Pathology of Breast Cancer

Summary.-Axillary lymph nodes draining mammary carcinoma showed an alteration of both micro-architecture and lymphocyte subpopulations. Lymph nodes with a normal or increased T and/or B lymphocyte compartment (assessed by histology) had a low incidence of nodal tumour spread, whilst hypocellularity of the T-or Blymphocyte-dependent areas was associated with a significant increase in metastatic invasion. Tumour-draining lymph nodes, in particular the more proximal ones, were often enlarged, spherical and tense due to an increased cellular content, predominantly B lymphocytes and their various subsets. The increased number and percentage of B lymphocytes was associated with follicular hyperplasia and prominent germinal centres. Lymph nodes with a prominent paracortex tended to have a higher ratio of T to B lymphocytes than nodes with a hypocellular paracortical area, but in many instances both the T-and B-lymphocyte-dependent areas were increased. There was no correlation between a particular axillary-node lymphocyte subpopulation pattern (assessed by surface markers) and the size, degree of necrosis, inflammatory infiltrate or histologic type of breast carcinoma, or the presence of metastatic node invasion.

Section: Tumour Histologycontrasting

confidence: 38%

Section: Tumour Histologymentioning

confidence: 99%

Human regional tumour lymph nodes: alterations of micro-architecture and lymphocyte subpopulations

Eremin¹,

Roberts²,

Plumb³

et al. 1980

“…Unfortunately, our new histological assessment differs from the previous one, and argues against a relationship between PGs and tumour spread into vessels. Since pathologists vary in their histological assessment of tumour grade (Delides et al, 1982) and malignant cells in blood vessels (4.7-52%;Fisher et al, 1975;Borah et al, 1980;Weigand et al, 1982), this argument is not settled. Furthermore, perhaps a tumour total PG-LM production of at least 16 ng g-1 aids the dispersion of malignant cells, as judged by the absence of positive bone scans near to the time of surgery in patients whose primary tumours produced very low amounts of total PG-LM.…”

Section: Resultsmentioning

confidence: 99%

Breast cancer, prostaglandins and patient survival

Bennett

Stamford²,

Berstock³

et al. 1989

Summary Prostaglandins may have both undesirable and desirable effects in malignant disease. Their possible roles in breast cancer were studied by examining the relationships between different variables and the amounts of prostaglandin-like material (PG-LM) extracted from 141 breast carcinomas. Univariate analysis indicates a direct correlation with patient age and menopausal status, with a greater yield from cancers of post-compared with pre-menopausal women. Tumours up to 2cm diameter yielded more PG-LM than those measuring >2-5cm. Although there was also a direct correlation with bone metastasis near to the time of surgery, this was because no positive bone scans occurred in patients whose tumours yielded little total PG-LM (<16ng PGE2 equivalents per g tissue). Since tumour PG-LM did not predict later spread to bone, and yields of > 16 ng g -' were similar in the positive and negative bone scan groups, tumour PG-LM appears to be unimportant for skeletal metastasis. There was no obvious relationship of tumour PG-LM to the grade of malignancy, tumour type, amounts of fibrous tissue (and therefore malignant cells), invasion of blood vessels and lymphatics or presence of plasma cells. Multivariate analysis indicates that disease-free survival is longest with an intermediate production of tumour total PG-LM. Of the 82 patients now dead, the cause was attributed to metastatic disease in 69 cases. No relationship of PG-LM to the length of survival was seen with univariate or multivariate analysis. However, when just the post-menopausal patients who died within the first 3 postoperative years were analysed, there was a highly significant inverse correlation between the tumour total PG-LM and the time to death. The reason(s) for these different findings on overall survival compared with just the patients who died are not understood, but the results may indicate that one or more other variables must co-exist with a high tumour PG-LM to hasten death.Many tumours can produce more prostaglandins (PGs) than the normal tissues in which they arise (Bennett, 1979(Bennett, , 1982(Bennett, , 1988. Similarly, more prostglandin-like material (PG-LM), assayed on rat gastric fundus which is most sensitive to PGE2, was extracted from homogenates of human mammary carcinomas than from benign tumours or macroscopically normal breast tissue (Bennet et al., 1977). Various PGs and related substances extracted from breast carcinomas were identified by Stamford et al. (1983) using gas chromatography-mass spectrometry; the products were arachidonate, 12-hydroxy-eicosatetraenoate (12-HETE), thromboxane B2, 15-keto-l 3,14-dihydro-TXB2, 6-keto-PGFJ,, 6,15-diketo-PGF1,,, 615-diketo-1 3,14-dihydro-PGF1,,, PGD2, PGE2 and PGF21,. Quantitative gas chromatography-mass spectrometry showed substantial amounts of 6-keto-PGF, . and some PGD2, PGE2 and PGF20,, with much higher yields of arachidonate (Stamford et al., 1986). It might be expected that these potent substances contribute to breast cancer, but the problem is complex because PGs have numerou...

“…The largest sub-group (65-68%) show no specific characteristics and have been termed carcinoma NOS not otherwise specified (Fisher et al, 1975) or ductal NOS (Dixon et al, 1985). These histological differences have been shown to have important influences upon prognosis (Gallagher, 1984;Dixon et al, 1985).…”

mentioning

confidence: 99%

A comparison of the clinical metastatic patterns of invasive lobular and ductal carcinomas of the breast

Dixon

Ellis²,

Elston³

et al. 1991

Summary Seventy seven patients with metastases from an invasive lobular carcinoma of the breast have been compared with 72 consecutive metastatic ductal carcinomas. There was no difference in the metastatic free interval between the two groups. A distinct pattern of clinical presentation of metastases was seen; hepatic (P = 0.01) and peritoneal metastases (P =0.0003) occurred more commonly in lobular tumours. Bilateral cancers were more common in the lobular group (P = 0.01). No difference was seen in terms of meningeal and pulmonary metastases. Survival after metastases was significantly longer in patients with metastatic lobular carcinoma (P = 0.02).Differences in cell morphology, growth patterns and tissue response allow for the division of invasive adenocarcinomas of the breast into specific types (Gallagher, 1984); infiltrating ductal (80%) and lobular (8-14.7%) carcinomas are the commonest (Martinez & Azzopardi, 1979;Dixon et al., 1982). The largest sub-group (65-68%) show no specific characteristics and have been termed carcinoma NOS not otherwise specified (Fisher et al., 1975) or ductal NOS (Dixon et al., 1985). These histological differences have been shown to have important influences upon prognosis (Gallagher, 1984;Dixon et al., 1985). A study based on clinical and post-mortem material (Harris et al., 1984) showed that lobular carcinoma of the breast had a distinctly different metastatic pattern to that seen in ductal carcinomas: lobular types were associated with carcinomatous meningitis and both peritoneal and retroperitoneal metastases of a diffuse micro-nodular fashion; lung parenchymal metastases were more common with ductal tumours. This series of lobular carcinomas has been studied in an attempt to verify this observation. (Mantel, 1966). Fisher's exact test was used to determine statistical differences between sites of metastases. Patients and methods ResultsThe median age at development of metastases was 56 years (28-72 years) for invasive lobular tumours and 54 years (37-70 years) for ductal carcinomas (not significant); medial follow-up time for both groups was 72 months. The sites of distant metastases as diagnosed clinically are shown in Table I. Hepatic (P = 0.01) and peritoneal (0.0003) metastases were detected significantly more often in lobular carcinomas. The clinical presentation of the 14 lobular peritoneal metastases included: retroperitoneal ureteric obstruction (3), large bowel obstruction and perforation (1), 'linitis plastica' of the stomach (2), small bowel obstruction (3), omental masses (5). The six patients with obstructive/dysphagic symptoms underwent laparotomy, the operative findings in each case being tiny serosal nodules, widespread throughout the bowel. These nodules were confluent at the site of obstruction.No significant difference existed between the two pathological types in terms of skeletal, pulmonary, pleural and cerebral metastases. Eighteen of the 149 patients with metastases developed metachronous contralateral cancers (12%), 14 of these occurred in the ...