Solid-tubular Carcinoma Research Articles

A Case of Solid Tubular Carcinoma of the Breast with Extensive Infarction of the Breast Cancer

A Case of Solid Tubular Carcinoma of the Breast with Extensive Infarction of the Breast Cancer

Characteristics and prognosis of Japanese female breast cancer patients: The BioBank Japan project.

BackgroundBreast cancer is currently the most common type of cancer in Japanese females. Unlike most other types of cancer, breast cancer develops more frequently in middle-aged females than in elderly females.MethodsOf all Japanese female breast cancer patients aged ≥20 years whom the BioBank Japan Project originally enrolled between 2003 and 2008, 2034 were registered within 90 days after their diagnosis. We described the lifestyle and clinical characteristics of these patients at study entry. Furthermore, we examined the effect of these characteristics on all-cause mortality.ResultsIn the female patients registered within 90 days after diagnosis, the frequency of stage 0 or unclassified, stage I, II, III and IV were 11.4%, 47.9%, 37.0%, 2.9% and 0.8%, respectively. The proportion of histological types was 12.9% for non-invasive carcinoma (ductal carcinoma and lobular carcinoma), 81.0% for invasive carcinoma (papillotubular carcinoma, solid tubular carcinoma, scirrhous carcinoma and special types), 0.2% for Paget's diseases and 5.8% for others. Those positive for the estrogen and progesterone receptors accounted for 75.8% and 62.1% of all patients, respectively. Among 1860 female participants registered within 90 days, 218 participants died during 144,54 person-years of follow-up. More advanced stage, elevation of serum carcinoembryonic antigen and carbohydrate antigen 15-3 levels and absence of the estrogen receptor at study entry were crudely associated with an increased risk of all-cause mortality after adjustment for age.ConclusionsThis study showed the association of several clinical characteristics with all-cause mortality in female breast cancer patients.

Computer Aided Detection of Breast Cancer on Ultrasound Imaging Using Deep Learning

Although breast ultrasound imaging is powerful and effective tool to detect breast lesions and have been widely performed worldwide, it is an operator-dependent test, hence the accuracy for detection and diagnosis of breast lesions depend on the operator. We develop a computer-aided detection system for masses in ultrasound image using deep convolutional neural network. A data set containing 818 ultrasound images were collected from our institute. Breast lesions on these images were cropped as 256x256 pixel images manually. All images were flipped horizontally and were collected to make new images. After data augmentation, a total of 2604 images were obtained. These images were labeled and classified by histological tissue type: cyst, concentrated cyst, ductal carcinoma in situ, fibroadenoma, intraductal papilloma, lymph node, invasive lobular carcinoma, mastitis, mastopathic change, mucinous carcinoma, invasive papillotubular carcinoma, phyllodes, tumor, invasive scirrhous carcinoma or invasive solidtubular carcinoma. For training and testing, the data set was randomly divided into a training set and an independent test set with a ratio of 80:20. Classification of data set images were trained using convolutional neural network(CNN) with ten hidden layers including convolutional layers and pooling layers. Its accuracy of classification was evaluated. Data set was also classified as either benign or malignant, and trained using CNN. Its accuracy, sensitivity and specificity were also evaluated. Images were classified as 14 tissue type and trained. The accuracy for classification of each tissue type was 86.9%. Images were classified as either benign or malignant. The accuracy, sensitivity and specificity were 95.4%, 93.2% and 96.4%, respectively. We achieved 95% of accuracy for classification from ultrasound imaging using CNN. Deep learning could potentially help detecting and diagnosing the breast cancer, improving accuracy and productivity of diagnosing breast cancer by physician.

Ki67 Heterogeneity in Estrogen Receptor-Positive Breast Cancers: Which Tumor Type Has the Most Heterogeneity?

Heterogeneity of Ki67 expression, often seen in breast cancer, can make evaluation of the expression of this marker difficult and give rise to confusion when considering adjuvant treatments for patients. Herein, we investigated estrogen receptor-positive breast cancers to reveal the tumor characteristics associated with Ki67 heterogeneity. Surgical specimens from 85 invasive ductal carcinomas of no special type and 13 invasive lobular carcinomas were examined. We first calculated the differences between Ki67 expression in a hot spot and those in 4 random fields on the same slide. We then evaluated Ki67 heterogeneity within the tumor, based on these differences. Among clinicopathological factors, solid-tubular carcinoma, an architectural growth pattern subtype of invasive ductal carcinoma, correlated with high Ki67 heterogeneity (P < .05). Our results indicate that we might need to be aware of histological patterns when selecting appropriate microscopic fields for evaluating Ki67 expression.

Decreased hormonal sensitivity after childbirth rather than the tumor size influences the prognosis of very young breast cancer patients.

PurposeThere is a significant difference in the mean tumor size between very young breast cancer patients and their elder counterparts. A simple comparison may show obvious prognostic differences. We investigated the prognostic impact of age by reducing the influence of the tumor size, which is thought to be a confounding factor.Patients and methodsWe investigated 1,880 consecutive pT1-4N0-3M0 breast cancer patients treated at less than 45 years of age between 1986 and 2002 and conducted a case–control study of breast cancer subjects less than 30 years of age. Each patient (Younger than 30) was matched with a corresponding control subject (Elder counterpart) based on an age 15 years above the patient’s age, a similar tumor size and a status of being within 1 year after surgery. In addition, we assessed 47 patients with pregnancy-associated breast cancer (PABC). The levels of hormone receptors were measured using an enzyme immunoassay (EIA), and receptor-positive cases were divided into “weakly” and “strongly” positive groups based on the median value. Years from the last childbirth (YFLC) was categorized as “recent” and “past” at the time point of 8 years.ResultsThere were fewer past YFLC cases, more partial mastectomy cases, a higher rate of scirrhous carcinoma or solid-tubular carcinoma in the Younger than 30 group than in the Elder counterpart group. The rates of a PgR-negative status in the Younger than 30 and Elder counterpart groups were 45.1 and 29.9%, respectively, As for the relationship between the PgR-negative rate and YFLC, the rates of a PgR-negative status in the past YFLC, nulliparous, recent YFLC and PABC groups were 31.9, 37.7, 44.4 and 65.7%, respectively. On the other hand, the rates of strongly positive cases were 42.6, 30.2, 22.2 and 8.6%, respectively. The 10-year recurrence-free survival rates in the Younger than 30, Elder counterpart and PABC groups were 61.7, 65.6 and 54.1%, respectively. The differences between the groups were not significant. In a multivariate analysis, independent prognostic facers included the number of lymph node metastases (4–9, HR:3.388, 95% CI 1.363–8.425, p = 0.0086, over 10, HR: 6.714, 2.033–22.177, p = 0.0018), solid-tubular carcinoma (HR 3.348, 1.352–8.292, p = 0.0090), scirrhous carcinoma (HR 2.294, 1.013–5.197, p = 0.0465) and past YFLC (HR 0.422, 0.186–0.956, p = 0.0387). An age younger than 30 was not found to be an independent prognostic factor.ConclusionsThe prognosis of the very young women was the same as their elder counterparts with a matched tumor size, and age was not identified to be an independent prognostic factor according to the multivariate analysis. Recent childbirth probably influences the prognosis of patients younger than 30 years of age with breast cancer by lowering hormonal sensitivity.

Telomere shortening in breast cancer correlates with the pathological features of tumor progression.

Telomeres are involved in the maintenance of genomic stability. Telomere alteration has been observed in most human cancer types, and is known to be a feature of malignancy. The aim of the present study was to evaluate whether the telomere length of breast cancer cells correlates with TNM stage and several pathological features. We investigated a total of 44 breast cancers, including 17 scirrhous, 15 papillotubular and 12 solid-tubular carcinomas. Telomere lengths were determined by tissue quantitative fluorescence in situ hybridization (Q-FISH), and compared according to the TNM stage, histological tumor size, lymph node metastases, vascular invasion and immunohistochemical status (ER, PR, HER2 status and Ki67 labeling index). In all histological types, telomeres of cancer cells were significantly shorter than those of normal epithelial cells. Mean telomere length was significantly less in patients with TNM stage III, and in those with large tumors, lymph node metastases and vascular invasion. Our results suggest that the telomere length of cancer cells is strongly correlated with the degree of cancer progression.

扁平上皮癌への分化を伴う充実腺管癌と分泌癌が併存した乳癌の 1 例

背景 : 扁平上皮癌への分化を伴う充実腺管癌と分泌癌が併存した症例を経験したので報告する. 症例 : 80 歳代女性. 右乳房のしこりを主訴に来院. 超音波で “ひょうたん型” の腫瘤がみられ, 針生検が施行された. 針生検捺印標本ならびに LBC 標本を作製した. 捺印標本では粘液を背景に, 重積集塊で出現し, 細胞は境界不明瞭, 核は楕円形の異型細胞を多数認めた. 悪性と判定し, 組織型は粘液癌を疑った. 針生検では, 浸潤性乳管癌と診断した. 後日, 右乳房切除術が施行された. 腫瘤は C 領域に位置し, 約 60% は充実腺管癌, 約 40% は分泌癌の成分が占め, 前者では扁平上皮癌への分化がみられた. 扁平上皮癌への分化を伴う充実腺管癌と分泌癌と診断された. 捺印標本を見直したところ, 複数個の異型細胞が粘液を取り囲む, 粘液小球状構造や印環型細胞, 腺系と扁平上皮系細胞の混在した集塊が認められた. LBC 標本では, 壊死物質とともに, 細胞質がオレンジ G 好染, 核の濃縮した扁平上皮系の異型細胞がみられた. 結論 : 異なる成分からなる乳癌もあるので, 従来法, LBC 法をあわせ慎重に細胞診断することが肝要と思われた.

Detection of Estrogen-Independent Growth-Stimulating Activity in Breast Cancer Tissues: Implication for Tumor Aggressiveness

Estrogen and various growth factors affecting tumor behavior are present in the breast cancer microenvironment, but their comprehensive effects and signal crosstalks are different in each case. However, there is no system to evaluate the factors, detected in individual breast cancer cases, that regulate ER activity and tumor progression. In this study, we analyzed the effects of individual breast cancer extracts by our original system using an estrogen-signal reporter cell line, MCF-7-E10, which we previously established. MCF-7-E10 cell line is stably transfected by an estrogen response element (ERE)-green fluorescent protein (GFP) gene; it expresses GFP when estrogen receptors (ERs) are activated by estrogen or growth factor signal-mediated ER phosphorylation. Using this cell line, we analyzed the comprehensive effects of factors derived from breast cancer tissues on ER activity and growth of MCF-7-E10 cells for each case. We also analyzed relationships between these activities and clinicopathologic characteristics of patients who provided cancer specimens. The breast cancer extracts, which reflect the combined activities of growth factors present in individual cases, stimulated MCF-7-E10 cell growth in an estrogen-independent manner, and specifically stimulated growth of other breast cancer cell lines, regardless of ER expression. High growth-promoting activities were seen in tumor regions of specimens with tumors > 10 mm in size, HER2 intrinsic subtype, and scirrhous and solid-tubular carcinoma histological subtypes. Anti-human hepatocyte growth factor (HGF) antibody and an inhibitor for insulin-like growth factor-1 (IGF-1) receptor inhibited MCF-7-E10 cell growth by the breast cancer extracts, indicating that signal pathways via HGF or IGF-1 receptor significantly affect breast cancer. These data suggest that growth factors other than estrogen in the tumor extract significantly affect breast cancer aggressiveness in an estrogen-independent manner, and could be useful therapeutic targets.

Thymic metastasis of breast cancer 22 years after surgery: A case report

We report a rare case of thymic metastasis of breast cancer. A 68-year-old woman, who had undergone surgery for cancer in her right breast and had been free of recurrence for 22 years, was noted to have an abnormal shadow on a chest X-ray at a regular medical checkup. Further workup, including chest CT, revealed a 22 × 18-mm mass in the anterior mediastinum. Fluorine-18-fluorodeoxyglucose-PET showed increased fluorine-18-fluorodeoxyglucose uptake that was highly suggestive of thymoma. Thoracoscopic thymothymectomy was performed. The tumor had invaded the pericardium, which was also resected. A small nodule was found in the right lung, and it was also resected. The intraoperative frozen-section diagnosis was breast cancer metastasis to the thymus and lung. The pathological diagnosis was luminal A solid tubular carcinoma (strongly estrogen receptor and progesterone receptor positive, HER2 negative) with an MIB-1 index of less than 5%. After surgery, the patient was treated with an aromatase inhibitor. As of August 2013, she has been free of recurrence for more than 36 months. It is extremely rare for breast cancer to metastasize to the thymus more than 20 years after surgery.

Characteristics of the Japanese histological classification for breast cancer: correlations with imaging and cytology

The Japanese histological classification of breast cancer is a unique classification that was published as the 2nd edition of the General Rules for Clinical and Pathological Recording of Breast Cancer in 1971. According to this classification, breast cancers are divided into three subgroups: noninvasive, invasive, and Paget's disease. Invasive carcinomas are further divided into two groups: invasive ductal carcinomas (IDCs) and special types. IDCs are the most common types, representing 70-80% of all breast cancers, and most of them correspond to invasive carcinoma-not special type-according to the latest WHO classification (4th edition). In particular, IDCs are subdivided into three subgroups as follows: (1) papillotubular carcinoma, which is characterized by the projection of papillae into spaces, and includes cribriform and comedo patterns; (2) solid-tubular carcinoma, which is a solid cluster of cancer cells with expansive growths that form relatively sharp borders; and (3) scirrhous carcinoma, which grows in a scirrhous manner characterized by cancer nests or cells accompanied by marked fibrosis. The concept of subclassification originated in Japan. The Japanese histological classification has taken on important roles since its publication, in particular for comparisons between histology and imaging or cytology.

Representation of lesion similarity by use of multidimensional scaling for breast masses on mammograms.

Presentation of similar reference images can be useful for diagnosis of new lesions. A similarity map which can visually present the overview of the relationship between the lesions with different types may provide the supplemental information to the reference images. A new method for constructing the similarity map by multidimensional scaling (MDS) for breast masses on mammograms was investigated. Nine pathologic types were included; three regions of interests each from the nine groups were employed in this study. Subjective similarity ratings by expert readers were obtained for all possible 351 pairs of masses. Using the average ratings, MDS similarity map was created. Each axis of the MDS configuration was fitted by the linear model with 13 image features to reconstruct the similarity map. Dissimilarity based on the distance in the reconstructed space was determined and compared with the subjective rating. The MDS map consistently represented the similarity between cysts and fibroadenomas, invasive lobular carcinomas and scirrhous carcinomas, and ductal carcinomas in situ, solid-tubular carcinomas, and papillotubular carcinomas with the experts' data. The correlation between the average subjective ratings and the dissimilarities based on the distance in the reconstructed feature space was much greater (-0.87) than that of the dissimilarities based on the distance in the conventional feature space (-0.65). The new similarity map by MDS can be useful for visualizing the relationship between breast masses with different pathologic types. It has potential usefulness in selecting the similarity measures and providing the supplemental information.

HER2-positive recurrent breast cancer and metastases of breast cancer, including life-threatening metastases to the brain and dura mater: a case effectively treated with lapatinib plus capecitabine before whole brain radiotherapy

Lapatinib is a new small molecule tyrosine kinase inhibitor. It targets both ErbB1 and ErbB2 (HER2) receptors and directly and reversibly acts on them to inhibit signaling. Since lapatinib has a low molecular weight, it can cross the blood–brain barrier. Thus, there is much interest in its potential effectiveness against brain metastases. Our patient was a 57-year-old postmenopausal woman with a non-contributory medical history. In September 2006, she underwent a partial mastectomy and axillary dissection for right breast cancer. Pathological diagnosis was solid-tubular carcinoma, n+ (6/23), nuclear grade 3, ly1, v0, ER+, PgR−, and HER2 3+ (pT1cN2aM0-stageIIIA). Adjuvant chemotherapy consisted of 6 cycles of epirubicin and cyclophosphamide (EC) and subsequent oral anastrozole. In May 2009, the patient developed choroidal, lung, liver, bone, and lymph node metastases. She underwent radiation therapy (choroids 40 Gy and cervical vertebrae 40 Gy), and the oral drug was changed to high-dose toremifene. In July 2009, the patient developed headache, vomiting, and seizures. MRI revealed multiple brain metastases and dura mater metastases. Administration of glycerol and steroid was begun. In addition, administration of lapatinib (1,250 mg/body, daily) plus capecitabine (2,000 mg/m2, day 1–14, every 3 weeks) was begun for treatment of brain and systemic metastatic lesions. Neurological symptoms improved on day 14. In January 2010, examinations revealed partial response of all metastatic lesions, including brain metastases. The patients continued the same treatment but exhibited progressive disease in March 2010. Thus, the treatment was discontinued as per the patient’s request. In May 2010, the patient developed generalized seizures again and underwent whole brain radiotherapy (30 Gy). However, the patient’s general condition gradually deteriorated and the patient died in June 2010.

Anticancer drug sensitivity testing using an oxygen electrode apparatus

Conventional anticancer drug sensitivity testing methods, such as succinate dehydrogenase inhibition (SDI), histoculture drug-response assay (HDRA) and collagen gel droplet embedded culture drug sensitivity testing (CD-DST), all require primary culturing and are extremely complex tests that require considerable time for analysis. A major drawback of these methods is that if culturing is not performed properly, ambiguous results are produced. Therefore, we developed an oxygen electrode apparatus that uses cellular metabolism as an indicator of anticancer drug sensitivity and investigated its usefulness in 29 breast cancer patients with the following histopathological classifications: papillotubular carcinoma (n= 15); solid tubular carcinoma (n= 6); and scirrhous carcinoma (n= 8). Comparison of anticancer drug sensitivity testing results obtained using the conventional HDRA method and those obtained using the oxygen electrode apparatus showed significant reproducibility between the two methods. In addition, similar anticancer drug sensitivity testing results using the oxygen electrode apparatus were obtained for in vivo testing of nude mice transplanted with established cancer cell lines. These findings suggest that the oxygen electrode apparatus is a useful procedure in anticancer drug sensitivity testing that provides better reproducibility and that is faster, more convenient, and less expensive than other testing methods.

Common and discriminative clinicopathological features between breast cancers with pathological complete response or progressive disease in response to neoadjuvant chemotherapy

To clarify clinicopathological similarities and differences between breast carcinomas that achieve pathological complete response (pCR) to neoadjuvant chemotherapy (NAC) and those showing progressive disease (PD) during NAC, we compared pre-NAC clinicopathological characteristics between these tumors. Subjects comprised 32 patients (6%) achieved pCR and 33 patients (7%) showed PD of 494 patients (498 breasts) with stage II or III breast carcinoma who underwent anthracycline-based or taxane chemotherapy or both, followed by surgery, between 2000 and 2006. We compared patient characteristics before NAC, and histomorphology, immunohistochemistry, and molecular subtypes of tumors using pre-NAC biopsy samples. Immunohistochemistry included estrogen receptor (ER), progesterone receptor (PgR), human epidermal growth factor receptor-2 (HER2), epidermal growth factor receptor (EGFR), cytokeratin 5/6 (CK5/6). Molecular subtypes were defined by ER, PgR, HER2, EGFR, and CK5/6. We compared these factors between pCR and PD using univariate chi (2) testing and multivariate logistic regression analyses. No significant differences between groups were seen regarding NAC regimens. Solid-tubular carcinoma (53% of pCR, 61% of PD), histological grade 3 (78% of pCR, 79% of PD), ER-status (91% of pCR, 82% of PD), and basal-like subtype (44% of pCR, 58% of PD) were often observed in both groups. In multivariate analyses, lower clinical N stage at diagnosis (P = 0.004) and HER2/ER-PgR- subtype (P = 0.020) were significantly associated with pCR. Breast carcinomas achieving pCR or showing PD with NAC have common peculiar characteristics such as solid-tubular carcinoma, high grade, hormone receptor negativity, and basal-like subtype. Conversely, discriminative factors include clinical N stage at diagnosis and HER2/ER-PgR- subtype.

Clinicopathological characteristics of triple-negative breast cancers

Triple-negative breast cancer (TNBC) is defined as a group of breast carcinomas that are negative for expression of hormone receptors and HER2. Although patients with TNBC tend to have a poor prognosis, only chemotherapy is expected to be effective because no therapeutic targets have yet been established. DNA microarray analyses have proved that TNBCs are composed of the basal-like subtype and normal breast (or unclassified) subtype, the former being correlated with an aggressive clinical course. Histological types of TNBCs are reported to be common with those of basal-like subtype, comprising high-grade invasive ductal carcinoma, no special type [solid-tubular carcinoma (or atypical medullary carcinoma), invasive ductal carcinoma with a large central acellular zone], typical medullary carcinoma, and metaplastic carcinomas. The basal-like subtype is characterized by the expression of myoepithelial/basal markers and molecular changes including TP53 gene mutations, BRCA1 inactivation, and many chromosomal alterations. New target molecules for the treatment of TNBCs are under extensive investigation, and their clinical application is awaited.

Therapeutic strategies for breast cancer based on histological type

Breast cancer has various histological types that reflect not only morphological features but also biological characteristics. Therefore, it is not an exaggeration to say that breast cancers of different histological types are different diseases. It is generally accepted that the histological types of breast cancer are clinically significant because they serve as prognosticators and as the common language for improving the accuracy of clinical diagnosis. It is necessary to diagnose breast cancer at the level of not only histological findings by needle biopsy, but also the histologic type based on diagnostic imaging and cytological diagnosis. From the viewpoint of treatment, preoperative drug therapy is being performed more frequently to shrink tumors before breast-conserving therapy or to determine treatment sensitivity. The prognosis is favorable for patients who respond completely or patients in whom interstitial infiltration is completely eliminated histopathologically, and, as a result, it is important to assess therapeutic efficacy clinically and pathologically. Past experience has shed some light on differentiating cancers responsive to drug therapy from those unresponsive to drug therapy, as well as differentiating cancers in which therapeutic efficacy can be easily ascertained from those in which therapeutic efficacy cannot be easily ascertained. Preoperative drug therapy can be planned by making a histological diagnosis based on needle biopsy findings. Preoperative drug therapy is not indicated for noninvasive carcinoma and papillotubular carcinoma (invasive carcinoma with predominant intraductal components). While complete loss of interstitial infiltration can be expected with solid-tubular carcinoma, it cannot be expected with other histological types, such as invasive lobular carcinoma, adenoid cystic carcinoma, or metaplastic carcinoma (squamous-cell carcinoma and spindle-cell carcinoma). On therapeutic response assessment, the clinical and pathological findings generally match for solid-tubular carcinoma but not for scirrhous carcinoma and invasive lobular carcinoma. With mucinous carcinoma, mucus accumulation can remain, even though most cancer cells disappear; as a result, assessment based on tumor diameter changes is difficult. Histological diagnosis is also significant from the viewpoint of drug sensitivity, and it is important to maintain the accuracy of histological diagnosis.

Clinicopathological analyses of triple negative breast cancer using surveillance data from the Registration Committee of the Japanese Breast Cancer Society

Triple negative (TN) breast cancer is defined as a subtype that is negative for estrogen receptor (ER), progesterone receptor (PgR), and human epidermal growth factor receptor 2 (HER2). To clarify the characteristics of TN breast cancer, surveillance data of the Registration Committee of the Japanese Breast Cancer Society were analyzed. Of 14,748 cases registered in 2004, 11,705 (79.4%) were examined for ER, PgR, and HER2. Of these, the most prevalent (53.8%) was a hormone-responsive subtype with ER positive/PgR positive/HER2 negative, followed by TN subtype (15.5%). The proportion of postmenopausal patients was relatively high in the TN subtype. This cancer was diagnosed at a slightly advanced stage and with more cases positive for lymph node metastases than other subtypes. Morphologically, the TN subtype was more frequently classified as solid-tubular carcinoma. Mucinous, tubular, or secretary carcinomas were frequently found in the hormone receptor positive/HER2 negative subtype, while squamous cell carcinoma, spindle cell carcinoma, and metaplastic carcinoma with bone/cartilage metaplasia were very frequently found in the TN group. Apocrine carcinoma was also found very frequently in the TN group. Selection of chemotherapy was not based on receptor subtypes, but was determined by the degree of tumor progression. Although TN types are similar to basal-like breast tumor, as determined by gene profiling, their diagnosis needs verification by determination of the level of epidermal growth factor receptor or cytokeratin 5/6 expression. TN type should be examined further for immunohistochemical features and analyzed for prognostic details in this cohort.

Histological features of breast cancer, highly sensitive to chemotherapy

To establish tailor-made therapy for breast cancer, we investigated the possibility of predicting chemotherapy sensitive cases based on pre-therapeutic histological features. A total of 87 breast cancer patients underwent neoadjuvant chemotherapy with a paclitaxel (80 mg/m(2)/q1w, 12 courses)or an epirubicin regimen (90 mg/m(2)/q3wks, 4 courses). We investigated the chemo-sensitivity of invasive ductal carcinoma, solid-tubular carcinoma consisting of highly malignant cancer cells with many mitoses. We refer to this type of carcinoma as " chemo-sensitive carcinoma " and compared the histological therapeutic effects of chemo-sensitive and chemo-insensitive carcinomas. 1) Out of 87 patients, 20 cases (23%) showed the histological features of chemo-sensitive carcinomas on pre-therapeutic needle biopsy specimens. The remaining 67 cases (77%) were classified as chemo-insensitive carcinoma. 2) Histologically marked or complete response were observed in 50% (10/20) of chemo-sensitive carcinomas and 10% (7/67) of chemo-insensitive carcinomas (chi(2)=15.33, p=0.0001). Multivariate analysis of chemo-sensitive carcinoma, including HER2, hormone receptor and p53 status, revealed that chemo-sensitive carcinoma had a significant correlation with the histological therapeutic effects (p=0.01119). 3) Pathological complete response (pCR) was achieved in 35% (7/20) of chemo-sensitive carcinomas and 1.5% (1/67)of chemo-insensitive carcinomas (chi(2)=20.71, p<0.0001). Multivariate analysis revealed that chemo-sensitive carcinoma had a significant correlation with pCR (p=0.0091). The histological features of chemo-sensitive carcinoma were significant predictive factors for chemotherapeutic efficacy.

Clinicopathologic significance of an immunohistochemical expression of p27 in scirrhous carcinoma of the breast

Scirrhous carcinoma has been known to have more aggressive biological behavior than other histologic subtypes of invasive ductal carcinoma of the breast. The significance of expression of p27kip1, which is thought to be a tumor suppressor gene, in breast carcinoma remains controversial. The aim of the current study was to clarify clinicopathologic significance of scirrhous carcinoma of the breast with special reference to p27 expression. Clinicopathologic features including immunohistochemical expression of p27 were compared between scirrhous carcinoma (n=42) and non-scirrhous invasive ductal carcinoma (papillotubular and solid-tubular carcinoma, n=63) of the breast. The proportion of pathologic lymph node metastasis among scirrhous carcinomas was significantly higher than that among carcinomas of other histologic types (papillotubular or solid-tubular carcinomas, p=0.029). The proportion of strong expression of p27 among scirrhous carcinomas was significantly lower than that among tumors of other histologic types (p<0.0001). Biological behavior of scirrhous carcinoma was found to be aggressive. The aggressiveness and poor cellular differentiation of scirrhous carcinoma of the breast might be related to low p27 expression.

Clinical and Pathologic Features of Fibroadenoma of the Mastopathic Type

Fibroadenoma with mastopathic change (FAM) is a relatively uncommon subtype of fibroadenoma of the breast, with a high incidence of pathological misdiagnosis. This histological subtype remains poorly understood because of its rarity. Many questions remain unanswered about its clinicopathological importance, especially in the differential diagnosis of breast cancers. Among 218 breast fibroadenomas surgically resected as excisional biopsies at our institute between 1990 and 2004, 19 were pathologically diagnosed as FAM. We reviewed these 19 patients. The ages of the patients ranged from 20 to 51 years (mean 36.8 years). The tumor sizes ranged from 0.8 to 7 cm (mean 2.1 cm). Six of the 19 patients underwent core needle biopsy, resulting in a diagnosis of fibroadenoma in four patients and atypical ductal hyperplasia in two patients. Ultrasonography showed findings suggestive of solid tubular carcinoma in seven patients, fibroadenoma in ten patients, and unspecific malignant tumors in two. They were not specified clinically. Recognition of this distinctive variant of fibroadenoma is important because it resembles intraductal carcinoma and is increasing in incidence. It is crucial to distinguish FAM from intraductal carcinoma in biopsy specimens. Thus, not only pathologists but also clinicians must be able to recognize this type of fibroadenoma, and cooperate closely to establish an accurate diagnosis.