Facteurs prédictifs et pronostiques des cancers du sein multifocaux

[Epidemiological and anatomopathological profile of breast cancer at the Ibn Rochd University Hospital, Casablanca]

Réaliser une revue récente comportant les particularités épidémiologiques, histologiques des patients nouvellement diagnostiqués d’un cancer de sein à Casablanca durant l’année 2018. Nous avons colligé 668 cas pendant l’année 2018, l’âge moyen était 51,6 ans, le sexe féminin était le plus représenté avec 662 cas (99,1%) et les hommes avec 6 cas (0,9%), soit un sexe ratio (H/F) de 0,009. L’âge moyen de la ménopause était 49,8 ans et l’âge moyen de la ménarche était 13,5 ans, 31,7% avait un antécédent de cancer (le sein 14,1%, l’estomac 9% et le foie 7%). Le délai moyen de consultation était 10 mois, la pathologie la plus représentée était la pathologie thyroïdienne. Selon la localisation, le sein gauche était atteint dans 50,2% et le sein droit dans 44,7% et une localisation bilatérale 1,3%, le siège le plus fréquent était le quadrant supérieur externe avec 28,7%, les stades T1 et T2 représentaient 73,6% et les stades T3 et T4 représentaient 26,4%, les tumeurs épithéliales infiltrantes carcinome canalaire infiltrant (CCI) étaient les plus fréquentes (73,2%). La présence des emboles vasculaires et lymphatiques a été notée chez 42,2%, les ganglions axillaires étaient atteints chez 71,1% des patients. Le grade histopronostique de Scarff Bloom et Richardson (SBR) avait révélé une prédominance du grade II dans 55,9% des cas. Le Luminal B continue à constituer le phénotype le plus fréquent (46%) suivi du Triple Negatif (15,3%) et du Luminal A (14,2%) et enfin le HER2 (7,4%). Le pronostic immédiat demeure inquiétant du fait du retard de diagnostic. Il nous paraît urgent de mettre en place une politique sanitaire d’information et d’éducation.

Interrelationships Between Ki67, HER2/neu, p53, ER, and PR Status and Their Associations With Tumor Grade and Lymph Node Involvement in Breast Carcinoma Subtypes: Retrospective-Observational Analytical Study

Various predictive and prognostic factors could affect breast carcinoma behavior, but to date no definitive correlation has been established between them and breast carcinoma subtypes. The present study was conducted to examine the interrelationships of these predictive and prognostic factors as well as their effects on breast carcinoma subtypes.The archives of all patients with breast carcinoma (from 2008 to 2014) were studied. Patients' data were extracted using a checklist that included age, histology type, size and grade of tumor, lymph node involvement, estrogen receptor (ER) and progesterone receptor (PR) status, along with the overexpression of human epidermal growth factor receptor (HER2/neu) and the rate of Ki67 and p53 mutations. All data were analyzed by SPSS-17 software with χ and Fisher exact tests, as well as the least significant difference pairwise comparison test.A total of 566 patients' records were included in this study. The mean age of patients was 50 ± 12.9 with an age range of 17 to 98 years. A meaningful correlation was found between age and the type of tumor (P = 0.001). Infiltrating lobular carcinoma had a higher ER positivity between groups (85.7%), whereas noninvasive carcinomas had a higher PR positivity (67%). In addition, a meaningful correlation was detected between the type and grade of tumor (P = 0.001). No meaningful relationship was observed between the type of tumor and HER2/neu overexpression and number of lymph nodes involved. Between the groups, medullary carcinoma had the highest Ki67 index (P = 0.007). Meaningful correlation was found between the grade of tumor and lymph node involvement (P = 0.005) and also with HER2/neu overexpression (P = 0.002). Higher grades had greater positivity in Ki67 index and p53 mutation rates (P = 0.002, P = 0.01). HER2/neu positive tumors had a higher Ki67 index (P = 0.03).Higher Ki67 index tumors showed more HER2/neu overexpression, larger size, and more lymph node involvement compared with other types and maybe considered aggressive. Moreover, in young patients with breast carcinoma, the rates of Ki67 with the overexpression of HER2/neu and p53 mutations are higher, and it shows a more aggressive behavior than other tumors assessed in this age group.

Morphological heterogeneity of the simultaneous ipsilateral invasive tumor foci in breast carcinoma: a retrospective study of 418 cases of carcinomas

The aim of this paper was to assess whether the morphological appearance (i.e. histological tumor type and histological grade) of simultaneous invasive breast carcinoma foci is heterogeneous, since it is known that adjuvant therapy is established according to these parameters. Patients with simultaneous breast tumors in which only the features of the largest neoplastic focus are reported could thus be undertreated. A retrospective study of 418 cases of breast carcinomas was conducted over a 3-year period. The histological tumor types and histological grades of multifocal/multicentric carcinomas in each tumor focus were compared, and mismatches among foci were recorded. Ninety-one of the 418 cases reviewed had multiple carcinomas (21.77%). A comparison between multiple synchronous tumor foci revealed that their histological type was different in 12.08% of the cases. Mismatches among foci were also observed in 9.89% of the cases when evaluating the histological grade, and 5 out of 9 additional tumor foci with a different grade from the largest (index) tumor (55.55%) displayed a higher grade compared to the index tumor. Since the histological tumor type and histological grade of the individual foci may vary considerably within the same tumor and the additional foci may be of higher grade than the index tumor, we believe that reporting morphologic parameters with more unfavorable characteristics in addition to the parameters of the index tumor is imperative.