DOCSLIB.ORG

Molecular Markers in Ductal Carcinoma in Situ of the Breast

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Molecular Markers in Ductal Carcinoma in Situ of the Breast 362 Vol. 1, 362–375, March 2003 Molecular Cancer Research Molecular Markers in Ductal Carcinoma in Situ of the Breast Dale Porter,1,6 Jaana Lahti-Domenici,1 Aparna Keshaviah,2 Young Kyung Bae,8 Pedram Argani,8 Jeffrey Marks,10 Andrea Richardson,3,6 Amiel Cooper,4 Robert Strausberg,9 Gregory J. Riggins,10 Stuart Schnitt,5 Edward Gabrielson,8 Rebecca Gelman,2,7 and Kornelia Polyak1,6 1Departments of Medical Oncology and 2Biostatistics, Dana-Farber Cancer Institute, Boston, MA; 3Department of Pathology, Brigham and Women’s Hospital, Boston, MA; 4Department of Pathology, Faulkner and Brigham and Women’s Hospital, Boston, MA; 5Department of Pathology, Beth-Israel Deaconess Medical Center, Boston, MA; 6Harvard Medical School and 7Harvard School of Public Health, Boston, MA; 8Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD; 9National Cancer Institute, Bethesda, MD; and 10Department of Pathology, Duke University Medical Center, Durham, NC Abstract DCIS may provide insight into their initiation and progression, Gene expression patterns in ductal carcinoma in situ but very little is known about DCIS at the molecular level. (DCIS), and in invasive, and metastatic breast tumors Current classification of DCIS is based on cytological and were determined using serial analysis of gene architectural features. Some studies have demonstrated a expression (SAGE). We used mRNA in situ hybridization correlation between these features, particularly nuclear to examine gene expression at the cellular level and grade and the presence of comedo necrosis, and clinical immunohistochemistry on tissue microarrays to behavior (1–3). In general, high nuclear grade and comedo determine association between gene expression DCIS are associated with high rate of local recurrence, while patterns and histopathologic characteristics of the low-grade non-comedo tumors have low recurrence rates (4). tumors. We found that that the most dramatic However, classification based on histological features can be transcriptome change occurs at the normal to DCIS determined only with moderate consistency and is complicated transition, while there is no clear universal ‘‘in situ’’ or by intratumoral heterogeneity. Moreover, none of these features ‘‘invasive’’ tumor molecular signature. From the 16,430 is able to predict the risk of progression to invasive disease transcripts analyzed, we identified only 5 and 11 that accurately. Therefore, the molecular characterization of DCIS were preferentially up-regulated in DCIS and invasive with the aim of identifying biologically and potentially tumors, respectively. The majority of invasive cancer clinically meaningful subgroups is of utmost importance. specific SAGE tags correspond to novel genes. The Comprehensive gene expression profiling has proven useful genes we identified may define biologically and clinically for the molecular classification of invasive breast tumors, but meaningful subgroups of DCIS with a high risk of no such extensive study has been performed in DCIS largely progression to invasive disease. due to technical difficulties with obtaining DCIS samples suitable for RNA-based analysis (5, 6). Our laboratory uses Introduction serial analysis of gene expression (SAGE) to identify genes Ductal carcinoma in situ (DCIS) of the breast includes a implicated in breast tumorigenesis (7–9). SAGE requires a heterogeneous group of preinvasive breast tumors with a wide relatively small amount of tissue (50,000 cells or less) for the range of malignant potential. Some DCIS, if untreated, will generation of comprehensive expression profiles without the rapidly progress to invasive cancer, while others will change requirement for RNA/cDNA amplification steps; thus, it is very little in 5–20 years. DCIS now represents a significant particularly well suited for the analysis of small, preinvasive (up to 25%) fraction of newly diagnosed breast cancer cases, tumors (10). Although SAGE allows the quantitative measure- yet the clinical management of DCIS patients is still ment of the mRNA levels of thousands of genes simultaneously controversial. The major challenge is to reliably determine the in one specimen, to establish how frequently an emerging risk of local recurrence and progression to invasive disease, and candidate gene is differentially expressed, it is necessary to to treat patients accordingly. Understanding the pathobiology of examine hundreds of breast specimens. The recently developed tissue microarray technology allows rapid profiling of hundreds of specimens on one slide and is therefore ideally suited for the further evaluation of candidate genes emerging from SAGE Received 12/2/02; revised 2/10/03; accepted 2/13/03. analysis (11, 12). The costs of publication of this article were defrayed in part by the payment of Here we report that based on SAGE analyses of breast page charges. This article must therefore be hereby marked advertisement in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. tumors of different histopathologic stages, we identified several Grant support: National Cancer Institute Cancer Genome Anatomy Project and transcripts that belong to one of the following groups: up- or Specialized Program in Research Excellence in Breast Cancer at Dana-Farber/ down-regulated in breast cancer regardless of stage; preferen- Harvard Cancer Center (CA89393) and Johns Hopkins University (CA88843); Department of Defense Breast Cancer Center of Excellence Grants. tially up-regulated in DCIS; or in invasive carcinomas. The Requests for reprints: Kornelia Polyak, Dana-Farber Cancer Institute, 44 Binney expression of 14 genes was confirmed at the cellular level by St. D740C, Boston, MA 02115. Phone: (617) 632-2106; Fax: (617) 632-4005. E-mail: [email protected] mRNA in situ hybridization using a panel of frozen DCIS and Copyright D 2003 American Association for Cancer Research. invasive breast tumors. Tissue microarrays composed of Downloaded from mcr.aacrjournals.org on September 24, 2021. © 2003 American Association for Cancer Research. Molecular Cancer Research 363 primary breast cancers of different pathological stages were and Methods’’). On the basis of these analyses, we found that used to explore the potential clinical usefulness of 10 genes by the expression of CD74 and a SAGE tag (CTGGGCGCCC) investigating their relationship to histopathologic features of the with no database match were significantly more abundant in tumors and patient outcome. invasive or metastatic tumors than in DCIS (P = 0.02 and P = 0.05, respectively, Table 3). The expression of MGC2328, DCD, and eight other genes was also more likely to occur in Results invasive/metastatic tumors than in DCIS, but none of these Normal and Cancerous Breast Transcriptomes reached statistical significance (Table 3). Similarly, the Genes differentially expressed between normal and cancer- expression of S100A7 and keratin 19 (KRT19) was more ous breast tissues were identified using SAGE. Confirming our frequent and at higher levels in DCIS than in invasive/ previous report using a limited set of SAGE libraries (8), we metastatic tumors, but this was also only marginally statistically found that the most dramatic difference in gene expression significant. In a second statistical analysis, receiver operating patterns occurs at the normal to in situ carcinoma transition and characteristic (ROC) curve analysis was used to choose the it involves the uniform down-regulation of 34 genes (Table 1). ‘‘best’’ cutoff for values that result in the most samples being Because many of these genes encode secreted proteins and correctly classified as DCIS or invasive, weighing both kinds of genes related to epithelial cell differentiation, loss of the misclassification equally (Table 3). Tags that do not include differentiated epithelial phenotype and abnormal autocrine/ 0.50 in the CI might be potentially useful for the differential paracrine interactions appear to play an essential role in the diagnosis of in situ and invasive carcinomas. This includes all initiation of breast tumorigenesis. We also identified 144 genes the tags that had P 0.13 using the higher of two normal up-regulated in a fraction of in situ and invasive or metastatic cutoffs as well as three other high in DCIS tags and three other tumors (Table 2). Nearly one-fourth of these SAGE tags high in invasive tags (Table 3). Using the best cutoff values, currently have no database match, indicating that many several of the SAGE tags correctly classified most of the DCIS transcripts specifically expressed in certain breast carcinomas and invasive SAGE libraries. For example, KRT19 classified remain to be identified. To delineate overall similarities and 75% of the DCIS and 0% of the invasive libraries as DCIS, differences among samples, the 19 SAGE libraries were while MGC23280 identified 78% of the invasive cancer and analyzed by hierarchical clustering (Fig. 1A). A dendogram 0% of the DCIS libraries as invasive. Thus, MGC23280 had created using this program revealed that the two normal 78% sensitivity and 100% specificity to correctly categorize samples (N1 and N2) and primary invasive tumors and lymph breast tumors as DCIS or invasive/metastatic in this data set. node metastases (I1 and LN1, and I2 and LN2) derived from the Next we selected 26 genes for further validation studies that same patients were most similar to each other. In situ and appeared to be the most highly differentially expressed between invasive tumors and metastases
Load more

Recommended publications
  • Genetic Markers in Lung Cancer Diagnosis: a Review
    International Journal of Molecular Sciences Review Genetic Markers in Lung Cancer Diagnosis: A Review Katarzyna Wadowska 1 , Iwona Bil-Lula 1 , Łukasz Trembecki 2,3 and Mariola Sliwi´ ´nska-Mosso´n 1,* 1 Department of Medical Laboratory Diagnostics, Division of Clinical Chemistry and Laboratory Haematology, Wroclaw Medical University, 50-556 Wroclaw, Poland; [email protected] (K.W.); [email protected] (I.B.-L.) 2 Department of Radiation Oncology, Lower Silesian Oncology Center, 53-413 Wroclaw, Poland; [email protected] 3 Department of Oncology, Faculty of Medicine, Wroclaw Medical University, 53-413 Wroclaw, Poland * Correspondence: [email protected]; Tel.: +48-71-784-06-30 Received: 1 June 2020; Accepted: 25 June 2020; Published: 27 June 2020 Abstract: Lung cancer is the most often diagnosed cancer in the world and the most frequent cause of cancer death. The prognosis for lung cancer is relatively poor and 75% of patients are diagnosed at its advanced stage. The currently used diagnostic tools are not sensitive enough and do not enable diagnosis at the early stage of the disease. Therefore, searching for new methods of early and accurate diagnosis of lung cancer is crucial for its effective treatment. Lung cancer is the result of multistage carcinogenesis with gradually increasing genetic and epigenetic changes. Screening for the characteristic genetic markers could enable the diagnosis of lung cancer at its early stage. The aim of this review was the summarization of both the preclinical and clinical approaches in the genetic diagnostics of lung cancer. The advancement of molecular strategies and analytic platforms makes it possible to analyze the genome changes leading to cancer development—i.e., the potential biomarkers of lung cancer.
    [Show full text]
  • DCIS): Pathological Features, Differential Diagnosis, Prognostic Factors and Specimen Evaluation
    Modern Pathology (2010) 23, S8–S13 S8 & 2010 USCAP, Inc. All rights reserved 0893-3952/10 $32.00 Ductal carcinoma in situ (DCIS): pathological features, differential diagnosis, prognostic factors and specimen evaluation Sarah E Pinder Breast Research Pathology, Research Oncology, Division of Cancer Studies, King’s College London, Guy’s Hospital, London, UK Ductal carcinoma in situ (DCIS) is a heterogeneous, unicentric precursor of invasive breast cancer, which is frequently identified through mammographic breast screening programs. The lesion can cause particular difficulties for specimen handling in the laboratory and typically requires even more diligent macroscopic assessment and sampling than invasive disease. Pitfalls and tips for macroscopic handling, microscopic diagnosis and assessment, including determination of prognostic factors, such as cytonuclear grade, presence or absence of necrosis, size of the lesion and distance to margins are described. All should be routinely included in histopathology reports of this disease; in order not to omit these clinically relevant details, synoptic reports, such as that produced by the College of American Pathologists are recommended. No biomarkers have been convincingly shown, and validated, to predict the behavior of DCIS till date. Modern Pathology (2010) 23, S8–S13; doi:10.1038/modpathol.2010.40 Keywords: ductal carcinoma in situ (DCIS); breast cancer; histopathology; prognostic factors Ductal carcinoma in situ (DCIS) is a malignant, lesions, a good cosmetic result can be obtained by clonal proliferation of cells growing within the wide local excision. Recurrence of DCIS generally basement membrane-bound structures of the breast occurs at the site of previous excision and it is and with no evidence of invasion into surrounding therefore better regarded as residual disease, as stroma.
    [Show full text]
  • Understanding Ductal Carcinoma in Situ (DCIS)
    Understanding ductal carcinoma in situ (DCIS) and deciding about treatment Understanding ductal carcinoma in situ (DCIS) and deciding about treatment Developed by National Breast and Ovarian Cancer Centre Funded by the Australian Government Department of Health and Ageing Understanding ductal carcinoma in situ Contents Acknowledgements .........................................................................................2 How to use this resource ..............................................................................3 Introduction ...........................................................................................................4 Why do I need treatment for DCIS? .........................................................5 Surgery ......................................................................................................................7 Radiotherapy ......................................................................................................11 What is the risk of developing invasive breast cancer or Understanding ductal carcinoma in situ (DCIS) and deciding about treatment was prepared and produced by: DCIS after treatment? ....................................................................................12 National Breast and Ovarian Cancer Centre What follow-up will I need? .......................................................................17 Level 1 Suite 103/355 Crown Street Surry Hills NSW 2010 How can I get more emotional support? .........................................18 Locked Bag 3
    [Show full text]
  • Surgical Management of Brain Tumors
    SURGICAL MANAGEMENT OF BRAIN TUMORS JASSIN M. JOURIA, MD DR. JASSIN M. JOURIA IS A MEDICAL DOCTOR, PROFESSOR OF ACADEMIC MEDICINE, AND MEDICAL AUTHOR. HE GRADUATED FROM ROSS UNIVERSITY SCHOOL OF MEDICINE AND HAS COMPLETED HIS CLINICAL CLERKSHIP TRAINING IN VARIOUS TEACHING HOSPITALS THROUGHOUT NEW YORK, INCLUDING KING’S COUNTY HOSPITAL CENTER AND BROOKDALE MEDICAL CENTER, AMONG OTHERS. DR. JOURIA HAS PASSED ALL USMLE MEDICAL BOARD EXAMS, AND HAS SERVED AS A TEST PREP TUTOR AND INSTRUCTOR FOR KAPLAN. HE HAS DEVELOPED SEVERAL MEDICAL COURSES AND CURRICULA FOR A VARIETY OF EDUCATIONAL INSTITUTIONS. DR. JOURIA HAS ALSO SERVED ON MULTIPLE LEVELS IN THE ACADEMIC FIELD INCLUDING FACULTY MEMBER AND DEPARTMENT CHAIR. DR. JOURIA CONTINUES TO SERVES AS A SUBJECT MATTER EXPERT FOR SEVERAL CONTINUING EDUCATION ORGANIZATIONS COVERING MULTIPLE BASIC MEDICAL SCIENCES. HE HAS ALSO DEVELOPED SEVERAL CONTINUING MEDICAL EDUCATION COURSES COVERING VARIOUS TOPICS IN CLINICAL MEDICINE. RECENTLY, DR. JOURIA HAS BEEN CONTRACTED BY THE UNIVERSITY OF MIAMI/JACKSON MEMORIAL HOSPITAL’S DEPARTMENT OF SURGERY TO DEVELOP AN E- MODULE TRAINING SERIES FOR TRAUMA PATIENT MANAGEMENT. DR. JOURIA IS CURRENTLY AUTHORING AN ACADEMIC TEXTBOOK ON HUMAN ANATOMY & PHYSIOLOGY. Abstract The field of brain tumor research, diagnosis, and treatment is rapidly evolving. Over 120 types of brain tumors have been identified to date, and that number continues to increase. As the information available about brain tumors grows, so does the ability to target screening and therapies to provide patients with optimal outcomes. It is critical that health clinicians understand the surgical and treatment options in order to educate patients and to develop a care plan that has a positive outcome while respecting the patient's needs and desires.
    [Show full text]
  • Full Text (PDF)
    Published OnlineFirst April 1, 2014; DOI: 10.1158/1940-6207.CAPR-13-0362 Cancer Prevention Research Article Research Inhibition of the Transition of Ductal Carcinoma In Situ to Invasive Ductal Carcinoma by a Gemini Vitamin D Analog Joseph Wahler1, Jae Young So1, Yeoun Chan Kim1, Fang Liu1,2,3, Hubert Maehr1, Milan Uskokovic1, and Nanjoo Suh1,3 Abstract Ductal carcinoma in situ (DCIS) is a nonmalignant lesion of the breast with the potential to progress to invasive ductal carcinoma (IDC). The disappearance and breakdown of the myoepithelial cell layer and basement membrane in DCIS have been identified as major events in the development of breast cancer. The MCF10DCIS.com cell line is a well-established model, which recapitulates the progression of breast cancer from DCIS to IDC. We have previously reported that a novel Gemini vitamin D analog, 1a,25-dihydroxy- 20R-21(3-hydroxy-3-deuteromethyl-4,4,4-trideuterobutyl)-23-yne-26,27-hexafluoro-cholecalciferol (BXL0124) is a potent inhibitor of the growth of MCF10DCIS.com xenografted tumors without hypercal- cemic toxicity. In this study, we utilized the MCF10DCIS.com in vivo model to assess the effects of BXL0124 on breast cancer progression from weeks 1 to 4. Upon DCIS progression to IDC from weeks 3 to 4, tumors lost the myoepithelial cell layer and basement membrane as shown by immunofluorescence staining with smooth muscle actin and laminin 5, respectively. Administration of BXL0124 maintained the critical myoepithelial cell layer as well as basement membrane, and animals treated with BXL0124 showed a 43% reduction in tumor volume by week 4.
    [Show full text]
  • Consensus Guideline on the Management of the Axilla in Patients with Invasive/In-Situ Breast Cancer
    - Official Statement - Consensus Guideline on the Management of the Axilla in Patients With Invasive/In-Situ Breast Cancer Purpose To outline the management of the axilla for patients with invasive and in-situ breast cancer. Associated ASBrS Guidelines or Quality Measures 1. Performance and Practice Guidelines for Sentinel Lymph Node Biopsy in Breast Cancer Patients – Revised November 25, 2014 2. Performance and Practice Guidelines for Axillary Lymph Node Dissection in Breast Cancer Patients – Approved November 25, 2014 3. Quality Measure: Sentinel Lymph Node Biopsy for Invasive Breast Cancer – Approved November 4, 2010 4. Prior Position Statement: Management of the Axilla in Patients With Invasive Breast Cancer – Approved August 31, 2011 Methods A literature review inclusive of recent randomized controlled trials evaluating the use of sentinel lymph node surgery and axillary lymph node dissection for invasive and in-situ breast cancer as well as the pathologic review of sentinel lymph nodes and indications for axillary radiation was performed. This is not a complete systematic review but rather, a comprehensive review of recent relevant literature. A focused review of non-randomized controlled trials was then performed to develop consensus guidance on management of the axilla in scenarios where randomized controlled trials data is lacking. The ASBrS Research Committee developed a consensus document, which was reviewed and approved by the ASBrS Board of Directors. Summary of Data Reviewed Recommendations Based on Randomized Controlled
    [Show full text]
  • EAU Guidelines on the Diagnosis and Treatment of Urothelial Carcinoma in Situ Adrian P.M
    European Urology European Urology 48 (2005) 363–371 EAU Guidelines EAU Guidelines on the Diagnosis and Treatment of Urothelial Carcinoma in Situ Adrian P.M. van der Meijdena,*, Richard Sylvesterb, Willem Oosterlinckc, Eduardo Solsonad, Andreas Boehlee, Bernard Lobelf, Erkki Rintalag for the EAU Working Party on Non Muscle Invasive Bladder Cancer aDepartment of Urology, Jeroen Bosch Hospital, Nieuwstraat 34, 5211 NL ’s-Hertogenbosch, The Netherlands bEORTC Data Center, Brussels, Belgium cDepartment of Urology, University Hospital Ghent, Ghent, Belgium dDepartment of Urology, Instituto Valenciano de Oncologia, Valencia, Spain eDepartment of Urology, Helios Agnes Karll Hospital, Bad Schwartau, Germany fDepartment of Urology, Hopital Ponchaillou, Rennes, France gDepartment of Urology, Helsinki University Hospital, Helsinki, Finland Accepted 13 May 2005 Available online 13 June 2005 Abstract Objectives: On behalf of the European Association of Urology (EAU), guidelines for the diagnosis, therapy and follow-up of patients with urothelial carcinoma in situ (CIS) have been established. Method: The recommendations in these guidelines are based on a recent comprehensive overview and meta-analysis in which two panel members have been involved (RS and AVDM). A systematic literature search was conducted using Medline, the US Physicians’ Data Query (PDQ), the Cochrane Central Register of Controlled Trials, and reference lists in trial publications and review articles. Results: Recommendations are provided for the diagnosis, conservative and radical surgical treatment, and follow- up of patients with CIS. Levels of evidence are influenced by the lack of large randomized trials in the treatment of CIS. # 2005 Elsevier B.V. All rights reserved. Keywords: Bladder cancer; Carcinoma in situ; Bacillus Calmette-Guerin; Chemotherapy; Diagnosis; Treatment; Follow up 1.
    [Show full text]
  • Carcinoma in Situ
    JPAC 13-65 Joint UKBTS Professional Advisory Committee (1) Summary Sheet 1. Paper for the JPAC meeting on: 14 November 2013 2. Date submitted: 31 October 2013 3. Title (including version no.): Carcinoma in Situ 4. Author(s): Dr Sue Barnes, Chair of the SAC on Care and Selection of Donors 5. Brief summary: The DSG allows the acceptance of a very limited number of donors diagnosed, treated and cured and only non- clonal premalignant disease. BSQR 2005 allows acceptance of donors with ‘in situ cancer with complete recovery’. The WHO recommends acceptance if ‘in situ carcinoma (e.g. BCC) has been successfully treated. The CoE recommends the donor may be accepted immediately after successful removal and cure. We are thus recommending a change to the current DSG entry for Malignancy to allow a wider range of carcinomas in situ to be accepted once cured and to clarify the position re premalignant conditions. 6. Action required by the JPAC: Discuss and approve recommendation (What do you want JPAC to do in response to this paper?) e.g. endorse a specific recommendation advise where there is a choice of possible actions advise on priorities within the work plan provide a steer on policy 7. Any other relevant information: (1) Joint United Kingdom Blood Transfusion Services Professional Advisory Committee Page 1 of 5 JPAC 13-65 Carcinoma in situ Background Carcinoma in situ (CIS) is an early form of cancer that is defined by the absence of invasion of tumor cells into the surrounding tissue, usually before penetration through the basement membrane.
    [Show full text]
  • Carcinoma, Carcinoma in Situ, and €Œearlylesions―Of the Uterine
    [CANCER RESEARCH 36. 2482-2484, July 1976] Carcinoma, Carcinoma in Situ, and “EarlyLesions―ofthe Uterine Cervix and the Urinary Bladder: Introduction and Definitions1 Gilbert H. Friedell Departments of Pathology, St. Vincent Hospital and University of Massachusetts Medical School, Worcester, Massachusetts 01610 At the outset of this combined session on “earlylesions― evident before calling the lesion cancer. Others have ac of the uterine cervix and the urinary bladder, I should like to cepted the terminological paradox of a ‘‘noninvasive propose some definitions as a basis for the discussions to cancer' ‘andhave used ‘‘superficialcarcinoma―or “carci follow. First of all, however, I would remind you how the noma in situ―when the markedly abnormal epithelium does pathologist gives meaningful names to morphological en not appear to penetrate the basement membrane when tities. Basically, there are 3 phases to naming such an en seen with the light microscope. I prefer the term carcinoma tity. in situ, and use the following definition. First, the pathologist applies a descriptive term to the Carcinoma in situ is epithelium that has the histological lesion so that all who hear the term or see it in print will features characteristic of cancer, but is noninvasive. It is know what the entity looks like. It is best if the term carries related in space or in time to the presence of carcinoma, with it neither pathogenetic nor prognostic implications, and will, if untreated, progress to carcinoma of the same since only a purely descriptive designation is appropriate at histological type in a significantly high percentage of cases.
    [Show full text]
  • Vulvar Cancer Causes, Risk Factors, and Prevention Risk Factors For
    cancer.org | 1.800.227.2345 Vulvar Cancer Causes, Risk Factors, and Prevention Risk Factors A risk factor is anything that affects your chance of getting a disease such as cancer. Learn more about the risk factors for vulvar cancer. ● Risk Factors for Vulvar Cancer ● What Causes Vulvar Cancer? Prevention There is no way to completely prevent cancer. But there are things you can do that might lower your risk. Learn more. ● Can Vulvar Cancer Be Prevented? Risk Factors for Vulvar Cancer A risk factor is anything that changes a person's chance of getting a disease such as cancer. Different cancers have different risk factors. For example, exposing skin to strong sunlight is a risk factor for skin cancer. Smoking is a risk factor for many cancers. There are different kinds of risk factors. Some, such as your age or race, can’t be 1 ____________________________________________________________________________________American Cancer Society cancer.org | 1.800.227.2345 changed. Others may be related to personal choices such as smoking, drinking, or diet. Some factors influence risk more than others. But risk factors don't tell us everything. Having a risk factor, or even several, does not mean that a person will get the disease. Also, not having any risk factors doesn't mean that you won't get it, either. Although several risk factors increase the odds of developing vulvar cancer, most women with these risks do not develop it. And some women who don’t have any apparent risk factors develop vulvar cancer. When a woman develops vulvar cancer, it is usually not possible to say with certainty that a particular risk factor was the cause.
    [Show full text]
  • Predictors of Invasion and Axillary Lymph Node Metastasis in Patients with a Core Biopsy Diagnosis of Ductal Carcinoma in Situ: an Analysis of 255 Cases
    ORIGINAL ARTICLE Predictors of Invasion and Axillary Lymph Node Metastasis in Patients with a Core Biopsy Diagnosis of Ductal Carcinoma In Situ: An Analysis of 255 Cases Jeong S. Han, MD, PhD, Kyle H. Molberg, MD and Venetia Sarode, MD Department of Pathology, The University of Texas Southwestern Medical Center, Dallas, Texas n Abstract: The diagnosis of ductal carcinoma in situ (DCIS) using core biopsy does not ensure the absence of invasion on final excision. We performed a retrospective analysis of 255 patients with DCIS who had subsequent excision. Clinical, radiologic, and pathologic findings were correlated with risk of invasion and sentinel lymph node (SLN) metastasis. Of 255 patients with DCIS, 199 had definitive surgery and 52 (26%) had invasive ductal carcinoma (IDC) on final excision. Extent of abnormal microcalcification on mammography, and presence of a radiologic ⁄ palpable mass and solid type of DCIS were significantly associated with invasion on final excision. Sentinel lymph node biopsy was performed in 131 (65.8%) patients of whom 18 (13.4%) had metastasis. Size of IDC and extent of DCIS on final pathology were significantly associated with positive SLN. Micrometastasis and isolated tumor cells comprised majority (71.4%) of the metastases in DCIS. SLN biopsy should be considered in those with high risk DCIS. n Key Words: Ductal carcinoma in situ, invasion, metastasis, sentinel lymph node biopsy uctal carcinoma in situ (DCIS) is a clonal prolif- require additional surgery, and accurate SLN mapping Deration of malignant cells confined to the ductal- could be compromised. On the other hand, for the lobular units without invading the periductal stroma.
    [Show full text]
  • Case Report Vaginal Primary Malignant Melanoma Complicating Cervical Carcinoma in Situ: a Case Report and Review of Literature
    Int J Clin Exp Pathol 2016;9(4):4555-4559 www.ijcep.com /ISSN:1936-2625/IJCEP0021903 Case Report Vaginal primary malignant melanoma complicating cervical carcinoma in situ: a case report and review of literature Fei-Fei Liu1, Quan Tian1, Yan Xue1, Mei-Li Pei1, Chun-Bao Wang2, Rui-Fang An1 Departments of 1Gynecology and Obstetrics, 2Pathology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shanxi, P. R. China Received December 14, 2015; Accepted February 25, 2016; Epub April 1, 2016; Published April 15, 2016 Abstract: Vaginal primary malignant melanoma (VPMM) is a rare and extremely aggressive tumor. Because of hid- den location and lack of early symptoms, it usually develops at advanced stage and has very high mortality rate. Moreover, the etiology of this tumor is largely unknown. Therefore, it is important for improving prognosis to early diagnosis of VPMM. In the present study, we describe a 35-year-old female patient who was diagnosed as VPMM combined with CIN3 before any report not mentioned. The patient presented to our hospital with abnormal vaginal bleeding of 2 months. Preoperative colposcopic-directed biopsy and physical examination suggested malignant le- sions occurred in the upper third of anterior vaginal wall. Then a wide local excision of the lesion was first performed. Postoperative pathological results confirmed and metastasis to left internal iliac lymphnodes. She underwent adju- vant radiotherapy and immunotherapy as further therapeutic measures. Although the patient could not complete a cycle due to intolerable toxicity of immunotherapy, she is still alive 14 months after diagnose. Keywords: VPMM, etiology, treatment, surgery, radiotherapy Introduction cm diameter in the upper third of anterior vagi- nal wall.
    [Show full text]