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Marin C, Weiss A, Gooch JC. Updates in the Surgical Management of Benign and High-Risk Breast Lesions. Clin Breast Cancer 2024; 24:278-285. [PMID: 38171944 DOI: 10.1016/j.clbc.2023.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/18/2023] [Accepted: 12/19/2023] [Indexed: 01/05/2024]
Abstract
Benign breast disease (BBD) is a heterogenous group of lesions often classified as nonproliferative or proliferative, with the latter group further categorized based on the presence of atypia. Although nonproliferative lesions are more common, the risk of breast cancer is elevated in women with proliferative lesions. Historically, the majority of proliferative lesions were excised due to concern for future and/or concomitant breast cancer at the site of the index lesion. However, contemporary data suggest that the risk of cancer associated with various proliferative lesions may be lower than previously thought, and management of BBD has become more nuanced. In this review, we will focus on recent updates in the management of a select group of benign and high-risk lesions.
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Affiliation(s)
- Chelsea Marin
- Department of Surgery, Division of Surgical Oncology, University of Rochester Medical Center, Rochester, NY
| | - Anna Weiss
- Department of Surgery, Division of Surgical Oncology, University of Rochester Medical Center, Rochester, NY; Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY
| | - Jessica C Gooch
- Department of Surgery, Division of Surgical Oncology, University of Rochester Medical Center, Rochester, NY; Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY.
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2
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Reyes A, Sun L, Ha R, Desperito E, Brown M, Francescone MA, Ugras S, Wiechmann L, Rao R, Taback B. A Comprehensive Assessment of Radial Scars on Core Needle Biopsy in Patients with or without Breast Cancer: Upgrade Rate and Implications on Management. Clin Breast Cancer 2024; 24:e273-e278. [PMID: 38402106 DOI: 10.1016/j.clbc.2024.01.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/26/2024]
Abstract
BACKGROUND Radial scars/radial sclerosing lesions (RS) are benign breast lesions identified on core needle biopsy (CNB) which can upgrade to malignancy at excision. There is limited data on RS detection and upgrade rates with more sensitive imaging such as magnetic resonance imaging (MRI) and none during their detection for breast cancer workup and its implication on patient treatment decisions. METHODS A retrospective institutional study of RS diagnosed on CNB between January 2008 and December 2017 was conducted. Clinicopathologic and radiologic features of RS, patient treatment decisions, upgrade rates and long-term follow-up were examined. RESULTS We identified 133 patients with RS on CNB, of whom 106 opted for surgery for an upgrade rate to malignancy of 1.9%, 2 patients. Radial scar was diagnosed on mammogram in 60%, MRI in 25% and ultrasound in 15% of patients. In this cohort, 32 patients had their RS detected during breast cancer workup (coexistent group) and they were more likely to have their radial scar detected by MRI (60% vs. 14%, P < .001) and undergo more extensive surgery (94% vs. 75%, P = .02). Among the 27 patients electing observation of their RS, only one (3.7%) developed breast cancer. CONCLUSIONS Our results show an extremely low upgrade rate to malignancy of RS, regardless if there is coexisting breast cancer elsewhere. Despite this, RS still prompted more extensive surgical excisions. The findings do not support excision of RS even among breast cancer patients when identified at a separate site from their cancer.
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Affiliation(s)
- Arith Reyes
- Department of Surgery, Breast Surgery Division, Columbia University Medical Center, New York, NY.
| | - Luona Sun
- Department of Surgery, Breast Surgery Division, Columbia University Medical Center, New York, NY
| | - Richard Ha
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Elise Desperito
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Marc Brown
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Mark A Francescone
- Department of Radiology, Columbia University Medical Center, New York, NY
| | - Stacy Ugras
- Department of Surgery, Breast Surgery Division, Columbia University Medical Center, New York, NY
| | - Lisa Wiechmann
- Department of Surgery, Breast Surgery Division, Columbia University Medical Center, New York, NY
| | - Roshni Rao
- Department of Surgery, Breast Surgery Division, Columbia University Medical Center, New York, NY
| | - Bret Taback
- Department of Surgery, Breast Surgery Division, Columbia University Medical Center, New York, NY
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3
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Ferre R, Covington MF, Kuzmiak CM. Meta-analysis: Radial Scar and Breast MRI. Acad Radiol 2024:S1076-6332(24)00214-9. [PMID: 38714429 DOI: 10.1016/j.acra.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/03/2024] [Accepted: 04/06/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND The implementation of digital breast tomosynthesis has increased the detection of radial scar (RS). Managing this finding may be experienced as a clinical dilemma in daily practice. Breast Contrast-Enhanced MRI (CE-BMR) is a known modality in case of problem-solving tool for mammographic abnormalities. However, the data about AD and CE-BMR are scant. OBJECTIVE The purpose was to estimate the benefit of CE-BMR in the setting of RS detected mammographically through a systematic review and meta-analysis of the literature. METHODS A search of MEDLINE and EMBASE databases were conducted in 2022. Based on the PRISMA guidelines, an analysis was performed. The primary endpoint was the correlation between CE-BMR findings and definite outcome for RS (pure RS versus RS associated with atypia or malignancy). RESULTS Three studies were available. The negative predictive value (NPV) was 100% for each. CONCLUSION The high NPV could allow for deferral of a biopsy in favor of a short-interval imaging follow-up in the setting of a negative CE-BMR.
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Affiliation(s)
| | - Matthew F Covington
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah 84112, USA
| | - Cherie M Kuzmiak
- Professor of Radiology Faculty, Division of Breast Imaging, Department of Radiology, CB #7510, UNC School of Medicine, Physicians' Office Building, Rm #118, 170 Manning Drive, Chapel Hill, North Carolina 27599, USA
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Kordowitzki P, Graczyk S, Haghani A, Klutstein M. Oocyte Aging: A Multifactorial Phenomenon in A Unique Cell. Aging Dis 2024; 15:5-21. [PMID: 37307833 PMCID: PMC10796106 DOI: 10.14336/ad.2023.0527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
The oocyte is considered to be the largest cell in mammalian species. Women hoping to become pregnant face a ticking biological clock. This is becoming increasingly challenging as an increase in life expectancy is accompanied by the tendency to conceive at older ages. With advancing maternal age, the fertilized egg will exhibit lower quality and developmental competence, which contributes to increased chances of miscarriage due to several causes such as aneuploidy, oxidative stress, epigenetics, or metabolic disorders. In particular, heterochromatin in oocytes and with it, the DNA methylation landscape undergoes changes. Further, obesity is a well-known and ever-increasing global problem as it is associated with several metabolic disorders. More importantly, both obesity and aging negatively affect female reproduction. However, among women, there is immense variability in age-related decline of oocytes' quantity, developmental competence, or quality. Herein, the relevance of obesity and DNA-methylation will be discussed as these aspects have a tremendous effect on female fertility, and it is a topic of continuous and widespread interest that has yet to be fully addressed for the mammalian oocyte.
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Affiliation(s)
- Pawel Kordowitzki
- Department of Preclinical and Basic Sciences, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun, Poland.
| | - Szymon Graczyk
- Department of Preclinical and Basic Sciences, Faculty of Biological and Veterinary Sciences, Nicolaus Copernicus University, Torun, Poland.
| | - Amin Haghani
- Department of Human Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Altos Labs, San Diego, CA, USA.
| | - Michael Klutstein
- Institute of Biomedical and Oral Research, Hebrew University of Jerusalem, Jerusalem, Israel
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Vicks E, Mason H, Perez Coulter A, Niakan S, Friedrich A, Cho R, Casaubon J. Increased risk of upstage when combinations of breast lesions of uncertain malignant potential are found on core needle biopsy: The need for surgical excision. Am J Surg 2024; 227:6-12. [PMID: 37863800 DOI: 10.1016/j.amjsurg.2023.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 09/30/2023] [Accepted: 10/02/2023] [Indexed: 10/22/2023]
Abstract
BACKGROUND Management of breast lesions of uncertain malignant potential diagnosed at core needle biopsy (CNB) is controversial due to variable upstage rate (UR) with surgical excision (SE). METHODS We performed an IRB-approved retrospective analysis of adult women who underwent CNB demonstrating atypical ductal hyperplasia (ADH), flat epithelial atypia, radial scar, or intraductal papilloma then SE between 2010 and 2022. We evaluated CNB pathology for combination diagnoses (CD), defined as multiple primary lesions or primary with lobular neoplasia (LN), and surgical pathology for upstage. RESULTS 719 patients were included. UR was 12.2% (88/719). CD experienced higher UR than pure (17.7% (45/254) vs. 9.2% (43/465), p = 0.001). ADH/LN had the highest UR of all CD (34.6% (9/26), p = 0.001). Increased size (15.6 vs. 10.5 mm, p < 0.001), distance from nipple (79 vs. 66 mm, p < 0.001), and personal history of breast cancer (p = 0.04) were associated with UR. CONCLUSIONS CD was associated with increased UR. ADH/LN had the highest UR.
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Affiliation(s)
- Emily Vicks
- University of Massachusetts Chan Medical School, Worcester, MA, 01655, USA.
| | - Holly Mason
- University of Massachusetts Chan Medical School - Baystate, Division of Surgical Oncology, Springfield, MA, 01199, USA.
| | - Aixa Perez Coulter
- University of Massachusetts Chan Medical School - Baystate, Department of Surgery, Springfield, MA, 01199, USA; Office of Research, Epidemiology/Biostatistics Research Core, Baystate Medical Center, Springfield, MA, 01199, USA.
| | - Shiva Niakan
- University of Massachusetts Chan Medical School - Baystate, Division of Surgical Oncology, Springfield, MA, 01199, USA.
| | - Ann Friedrich
- University of Massachusetts Chan Medical School - Baystate, Division of Surgical Oncology, Springfield, MA, 01199, USA.
| | - Ruth Cho
- University of Massachusetts Chan Medical School - Baystate, Division of Surgical Oncology, Springfield, MA, 01199, USA.
| | - Jesse Casaubon
- University of Massachusetts Chan Medical School - Baystate, Division of Surgical Oncology, Springfield, MA, 01199, USA.
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Darras C, Uchida M. Upgrade risk of image-targeted radial scar and complex sclerosing lesions diagnosed at needle-guided biopsy: a retrospective study. Eur Radiol 2023; 33:8399-8406. [PMID: 37386299 DOI: 10.1007/s00330-023-09877-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 04/29/2023] [Accepted: 06/04/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES To determine the upgrade rate of radial scar (RS) and complex sclerosing lesions (CSL) diagnosed with percutaneous biopsy. The secondary objectives were to determine the new atypia rate after surgery and to assess the diagnosis of subsequent malignancy on follow-up. METHODS This single-institution retrospective study had IRB approval. All image-targeted RS and CSL diagnosed with percutaneous biopsy between 2007 and 2020 were reviewed. Patient demographics, imaging presentation, biopsy characteristics, histological report, and follow-up data were collected. RESULTS During the study period, 120 RS/CSL were diagnosed in 106 women (median age, 43.5 years; range, 23-74), and 101 lesions were analyzed. At biopsy, 91 (90.1%) lesions were not associated with another atypia or malignancy and 10 (9.9%) were associated with another atypia. Out of the 91 lesions that were not associated with malignancy or atypia, 75 (82.4%) underwent surgical excision, and one upgrade to low-grade CDIS was detected (1.3%). Among the 10 lesions initially associated with another atypia, 9 were surgically excised and no malignancy was detected. After a median follow-up of 47 months (range: 12-143 months), two (1.98%) developed malignancy in a different quadrant; in both cases, another atypia was present at biopsy. CONCLUSION We found a low upgrade rate on image-detected RS/CSL, with or without another atypia associated. Associated atypia was underdiagnosed at biopsy in almost one-third of cases. Subsequent cancer risk could not be established because the only two cases were associated with another high-risk lesion (HRL), which might have increased the patient's risk of developing malignancy. CLINICAL RELEVANCE STATEMENT Our upgrade rates of RS/CSL with or without atypia diagnosed with core needle biopsy are almost as low as the ones reported with larger sampling methods. This result has particular importance in places with limited accessibility to US-guided vacuum-assisted biopsy. KEY POINTS •New evidence is showing lower upgrade rates of RS and CSL after surgery, leading to a more conservative management with extensive sampling using VAB or VAE. •Our study showed only one upgrade to a low-grade DCIS after surgery, yielding an upgrade rate of 1.33%. •During follow-up, no new malignancy was detected in the same quadrant where RS/CSL was diagnosed, including patients without surgery.
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Affiliation(s)
- Carla Darras
- Radiology Department, Clínica Alemana de Santiago, Vitacura 5951, 7630000, Santiago, RM, Chile.
| | - Marcela Uchida
- Radiology Department, Clínica Alemana de Santiago, Vitacura 5951, 7630000, Santiago, RM, Chile
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Barker CS, Chung CW, Mukherjee R, Siegel JB, Cole DJ, Lockett MA, Klauber-DeMore N, Abbott AM. The impact of nurse navigation on timeliness to treatment for benign high-risk breast pathology. Breast Cancer Res Treat 2023; 202:129-137. [PMID: 37584883 DOI: 10.1007/s10549-023-07049-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 07/13/2023] [Indexed: 08/17/2023]
Abstract
PURPOSE High-risk breast pathology is a breast cancer risk factor for which timely treatment is crucial. Nurse navigation programs have been implemented to minimize delays in patient care. This study evaluated nurse navigation in terms of timeliness to surgery for patients with high-risk breast pathology. METHODS This was a single-institution, retrospective review of patients with identified high-risk breast pathology undergoing lumpectomy between January 2017 and June 2019. Patients were stratified into cohorts based on periods with and without nurse navigation. Preoperative and postoperative time to care as well as demographic and tumor characteristics were compared using univariate and multivariate analysis. RESULTS 100 patients had assigned nurse navigators and 29 patients did not. Nurse navigation was associated with reduced time from referral to date of surgery (DOS) by 16.9 days (p = 0.003). Patients > 75 years had a shorter time to first appointment (p = 0.03), and patients with Medicare insurance had a reduced time from referral to DOS (p = 0.005). 20% of all patients were upstaged to cancer on final surgical pathology. CONCLUSION Nurse navigation was significantly associated with decreased time to care for patients with high-risk breast pathology undergoing lumpectomy. We recommend nurse navigation programs as part of a comprehensive approach for patients with high-risk breast pathology.
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Affiliation(s)
- Catherine S Barker
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine W Chung
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rupak Mukherjee
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Julie B Siegel
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA.
| | - David J Cole
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Mark A Lockett
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Nancy Klauber-DeMore
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Andrea M Abbott
- Department of Surgery, Medical University of South Carolina, Charleston, SC, USA
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Salardani M, Barcick U, Zelanis A. Proteolytic signaling in cancer. Expert Rev Proteomics 2023; 20:345-355. [PMID: 37873978 DOI: 10.1080/14789450.2023.2275671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 10/17/2023] [Indexed: 10/25/2023]
Abstract
INTRODUCTION Cancer is a disease of (altered) biological pathways, often driven by somatic mutations and with several implications. Therefore, the identification of potential markers of disease is challenging. Given the large amount of biological data generated with omics approaches, oncology has experienced significant contributions. Proteomics mapping of protein fragments, derived from proteolytic processing events during oncogenesis, may shed light on (i) the role of active proteases and (ii) the functional implications of processed substrates in biological signaling circuits. Both outcomes have the potential for predicting diagnosis/prognosis in diseases like cancer. Therefore, understanding proteolytic processing events and their downstream implications may contribute to advances in the understanding of tumor biology and targeted therapies in precision medicine. AREAS COVERED Proteolytic events associated with some hallmarks of cancer (cell migration and proliferation, angiogenesis, metastasis, as well as extracellular matrix degradation) will be discussed. Moreover, biomarker discovery and the use of proteomics approaches to uncover proteolytic signaling events will also be covered. EXPERT OPINION Proteolytic processing is an irreversible protein post-translational modification and the deconvolution of biological data resulting from the study of proteolytic signaling events may be used in both patient diagnosis/prognosis and targeted therapies in cancer.
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Affiliation(s)
- Murilo Salardani
- Functional Proteomics Laboratory, Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, SP, Brazil
| | - Uilla Barcick
- Functional Proteomics Laboratory, Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, SP, Brazil
| | - André Zelanis
- Functional Proteomics Laboratory, Institute of Science and Technology, Federal University of São Paulo, São José dos Campos, SP, Brazil
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Ryu J, Lee EY, Min J, Yeon S, Lee JW, Chu SH, Lee H, Kim SI, Kim JY, Park S, Jeon JY. Effect of a 1-year tailored exercise program according to cancer trajectories in patients with breast cancer: study protocol for a randomized controlled trial. BMC Cancer 2023; 23:200. [PMID: 36864418 PMCID: PMC9983270 DOI: 10.1186/s12885-023-10664-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 02/20/2023] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND Patients with breast cancer undergo various treatments according to their tumor subtype and cancer stages within 1 year after being diagnosed. Each treatment may cause treatment-related symptoms that have negative impacts on patients' health and quality of life (QoL) The symptoms can be mitigated when exercise interventions are appropriately applied to patients' physical and mental conditions. Although many exercise programs were developed and implemented during this period, the effects of tailored exercise programs according to symptoms and cancer trajectories on patients' long-term health outcomes have not yet been fully elucidated. Therefore, this randomized controlled trial (RCT) aims to investigate the effect of tailored home-based exercise programs on short-term and long-term physiological outcomes in patients with breast cancer. METHODS This 12-month RCT includes 96 patients with (stages 1-3) breast cancer randomly assigned to the exercise or control groups. Participants in the exercise group will receive an exercise program tailored to their phase of treatment, type of surgery, and physical function. During post-operative recovery, exercise interventions will be emphasized to improve shoulder range of motion (ROM) and strength. During chemoradiation therapy, exercise intervention will focus on improving physical function and preventing loss of muscle mass. Once chemoradiation therapy is completed, exercise intervention will focus on improving cardiopulmonary fitness and insulin resistance. All interventions will be home-based exercise programs supplemented with once-monthly exercise education and counseling sessions. The main outcome of the study is fasting insulin level at baseline, 6 months, and 1 year post-intervention. Our secondary outcomes include shoulder ROM and strength at 1 month and 3 months, body composition, inflammatory markers, microbiome, QoL, and physical activity levels at 1 month, 6 months, and 1 year post-intervention. CONCLUSION This trial is the first tailored home-based exercise oncology trial to better understand the comprehensive phase-dependent short- and long-term effects of exercise on shoulder function, body composition, fasting insulin, biomarkers, and microbiome. The results of this study will inform the development of effective exercise programs tailored to the needs of patients with breast cancer post-operatively. TRIAL REGISTRATION The protocol for this study is registered with the Korean Clinical Trials Registry (KCT0007853).
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Affiliation(s)
- Jiin Ryu
- grid.15444.300000 0004 0470 5454Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
| | - Eun-Young Lee
- grid.410356.50000 0004 1936 8331School of Kinesiology & Health Studies, Queen’s University, Kingston, ON Canada
| | - Jihee Min
- grid.410914.90000 0004 0628 9810National Cancer Survivorship Center, National Cancer Center, Goyang, Republic of Korea
| | - Sujin Yeon
- grid.15444.300000 0004 0470 5454Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea
| | - Ji-Won Lee
- grid.15444.300000 0004 0470 5454Department of Family Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sang Hui Chu
- grid.15444.300000 0004 0470 5454Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Hyangkyu Lee
- grid.15444.300000 0004 0470 5454Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Seung Il Kim
- grid.15444.300000 0004 0470 5454Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Jee Ye Kim
- grid.15444.300000 0004 0470 5454Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Seho Park
- Division of Breast Surgery, Department of Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
| | - Justin Y. Jeon
- grid.15444.300000 0004 0470 5454Department of Sport Industry Studies, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722 Republic of Korea ,grid.15444.300000 0004 0470 5454Exercise Medicine Center for Diabetes and Cancer Patients, ICONS, Yonsei University, Seoul, Republic of Korea ,grid.15444.300000 0004 0470 5454Cancer Prevention Center, Shinchon Severance Hospital, Yonsei Cancer Center, Yonsei University College of Medicine, Yonsei University, Seoul, Republic of Korea
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Lee JH, Massagué J. TGF-β in Developmental and Fibrogenic EMTs. Semin Cancer Biol 2022; 86:136-145. [PMID: 36183999 PMCID: PMC10155902 DOI: 10.1016/j.semcancer.2022.09.004] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/25/2022] [Accepted: 09/27/2022] [Indexed: 11/18/2022]
Abstract
TGF-β plays a prominent role as an inducer of epithelial-mesenchymal transitions (EMTs) during development and wound healing and in disease conditions such as fibrosis and cancer. During these processes EMT occurs together with changes in cell proliferation, differentiation, communication, and extracellular matrix remodeling that are orchestrated by multiple signaling inputs besides TGF-β. Chief among these inputs is RAS-MAPK signaling, which is frequently required for EMT induction by TGF-β. Recent work elucidated the molecular basis for the cooperation between the TGF-β-SMAD and RAS-MAPK pathways in the induction of EMT in embryonic, adult and carcinoma epithelial cells. These studies also provided direct mechanistic links between EMT and progenitor cell differentiation during gastrulation or intra-tumoral fibrosis during cancer metastasis. These insights illuminate the nature of TGF-β driven EMTs as part of broader processes during development, fibrogenesis and metastasis.
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Affiliation(s)
- Jun Ho Lee
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA
| | - Joan Massagué
- Cancer Biology and Genetics Program, Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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11
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Lueders A, Spivey T. Breast Density Lacks Influence on Upgrade Rates to High Risk Lesions and Cancer Among Proliferative Breast Lesion Excisions. Am Surg 2022; 88:2119-2123. [PMID: 35477318 DOI: 10.1177/00031348221091949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Breast density is an independent risk factor for the development of breast cancer. We assessed if upgrade rates to high-risk lesions and cancer were influenced by density when evaluating proliferative complex sclerosing lesions and intraductal papillomas. METHODS This is a retrospective single institution study. We evaluated 168 women aged 18-86 who received a core needle biopsy revealing a breast proliferative lesion of complex sclerosing lesion (CSL) or intraductal papilloma. We analyzed the upgrade rate to high-risk atypia (HRL) and cancer. Subgroup analysis based on age and breast density was performed. RESULTS The patient collective was well balanced-51% had dense breasts and 42% were under 50 years old. Half were diagnosed with papilloma based on CNB and the other half with CSL. For those proliferative lesions without atypia, the upgrade rate to cancer was 1.6%. CNB showed concomitant HRL in 23% of patients with non-dense breasts and in 22% with dense tissue. In 24 cases, the pathology was considered an upgrade by showing either a not prior noted HRL or carcinoma. Most patients with upgrade following surgical excision were over 50 years old. Dense breasts did not show a higher risk of upgrade following surgical excision (P = .975). CONCLUSION Our data did not reveal a difference between upgrade rates of proliferative lesions excised in dense and non-dense breasts. Further evaluation is warranted to establish whether density should be considered as a meaningful factor in excision vs observation of CSL and papillomas.
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Affiliation(s)
- Amelie Lueders
- General Surgery Department, 24104St Vincent Indianapolis, Indianapolis, IN, USA
| | - Tara Spivey
- Breast Surgery Department, 24104St Vincent Indianapolis, Indianapolis, IN, USA
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Elwakeel E, Brüggemann M, Wagih J, Lityagina O, Elewa MAF, Han Y, Froemel T, Popp R, Nicolas AM, Schreiber Y, Gradhand E, Thomas D, Nüsing R, Steinmetz-Späh J, Savai R, Fokas E, Fleming I, Greten FR, Zarnack K, Brüne B, Weigert A. Disruption of prostaglandin E2 signaling in cancer-associated fibroblasts limits mammary carcinoma growth but promotes metastasis. Cancer Res 2022; 82:1380-1395. [PMID: 35105690 DOI: 10.1158/0008-5472.can-21-2116] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 11/16/2022]
Abstract
The activation and differentiation of cancer-associated fibroblasts (CAF) are involved in tumor progression. Here we show that the tumor-promoting lipid mediator prostaglandin E2 (PGE2) plays a paradoxical role in CAF activation and tumor progression. Restricting PGE2 signaling via knockout of microsomal prostaglandin E synthase-1 (mPGES-1) in PyMT mice or of the prostanoid E receptor 3 (EP3) in CAFs stunted mammary carcinoma growth associated with strong CAF proliferation. CAF proliferation upon EP3 inhibition required p38 MAPK signaling. Mechanistically, TGF-β-activated kinase-like protein (TAK1L), which was identified as a negative regulator of p38 MAPK activation, was decreased following ablation of mPGES-1 or EP3. In contrast to its effects on primary tumor growth, disruption of PGE2 signaling in CAFs induced epithelial to mesenchymal transition in cancer organoids and promoted metastasis in mice. Moreover, TAK1L expression in CAFs was associated with decreased CAF activation, reduced metastasis, and prolonged survival in human breast cancer. These data characterize a new pathway of regulating inflammatory CAF activation, which affects breast cancer progression.
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Affiliation(s)
- Eiman Elwakeel
- Faculty of Medicine/Institute of Biochemistry I, Goethe University Frankfurt
| | - Mirko Brüggemann
- Computational RNA Biology, Buchmann Institute for Molecular Life Sciences (BMLS) and Faculty of Biological Sciences, Goethe University Frankfurt
| | - Jessica Wagih
- Institute of Biochemistry I, Goethe University Frankfurt
| | - Olga Lityagina
- Institute of Biochemistry I, Goethe University Frankfurt
| | | | - Yingying Han
- Institute of Biochemistry I, Goethe University Frankfurt
| | | | - Rüdiger Popp
- Insitute of Vascular Signalling, Goethe University Frankfurt
| | - Adele M Nicolas
- Institute for Tumor Biology and Experimental Therapy, Georg Speyer Haus
| | - Yannick Schreiber
- Fraunhofer Institute for Translational Medicine and Pharmacology, Frankfurt
| | - Elise Gradhand
- Senckenbergisches Institut für Pathologie, Goethe University Frankfurt
| | | | - Rolf Nüsing
- Institute of Clinical Pharmacology, Goethe University
| | - Julia Steinmetz-Späh
- Division of Rheumatology, Department of Medicine, Solna, Karolinska Institutet and Karolinska University Hospita
| | - Rajkumar Savai
- Lung Microenvironmental Niche in Cancerogenesis, Max Planck Institute for Heart and Lung Research
| | - Emmanouil Fokas
- Radiation Therapy and Oncology, Goethe University Frankfurt am Main
| | | | - Florian R Greten
- Georg-Speyer-Haus, Institute for Tumor Biology and Experimental Therapy Paul-Ehrlich-Str
| | - Kathi Zarnack
- Buchmann Institute for Molecular Life Sciences (BMLS) and Faculty of Biological Sciences, Goethe University Frankfurt
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13
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Indeterminate (B3) Breast Lesions and the Ongoing Role of Diagnostic Open Biopsy. Int J Breast Cancer 2022; 2021:5555458. [PMID: 34987869 PMCID: PMC8723853 DOI: 10.1155/2021/5555458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 12/01/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction Due to their uncertain malignant potential, indeterminate breast lesions on core needle biopsy (CNB) require diagnostic open biopsy (DOB). This study evaluated DOB results given largely benign pathology. Lesions included are atypical papilloma, atypical ductal hyperplasia (ADH), atypical lobular hyperplasia (ALH), and radial scar/complex sclerosing lesions (RS/CSL). Methodology. A retrospective audit from 2010 to 2017 analysed patients with a screen-detected suspicious lesion and indeterminate (B3) CNB diagnosis. Primary outcome was the malignancy upgrade rate, with secondary evaluation of patient factors predictive of malignancy including age, symptoms, mammogram characteristics, lesion size, biopsy method, and past and family history. Results 152 patients (median age 57 years) were included, with atypical papillomas being the largest subgroup (44.7%). On DOB histology, 99.34% were benign, resulting in a 0.66% malignancy upgrade rate. Patient characteristic analysis identified 86.84% of B3 lesions were in patients greater than 50 years old. 90.13% were asymptomatic, whilst 98.68% and 72.37% had a negative past and family history. Majority 46.71% of lesions had the mammogram characteristic of being a mass. However, with 57.89% of the lesion imaging size less than 4 mm, a corresponding 60.5% of core needle biopsies were performed stereotactically. The small malignant subgroup limited predictive factor evaluation. Conclusion Albeit a low 0.66% malignancy upgrade rate in B3 lesions, no statistically significant patient predictive factors were identified. Until predictive factors and further assessment of vacuum-assisted excision (VAE) techniques evolve, DOB remains the standard of care.
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14
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Yan P, DeMello L, Baird GL, Lourenco AP. Malignancy Upgrade Rates of Radial Sclerosing Lesions at Breast Cancer Screening. Radiol Imaging Cancer 2021; 3:e210036. [PMID: 34766844 DOI: 10.1148/rycan.2021210036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the upgrade rate for biopsy-proven radial scars and radial sclerosing lesions (RS). Materials and Methods In this retrospective study, radiology and pathology databases from two tertiary breast centers were searched to identify patients with biopsy-confirmed RS between March 1, 2012, and December 31, 2017, during which all mammography was performed with digital breast tomosynthesis (DBT). Adjunct modalities such as MRI or US are performed at our centers to better characterize lesions identified at DBT. Patient demographics, imaging, needle and excisional biopsies, and follow-up data were collected at the patient level. Clopper-Pearson interval estimate for upgrade was calculated for 95% confidence using PropCIs package with R version 4.1.0 (R Foundation for Statistical Computing) (1). Results During the study period, a total of 155 885 DBT examinations were performed. From these examinations, 146 biopsy-proven RS were identified in 142 women (median age, 58 years; age range, 26-87 years). A total of 80.1% (117 of 146) of all RS did not have associated atypia or malignancy, and 19.9% (29 of 146) had associated atypia at initial biopsy. A total of 66.7% (78 of 117) of RS without atypia or malignancy were surgically excised, 25.6% (30 of 117) were followed (median, 3 years; range, 1-7 years) with benign findings on imaging, and 7.7% (nine of 117) were lost to follow-up. The rate of malignancy upgrade was 0.9% (one of 117 [95% CI: 0.02, 4.7]); one RS without concurrent atypia or malignancy demonstrated invasive carcinoma at surgical excision. Conclusion RS without atypia had a low upgrade rate. Keywords: Mammography, Breast © RSNA, 2021.
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Affiliation(s)
- Pamela Yan
- From the Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - Linda DeMello
- From the Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - Grayson L Baird
- From the Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
| | - Ana P Lourenco
- From the Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903
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15
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Elwakeel E, Weigert A. Breast Cancer CAFs: Spectrum of Phenotypes and Promising Targeting Avenues. Int J Mol Sci 2021; 22:11636. [PMID: 34769066 PMCID: PMC8583860 DOI: 10.3390/ijms222111636] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 10/22/2021] [Accepted: 10/22/2021] [Indexed: 01/03/2023] Open
Abstract
Activationof the tumor-associated stroma to support tumor growth is a common feature observed in different cancer entities. This principle is exemplified by cancer-associated fibroblasts (CAFs), which are educated by the tumor to shape its development across all stages. CAFs can alter the extracellular matrix (ECM) and secrete a variety of different molecules. In that manner they have the capability to affect activation, survival, proliferation, and migration of other stromal cells and cancer cell themselves. Alteration of the ECM, desmoplasia, is a common feature of breast cancer, indicating a prominent role for CAFs in shaping tumor development in the mammary gland. In this review, we summarize the multiple roles CAFs play in mammary carcinoma. We discuss experimental and clinical strategies to interfere with CAFs function in breast cancer. Moreover, we highlight the issues arising from CAFs heterogeneity and the need for further research to identify CAFs subpopulation(s) that can be targeted to improve breast cancer therapy.
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Affiliation(s)
- Eiman Elwakeel
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, 60590 Frankfurt, Germany;
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, 60590 Frankfurt, Germany;
- Frankfurt Cancer Institute, Goethe-University Frankfurt, 60596 Frankfurt, Germany
- German Cancer Consortium (DKTK), Partner Site Frankfurt, 60590 Frankfurt, Germany
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16
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Ray SK, Mukherjee S. Consequences of Extracellular Matrix Remodeling in Headway and Metastasis of Cancer along with Novel Immunotherapies: A Great Promise for Future Endeavor. Anticancer Agents Med Chem 2021; 22:1257-1271. [PMID: 34254930 DOI: 10.2174/1871520621666210712090017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/23/2021] [Accepted: 05/30/2021] [Indexed: 12/12/2022]
Abstract
Tissues are progressively molded by bidirectional correspondence between denizen cells and extracellular matrix (ECM) via cell-matrix connections along with ECM remodeling. The composition and association of ECM are spatiotemporally directed to control cell conduct and differentiation; however, dysregulation of ECM dynamics prompts the development of diseases, for example, cancer. Emerging information demonstrates that hypoxia may have decisive roles in metastasis. In addition, the sprawling nature of neoplastic cells and chaotic angiogenesis are increasingly influencing microcirculation as well as altering the concentration of oxygen. In various regions of the tumor microenvironment, hypoxia, an essential player in the multistep phase of cancer metastasis, is necessary. Hypoxia can be turned into an advantage for selective cancer therapy because it is much more severe in tumors than in normal tissues. Cellular matrix gives signaling cues that control cell behavior and organize cells' elements in tissue development and homeostasis. The interplay between intrinsic factors of cancer cells themselves, including their genotype and signaling networks, and extrinsic factors of tumor stroma, for example, ECM and ECM remodeling, together decide the destiny and behavior of tumor cells. Tumor matrix encourages the development, endurance, and invasion of neoplastic and immune cell activities to drive metastasis and debilitate treatment. Incipient evidence recommends essential parts of tumor ECM segments and their remodeling in controlling each progression of the cancer-immunity cycle. Scientists have discovered that tumor matrix dynamics as well as matrix remodeling in perspective to anti-tumor immune reactions are especially important for matrix-based biomarkers recognition and followed by immunotherapy and targeting specific drugs.
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Affiliation(s)
- Suman Kumar Ray
- Department of Applied Sciences, Indira Gandhi Technological and Medical Sciences University, India
| | - Sukhes Mukherjee
- Department of Biochemistry. All India Institute of Medical Sciences Bhopal, Madhya pradesh-462020, India
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17
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Tumor microenvironment and radioresistance. Exp Mol Med 2021; 53:1029-1035. [PMID: 34135469 PMCID: PMC8257724 DOI: 10.1038/s12276-021-00640-9] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 02/05/2023] Open
Abstract
Metastasis is not the result of a random event, as cancer cells can sustain and proliferate actively only in a suitable tissue microenvironment and then form metastases. Since Dr. Stephen Paget in the United Kingdom proposed the seed and soil hypothesis of cancer metastasis based on the analogy that plant seeds germinate and grow only in appropriate soil, considerable attention has focused on both extracellular environmental factors that affect the growth of cancer cells and the tissue structure that influences the microenvironment. Malignant tumor tissues consist of not only cancer cells but also a wide variety of other cells responsible for the inflammatory response, formation of blood vessels, immune response, and support of the tumor tissue architecture, forming a complex cellular society. It is also known that the amounts of oxygen and nutrients supplied to each cell differ depending on the distance from tumor blood vessels in tumor tissue. Here, we provide an overview of the tumor microenvironment and characteristics of tumor tissues, both of which affect the malignant phenotypes and radioresistance of cancer cells, focusing on the following keywords: diversity of oxygen and nutrient microenvironment in tumor tissue, inflammation, immunity, and tumor vasculature.
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18
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Wilsher MJ. Significance of adenosquamous proliferation in breast lesions. J Clin Pathol 2021; 74:559-567. [PMID: 33380461 DOI: 10.1136/jclinpath-2020-207097] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/27/2020] [Accepted: 12/07/2020] [Indexed: 12/17/2022]
Abstract
Adenosquamous proliferation (ASP), characterised by ductal structures with a dual glandular and squamous phenotype within desmoplastic stroma, is essentially a hallmark of various sclerosing lesions of the breast (SL) and breast lesions with sclerosis (BLWS), not including sclerosing adenosis. In radial scar/complex sclerosing lesion (RS/CSL), clonality has been previously demonstrated in microdissected ASP. SL/BLWS encompass a diverse range of pathological entities that historically have an equally diverse list of names, often for histologically alike or identical lesions at different anatomical locations. In common they are comprised of one or more components of fibrocystic or proliferative breast disease and papillomata, which become distorted and even obliterated by a sclerosing process that appears to be associated with and/or secondary to ASP, which in an individual lesion may be inconspicuous at the time of biopsy. The histological overlap of various SL/BLWS with RS/CSL, in which a nidus containing ASP is pathognomonic of early lesions, also supports a common element of ASP across various SL/BLWS. SL/BLWS show an interesting association with low-grade metaplastic carcinoma, particularly low-grade adenosquamous carcinoma (LGASC) with which, they appear to form a histological and possible biological spectrum because ASP and LGASC share similar histological and immunophenotypical characteristics. The presentation of ASP in various SL/BLWS will be discussed.
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19
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Bargallo X, Ubeda B, Ganau S, Gonzalez B, Macedo M, Alonso I, Oses G, Vidal M, Santamaria G. Magnetic Resonance Imaging Assessment of Radial scars/complex Sclerosing Lesions of the Breast. Curr Med Imaging 2020; 18:242-248. [PMID: 33390120 DOI: 10.2174/1573405616666201231095918] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/02/2020] [Accepted: 10/14/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE To describe the magnetic resonance characteristics of radial scars/complex sclerosing lesions (RS/CSL) of the breast using the current BI-RADS lexicon. To investigate the value of diffusion weighted imaging to predict malignancy. PATIENTS AND METHODS From 2010 to 2017 we have found 25 women with architectural distortion at mammography who underwent surgical resection with a final hystopathologic report of RS/CSL. For description of MRI findings we adhered to BI-RADS classification (5th edition). RESULTS The final pathological diagnosis was: "pure" RS/CSL in 7 cases (28%), RS/CSL with associated high risk lesions in 12 (48%) and 6 cases (24%) were associated with malignancy. Magnetic resonance findings: four of 25 negative or focus. Five of 25 mass enhancement: irregular, non circumscribed spiculated mass with heterogeneous or rim enhancement and most with type II curves. Sixteen of 25 non mass enhancement: focal or linear distribution and heterogeneous internal enhancement most with type I curves. Six of 25 had cancer associated with the complex sclerosing lesion. All six showed non-mass, focal and clustering-ring enhancement. Two cases with invasive breast carcinoma had ADC values under 1.15 x10-3 mm/s while most of the rest had values above. CONCLUSION Most RS/CSL showed enhancement at MR. The predominant pattern was a non-mass, focal, heterogeneous internal enhancement with type 1 curves. All cases with associated cancer showed non mass enhancement. Invasive breast cancers had ADC values < 1.15 10-3 s/mm2.
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Affiliation(s)
- Xavier Bargallo
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Belen Ubeda
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Sergi Ganau
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Blanca Gonzalez
- Hospital Clinic de Barcelona, Department of Pathology (CDIC), Barcelona. Spain
| | - Miguel Macedo
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
| | - Inma Alonso
- Hospital Clinic de Barcelona, Department of Gynecology (CDIC), Barcelona. Spain
| | - Gabriela Oses
- Hospital Clinic de Barcelona, Department of Radiation Oncology (CDIC), Barcelona. Spain
| | - Maria Vidal
- Hospital Clinic de Barcelona, Department of Oncology (CDIC), Barcelona. Spain
| | - Gorane Santamaria
- Hospital Clinic de Barcelona, Department of Radiology (CDIC), Barcelona. Spain
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20
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miR-876 Inhibits EMT and Liver Fibrosis via POSTN to Suppress Metastasis in Hepatocellular Carcinoma. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1964219. [PMID: 33083453 PMCID: PMC7559219 DOI: 10.1155/2020/1964219] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/19/2020] [Accepted: 08/14/2020] [Indexed: 02/06/2023]
Abstract
Background The asymptomatic onset, frequent recurrence, and poor prognosis of hepatocellular carcinoma (HCC) prompted us to identify new therapeutic targets or predictive markers of HCC diagnosis or prognosis. Methods In this study, bioinformatics analysis was used to screen for target miRNAs from the open-access TCGA database. Transwell assays, Western blotting, and qRT-PCR analyses were used to detect cellular functions and gene expression in HCC cells and samples. A nude mouse tumorigenesis model was established to facilitate the observation of HCC progression. Other assays included luciferase reporter assays, IHC, and survival analysis. Results We found that the identified miR-876 from TCGA was expressed at low levels in HCC cell lines and that low miR-876 expression was corrected with liver cirrhosis, tumor thrombus, and TNM stage. Further research revealed that miR-876 regulated cell invasion, EMT, and collagen expression by targeting POSTN expression. miR-876 and POSTN were inversely correlated in HCC samples and associated with EMT status and liver fibrosis in clinical HCC tissues. miR-876 inhibited the liver cancer progression in in vivo animal assays. Finally, both miR-876 and POSTN were risk factors for HCC survival, and HCC patients with combined low miR-876 and high POSTN expression had worse prognosis. Conclusions miR-876 inhibited HCC EMT and fibrosis by targeting POSTN, thus affecting HCC progression and prognosis. miR-876 and POSTN may be useful therapeutic targets or prognostic markers of HCC.
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21
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Marco Molina V, García Hernández F. [Histological lesions of risk of breast carcinoma. Survival guide for the general pathologist]. REVISTA ESPANOLA DE PATOLOGIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ANATOMIA PATOLOGICA Y DE LA SOCIEDAD ESPANOLA DE CITOLOGIA 2020; 53:158-166. [PMID: 32650967 DOI: 10.1016/j.patol.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/24/2019] [Accepted: 02/12/2020] [Indexed: 06/11/2023]
Abstract
Proliferative epithelial lesions are risk factors for breast cancer. They are a heterogeneous group of lesions in which the presence of atypia is related to varying degrees of risk. They should be considered in the differential diagnosis with benign lesions, in situ ductal carcinoma and infiltrating carcinoma. An accurate histopathological diagnosis is important in choosing the best therapeutic option, including vacuum assisted biopsy and surgery. We revise diagnostic criteria and the differential diagnosis of usual ductal hyperplasia, radial scar and complex sclerosing lesions, distinct types of adenosis, papillary lesions, atypical ductal hyperplasia, flat epithelial atypia and lobular neoplasia in situ. Furthermore, we summarize the degree of risk associated with the different conditions and management possibilities.
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MESH Headings
- Biopsy, Needle
- Breast/pathology
- Breast/surgery
- Breast Carcinoma In Situ/diagnosis
- Breast Carcinoma In Situ/pathology
- Breast Carcinoma In Situ/surgery
- Breast Diseases/diagnosis
- Breast Diseases/pathology
- Breast Diseases/surgery
- Carcinoma, Ductal, Breast/diagnosis
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Ductal, Breast/surgery
- Carcinoma, Intraductal, Noninfiltrating/diagnosis
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Cicatrix/diagnosis
- Cicatrix/pathology
- Diagnosis, Differential
- Female
- Fibrocystic Breast Disease/diagnosis
- Fibrocystic Breast Disease/pathology
- Humans
- Hyperplasia/diagnosis
- Hyperplasia/pathology
- Pathologists
- Risk Factors
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Affiliation(s)
- Vicente Marco Molina
- Servicio de Anatomía Patológica, Hospital Quirónsalud Barcelona, Barcelona, España.
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22
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Kim WG, Cummings MC, Lakhani SR. Pitfalls and controversies in pathology impacting breast cancer management. Expert Rev Anticancer Ther 2020; 20:205-219. [PMID: 32174198 DOI: 10.1080/14737140.2020.1738222] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Breast cancer is a heterogeneous disease, at morphological, molecular, and clinical levels and this has significant implications for the diagnosis and management of the disease. The introduction of breast screening, and the use of small tissue sampling for diagnosis, the recognition of new morphological and molecular subtypes, and the increasing use of neoadjuvant therapies have created challenges in pathological diagnosis and classification.Areas covered: Areas of potential difficulty include columnar cell lesions, particularly flat epithelial atypia, atypical ductal hyperplasia, lobular neoplasia and its variants, and a range of papillary lesions. Fibroepithelial, sclerosing, mucinous, and apocrine lesions are also considered. Established and newer prognostic and predictive markers, such as immune infiltrates, PD-1 and PD-L1 and gene expression assays are evaluated. The unique challenges of pathology assessment post-neoadjuvant systemic therapy are also explored.Expert opinion: Controversies in clinical management arise due to incomplete and sometimes conflicting data on clinicopathological associations, prognosis, and outcome. The review will address some of these challenges.
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Affiliation(s)
- Woo Gyeong Kim
- Department of Pathology, University of Inje College of Medicine, Busan, Korea.,University of Queensland Centre for Clinical Research, Brisbane, Australia
| | - Margaret C Cummings
- University of Queensland Centre for Clinical Research, Brisbane, Australia.,Department of Anatomical Pathology, Pathology Queensland, Brisbane, Australia
| | - Sunil R Lakhani
- University of Queensland Centre for Clinical Research, Brisbane, Australia.,Department of Anatomical Pathology, Pathology Queensland, Brisbane, Australia
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23
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Approach to histopathological incidental lesions after reduction mammoplasty. EUROPEAN JOURNAL OF PLASTIC SURGERY 2019. [DOI: 10.1007/s00238-019-01576-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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24
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Bacci J, MacGrogan G, Alran L, Labrot-Hurtevent G. Management of radial scars/complex sclerosing lesions of the breast diagnosed on vacuum-assisted large-core biopsy: is surgery always necessary? Histopathology 2019; 75:900-915. [PMID: 31286532 DOI: 10.1111/his.13950] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/10/2019] [Accepted: 07/04/2019] [Indexed: 11/30/2022]
Abstract
AIMS The diagnosis of radial scars/complex sclerosing lesions (RSs/CSLs) onpercutaneous biopsy carries a risk of histological underestimation. Consequently, surgical excision is often performed in order to exclude a possible associated malignancy. The aim of this study was to assess the rate of 'upgrade to carcinoma' upon subsequent surgical excision of RS/CSL cases diagnosed on vacuum-assisted large-core biopsy (VALCB). We also analysed the risk factors for upgrade in order to determine a subset of patients who could avoid surgery and benefit from conservative management with clinical and imaging follow-up. METHODS AND RESULTS This was a retrospective observational single-centre study on 174 consecutive RS/CSL cases diagnosed on VALCB from May 2008 to October 2015. Univariate analysis was performed to identify clinical, radiological and histological risk factors for upgrade. Surgical excision was performed following VALCB diagnosis of 88 RS/CSL cases with or without associated atypia. The overall rate of surgical upgrade to carcinoma was 9.1% (8/88). None of the benign biopsies without atypia was surgically upgraded. Additional to atypia, risk factors for upgrade were non-incidental finding of the RS/CSL, the mammographic appearance, and the number of fragments obtained during the biopsy procedure (P < 0.05). CONCLUSION We demonstrate that VALCB revealing an RS/CSL is reliable for excluding malignancy when there is no associated atypia and when radiological and histological findings are concordant. In such cases, surgery can be avoided in favour of clinical and imaging follow-up. When an RS/CSL is associated with atypia, the decision to perform surgical excision depends on other associated risk factors.
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Affiliation(s)
- Julia Bacci
- Medical Imaging Department, Institut Bergonié, Bordeaux, France
| | | | - Léonie Alran
- Department of Biopathology, Institut Bergonié, Bordeaux, France
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25
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McCloskey CW, Cook DP, Kelly BS, Azzi F, Allen CH, Forsyth A, Upham J, Rayner KJ, Gray DA, Boyd RW, Murugkar S, Lo B, Trudel D, Senterman MK, Vanderhyden BC. Metformin Abrogates Age-Associated Ovarian Fibrosis. Clin Cancer Res 2019; 26:632-642. [PMID: 31597663 DOI: 10.1158/1078-0432.ccr-19-0603] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 06/02/2019] [Accepted: 10/04/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE The ovarian cancer risk factors of age and ovulation are curious because ovarian cancer incidence increases in postmenopausal women, long after ovulations have ceased. To determine how age and ovulation underlie ovarian cancer risk, we assessed the effects of these risk factors on the ovarian microenvironment. EXPERIMENTAL DESIGN Aged C57/lcrfa mice (0-33 months old) were generated to assess the aged ovarian microenvironment. To expand our findings into human aging, we assembled a cohort of normal human ovaries (n = 18, 21-71 years old). To validate our findings, an independent cohort of normal human ovaries was assembled (n = 9, 41-82 years old). RESULTS We first validated the presence of age-associated murine ovarian fibrosis. Using interdisciplinary methodologies, we provide novel evidence that ovarian fibrosis also develops in human postmenopausal ovaries across two independent cohorts (n = 27). Fibrotic ovaries have an increased CD206+:CD68+ cell ratio, CD8+ T-cell infiltration, and profibrotic DPP4+αSMA+ fibroblasts. Metformin use was associated with attenuated CD8+ T-cell infiltration and reduced CD206+:CD68+ cell ratio. CONCLUSIONS These data support a novel hypothesis that unifies the primary nonhereditary ovarian cancer risk factors through the development of ovarian fibrosis and the formation of a premetastatic niche, and suggests a potential use for metformin in ovarian cancer prophylaxis.See related commentary by Madariaga et al., p. 523.
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Affiliation(s)
- Curtis W McCloskey
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David P Cook
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brendan S Kelly
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Feryel Azzi
- Institut du Cancer de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Department of Pathology and Cellular Biology, Université de Montréal, Montréal, Quebec, Canada
| | | | - Amanda Forsyth
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada
| | - Jeremy Upham
- Department of Physics and School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Canada
| | - Katey J Rayner
- University of Ottawa Heart Institute, Department of Biochemistry, Microbiology and Immunology, Faculty of Medicine, Ottawa, Ontario, Canada
| | - Douglas A Gray
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada
| | - Robert W Boyd
- Department of Physics and School of Electrical Engineering and Computer Science, University of Ottawa, Ottawa, Canada
| | | | - Bryan Lo
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada.,Molecular Oncology Diagnostics Laboratory, Division of Anatomical Pathology, The Ottawa Hospital, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dominique Trudel
- Institut du Cancer de Montréal and Centre de recherche du Centre hospitalier de l'Université de Montréal, Montréal, Quebec, Canada.,Department of Pathology and Cellular Biology, Université de Montréal, Montréal, Quebec, Canada
| | - Mary K Senterman
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Barbara C Vanderhyden
- Cancer Therapeutics Program, Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, Ontario, Canada. .,Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
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26
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Phenotypic Plasticity of Fibroblasts during Mammary Carcinoma Development. Int J Mol Sci 2019; 20:ijms20184438. [PMID: 31505876 PMCID: PMC6769951 DOI: 10.3390/ijms20184438] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/04/2019] [Accepted: 09/06/2019] [Indexed: 02/08/2023] Open
Abstract
Cancer-associated fibroblasts (CAFs) in the tumor microenvironment contribute to all stages of tumorigenesis and are usually considered to be tumor-promoting cells. CAFs show a remarkable degree of heterogeneity, which is attributed to developmental origin or to local environmental niches, resulting in distinct CAF subsets within individual tumors. While CAF heterogeneity is frequently investigated in late-stage tumors, data on longitudinal CAF development in tumors are lacking. To this end, we used the transgenic polyoma middle T oncogene-induced mouse mammary carcinoma model and performed whole transcriptome analysis in FACS-sorted fibroblasts from early- and late-stage tumors. We observed a shift in fibroblast populations over time towards a subset previously shown to negatively correlate with patient survival, which was confirmed by multispectral immunofluorescence analysis. Moreover, we identified a transcriptomic signature distinguishing CAFs from early- and late-stage tumors. Importantly, the signature of early-stage CAFs correlated well with tumor stage and survival in human mammary carcinoma patients. A random forest analysis suggested predictive value of the complete set of differentially expressed genes between early- and late-stage CAFs on bulk tumor patient samples, supporting the clinical relevance of our findings. In conclusion, our data show transcriptome alterations in CAFs during tumorigenesis in the mammary gland, which suggest that CAFs are educated by the tumor over time to promote tumor development. Moreover, we show that murine CAF gene signatures can harbor predictive value for human cancer.
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Rosa M, Agosto-Arroyo E. Core needle biopsy of benign, borderline and in-situ problematic lesions of the breast: Diagnosis, differential diagnosis and immunohistochemistry. Ann Diagn Pathol 2019; 43:151407. [PMID: 31634810 DOI: 10.1016/j.anndiagpath.2019.151407] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 08/22/2019] [Accepted: 09/02/2019] [Indexed: 12/11/2022]
Abstract
Core needle biopsy (CNB) is the most common sampling technique for the histologic evaluation of breast abnormalities. Diagnosing benign proliferative, borderline and some in-situ lesions in CNB is challenging and subject to a significant degree of interobserver variability. In addition, due to the inherent limitations of CNB, "upgrading" to a more significant pathology at excision is an important consideration for some lesions. Pathologists carry a major responsibility in patient diagnosis, risk stratification and management. Familiarity with the histologic features and the clinical significance of these common and problematic lesions encountered in CNB is necessary for adequate treatment and patient follow-up. This review will focus on benign, atypical and in-situ epithelial proliferations, papillary lesions, radial sclerosing lesions, adenosis and cellular fibroepithelial lesions. Highlights of histologic features, useful strategies for accurate diagnosis, basic immunohistochemistry and management will be presented.
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Affiliation(s)
- Marilin Rosa
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
| | - Emmanuel Agosto-Arroyo
- Department of Anatomic Pathology, Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, United States of America.
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Rakha E, Beca F, D'Andrea M, Abbas A, Petrou-Nunn W, Shaaban AM, Kandiyil A, Smith S, Menon S, Elsheikh S, ElSayed ME, Lee AH, Sharma N. Outcome of radial scar/complex sclerosing lesion associated with epithelial proliferations with atypia diagnosed on breast core biopsy: results from a multicentric UK-based study. J Clin Pathol 2019; 72:800-804. [PMID: 31350292 DOI: 10.1136/jclinpath-2019-205764] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/13/2019] [Accepted: 06/10/2019] [Indexed: 11/04/2022]
Abstract
AIMS The clinical significance of radial scar (RS)/complex sclerosing lesion (CSL) with high-risk lesions (epithelial atypia) diagnosed on needle core biopsy is not well defined. We aimed at assessing the upgrade rate to ductal carcinoma in situ (DCIS) and invasive carcinoma on the surgical excision specimen in a large cohort with RS/CSL associated with atypia. METHODS 157 women with a needle core biopsy diagnosis of a RS/CSL with atypia and follow-up histology were studied. Histological findings, including different forms of the atypical lesions and final histological outcome in the excision specimens, were retrieved and analysed, and the upgrade rates for malignancy and for invasive carcinoma were calculated. RESULTS 69.43% of the cases were associated with atypical ductal hyperplasia (ADH) or atypia not otherwise classifiable, whereas lobular neoplasia was seen in 21.66%. On final histology, 39 cases were malignant (overall upgrade rate of 24.84%); 12 were invasive and 27 had DCIS. The upgrade differed according to the type of atypia and was highest for ADH (35%). When associated with lobular neoplasia, the upgrade rate was 11.76%. The upgrade rate's variability was also considerably lower when considering the upgrade to invasive carcinoma alone for any associated lesion. CONCLUSIONS The upgrade rate for ADH diagnosed on needle core biopsy with RS is similar to that of ADH without RS and therefore should be managed similarly. RS associated with lobular neoplasia is less frequently associated with malignant outcome. Most lesions exhibiting some degree of atypia showed a similar upgrade rate to invasive carcinoma. Management of RS should be based on the concurrent atypical lesion.
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Affiliation(s)
- Emad Rakha
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK .,Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
| | - Francisco Beca
- Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Mariangela D'Andrea
- Specialization School in Anatomic Pathology, University of Pavia, Pavia, Italy
| | - Areeg Abbas
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - William Petrou-Nunn
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Abeer M Shaaban
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Aneeshya Kandiyil
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Samantha Smith
- South Birmingham Breast Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK
| | - Sindhu Menon
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Somaia Elsheikh
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
| | - Maysa E ElSayed
- Faculty of Medicine, Menoufiya University, Al Minufya, Egypt
| | - Andrew Hs Lee
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Nisha Sharma
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Elwakeel E, Brüne B, Weigert A. PGE 2 in fibrosis and cancer: Insights into fibroblast activation. Prostaglandins Other Lipid Mediat 2019; 143:106339. [PMID: 31100473 DOI: 10.1016/j.prostaglandins.2019.106339] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 04/18/2019] [Accepted: 05/13/2019] [Indexed: 02/07/2023]
Abstract
Fibroblasts are the essential cellular architects of connective tissue and as such are crucial cells in contributing to organ homeostasis. While fulfilling important repair functions during tissue regeneration upon wounding, chronic fibroblast activation provokes pathological organ fibrosis and promotes neoplastic disease progression. Identifying targets that may serve to therapeutically terminate fibroblast activation is therefore desirable. Among the mediators that may be relevant in this context is the prostanoid prostaglandin E2 (PGE2) that is produced during inflammatory settings, where pathological fibrosis occurs. Here, we summarize current, in part controversial, concepts on the impact of PGE2 on fibroblast activation in fibrotic diseases including cancer, and discuss these findings in the context of the evolving concept of fibroblast heterogeneity.
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Affiliation(s)
- Eiman Elwakeel
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, 60590 Frankfurt, Germany
| | - Bernhard Brüne
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, 60590 Frankfurt, Germany; German Cancer Consortium (DKTK), Partner Site Frankfurt, Germany
| | - Andreas Weigert
- Institute of Biochemistry I, Faculty of Medicine, Goethe-University Frankfurt, 60590 Frankfurt, Germany.
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Crnogorac M, Ivanac G, Tomasović-Lončarić Č, Žic R, Kelava T, Brkljačić B. SONOELASTOGRAPHIC FEATURES OF HIGH-RISK BREAST LESIONS AND DUCTAL CARCINOMA IN SITU - A PILOT STUDY. Acta Clin Croat 2019; 58:13-22. [PMID: 31363320 PMCID: PMC6629205 DOI: 10.20471/acc.2019.58.01.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The aim of this study was to evaluate the quantitative sonoelastographic values recorded on shear-wave sonoelastography (SWE) of high-risk breast lesions and ductal carcinoma in situ (DCIS). We retrospectively analyzed histopathologic and SWE data (quantitative maximum, minimum and mean stiffness, lesion-to-fat ratio (E-ratio), lesion size) of 228 women referred to our Department for core needle breast biopsy during a four-year period. Among 230 lesions, histopathologic findings showed 34 high-risk breast lesions and 29 DCIS, which were compared with 167 ductal invasive carcinomas. High-risk lesions had lower values of all sonoelastographic features than ductal in situ and invasive carcinoma, however, only E-ratio showed a statistically significant difference in comparison to DCIS (3.7 vs. 6, p<0.001). All sonoelastographic features showed significant difference between in situ and invasive carcinoma. There was a significant correlation between lesion size and stiffness (r=0.36; p<0.001). Stiffness measured by SWE is an effective predictor of the histopathologic severity of sonographically detectable breast lesions. Elasticity values of high-risk lesions are significantly lower than those of malignant lesions. Furthermore, we showed that along with the sonographic appearance, which in most cases shows typical microcalcifications, DCIS had significantly different elasticity parameters than invasive carcinoma.
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Affiliation(s)
| | - Gordana Ivanac
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Čedna Tomasović-Lončarić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Rado Žic
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Tomislav Kelava
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Boris Brkljačić
- 1Department of Diagnostic and Interventional Radiology, Dubrava University Hospital, Zagreb, Croatia; 2University of Zagreb, School of Medicine, Zagreb, Croatia; 3Department of Pathology, Dubrava University Hospital, Zagreb, Croatia; 4Department of Plastic and Reconstructive Surgery, Dubrava University Hospital, Zagreb, Croatia; 5Department of Physiology and Immunology, University of Zagreb, School of Medicine, Zagreb, Croatia
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Farshid G, Buckley E. Meta-analysis of upgrade rates in 3163 radial scars excised after needle core biopsy diagnosis. Breast Cancer Res Treat 2018; 174:165-177. [PMID: 30460464 DOI: 10.1007/s10549-018-5040-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 11/02/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Since concurrent malignancy may be associated with radial scars (RS) in up to 45% of RS diagnosed on core biopsy, surgical excision is usually advised. Recent very low upgrade rates have caused a re-evaluation of the need for routine surgery. We aimed to find subsets of RS at such low risk of upgrade, as to render imaging surveillance a plausible alternative to surgery. DESIGN We performed a systematic review of the Pubmed, Cochrane and Embase databases, focusing on the following eligibility criteria: full papers, published after 1998, in English, included at least 5 RS, provided information on needle biopsy gauge and upgrade rates based on the excised lesion. For the meta-analysis, studies were grouped by the presence of histologic atypia and the core needle gauge. Study-specific and pooled upgrade rates were calculated for each subgroup. RESULTS 49 studies that included 3163 RS with surgical outcomes are included. There were 217 upgrades to malignancies, 71 (32.7%) invasive and 144 (66.4%) DCIS. The random-effects pooled estimate was 7% (95% CI 5, 9%). Among the pre-planned subgroups, in RS assessed by 14G NCB the upgrade rates were: without atypia - 5% (95% CI 3, 8%), mixed or presence of atypia not specified - 15% (95% CI 10, 20%), with atypia - 29% (95% CI 20, 38%). For RS assessed by a mix of 8-16G cores the respective upgrade rates were 2% (95% CI 1, 4%), 12% (95% CI 6, 18%) and 11% (95% CI 3, 23%) and for RS assessed by 8-11 vacuum assisted biopsies 1% (95% CI 0, 4%), 5% (95% CI 0, 11%) and 18% for the one study of RS with atypia assessed by VAB. Surgery after VAB excision showed no upgrades. The difference across all subgroups was statistically significant. CONCLUSION When stratified by atypia and biopsy gauge, upgrade rates in RS are consistent and predictable. RS assessed by VABs and lacking atypia have a 1% (95% CI 0, 4%) upgrade rate to DCIS. Other groups have upgrade rates of 2-28%. This risk may be reduced by VAB excision. The results of this meta-analysis provide a decision aid and evidence-based selection criteria for surgery after a needle biopsy diagnosis of RS.
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Affiliation(s)
- Gelareh Farshid
- South Australian Pathology, Royal Adelaide Hospital, Adelaide, SA, Australia. .,BreastScreen South Australia, Flinders Street, Adelaide, SA, Australia. .,Discipline of Medicine, Adelaide University, North Terrace, Adelaide, SA, Australia.
| | - Elizabeth Buckley
- Cancer Epidemiology and Population Health Research Group, University of South Australia, Adelaide, Australia
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32
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van Zelst JCM, Mann RM. Automated Three-dimensional Breast US for Screening: Technique, Artifacts, and Lesion Characterization. Radiographics 2018; 38:663-683. [DOI: 10.1148/rg.2018170162] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jan C. M. van Zelst
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Internal Address 766, Geert Grooteplein Zuid 10, PO Box 9101, 6500HB Nijmegen, the Netherlands
| | - Ritse M. Mann
- From the Department of Radiology and Nuclear Medicine, Radboud University Medical Centre, Internal Address 766, Geert Grooteplein Zuid 10, PO Box 9101, 6500HB Nijmegen, the Netherlands
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Lysophosphatidic acid (LPA) as a pro-fibrotic and pro-oncogenic factor: a pivotal target to improve the radiotherapy therapeutic index. Oncotarget 2018; 8:43543-43554. [PMID: 28402936 PMCID: PMC5522168 DOI: 10.18632/oncotarget.16672] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 03/08/2017] [Indexed: 12/21/2022] Open
Abstract
Radiation-induced fibrosis is widely considered as a common but forsaken phenomenon that can lead to clinical sequela and possibly vital impairments. Lysophosphatidic acid is a bioactive lipid involved in fibrosis and probably in radiation-induced fibrosis as suggested in recent studies. Lysophosphatidic acid is also a well-described pro-oncogenic factor, involved in carcinogenesis processes (proliferation, survival, angiogenesis, invasion, migration). The present review highlights and summarizes the links between lysophosphatidic acid and radiation-induced fibrosis, lysophosphatidic acid and radioresistance, and proposes lysophosphatidic acid as a potential central actor of the radiotherapy therapeutic index. Besides, we hypothesize that following radiotherapy, the newly formed tumour micro-environment, with increased extracellular matrix and increased lysophosphatidic acid levels, is a favourable ground to metastasis development. Lysophosphatidic acid could therefore be an exciting therapeutic target, minimizing radio-toxicities and radio-resistance effects.
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Abstract
PURPOSE Radial scar's stellate appearance may mimic carcinoma mammographically and histologically. Management of radial scar (RS) found on breast core needle biopsies (CNB) ranges from excision to clinical observation due to the variation in reported upgrades to malignancy at surgical excision. We examined the upgrade rate in patients with RS detected on CNB at our institution and reviewed the current literature. METHODS A retrospective study was conducted of all cases with RS diagnosed on CNB between December 2006 and March 2017 at our institution. Inclusion criteria were patients with "pure" RS and RS associated with high-risk lesions (HRL). Upgrade was defined as invasive or non-invasive cancer in the excisional biopsy. RESULTS 157 cases were identified with RS on CNB, and 122 cases met inclusion criteria. Of these 122 cases, 91 (75%) had pure RS on CNB while 31 (25%) had associated atypia or HRL. 81 (66%) of patients proceeded to excisional biopsy and 41 (34%) did not. Two patients (1.6% of total) were found to have a low-grade invasive ductal carcinoma (0.6 and 0.8 cm) upon surgical excision. None of the remaining 120 patients developed an ipsilateral breast cancer with a mean of 32.3-month follow-up. CONCLUSIONS We found a very low upgrade rate to breast cancer when RS was found on CNB with or without associated HRL. Our results are consistent with other reported series. Our data do not support surgical excision for RS but rather close clinical follow-up for patients with RS on CNB.
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Abstract
Benign and atypical lesions associated with breast cancer risk are often encountered in core needle biopsies (CNBs) of the breast. For these lesions, the rate of "upgrade" to carcinoma in excision specimens varies widely in the literature. Many CNB studies are limited by a lack of radiological-pathological correlation, consistent criteria for excision, and clinical follow-up for patients who forego excision. This article highlights contemporary diagnostic criteria and outcome data that would support an evidence-based approach to the management of these nonmalignant lesions of the breast diagnosed on CNB.
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Affiliation(s)
- Benjamin C Calhoun
- Department of Pathology and Laboratory Medicine, University of North Carolina, Women's and Children's Hospitals, 3rd Floor, Room 30212, 101 Manning Drive, Chapel Hill, NC 27514, USA.
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36
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Mesa-Quesada J, Romero-Martín S, Cara-García M, Martínez-López A, Medina-Pérez M, Raya-Povedano J. Radial scars without atypia in percutaneous biopsy specimens: Can they obviate surgical biopsy? RADIOLOGIA 2017. [DOI: 10.1016/j.rxeng.2017.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Mesa-Quesada J, Romero-Martín S, Cara-García M, Martínez-López A, Medina-Pérez M, Raya-Povedano J. Cicatriz radial sin atipia en biopsia percutánea. ¿Puede evitarse la biopsia quirúrgica? RADIOLOGIA 2017; 59:523-530. [DOI: 10.1016/j.rx.2017.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 04/12/2017] [Accepted: 04/13/2017] [Indexed: 11/28/2022]
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Akram M, Iqbal M, Daniyal M, Khan AU. Awareness and current knowledge of breast cancer. Biol Res 2017; 50:33. [PMID: 28969709 PMCID: PMC5625777 DOI: 10.1186/s40659-017-0140-9] [Citation(s) in RCA: 570] [Impact Index Per Article: 81.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Accepted: 09/22/2017] [Indexed: 02/01/2023] Open
Abstract
Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe. Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading cause of mortality among women population. For the previous two decades, studies related to the breast cancer has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell therapy etc for breast cancer.
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Affiliation(s)
- Muhammad Akram
- Department of Eastern Medicine and Surgery, Directorate of Medical Sciences, GC University Faisalabad, Old Campus, Allam Iqbal Road, Faisalabad, 38000 Pakistan
| | - Mehwish Iqbal
- Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan
| | - Muhammad Daniyal
- Faculty of Eastern Medicine, Hamdard University Karachi, Main Campus, Sharea Madinat al-Hikmah, Mohammad Bin Qasim Avenue, Karachi, 74600 Sindh Pakistan
| | - Asmat Ullah Khan
- Laboratory of Neuroanatomy & Neuropsychobiology, Department of Pharmacology, RibeirãoPreto Medical School of the University of São Paulo, AV. Bandeirantes, 3900, RibeirãoPreto, 14049-900 São Paulo, Brazil
- Department of Eastern Medicine and Surgery, School of Medical and Health Sciences, University of Poonch Rawalakot, Hajira Road, Shamsabad, Rawalakot, 12350 Azad Jammu and Kashmir Pakistan
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Benyahia Z, Dussault N, Cayol M, Sigaud R, Berenguer-Daizé C, Delfino C, Tounsi A, Garcia S, Martin PM, Mabrouk K, Ouafik L. Stromal fibroblasts present in breast carcinomas promote tumor growth and angiogenesis through adrenomedullin secretion. Oncotarget 2017; 8:15744-15762. [PMID: 28178651 PMCID: PMC5362520 DOI: 10.18632/oncotarget.14999] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 01/03/2017] [Indexed: 11/25/2022] Open
Abstract
Tumor- or cancer-associated fibroblasts (TAFs or CAFs) are active players in tumorigenesis and exhibit distinct angiogenic and tumorigenic properties. Adrenomedullin (AM), a multifunctional peptide plays an important role in angiogenesis and tumor growth through its receptors calcitonin receptor-like receptor/receptor activity modifying protein-2 and -3 (CLR/RAMP2 and CLR/RAMP3). We show that AM and AM receptors mRNAs are highly expressed in CAFs prepared from invasive breast carcinoma when compared to normal fibroblasts. Immunostaining demonstrates the presence of immunoreactive AM and AM receptors in the CAFs (n = 9). The proliferation of CAFs is decreased by anti-AM antibody (αAM) and anti-AM receptors antibody (αAMR) treatment, suggesting that AM may function as a potent autocrine/paracrine growth factor. Systemic administration of αAMR reduced neovascularization of in vivo Matrigel plugs containing CAFs as demonstrated by reduced numbers of the vessel structures, suggesting that AM is one of the CAFs-derived factors responsible for endothelial cell-like and pericytes recruitment to built a neovascularization. We show that MCF-7 admixed with CAFs generated tumors of greater volume significantly different from the MCF-7 xenografts in nude mice due in part to the induced angiogenesis. αAMR and AM22-52 therapies significantly suppressed the growth of CAFs/MCF-7 tumors. Histological examination of tumors treated with AM22-52 and aAMR showed evidence of disruption of tumor vasculature with depletion of vascular endothelial cells, induced apoptosis and decrease of tumor cell proliferation. Our findings highlight the importance of CAFs-derived AM pathway in growth of breast carcinoma and in neovascularization by supplying and amplifying signals that are essential for pathologic angiogenesis.
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Affiliation(s)
- Zohra Benyahia
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Nadège Dussault
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Mylène Cayol
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Romain Sigaud
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Caroline Berenguer-Daizé
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Christine Delfino
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Asma Tounsi
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Stéphane Garcia
- Assistance Publique Hôpitaux de Marseille, Laboratoire d'Anatomie Pathologique, 13015, Marseille, France
| | - Pierre-Marie Martin
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France
| | - Kamel Mabrouk
- Aix Marseille University, CNRS, ICR, UMR 7273 CROPS, 13397, Marseille, France
| | - L'Houcine Ouafik
- Aix Marseille University, The Institut National pour la Recherche Médicale, Centre de Recherche en Oncologie et Oncopharmacologie, UMR 911, 13005, Marseille, France.,Assistance Publique Hôpitaux de Marseille, Service de Transfert d'Oncologie Biologique, 13015, Marseille, France
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40
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Abstract
Benign breast disease is a spectrum of common disorders. The majority of patients with a clinical breast lesion will have benign process. Management involves symptom control when present, pathologic-based and imaging-based evaluation to distinguish from a malignant process, and counseling for patients that have an increased breast cancer risk due to the benign disorder.
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Mohlin S, Wigerup C, Jögi A, Påhlman S. Hypoxia, pseudohypoxia and cellular differentiation. Exp Cell Res 2017; 356:192-196. [PMID: 28284840 DOI: 10.1016/j.yexcr.2017.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/07/2017] [Indexed: 11/19/2022]
Abstract
Tumor hypoxia correlates to aggressive disease, and while this is explained by a variety of factors, one clue to understand this phenomena was the finding that hypoxia induces a de-differentiated, stem cell-like phenotype in neuroblastoma and breast tumor cells. The hypoxia inducible transcription factors (HIFs) are regulated at the translational level by fluctuating oxygen concentrations, but emerging data reveal that both HIF-1α and HIF-2α expression can be induced by aberrantly activated growth factor signaling independently of oxygen levels. Furthermore, HIF-2α is regulated by hypoxia also at the transcriptional level in neuroblastoma and glioma cells. In cultured tumor cells, HIF-2α is stabilized at physiological oxygen concentrations followed by induced expression of classical hypoxia-driven genes, resulting in a pseudohypoxic phenotype. In addition, in neuroblastoma and glioma specimens, a small subset of HIF-2α positive, HIF-1α negative, tumor cells is found adjacent to blood vessels, i.e. in areas with presumably adequate oxygenation. These tumor niches are thus pseudohypoxic, and the HIF-2α expressing cells present immature features. We have postulated that this niche in neuroblastomas encompass the tumor stem cells. Oncogenes or tumor suppressor genes associated with pseudohypoxia are frequently mutated or deleted in the germline, implicating that the pseudohypoxic phenotype indeed is tumorigenic. In summary, the hypoxic and pseudohypoxic phenotypes of solid tumors are attractive therapeutic targets.
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Affiliation(s)
- Sofie Mohlin
- Translational Cancer Research, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden
| | - Caroline Wigerup
- Translational Cancer Research, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden
| | - Annika Jögi
- Translational Cancer Research, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden
| | - Sven Påhlman
- Translational Cancer Research, Lund University Cancer Center at Medicon Village, Lund University, Lund, Sweden.
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Radial scar of the breast: Is it possible to avoid surgery? Eur J Surg Oncol 2017; 43:1265-1272. [PMID: 28215506 DOI: 10.1016/j.ejso.2017.01.238] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Breast radial scar (RS) management remains controversial. The need for surgical excision is supported by the concern of an associated high-grade lesion missed in the biopsy. The aim of this study was to assess histologic upgrade rate after a percutaneous biopsy, to determine if vacuum assisted biopsy prevents the need for subsequent RS surgical resection and to evaluate the upgrade risk factors. PATIENTS AND METHODS This was a uni-institutional retrospective study of consecutive patients with RS histologically diagnosed from January 2010 to December 2015. RESULTS A total of 113 cases of RS were diagnosed. We verify that there was a histologic upgrade in 22 (19.5%) cases. The upgrade risk factors were the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained in the biopsy (p < 0.05). The biopsy type was vacuum assisted in 25 (22.1%). The upgrade rate in the vacuum assisted biopsy group was 4.0%, whereas in the standard core needle biopsy group was 23,9% (p = 0.041). DISCUSSION AND CONCLUSION We demonstrated that the risk of upgrade after a RS diagnosis depends on the type of biopsy performed, the presence of atypia, the presence of calcifications and the number of fragments obtained. When a standard core biopsy is performed the risk of upgrade and malignancy is not negligible, and surgery is indicated. When the biopsy is vacuum assisted, the risk of upgrade and malignancy is significantly decreased and so the indication for excisional biopsy seems not to be so imperative.
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Upgrade rates of high-risk breast lesions diagnosed on core needle biopsy: a single-institution experience and literature review. Mod Pathol 2016; 29:1471-1484. [PMID: 27538687 DOI: 10.1038/modpathol.2016.127] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 05/31/2016] [Accepted: 06/02/2016] [Indexed: 11/08/2022]
Abstract
Optimal management of high-risk breast lesions detected by mammogram yielding atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia on core needle biopsy is controversial. This is a single-institution retrospective review of 5750 core needle biopsy cases seen over 14.5 years, including 249 (4.3%), 72 (1.3%), 50 (0.9%), 37 (0.6%), and 54 (0.9%) cases of atypical ductal hyperplasia, flat epithelial atypia, atypical lobular hyperplasia, lobular carcinoma in situ, and radial scar without atypia, respectively. Patient age, radiologic characteristics, needle gauge, and excision diagnoses were recorded. Of 462 high-risk cases analyzed, 333 (72%) underwent excision. Upgrade rate to ductal carcinoma in situ, pleomorphic carcinoma in situ, or invasive mammary carcinoma was 18% for atypical ductal hyperplasia, 11% for flat epithelial atypia, 9% for atypical lobular hyperplasia, 28% for lobular carcinoma in situ, and 16% for radial scar. Carcinoma diagnosed on excision was more likely to be in situ than invasive, and if invasive, more likely to be low grade than high grade. Overall, cases that were benign (vs high risk or carcinoma) on excision were less likely to have residual calcifications after biopsy (17% vs 27%, P=0.013), and more likely to have a smaller mass size (<1 cm) (82% vs 50%, P=0.001). On subgroup analysis, atypical ductal hyperplasia cases that were benign (vs high risk or carcinoma) on excision were more likely to have smaller mass size (<1 cm) (P=0.025). Lobular neoplasia diagnosed incidentally (vs targeted) on core needle biopsy was less likely to upgrade on excision (5% vs 39%, P=0.002). A comprehensive literature review was performed, identifying 116 studies reporting high-risk lesion upgrade rates, and our upgrade rates were similar to those of more recent larger studies. Careful radiological-pathological correlation is needed to identify high-risk lesion subgroups that may not need excision.
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Cheng E, D'Alfonso TM, Arafah M, Marrero Rolon R, Ginter PS, Hoda SA. Subareolar Sclerosing Ductal Hyperplasia. Int J Surg Pathol 2016; 25:4-11. [PMID: 27831531 DOI: 10.1177/1066896916677288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Subareolar sclerosing duct hyperplasia (SSDH) remains to be fully characterized nearly 20 years after initial description. Thirty-five SSDH cases diagnosed over a 16-year period (January 2000 to December 2015) were reviewed. All patients were female (mean age = 59 years, range = 18-80) who had presented with a unilateral solitary lesion (left 22, right 13) with a mean size of 1.3 cm (range = 0.4-3.0 cm), and showed florid and papillary epithelial hyperplasia with dense sclerosis without involvement of nipple or areolar epidermis. Significant lesions concurrent within SSDH included low-grade adenosquamous carcinoma (n = 1), ductal carcinoma in situ (DCIS; n = 1), lobular carcinoma in situ (LCIS; n = 1), and atypical ductal hyperplasia (ADH; n = 13). No case of SSDH recurred in a mean follow-up of 44 months (range = 6-189). Subsequent significant lesions occurred in 6 patients: DCIS (n = 3; ipsilateral 2, contralateral 1), ipsilateral ADH (n = 2), and ipsilateral atypical lobular hyperplasia (n = 1). Long-term follow-up for patients with SSDH is indicated as DCIS can occur subsequently in either breast.
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Affiliation(s)
- Esther Cheng
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Timothy M D'Alfonso
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Maria Arafah
- 3 King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Rebecca Marrero Rolon
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Paula S Ginter
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
| | - Syed A Hoda
- 1 Weill Cornell Medicine, New York, NY, USA.,2 New York Presbyterian Hospital-Weill Cornell Medical Center,New York, NY, USA
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Kalife ET, Lourenco AP, Baird GL, Wang Y. Clinical and Radiologic Follow-up Study for Biopsy Diagnosis of Radial Scar/Radial Sclerosing Lesion without Other Atypia. Breast J 2016; 22:637-644. [DOI: 10.1111/tbj.12645] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Elizabeth Tágide Kalife
- Department of Pathology; Alpert Medical School of Brown University; Rhode Island Hospital; Providence Rhode Island
| | - Ana P. Lourenco
- Department of Diagnostic Imaging; Alpert Medical School of Brown University; Rhode Island Hospital; Providence Rhode Island
| | - Grayson L. Baird
- Department of Diagnostic Imaging; Alpert Medical School of Brown University; Rhode Island Hospital; Providence Rhode Island
| | - Yihong Wang
- Department of Pathology; Alpert Medical School of Brown University; Rhode Island Hospital; Providence Rhode Island
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Rageth CJ, O'Flynn EA, Comstock C, Kurtz C, Kubik R, Madjar H, Lepori D, Kampmann G, Mundinger A, Baege A, Decker T, Hosch S, Tausch C, Delaloye JF, Morris E, Varga Z. First International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions). Breast Cancer Res Treat 2016; 159:203-13. [PMID: 27522516 PMCID: PMC5012144 DOI: 10.1007/s10549-016-3935-4] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to obtain a consensus for the therapy of B3 lesions. The first International Consensus Conference on lesions of uncertain malignant potential in the breast (B3 lesions) including atypical ductal hyperplasia (ADH), flat epithelial atypia (FEA), classical lobular neoplasia (LN), papillary lesions (PL), benign phyllodes tumors (PT), and radial scars (RS) took place in January 2016 in Zurich, Switzerland organized by the International Breast Ultrasound School and the Swiss Minimally Invasive Breast Biopsy group-a subgroup of the Swiss Society of Senology. Consensus recommendations for the management and follow-up surveillance of these B3 lesions were developed and areas of research priorities were identified. The consensus recommendation for FEA, LN, PL, and RS diagnosed on core needle biopsy or vacuum-assisted biopsy (VAB) is to therapeutically excise the lesion seen on imaging by VAB and no longer by open surgery, with follow-up surveillance imaging for 5 years. The consensus recommendation for ADH and PT is, with some exceptions, therapeutic first-line open surgical excision. Minimally invasive management of selected B3 lesions with therapeutic VAB is acceptable as an alternative to first-line surgical excision.
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Affiliation(s)
- Christoph J Rageth
- Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland. .,Centre du sein, Département de Gynécologie et d'Obstétrique, Hôpitaux Universitaires de Genève, Bd de la Cluse 30, 1211, Genève 14, Switzerland.
| | | | - Christopher Comstock
- Memorial Sloan Kettering Cancer Center, Breast and Imaging Center, 300 E 66th St Suite 723, New York, NY, 10065, USA
| | - Claudia Kurtz
- Institut für Radiologie und Nuklearmedizin, Luzerner Kantonsspital, 6000, Lucerne, Switzerland
| | - Rahel Kubik
- Institute of Radiology, Department of Medical Services, Kantonsspital Baden, im Ergel, 5404, Baden, Switzerland
| | - Helmut Madjar
- DKD HELIOS Klinik, Aukammallee 33, 65191, Wiesbaden, Germany
| | | | - Gert Kampmann
- Centro di Radiologia e Senologia Luganese, Corso Pestalozzi 3, 6900, Lugano, Switzerland
| | | | - Astrid Baege
- Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland
| | - Thomas Decker
- Institut für Pathologie am Dietrich-Bonhoeffer-Klinikum, Salvador-Allende-Straße 30, 17036, Neubrandenburg, Germany
| | - Stefanie Hosch
- Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland
| | - Christoph Tausch
- Brust-Zentrum Zürich, Seefeldstr. 214, 8008, Zurich, Switzerland
| | | | - Elisabeth Morris
- Memorial Sloan Kettering Cancer Center, Breast and Imaging Center, 300 E 66th St Suite 723, New York, NY, 10065, USA
| | - Zsuzsanna Varga
- Institute of Surgical Pathology, University Hospital Zurich, Schmelzbergstrasse 12, 8091, Zurich, Switzerland
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Donaldson AR, Sieck L, Booth CN, Calhoun BC. Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management. Breast 2016; 30:201-207. [PMID: 27371970 DOI: 10.1016/j.breast.2016.06.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/03/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022] Open
Abstract
AIMS The risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable. The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar. METHODS AND RESULTS Dedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ. Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications. CONCLUSIONS In this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy.
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Affiliation(s)
- Alana R Donaldson
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
| | - Leah Sieck
- Imaging Institute, Department of Breast Imaging, Cleveland Clinic, Cleveland, OH, USA.
| | - Christine N Booth
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
| | - Benjamin C Calhoun
- Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic, Cleveland, OH, USA.
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48
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Hou Y, Hooda S, Li Z. Surgical excision outcome after radial scar without atypical proliferative lesion on breast core needle biopsy: a single institutional analysis. Ann Diagn Pathol 2016; 21:35-8. [DOI: 10.1016/j.anndiagpath.2015.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 11/02/2015] [Indexed: 10/22/2022]
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49
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Li Z, Ranade A, Zhao C. Pathologic findings of follow-up surgical excision for radial scar on breast core needle biopsy. Hum Pathol 2016; 48:76-80. [DOI: 10.1016/j.humpath.2015.06.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 06/05/2015] [Accepted: 06/10/2015] [Indexed: 10/22/2022]
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50
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Eberle CA, Piscuoglio S, Rakha EA, Ng CKY, Geyer FC, Edelweiss M, Sakr RA, Weigelt B, Reis-Filho JS, Ellis IO. Infiltrating epitheliosis of the breast: characterization of histological features, immunophenotype and genomic profile. Histopathology 2016; 68:1030-9. [PMID: 26497122 DOI: 10.1111/his.12897] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Accepted: 10/21/2015] [Indexed: 01/01/2023]
Abstract
AIMS Infiltrating epitheliosis is a rare complex sclerosing lesion (CSL) of the breast, characterized by infiltrating ducts immersed in a scleroelastotic stroma and filled with cells having architectural and cytological patterns reminiscent of those of usual ductal hyperplasia. In this study we sought to define the molecular characteristics of infiltrating epitheliosis. METHODS AND RESULTS Eight infiltrating epitheliosis, adjacent breast lesions (one usual ductal hyperplasia, one papilloma, one micropapillary ductal carcinoma in situ and one low-grade adenosquamous carcinoma), and corresponding normal breast tissue from each case were microdissected and subjected to massively parallel sequencing analysis targeting all coding regions of 254 genes mutated recurrently in breast cancer and/or related to DNA repair. Mutations in components of the PI3K pathway were found in all infiltrating epitheliosis samples, seven of which harboured PIK3CA hotspot mutations, while the remaining case displayed a PIK3R1 somatic mutation. CONCLUSIONS Somatic mutations affecting PI3K pathway genes were found to be highly prevalent in infiltrating epitheliosis, suggesting that these lesions may be neoplastic rather than hyperplastic. The landscape of somatic genetic alterations found in infiltrating epitheliosis is similar to that of radial scars/CSLs, suggesting that infiltrating epitheliosis may represent one end of this spectrum of lesions.
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Affiliation(s)
- Carey A Eberle
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Salvatore Piscuoglio
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emad A Rakha
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
| | - Charlotte K Y Ng
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Felipe C Geyer
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Hospital Israelita Albert Einstein, Instituto Israelita de Ensino e Pesquisa, São Paulo, Brazil
| | - Marcia Edelweiss
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rita A Sakr
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ian O Ellis
- Department of Histopathology, Nottingham University Hospitals, Nottingham, UK
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