Impact of an Extensive in Situ Component on the Presence of Residual Disease in Screen Detected Breast Cancer

This study investigates the histopathological characteristics of a consecutive series of 100 screen detected breast cancers in relation to residual disease. Tumour type, size, grade, resection margins and extent of primary or associated in situ disease were all assessed by one pathologist. Thirty-seven women underwent further surgery (wider excision or mastectomy) and the resected specimen was examined for residual in situ or invasive cancer.

In total, 36 cancers had an extensive in situ component, of which 69% were predominantly intra-duct carcinoma of comedo type. Of the 37 women who underwent further resection, 21 (57%) women had residual cancer. Of those with initial disease at the resection margin, 16/25 (64%) had residual disease. Five of 12 (42%) with disease close to (within 2–3 mm) but not at the margin had residual disease. Of those with an extensive in situ component, 18/25 (72%) had residual disease, whereas only 2/12 (17%) women with none or some in situ disease had residual cancer.

In screen detected breast cancer, residual cancer was present in 72% of women with an extensive in situ component at initial surgery. These women comprise a group in whom conservation surgery may be inappropriate if completeness of excision is considered a prerequisite for breast conserving surgery.

Hormonal modulation of plant growth: the role of auxin perception

The organisation of growth and development in vascular plants appears to be highly adapted to meet the specific demands of a sessile, autotrophic habit. Many of the characteristic features of plant development are associated with the activities of five groups of phytohormones. Each of the phytohormones has the ability to influence fundamentally a remarkable variety of developmental and physiological processes. This ability has been widely documented but remains to be explained. Here we describe how recent breakthroughs in the analysis and understanding of eucaryotic signal transduction are being applied, in conjunction with technical advances in molecular genetics, to elucidate the molecular basis of the phytohormonal properties of auxin. Both auxin concentration, and the sensitivity of plant cells to this phytohormone have been implicated as important parameters in auxin action. We describe recent molecular biological approaches to assess the contribution made by each of these parameters. Emphasis is given to a description of recent genetic and biochemical progress towards identification of the molecular targets of the auxin signal and the molecular components involved in its subsequent transduction.

An evaluation of the preoperative diagnosis and management of cystosarcoma phyllodes

Cystosarcoma phyllodes is a rare tumour of the breast which is notoriously difficult to diagnose accurately preoperatively. In this review we report the clinical, imaging and histopathological features of 20 patients who have presented in our Centre over a 10-year period.

Caregivers and elderly relatives. The prevalence of caregiving in a family practice

Persons 65 years and older are the most rapidly growing age group in the United States. As age increases, functional ability deteriorates and the need for help from another person escalates. Caring for elderly persons experiencing functional deterioration is stressful, creating hidden patients among caregivers. This study surveyed randomly selected active family practice patients 40 years and older to determine the prevalence and extent of the caregiving role and functional disability among elderly relatives. One in five patients (126/602) surveyed had caregiving responsibilities for noninstitutionalized relatives (total, 153 patients). One third of caregivers lived with the relative; most of the remaining two thirds visited their relative at least twice weekly. Caregivers reported some functional impairment in 60% of their relatives, and substantial impairment in 40%. The caregiving experience is common, and the potential for stress from managing an elderly relative's disability is substantial. Further research is needed to elaborate on the burden of the caregiver.

The lateral diffusion of lipid probes in the surface membrane of Schistosoma mansoni

The technique of fluorescence recovery after photobleaching was used to measure the lateral diffusion of fluorescent lipid analogues in the surface membrane of Schistosoma mansoni. Our data reveal that although some lipids could diffuse freely others exhibited restricted lateral diffusion. Quenching of lipid fluorescence by a non-permeant quencher, trypan blue, showed that there was an asymmetric distribution of lipids across the double bilayer of mature parasites. Those lipids that diffused freely were found to reside mainly in the external monolayer of the outer membrane whereas lipids with restricted lateral diffusion were located mainly in one or more of the monolayers beneath the external monolayer. Formation of surface membrane blebs allowed us to measure the lateral diffusion of lipids in the membrane without the influence of underlying cytoskeletal structures. The restricted diffusion found on the normal surface membrane of mature parasites was found to be released in membrane blebs. Quenching of fluorescent lipids on blebs indicated that all probes were present almost entirely in the external monolayer. Juvenile worms exhibited lower lateral diffusion coefficients than mature parasites: in addition, the lipids partitioned into the external monolayer. The results are discussed in terms of membrane organization, cytoskeletal contacts, and biological significance.

Primary gastric lymphoma--a tumour of mucosa-associated lymphoid tissue. A histological and immunohistochemical study of 36 cases

A series of 36 cases of non-Hodgkin's lymphoma of the stomach have been analysed using routine histological techniques and immunohistochemistry. All cases were categorized as follicle centre cell lymphomas. Apart from two cases who had nodal lymphomas followed by gastric lymphomas, all cases appeared to represent primary lymphoma of mucosa-associated lymphoid tissue. It is proposed that the morphology and behaviour of these tumours reflect their origin from gut-associated lymphoid tissue. Physiologically well-differentiated examples show monotypic plasmacytic differentiation. Infiltration of gastric glands by follicle centre cells forming characteristic lympho-epithelial lesions is, we believe, a pathognomonic feature of primary gastric lymphoma. The spread of these tumours is within the mucosa-associated lymphoid tissues involving, in particular, the nasopharynx and lung but seldom spreading to peripheral lymph nodes or bone marrow. This concept of gastric lymphomas as primary neoplasms of gut-associated lymphoid tissue has important implications with respect to the investigation and treatment of this disease.

The Pathology of Œsophagectasia (Dilatation of the Œsophagus without Anatomic Stenosis at the Cardiac Orifice)

Images