HighlightsLarge multicentre prospective study involving breast cancer units across the UK.Valuable data collection regarding utilisation of NST in breast cancer treatment.Data on real-world short-term surgical and pathological outcomes.Potentially strengthen the multidisciplinary collaborative network in breast cancer.
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We highlight the need for a high index of suspicion, biopsies at staging laparoscopy and undertake a review of the literature regarding this uncommon condition.
SUMMARYA 70-year-old man presented to the accident and emergency department with a 1-day history of right upper quadrant pain and nausea. Examination revealed mild tenderness in the right upper quadrant but no evidence of peritonism or haemodynamic instability. The patient was admitted to the general surgical ward with a diagnosis of cholecystitis and remained stable overnight. In the morning, he developed acute severe pain in the upper abdomen. Examination found him to be tachycardic, tachypnoeic and to have peritonism in the upper abdomen. An urgent CT scan demonstrated cholecystitis but also a small amount of fluid in the pelvis, with Hounsfield units suggestive of blood. The patient proceeded to laparotomy and was found to have massive haemoperitoneum secondary to intrahepatic gallbladder perforation causing liver capsule tear. Cholecystectomy was performed and the liver packed until haemostasis was achieved. The patient made an uneventful recovery.
BACKGROUND
The human breast is a radiosensitive tissue and radiation exposure is proposed to contribute to mammary gland carcinogenesis through changes to stem and progenitor cells that result in aberrant proliferation, differentiation and genome instability. However, little is known about the low dose radiation response (LD IR) under conditions of relevance to environmental and occupational and medical imaging exposures.
This study utilises 2-D and 3-D breast models derived from two normal breast cell lines (MCF10A and HME1) and primary human mammary epithelial cells from reduction mammoplasty surgery, to investigate the mechanisms underpinning sensitivity of normal breast to LD IR and elucidate its role in breast cancer initiation and progression.
We have shown that DNA damage can be detected in both cell lines after doses <50 mGy and that an increased level of DNA damage foci at 1 h post LD IR is observed in a subpopulation of cells.
Using antibodies to cell surface markers suggested to be putative breast stem cell markers, we have performed Fluoresence Activated Cell Sorting (FACS) to isolate subpopulations from the MCF10A cell line. CD49fhi, EpCAM-, MUC1- cells thought to be progenitor like cells were found to be more resistant to LD IR than the EpCAM+, MUC1+ population.
As the pathways that govern survival/proliferation of stem and progenitor cells versus differentiation are interconnected, we have investigated if radiation resistance is also correlated with changes to breast cell differentiation. It was observed that LD IR modulated breast cell lineage markers in 2D cultures of both cell lines.
We subsequently found that radiation induces a decrease in MUC1 mRNA expression levels which coincides with increased Lef1 expression. Lef1 has been shown to promote Mre11 expression thereby conferring elevated DNA repair and radiation resistance in tumour cells.
Based on our findings, we hypothesize that progenitor cell populations within normal breast cell lines may be more efficient at detecting DNA DSBs resulting from LD IR leading to a pro-survival response. We are currently investigating these effects in primary mammary epithelial cell samples, using FACS to isolate progenitor subpopulations.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-03-14.
Background: Approximately 5-10% of all breast cancers are hereditary and the majority of these arise due to germline mutations in the BRCA1 and BRCA2 tumour suppressor genes. BRCA1 is involved in multiple cellular pathways including DNA damage signalling, DNA repair, cell cycle regulation, protein ubiquitination, chromatin remodelling, transcriptional regulation and apoptosis. Several distinct pathological features can be used to estimate the likelihood of the presence of a BRCA1 mutation, however, it is not yet possible to fully categorise a BRCA1 mutated tumour. BRCA1-associated breast cancers are generally defined as being ER (Estrogen Receptor) negative and indeed triple negative for ER, PR and HER2. However, approximately 10-36% of BRCA1 mutated breast cancers are, in fact, ER positive. These tumours less frequently demonstrate the characteristics more commonly associated with BRCA 1 -associated breast cancers. Initial molecular evidence also suggests that there is heterogeneity within BRCA1-associated breast tumours and this is dependent on the presence or absence of the estrogen receptor. The aims of this study are to investigate the underlying biology of BRCA1-mutated (ER positive) and BRCA1-mutated (ER negative) breast tumours. Methods: Extensive gene expression profiling and data analysis was performed on a cohort of 70 FFPE (Formalin Fixed Paraffin Embedded) derived BRCA1 mutated breast tumours and matched sporadic controls using the ALMAC Breast Cancer DSA™ research tool. Within this dataset we have generated molecular profiles of: (1) BRCA 1 -mutated ER positive and (2) BRCA1-mutated ER negative breast cancer. Functional analysis was performed using DAVID and METACORE. Validation of gene targets was performed by qRT-PCR and Western blotting. Results: A list of differentially expressed transcripts was derived from the comparison of 35 BRCA1 mutant breast tumours and 35 matched sporadic controls. Further analysis based on the presence and absence of ER identified a set of transcripts defining BRCA1-mutated (ER positive) and BRCA1-mutated (ER negative) breast cancer. Functional analysis of these two datasets has identified the main pathways and processes that are deregulated. Specifically, BRCA1-deficiency in the absence of ER was associated with deregulation of pathways implicated in immune response whereas BRCA 1 deficiency in the presence of ER was associated with pathways implicated in cell adhesion and cytoskeletal remodelling. Validation of the key genes underlying these two BRCA1-deficient breast cancer subtypes has been performed.
Discussion: This approach has revealed significant heterogeneity within BRCA1 mutated breast cancer based on the presence or absence of ER. Significant differences in the transcripts and molecular processes underlying BRCA1-mutated (ER positive) and BRCA1-mutated (ER negative) breast tumours have been identified. The ability to identify BRCA 1 -deficiency by gene expression profiling from FFPE derived breast tissue may also have significant clinical application.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-04-14.
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