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The authors retrospectively reviewed the cytological slides of 44 histopathologically confirmed fibroepithelial lesions of the breast, of which 11 were fibroadenoma (FA), 19 benign phyllodes tumours (PTLGM), 8 borderline (PTBM) and 6 malignant (PTHGM). The 2 FA misdiagnosed as PTLGM in cytological smears were both of cellular type. NORS were quantified in a series of the above cases using the silver-colloid method. Expression of Ki-67 and PCNA were evaluated by immunohistochemistry on sections from the corresponding paraffin blocks. The results were compared with morphological parameters. In phyllodes tumours (PT), the AgNOR scores showed a tendency to increase with degrees of malignancy. There was significant correlation between AgNOR counts and proliferation rates as determined by Ki-67 and PCNA immunostaining. Ki-67 and PCNA expression correlated with mitotic count, stromal overgrowth, cellularity and atypia in PT. Determination of the AgNOR number per cell revealed an overlap between FA and PTLGM. The proliferating activity determined by immunohistochemistry with Ki-67 and PCNA antibodies did not reveal any significant difference between FA and PTLGM. In summary, Ki-67 and PCNA expression is suggested as a marker of stromal element proliferation. The results obtained confirm the diagnostic difficulties in distinguishing PTLGM from FA of the cellular type using fine needle aspiration cytology.
The activities of six enzymes associated with carbohydrate metabo­lism were measured both in carcinomas and in normal breast tissues. The following differences were observed. 1. The carcinoma showed higher enzyme activities than the normal nummary tissue. 2. The ratios of glutamate dehydrogenase, hydroxybutyrate dehydrogenase, gluta­thione reductase and catalase to lactate dehydrogenase were lower in carcinomas than in normal tissues. Similarly, the ratios of glutamate dehydrogenase, hydroxybutyrate dehydrogenase, glutathione reduc­tase and catalase to glucose-6-phosphate dehydrogenase were also sig­nificantly lower in carcinomas. 3. There were no significant differences in enzyme activities between I and II stage of the disease and the metastatic tissues, however, there were significant differences between I and III stage. The significance of these findings is discussed in terms of the alterations in the balance between the metabolic pathways.
The aim of this study was to use a two-marker assay for the detection of breast can­cer cells circulating in patients' blood. We have applied a PCR-based methodology to follow up the possibility of the development of metastatic disease in stage I and II pa­tients who had undergone curative surgery. Since the number of circulating cancer cells in peripheral blood is very low, the technique for their detection needs to be not only highly sensitive, but also very specific. The reverse transcriptase-polymerase chain reaction (RT-PCR) technique may improve the sensitivity of breast cancer cell detection up to only a few cells per one million. The principle of the RT-PCR assay is to amplify a messenger RNA characteristic for breast epithelial cells in a blood sam­ple. Since we do not expect such cells to be circulating in peripheral blood of healthy subjects, detection of the characteristic mRNA should indicate the presence of circu­lating breast cancer cells. We analyzed the usefulness of three mRNA markers: cytokeratin 19 (CK19), mammaglobin (hMAM) and S subunit of human chorionic gonadotropin (S-hCG) for this test. Blood samples (112) were obtained from 55 patients, in stages I and II, with or without metastasis to regional lymph nodes (N0 or N1). We found that a two-marker assay increases the sensitivity of detection of breast cancer cells in com­parison with a single-marker one. Combination of two tumor-specific mRNA mark­ers, hMAM/CK19 or S-hCG/CK19, allowed the detection of circulating breast cancer cells in 65% of N1 patients and 38% of N0 patients. By comparison, the combination hMAM/-hCG allowed the detection of circulating breast cancer cells in the blood of 68% of N1 patients and 46% of N0 patients. Addition of the third marker did not significantly increase the detection sensitivity.
The sternalis muscle variation is a well-known anatomical situation. It is present in 8.7% of women and 6.4% of men, although the incidence varies according to sex, race and ethnicity. During a left modified radical mastectomy operation on a 46-year-old female patient a sternalis muscle was detected on the pectoralis major muscle in the superficial fascia. It was in craniocaudal position and was parallel to the body of the sternum. The cylindrical muscle was approximately 8 cm in length and 2 cm in diameter. Such variations are considered to have their origin in embryological development. Awareness of muscular variations and their identification is important both for procedure through the proper dissection planes during breast surgery and in radiological examination and follow-up.
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