoma. Silver impregnation of reticulin fibers is very useful for the differential diagnosis of nodal metastases of breast carcinoma.

An improved technique for the study of lymph nodes in surgical specimens.

The importance of the meticulous study by pathologists of the lymph nodes in surgical specimens is emphasized. Most pathologists identify only a small proportion of the lymph nodes in these specimens and valuable prognostic information is lost. Data illustrating the evolution in the Columbia Laboratory of surgical pathology of methods used to study surgical lymph node specimens over a 44-year period (1935--1979) are reviewed. An improved method of clearing the specimens of axillary dissections in radical mastectomy finds more lymph nodes and more metastases, and greatly shortens the time required for clearing. The importance of identifying metastases in the interpectoral nodes is emphasized. In a special study with our new clearing technique metastases were found in the interpectoral nodes in 19% of the radical mastectomy specimens. These nodes are not removed in the modified operation, which does not include resection of the pectoral muscles. The opportunity to cure a substantial proportion of patients is thus lost.

Survival of patients with carcinoma of breast without lymph node metastases in relation to the tumor types

Carcinoma of breast radical mastectomy specimens were examined. The tumors were classified in accordance with their morphologic appearance. The tumors were also graded on the basis of their cytological makeup and assigned a cytologic malignancy score (CMS). While the classification of tumors was based on the overall pattern of the tumor, the CMS was arrived at by examining the least differentiated portion of the tumor. The following conclusions were suggested by the study: Patients with tumors with high CMS have a poor prognosis, even in the absence of axillary lymph node metastases. It appears reasonable to suggest that patients without overt metastases, but with high CMS, should be considered for treatment with all therapeutic measures available. Such an aggressive approach to patients with low CMS does not appear to be justified.

Pathologic findings from the national surgical adjuvant breast project. (Protocol no. 4). III. The significance of extranodal extension of axillary metastases.

One hundred fifty-eight patients with axillary nodal metastases recovered from radical mastectomy specimens for operable, invasive breast cancer were divided into those in whom such metastases were confined within the node and those in whom one or more nodes manifested extranodal extension. The relationships of these patterns to 33 pathologic and seven clinical features of these cases were investigated by contingency table analysis. Statistically significant associations (p less than .05) between extranodal extension of such metastases and short-term treatment failure, as well as the presence of four or more involved nodes, infiltrating ductal NOS histologic tumor type, stellate tumor border, and nipple involvement, were found. When the metastases were confined to the node there was a significantly greater likelihood that the cancers were either medullary or tubular histologic types. Associations with severe cell reaction and a nuclear grade of 1 were also found, but appeared to reflect the high frequency of medullary carcinomas in this group. The results suggest that evaluation of extranodal extension of axillary nodal metastases in patients with breast cancer may represent an important prognostic discriminant.

Pathologic Findings from the National Surgical Adjuvant Breast Project (Protocol No. 4): II. The Significance of Regional Node Histology Other Than Sinus Histiocytosis in Invasive Mammary Cancer

The morphologic appearances of regional lymph nodes in radical mastectomy specimens obtained from 303 women entered into a prospective study of invasive breast cancer were categorized into patterns that have been considered to reflect immunologic function. An attempt was made to correlate these with 31 other histological and 8 clinical features, including short-term treatment failure (3 months to 4 years, average 24 months). No significant relationship to the latter was encountered. However, a lymphocyte predominance pattern was significantly associated with a stellate tumor border, absent cell reaction within the dominant tumor, absent sinus histocytosis of lymph nodes, combination tumor types, and a patient age of 55 years or more. A similar relationship between age of patient and sinus histiocytosis was found with the germinal center predominance pattern. In addition, this histologic appearance was associated with circumscribed tumors, severe cell reaction, and the infiltrating ductal carcinoma NOS and medullary types. Nodes with an unstimulated appearance were also found to be related to an absent cell reaction but marked sinus histiocytosis and a patient age of 45-54 years. Possible reasons for the differences between these findings and those of others relating prognostic value to such assessment of nodal histology is discussed, as are the findings of studies relevant to the identity of immunologic function with the morphologic appearance of nodal structure. The findings from this study fail to indicate any value of such nodal assessments as prognostic discriminants for breast cancer. Although longer periods of observation might alter this conclusion, such an event is regarded as unlikely.

Paracortical alteration in lymphadenopathic and tumor-draining lymph nodes: Histologic study

Histologic studies of 142 enlarged lymph nodes from 124 patients, diagnosed histologically as nonspecific chronic lymphadenitis or reactive hyperplasia, revealed a characteristic nodular alteration in the paracortical area of nodes from the axillary, cervical, and inguinal regions, and rarely in abdominal, mediastinal, and retroperitoneal groups. In 1389 lymph nodes from 100 radical mastectomy specimens similar changes were noted more frequently in the lower than in higher levels of the tumor-draining axillary nodes. The nodule was composed of small lymphocytes associated with postcapillary venules and histiocytes-macrophages. The latter varied in distribution from a scattered pattern resembling a starry-sky appearance in the initial phase of paracortical alteration to the replacement of small lymphocytes in advanced stages. Plasma cells and lymphatic sinuses were characteristically absent from this nodular alteration. An impressive example of such changes was seen in four cases of dermatopathic lymphadenitis. Studies of the paracortical area may provide new insight into the pathogenesis of some lymphadenopathies.

Carcinoma of breast: Influence of size of primary lesion and lymph node involvement based on selective biopsy

Two hundred patients with stage I and II carcinoma of the breast, subjected to selective biopsy of the apex and internal mammary nodes, have been followed for eight years, and 141 of these have been followed for ten years. In fifty-five patients (27.5 per cent) there was involvement of these nodes. In the remaining 145 patients, without involvement, and in whom therefore the primary therapy employed, radical mastectomy with postoperative radiation, could encompass both the local disease and lymph node metastases, ninety-eight patients could be followed up for ten years. The local recurrence rate was 3.1 per cent, although distant metastases subsequently appeared in 26.5 per cent. It is postulated that because no local disease remained as a source from which these distant metastases could have arisen after therapy, they must have been present but occult at the time of therapy. Because only stage I and II disease was included, the only variable with regard to the local tumor was its size, and because the radical mastectomy specimen enabled the axillary nodes to be evaluated, it was possible to correlate size of tumor, lymph node metastases, and the presence of distant metastases at the time of primary therapy. Seventy-one per cent of patients with tumors 5 cm or larger already had extensive disease with metastases to apex or internal mammary nodes or distant metastases. When no lymph nodes were involved, 12.3 per cent of patients had distant metastases, but when one or more nodes were involved, 46.3 per cent had distant metastases. There was no significantly higher incidence of distant metastases with increasing numbers of nodes or for different levels in the axilla. In 48.9 per cent of patients with clinically operable disease, this was already beyond being influenced by the conventional therapy of radical mastectomy. The remainder, free of distant metastases, had local disease which was successfully extirpated by radical mastectomy even though lymph nodes were involved, regardless of their number or level. When local inoperability was established by selective biopsy, 88.4 per cent of patients returned with recurrent disease; 76.7 per cent showed local recurrence despite treatment of the breast and involved lymph nodes by radiation.

Desmolase activity of normal and malignant human breast tissue.

SUMMARY [4-14C]Cholesterol was cleaved to pregnenolone and progesterone by a washed particulate fraction isolated from involved lymph nodes obtained from a radical mastectomy specimen. Difficulties were experienced in isolating subcellular fractions from primary breast tumours and normal breast tissue. However, an acetone powder fraction, obtained from normal tissue derived from a radical mastectomy specimen, yielded pregnenolone from [4-14C]cholesterol. [7α-3H]17α-Hydroxyprogesterone was converted to androstenedione and to 17α,20α-dihydroxypregn-4-en-3-one and its 17α,20β-epimer by homogenates of secondary breast carcinoma tissue and normal breast tissue obtained from radical mastectomy specimens. These results, in conjunction with those obtained previously (Adams & Wong, 1968a), show that human breast carcinoma tissue contains the enzymes necessary to convert cholesterol to androgens and oestrogens.

Prediction of axillary nodal metastases from the morphology of primary mammary carcinomas. Guide to operative therapy.

This study assesses the ability of an experienced surgical pathologist to predict from microscopic examination of primary mammary carcinomas whether axillary metastases existed in the radical mastectomy specimens. Primary mammary carcinomas treated by radical mastectomy from 1956 to 1960 were reexamined and classified by type of cellular growth pattern and by configuration of the neoplastic borders (pushing or infiltrating). The only information available to the pathologist was the size of the primary tumor. The predictions were compared with the microscopic findings in the axillary nodes and with the survival of the patients. The accuracy of predicting axillary nodal metastases did not exceed 70% except when Type I neoplasms existed. The incidences of axillary nodal metastases differed significantly between the less-well-differentiated mammary carcinomas with pushing borders and those with infiltrating borders. However, the incidence of nodal metastases in the former group was high enough to prevent accurate assessment of the status of the axillary nodes from study of the borders of the primary tumors. Survival rates after radical mastectomy correlated with the cellular growth patterns of the primary tumors but not with the character of the tumor borders. The survival rates were adversely affected by the presence of axillary metastases only among those patients treated for the less-well-differentiated Type III and Type IV tumors. Radical mastectomy with axillary dissection but without sacrifice of the pectoral muscles would have removed the tumor-bearing lymph nodes in at least 85 of the 89 Type I and Type II tumors. These tumors constituted over 20% of the mammary caracinomas treated by radical mastectomy in a five-year period. On the basis of this study, a more conservative approach to the Type I and Type II tumors appears to be justified.

Lipogenesis in Human Skin. IV. In Vitro Rate Studies

In previous publications (1, 2) on the synthesis of squalene, cholesterol and fatty acids from acetate-1-C1 * by slices of human skin, the effects of various physical and chemical factors and of body site were evaluated. Freezing, and homogenization of skin completely inhibited lipogenesis. Procain and xylocain caused marked inhibition; an annular field block around a biopsy site was required. Epidermal slices synthesized cholesterol, but sebaceous glands carried the synthesis only as far as squalene. Cholesterol synthesis was constant in all body sites because of the nearly constant thickness of viable epidermis over the entire body. The activity of squalene synthesis was directly proportional to the number and size of sebaceous glands in different body sites.In this paper data have been presented to show the constancy of the rate of synthesis of these lipids in human skin during the 3 hour period of in vitro incubation. But the distribution pattern of the C14 label among individual fatty acids was different from the pattern of pre-formed fatty acids.METHODNormal human skin was obtained mostly from radical mastectomy specimens within an hour after the start of the operation. Skin from other body sites (abdomen) was supplied by general surgeons and (scalp) by plastic surgeons.Preparation of Skin SamplesExperiments with skin were conducted with 8 mm discs of whole skin cut from operative specimens with a cutaneous punch and trimmed of subcutaneous fat. In some experiments subcutaneous adipose tissue was studied separately. Gentleness in handling all specimens was empha-sized. Experiments were begun from 30 to 60 minutes after excision of specimens.Procedure for Incubation of Skin with Labeled Acetate and Recovery of LipidsThe details of this procedure have been reported (1). In brief, one to three discs of whole skin were shaken in one ml of phosphate buffer at 37°C in 100% oxygen for varying periods of time 0/2 to 3 hours). The buffer contained 25 micro-moles of acetate-1-C14 with a radioactivity of 10 or 50 microcuries.For subcutaneous adipose tissue, conditions were changed as follows: the buffer was glucose-bicarbonate, the gas phase 95% oxygen 5% carbon dioxide, and the incubation time 10 to 60 minutes.The labeled lipids were recovered from the tissue by hydrolysis in alcoholic KOH overnight, extraction by appropriate solvents and alumina chromatography. Squalene, sterols and fatty acids were isolated. Radioactivity measurements were made in a scintillation counter and expressed as m/u moles of acetate converted to lipid per gram wet tissue per hour.Gas-Liquid Chromatography of Fatty AcidsA Jarrell-Ash Model 700 Universal Gas Chro-matograph with an Argon Diode ionization detector whose source was tritium foil was used for most of the experiments. A Barber-Colman Series 5000 gas chromatograph with hydrogen flame detector and temperature programmer was available for the most recent experiments. Both instruments gave similar results, although the Barber-Colman produced a crjsper chromatogram because the design of the injection port facilitated direct on-column injection of the sample. Both instruments contained a 9:1 stream spliting device inserted between the column and the detector; only 10% of the column effluent passed through the detector, 90% being diverted to a heated exit port for collection.Satisfactory separation of methyl esters of fatty acids from human skin was obtained with either 15% diethylene glycol succinate on Ana-chrom ABS 100

Evaluation of Rotter's lymph nodes in radical mastectomy specimens as a guide to prognosis

CancerVolume 18, Issue 11 p. 1441-1444 ArticleFree Access Evaluation of Rotter's lymph nodes in radical mastectomy specimens as a guide to prognosis Saul Kay M.D., Saul Kay M.D. Laboratory of Surgical Pathology, Medical College of Virginia, Richmond, Va.Search for more papers by this author Saul Kay M.D., Saul Kay M.D. Laboratory of Surgical Pathology, Medical College of Virginia, Richmond, Va.Search for more papers by this author First published: November 1965 https://doi.org/10.1002/1097-0142(196511)18:11<1441::AID-CNCR2820181110>3.0.CO;2-RCitations: 15AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat References 1 Auchincloss, H.: Significance of location and number of axillary metastases in carcinoma of the breast—A justification for a conservative operation. Ann. Surg. 158: 37– 46, 1963. 2 Berkson, J., Harrington, S. W., Claqett, O. T., Kirklin, J. W., Dockerty, M. B., and McDonald, J. R.: Mortality and survival in surgically treated cancer of the breast—A statistical summary of some experience of the Mayo Clinic. Proc. Staff Mtg. Mayo Clinic 32: 645– 660, 1957. 3 Cutler, M.: Tumors of the Breast Philadelphia, J. B. Lippincott Co., 1962; pp. 252– 253. 4 Haagensen, C. D.: Diseases of the Breast, Philadelphia, W. B. Saunders Co., 1956; pp. 29– 30. 5 Diseases of the Breast: pp. 365– 366. 6 Diseases of the Breast: p. 629. 7 Kay, S., and Poulos, N. G.: Evaluation of the criteria of operability of carcinoma of the breast. Surg. Gynec. Obstet. 113: 562– 666, 1961. 8 Pickren, J. W.: Personal communication. Citing Literature Volume18, Issue11November 1965Pages 1441-1444 ReferencesRelatedInformation

The role of the surgical pathologist in the diagnosis, treatment and prognosis of cancer of the breast: A preliminary report on ninety-five consecutive radical mastectomy specimens

The role of the surgical pathologist in the diagnosis, treatment and prognosis of cancer of the breast: A preliminary report on ninety-five consecutive radical mastectomy specimens