[Macro- and microscopic peculiarities of suspensions and smears from scrapings of breast neoplasms].
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By an immunoperoxidase method, lactalbumin was demonstrated in the cytoplasm of epithelial cells of normal breast, primary and metastatic breast carcinomas, and benign breast disease. Lactalbumin was present in 39 of 64 breast carcinomas of different types, including 77% (31) of infiltrating ductal carcinomas and 42% (seven) of infiltrating lobular carcinomas. It also was present in 55% (nine) of metastatic breast carcinomas and in 100% (five) of fibroadenomas. Lactalbumin was not observed in normal tissues and malignant neoplasms of other tissues, indicating that lactalbumin can serve as a specific tissue marker for malignant neoplasms of the breast and their metastases.
We describe a patient with a microangiopathic hemolytic anemia, associated with thrombocytopenia, in consequence of breast cancer in an advanced phase. Microangiopathic hemolytic anemia is a rare and serious compliance of malignant neoplasms, in particular of breast and gastric carcinomas. Microangiopathic hemolytic anemia has always a serious prognosis: survivance in non-treated patients is of a few weeks. Our patient, treated by chemotherapy, has gained a partial remission of MHA, with a reduction of blood transfusions.
Connective tissue changes with particular reference to elastosis in malignant and dysplastic breasts are studied. Hyperelastosis was closely associated with carcinoma particular with scirrhous type also in the perineoplastic area; on the contrary the percentage of the phenomena in benign displastic disease is significantly low. Elastosis was located around carcinomatous tissue, mammary neoplastic ducts and also around veins and as scattered foci in the stroma. The site of production of elastic fibers is discussed. Elastosis accompanying carcinoma is considered more than a simple association but its prognostic significance has not an absolute value.
In 91 patients with advanced breast cancer testololactone, drostanolone, and nandrolone were compared in a controlled clinical trial. Remissions were registered after 4 weeks and after another 12 week period; during this second interval the patients received an additional treatment with cyclophosphamide. There was no difference in the effectivity between the three drugs. Remission rate was in average after 4 weeks 24% and after 16 weeks 46%.
Proliferative activity was studied in 58 breast tumors: 10 benign tumors and 48 carcinomas 41 of which were invasive ductal carcinomas. Combined use of 3 proliferation markers (5-bromo-2-deoxyuridine, nuclear antigen of proliferating cells and Ki-67 antigen) which reflect different phases of mitotic cycle, enable determination of the S-phase index and estimation of the tumor proliferative pool as well as percentage of cells in S-phase and in mitosis and, respectively, relative duration of these phases. In breast carcinoma, S-phase is the longest phase of the mitotic cycle (45% of its duration), mitosis takes 5%. Proliferation indices when all three markers were used carry high positive correlation (r = 0.73-0.94; p < 0.000001). Proliferative activity of breast carcinoma is 5 times higher than in benign tumors and significantly increases in recurrent tumors and with growing histological malignancy of the tumor. A positive correlation exists between proliferative activity of the primary carcinoma and that of metastatic tumor in regional lymph nodes but proliferation in metastasis is, as a rule, less active than in the primary tumors. Antigen Ki-67 is the most optimal among the above proliferation markers because its expression reflects the tumor proliferative pool and its use does not require additional procedures and calculation of proliferating cells is simple and reliable.
A 69-year-old patient treated with anticancer polychemotherapy for metastatic breast carcinoma died of respiratory distress and cardiac failure 3 months after commencement of therapy. At autopsy only a few pleural micrometastases were found. Microscopic study revealed early lung lesions due to cytotoxic drug treatment. While the earlier literature described different lesions associated with different antineoplastic drugs (busulfan, bleomycin), today there is more emphasis on the common pathological features. Therefore, instead of the expressions "busulfan lung" or "bleomycin lung", we suggest the use of the term "Zytostatika-Pneumopathie" (cytostatic drug induced lung disease).
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