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Nagy-Mikó B, Németh-Szatmári O, Faragó-Mészáros R, Csókási A, Bognár B, Ördög N, Borsos BN, Majoros H, Ujfaludi Z, Oláh-Németh O, Nikolényi A, Dobi Á, Kószó R, Sántha D, Lázár G, Simonka Z, Paszt A, Ormándi K, Pankotai T, Boros IM, Villányi Z, Vörös A. Predictive Potential of RNA Polymerase B (II) Subunit 1 (RPB1) Cytoplasmic Aggregation for Neoadjuvant Chemotherapy Failure. Int J Mol Sci 2023; 24:15869. [PMID: 37958852 PMCID: PMC10650411 DOI: 10.3390/ijms242115869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 11/15/2023] Open
Abstract
We aimed to investigate the contribution of co-translational protein aggregation to the chemotherapy resistance of tumor cells. Increased co-translational protein aggregation reflects altered translation regulation that may have the potential to buffer transcription under genotoxic stress. As an indicator for such an event, we followed the cytoplasmic aggregation of RPB1, the aggregation-prone largest subunit of RNA polymerase II, in biopsy samples taken from patients with invasive carcinoma of no special type. RPB1 frequently aggregates co-translationally in the absence of proper HSP90 chaperone function or in ribosome mutant cells as revealed formerly in yeast. We found that cytoplasmic foci of RPB1 occur in larger sizes in tumors that showed no regression after therapy. Based on these results, we propose that monitoring the cytoplasmic aggregation of RPB1 may be suitable for determining-from biopsy samples taken before treatment-the effectiveness of neoadjuvant chemotherapy.
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Affiliation(s)
- Bence Nagy-Mikó
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Orsolya Németh-Szatmári
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Réka Faragó-Mészáros
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Aliz Csókási
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Bence Bognár
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Nóra Ördög
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Barbara N. Borsos
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Hajnalka Majoros
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
- Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér 13, H-6720 Szeged, Hungary
| | - Zsuzsanna Ujfaludi
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
- Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér 13, H-6720 Szeged, Hungary
| | - Orsolya Oláh-Németh
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
| | - Aliz Nikolényi
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - Ágnes Dobi
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - Dóra Sántha
- Department of Oncotherapy, Albert Szent-Györgyi Health Centre, University of Szeged, 12 Korányi Fasor, H-6720 Szeged, Hungary
| | - György Lázár
- Department of Surgery, Albert Szent-Györgyi Health Centre, University of Szeged, 8 Semmelweis Street, H-6725 Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, Albert Szent-Györgyi Health Centre, University of Szeged, 8 Semmelweis Street, H-6725 Szeged, Hungary
| | - Attila Paszt
- Department of Surgery, Albert Szent-Györgyi Health Centre, University of Szeged, 8 Semmelweis Street, H-6725 Szeged, Hungary
| | - Katalin Ormándi
- Department of Radiology, Albert Szent-Györgyi Health Centre, University of Szeged, 6 Semmelweis Street, H-6725 Szeged, Hungary
| | - Tibor Pankotai
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
- Competence Centre of the Life Sciences Cluster of the Centre of Excellence for Interdisciplinary Research, Development and Innovation, University of Szeged, Dugonics tér 13, H-6720 Szeged, Hungary
- Genome Integrity and DNA Repair Core Group, Hungarian Centre of Excellence for Molecular Medicine (HCEMM), University of Szeged, Budapesti út 9, H-6728 Szeged, Hungary
| | - Imre M. Boros
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - Zoltán Villányi
- Department of Biochemistry and Molecular Biology, University of Szeged, 52 Középfasor, H-6726 Szeged, Hungary
| | - András Vörös
- Department of Pathology, Albert Szent-Györgyi Medical School, University of Szeged, Állomás utca 1, H-6725 Szeged, Hungary
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Tabár L, Dean PB, Ming-Fang Yen A, Yi-Ying Wu W, Tarján M, Lee Tucker F, Hsiu-Hsi Chen T, Vörös A. The term "classic invasive lobular carcinoma" of the breast defines breast malignancies of vastly different nature. Eur J Radiol 2023; 168:111119. [PMID: 37813006 DOI: 10.1016/j.ejrad.2023.111119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 09/10/2023] [Accepted: 09/26/2023] [Indexed: 10/11/2023]
Abstract
PURPOSE To describe in detail the special features of a previously unappreciated "classic invasive lobular carcinoma" which is confined to the terminal ductal lobular units (TDLUs) and differs considerably from the extensive classic invasive lobular carcinoma, and to suggest specific terminology. METHOD All invasive breast cancer cases without associated microcalcifications diagnosed in our Institution with the histopathologic diagnosis of classic invasive lobular carcinoma during the years 1996-2019 (n = 560) formed the basis of this study. The cases were prospectively classified according to their imaging biomarkers (mammographic features) and followed up to Dec 31, 2021, to determine long-term patient outcome. An additional 2600 invasive breast cancer cases (diagnosed other than invasive lobular carcinoma) without associated microcalcifications served as a reference group. Detailed histopathologic analysis used large format (10x8 cm) thin section technique and staining methods including hematoxylin-eosin (H&E), E-cadherin, cytokeratin CK 5/6, a transmembrane glycoprotein (CD44) and anti-actin or anti-smooth muscle myosin heavy chain. RESULTS The imaging biomarkers differentiated two separate disease subgroups, having the same histopathologic diagnosis, classic invasive lobular carcinoma. One of these has the imaging biomarker of extensive architectural distortion with no central tumour mass, occupies the extralobular mesenchyme and has a long-term survival of 56%. The other subgroup forms stellate or circular non-calcified tumour masses usually smaller than 20 mm, which appear to arise in the intralobular mesenchyme, and has a significantly better long-term survival of 84%. CONCLUSIONS There is a striking difference between the subgross histopathology and the mammographic appearance (imaging biomarkers) of two breast malignancies having the same histopathologic diagnosis, "classic invasive lobular carcinoma". The large difference in the long-term outcome of these two tumour types is even more striking. Using the same specific term, "classic invasive lobular carcinoma", to describe these two separate entities can adversely affect management decisions.
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Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Miklós Tarján
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - F Lee Tucker
- Virginia Biomedical Laboratories, Wirtz, VA, USA
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás út 1, H-6720 Szeged, Hungary
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Tabár L, Dean PB, Tucker FL, Yen AMF, Chen SLS, Lin ATY, Hsu CY, Munpolsri P, Wu WYY, Smith RA, Duffy SW, Chen THH, Tarján M, Vörös A. Imaging biomarkers are underutilised but highly predictive prognostic factors for the more fatal breast cancer subtypes. Eur J Radiol 2023; 166:111021. [PMID: 37542814 DOI: 10.1016/j.ejrad.2023.111021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 07/25/2023] [Accepted: 07/30/2023] [Indexed: 08/07/2023]
Abstract
PURPOSE The development and refinement of breast imaging modalities offer a wealth of diagnostic information such as imaging biomarkers, which are primarily the mammographic appearance of the various breast cancer subtypes. These are readily available preoperatively at the time of diagnosis and can enhance the prognostic value of currently used molecular biomarkers. In this study, we investigated the relative utility of the molecular and imaging biomarkers, both jointly and independently, when predicting long-term patient outcome according to the site of tumour origin. METHODS We evaluated the association of imaging biomarkers and conventional molecular biomarkers, (ER, PR, HER-2, Ki67), separately and combined, with long-term patient outcome in all breast cancer cases having complete data on both imaging and molecular biomarkers (n = 2236) diagnosed in our Institute during the period 2008-2019. Large format histopathology technique was used to document intra- and intertumoural heterogeneity and select the appropriate foci for evaluating molecular biomarkers. RESULTS The breast cancer imaging biomarkers were strongly predictive of long-term patient outcome. The molecular biomarkers were predictive of outcome only for unifocal acinar adenocarcinoma of the breast (AAB), but less reliable in the multifocal AAB cases due to variability of molecular biomarkers in the individual tumour foci. In breast cancer of mesenchymal origin (BCMO), conventionally termed classic invasive lobular carcinoma, and in cancers originating from the major lactiferous ducts (ductal adenocarcinoma of the breast, DAB), the molecular biomarkers misleadingly indicated favourable prognosis, whereas the imaging biomarkers in BCMO and DAB reliably indicated the high risk of breast cancer death. Among the 2236 breast cancer cases, BCMO and DAB comprised 21% of the breast cancer cases, but accounted for 45% of the breast cancer deaths. CONCLUSIONS Integration of imaging biomarkers into the diagnostic workup of breast cancer yields a more precise, comprehensive and prognostically accurate diagnostic report. This is particularly necessary in multifocal AAB cases having intertumoural heterogeneity, in diffuse carcinomas (DAB and BCMO), and in cases with combined DAB and AAB. In such cases, the imaging biomarkers should be prioritised over molecular biomarkers in planning treatment because the latter fail to predict the severity of the disease. In combination with the use of the large section histopathology technique, imaging biomarkers help alleviate some of the current problems in breast cancer management, such as over- and under-assessment of disease extent, which carry the risk of overtreatment and undertreatment.
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Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | | | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan
| | - Abbie Ting-Yu Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - Chen-Yang Hsu
- Daichung Hospital, No. 304, Guangfu Rd, Zhunan Township, Miaoli 350, Taiwan
| | - Pattaranan Munpolsri
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, 250 Wuxing Street, Taipei 110, Taiwan
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, GA 30303, USA
| | - Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, Queen Mary University of London, Charterhouse Square London EC1M 6BQ, UK
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - Miklós Tarján
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás street 1, H-6720 Szeged, Hungary
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Tabár L, Bozó R, Dean PB, Ormándi K, Puchkova O, Oláh-Németh O, Németh IB, Veréb Z, Yen MF, Chen LS, Chen HH, Vörös A. Does Diffusely Infiltrating Lobular Carcinoma of the Breast Arise from Epithelial-Mesenchymal Hybrid Cells? Int J Mol Sci 2023; 24:10752. [PMID: 37445938 DOI: 10.3390/ijms241310752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Revised: 06/19/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Classic diffusely infiltrating lobular carcinoma has imaging features divergent from the breast cancers originating from the terminal ductal lobular units and from the major lactiferous ducts. Although the term "invasive lobular carcinoma" implies a site of origin within the breast lobular epithelium, we were unable to find evidence supporting this assumption. Exceptional excess of fibrous connective tissue and the unique cell architecture combined with the aberrant features at breast imaging suggest that this breast malignancy has not originated from cells lining the breast ducts and lobules. The only remaining relevant component of the fibroglandular tissue is the mesenchyme. The cells freshly isolated and cultured from diffusely infiltrating lobular carcinoma cases contained epithelial-mesenchymal hybrid cells with both epithelial and mesenchymal properties. The radiologic and histopathologic features of the tumours and expression of the mesenchymal stem cell positive markers CD73, CD90, and CD105 all suggest development in the direction of mesenchymal transition. These hybrid cells have tumour-initiating potential and have been shown to have poor prognosis and resistance to therapy targeted for malignancies of breast epithelial origin. Our work emphasizes the need for new approaches to the diagnosis and therapy of this highly fatal breast cancer subtype.
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Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden
| | - Renáta Bozó
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Peter B Dean
- Department of Diagnostic Radiology, Faculty of Medicine, University of Turku, FI-20014 Turun, Finland
| | - Katalin Ormándi
- Department of Radiology, University of Szeged, Semmelweis Street 6, H-6725 Szeged, Hungary
| | - Olga Puchkova
- Department of Breast Imaging, Il'inskaya Hospital, Novorizhskoye Highway 9 km, 101000 Moscow, Russia
| | - Orsolya Oláh-Németh
- Department of Pathology, University of Szeged, Állomás Street 2, H-6725 Szeged, Hungary
| | - István Balázs Németh
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Zoltán Veréb
- Department of Dermatology and Allergology, Albert Szent-Györgyi Medical School, University of Szeged, Korányi Street 6, H-6720 Szeged, Hungary
| | - Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17 Hsuchow Road, Taipei 100, Taiwan
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás Street 2, H-6725 Szeged, Hungary
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Tabár L, Dean PB, Tucker FL, Yen AMF, Chen THH, Wu WYY, Vörös A. Multifocal and diffusely infiltrating breast cancers are highly fatal subgroups needing further improvement in diagnostic and therapeutic strategies. Eur J Radiol 2023; 164:110854. [PMID: 37163829 DOI: 10.1016/j.ejrad.2023.110854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/12/2023]
Abstract
Physicians treating breast cancer patients often wonder why this dreaded disease is still fatal in some women despite our best diagnostic and therapeutic efforts. Our own studies on prospectively documented cases spanning several decades have given us new insights for approaching this problem. By using imaging biomarkers to classify breast cancer subtypes according to their apparent site of origin, we found that a majority of breast cancer deaths (71%) occur in a minority of breast cancers (45%). Breast cancer deaths are significantly more likely to occur in women with multifocal acinar adenocarcinoma of the breast, AAB (13.1%), diffusely invasive breast cancers of ductal origin, DAB (24 %) and breast malignancies of mesenchymal hybrid cell origin, BCMO (33.7%) compared with women having unifocal invasive breast cancers (6.1%). Preventing more of these fatal events will require a re-evaluation of the current imperfect histopathologic terminology of breast cancer with special attention to the diffuse breast cancer subtypes, intensification of multimodality imaging and multidisciplinary management, as well as application of image guided large format histopathology.
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Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen, 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | - F Lee Tucker
- Virginia Biomedical Laboratories, Wirtz, VA, USA
| | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Wuxing Street, Taipei 110, Taiwan
| | - Tony Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, 17, Hsuchow Road, Taipei 100, Taiwan
| | - Wendy Yi-Ying Wu
- Department of Radiation Sciences, Oncology, Umeå University, Sweden
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás út 1, H-6720 Szeged, Hungary
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Almási S, Kuthi L, Sejben A, Vörös A, Nagy Á, Zombori T, Cserni G. TRPS1 expression in cytokeratin 5 expressing triple negative breast cancers, its value as a marker of breast origin. Virchows Arch 2023; 482:861-868. [PMID: 37012444 PMCID: PMC10156897 DOI: 10.1007/s00428-023-03535-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/06/2023] [Accepted: 03/23/2023] [Indexed: 04/05/2023]
Abstract
The lack of oestrogen receptor, progesterone receptor and human epidermal growth factor receptor-2 expression in breast cancer (BC) is the basis for the categorization of the tumour as triple negative breast carcinoma (TNBC). The majority of TNBCs are aggressive tumours with common metastases and decreased expression of markers that could help in identifying the metastatic lesion as of mammary origin. Breast markers, such as gross cystic disease fluid protein-15 (GCDPF-15), GATA binding protein 3 (GATA3), mammaglobin (MGB) and SOX10, are not uniquely specific to BC. Our aim was to evaluate trichorhinophalangeal syndrome type 1 (TRPS1) protein as a breast marker in a series of cytokeratin-5-expressing TNBC, mostly corresponding to basal-like TNBCs, previously characterized for the expression of other breast markers. One hundred seventeen TNBCs in tissue microarrays were immunostained for TRPS1. The cut-off for positivity was ≥ 10%. The reproducibility of this classification was also assessed. TRPS1 positivity was detected in 92/117 (79%) cases, and this exceeded the expression of previously tested markers like SOX10 82 (70%), GATA3 11 (9%), MGB 10 (9%) and GCDFP-15 7 (6%). Of the 25 TRPS1-negative cases, 11 were positive with SOX10, whereas 5 to 6 dual negatives displayed positivity for the other makers. The evaluation showed substantial agreement. Of the five markers compared, TRPS1 seems the most sensitive marker for the mammary origin of CK5-expressing TNBCs. Cases that are negative are most often labelled with SOX10, and the remainder may still demonstrate positivity for any of the 3 other markers. TRPS1 has a place in breast marker panels.
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Affiliation(s)
- Szintia Almási
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical School, Állomás u. 1, Szeged, 6725, Hungary.
| | - Levente Kuthi
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical School, Állomás u. 1, Szeged, 6725, Hungary
| | - Anita Sejben
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical School, Állomás u. 1, Szeged, 6725, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical School, Állomás u. 1, Szeged, 6725, Hungary
| | - Ákos Nagy
- Hungarian Centre of Excellence for Molecular Medicine-Semmelweis University, Molecular Oncohematology Research Group, Department of Pathology and Experimental Cancer Research, Semmelweis University, Üllői út 26, Budapest, 1085, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical School, Állomás u. 1, Szeged, 6725, Hungary
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Medical School, Állomás u. 1, Szeged, 6725, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, Kecskemét, 6000, Hungary
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Tabár L, Dean PB, Lee Tucker F, Vörös A. Can we improve breast cancer management using an image-guided histopathology workup supported by larger histopathology sections? Eur J Radiol 2023; 161:110750. [PMID: 36821956 DOI: 10.1016/j.ejrad.2023.110750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 02/14/2023] [Indexed: 02/21/2023]
Abstract
PURPOSE Breast radiologists examine the entire breast in full-size images, while breast pathologists examine small tissue samples at high magnification. The diagnostic information from these complementary imaging approaches can be difficult to integrate for a more clinically relevant evaluation of malignancies spanning several centimetres. We have explored the advantages and disadvantages of imaging guided larger section pathology techniques compared with the standard 2 × 2.5 cm. small section technique. METHODS We compared the ability of conventional small section histopathology with larger section histopathology techniques to examine surgical resection margins and full disease extent. We evaluated the pre-surgical imaging workup and use of microfocus magnification radiography of sliced surgical specimens in the histopathologic evaluation of disease extent and status of surgical margins. RESULTS Image assisted large section histopathology of excised breast tissue enables comprehensive examination of an approximately tenfold larger contiguous tissue area than is provided by conventional small section technology. Attempting to cover the full area of each consecutive slice of resected tissue is more labour-intensive and expensive with the small section approach and poses challenges in reconstituting three-dimensional tumour architecture after morcellation and sectioning. Restricting histopathologic examination to a limited number of samples provides an incomplete evaluation of surgical margins. CONCLUSIONS A considerably improved documentation of breast cancer and a more reliable assessment of tissue margins is provided by using larger sized histopathology samples to correlate with breast imaging findings. These in turn can enable more appropriate treatment planning, improved surgical performance, fewer recurrences, and better patient outcome. Uncertainty of surgical margin evaluation inherent to the standard small section technique can lead to inappropriate decisions in surgical management and adjunctive therapy. Progress in breast diagnosis and treatment will largely depend on whether histopathology terminology and technique will undergo a revolution similar to the one that has already occurred in breast imaging.
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Affiliation(s)
- László Tabár
- Falun Central Hospital, Lasarettsvägen 10, 791 82 Falun, Sweden.
| | - Peter B Dean
- University of Turku, FI-20014 Turun Yliopisto, Finland
| | - F Lee Tucker
- Virginia Biomedical Laboratories, Wirtz, Virginia, USA
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás street 1, H-6720 Szeged, Hungary
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Cserni B, Kilmartin D, O’Loughlin M, Andreu X, Bagó-Horváth Z, Bianchi S, Chmielik E, Figueiredo P, Floris G, Foschini MP, Kovács A, Heikkilä P, Kulka J, Laenkholm AV, Liepniece-Karele I, Marchiò C, Provenzano E, Regitnig P, Reiner A, Ryška A, Sapino A, Stovgaard ES, Quinn C, Zolota V, Webber M, Glynn SA, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Callagy G, Cserni G. ONEST (Observers Needed to Evaluate Subjective Tests) Analysis of Stromal Tumour-Infiltrating Lymphocytes (sTILs) in Breast Cancer and Its Limitations. Cancers (Basel) 2023; 15:cancers15041199. [PMID: 36831541 PMCID: PMC9954449 DOI: 10.3390/cancers15041199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 02/04/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023] Open
Abstract
Tumour-infiltrating lymphocytes (TILs) reflect antitumour immunity. Their evaluation of histopathology specimens is influenced by several factors and is subject to issues of reproducibility. ONEST (Observers Needed to Evaluate Subjective Tests) helps in determining the number of observers that would be sufficient for the reliable estimation of inter-observer agreement of TIL categorisation. This has not been explored previously in relation to TILs. ONEST analyses, using an open-source software developed by the first author, were performed on TIL quantification in breast cancers taken from two previous studies. These were one reproducibility study involving 49 breast cancers, 23 in the first circulation and 14 pathologists in the second circulation, and one study involving 100 cases and 9 pathologists. In addition to the estimates of the number of observers required, other factors influencing the results of ONEST were examined. The analyses reveal that between six and nine observers (range 2-11) are most commonly needed to give a robust estimate of reproducibility. In addition, the number and experience of observers, the distribution of values around or away from the extremes, and outliers in the classification also influence the results. Due to the simplicity and the potentially relevant information it may give, we propose ONEST to be a part of new reproducibility analyses.
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Affiliation(s)
- Bálint Cserni
- TNG Technology Consulting GmbH, Király u. 26., 1061 Budapest, Hungary
| | - Darren Kilmartin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Mark O’Loughlin
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Xavier Andreu
- Pathology Department, Atryshealth Co., Ltd., 08039 Barcelona, Spain
| | - Zsuzsanna Bagó-Horváth
- Department of Pathology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria
| | - Simonetta Bianchi
- Division of Pathological Anatomy, Department of Health Sciences, University of Florence, 50134 Florence, Italy
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, 44-102 Gliwice, Poland
| | - Paulo Figueiredo
- Laboratório de Anatomia Patológica, IPO Coimbra, 3000-075 Coimbra, Portugal
| | - Giuseppe Floris
- Laboratory of Translational Cell & Tissue Research and KU Leuven, Department of Imaging and Pathology, Department of Pathology, University Hospitals Leuven, University of Leuven, Oude Market 13, 3000 Leuven, Belgium
| | - Maria Pia Foschini
- Unit of Anatomic Pathology, Department of Biomedical and Neuromotor Sciences, University of Bologna, Bellaria Hospital, 40139 Bologna, Italy
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, 41345 Gothenburg, Sweden
| | - Päivi Heikkilä
- Department of Pathology, Helsinki University Central Hospital, 00029 Helsinki, Finland
| | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University Budapest, Üllői út 93, 1091 Budapest, Hungary
| | - Anne-Vibeke Laenkholm
- Department of Surgical Pathology, Zealand University Hospital, 4000 Roskilde, Denmark
| | - Inta Liepniece-Karele
- Department of Pathology, Riga Stradins University, Riga East Clinical University Hospital, LV-1038 Riga, Latvia
| | - Caterina Marchiò
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge CB2 0QQ, UK
- National Institute for Health Research Cambridge Biomedical Research Centre, Cambridge CB2 0QQ, UK
| | - Peter Regitnig
- Diagnostic and Research Institute of Pathology, Medical University of Graz, 8010 Graz, Austria
| | - Angelika Reiner
- Department of Pathology, Klinikum Donaustadt, 1090 Vienna, Austria
| | - Aleš Ryška
- The Fingerland Department of Pathology, Charles University Medical Faculty and University Hospital, 50003 Hradec Kralove, Czech Republic
| | - Anna Sapino
- Unit of Pathology, Candiolo Cancer Institute FPO-IRCCS, 10060 Candiolo, Italy
- Department of Medical Sciences, University of Turin, 10126 Turin, Italy
| | | | - Cecily Quinn
- Department of Histopathology, Irish National Breast Screening Programme, BreastCheck, St. Vincent’s University Hospital and School of Medicine, University College Dublin, D04 T6F4 Dublin, Ireland
- School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland
| | - Vasiliki Zolota
- Department of Pathology, School of Medicine, University of Patras, 26504 Rion, Greece
| | - Mark Webber
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Sharon A. Glynn
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - Erika Csörgő
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | | | - Tamás Pancsa
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, 6720 Szeged, Hungary
| | - Grace Callagy
- Discipline of Pathology, Lambe Institute for Translational Research, School of Medicine, University of Galway, H91 TK33 Galway, Ireland
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, 6000 Kecskemét, Hungary
- Department of Pathology, University of Szeged, 6720 Szeged, Hungary
- Correspondence:
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9
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Cserni G, Francz M, Járay B, Kálmán E, Kovács I, Krenács T, Tóth E, Udvarhelyi N, Vass L, Vörös A, Krivokuca A, Kajo K, Kajová Macháleková K, Kulka J. Pathological Diagnosis, Work-Up and Reporting of Breast Cancer 1st Central-Eastern European Professional Consensus Statement on Breast Cancer. Pathol Oncol Res 2022; 28:1610373. [PMID: 35845921 PMCID: PMC9284216 DOI: 10.3389/pore.2022.1610373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 04/29/2022] [Indexed: 12/18/2022]
Abstract
This text is based on the recommendations accepted by the 4th Hungarian Consensus Conference on Breast Cancer, modified on the basis of the international consultation and conference within the frames of the Central-Eastern European Academy of Oncology. The recommendations cover non-operative, intraoperative and postoperative diagnostics, determination of prognostic and predictive markers and the content of cytology and histology reports. Furthermore, they address some specific issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, and some remarks about the future.
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Affiliation(s)
- Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
- Institute of Pathology, University of Szeged, Szeged, Hungary
- *Correspondence: Gábor Cserni,
| | - Monika Francz
- Department of Pathology, Szabolcs-Szatmár-Bereg County Hospitals and University Teaching Hospital, “Jósa András” Teaching Hospital, Nyíregyháza, Hungary
| | | | - Endre Kálmán
- Institute of Pathology, University of Pécs, Pécs, Hungary
| | - Ilona Kovács
- Department of Pathology, University of Debrecen, “Kenézy Gyula” University Hospital, Debrecen, Hungary
| | - Tibor Krenács
- Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Erika Tóth
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
| | - Nóra Udvarhelyi
- Department of Pathology, National Institute of Oncology, Budapest, Hungary
| | - László Vass
- Department of Pathology, Pest County “Flór Ferenc” University Teaching Hospital, Kistarcsa, Hungary
| | - András Vörös
- Institute of Pathology, University of Szeged, Szeged, Hungary
| | - Ana Krivokuca
- Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Karol Kajo
- Department of Pathology, St. Elisabeth Cancer Institute, Bratislava, Slovakia
| | | | - Janina Kulka
- Department of Pathology, Forensic and Insurance Medicine, Semmelweis University, Budapest, Hungary
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Horváth Z, Paszt A, Simonka Z, Látos M, Kaizer L, Hamar S, Vörös A, Ormándi K, Fejes Z, Oláh J, Lázár G. [New trends in the surgical treatment of axilla in breast cancer]. Magy Seb 2022; 75:169-178. [PMID: 35895538 DOI: 10.1556/1046.2022.20012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 04/04/2022] [Indexed: 06/15/2023]
Abstract
Oncosurgical treatment of breast tumors involves the removal of metastatic axillary lymph nodes. In the last 30 years, the diagnosis and treatment of axillary lymph nodes have also undergone significant changes. The introduction of sentinel lymph node biopsy in 1993 made axillary block dissection with high morbidity safely omitted in a significant proportion of patients, and similarly, the staging of breast tumors and thus oncology and complex treatment became significantly more accurate. Shortly after the introduction of sentinel lymph node biopsy, intraoperative examination of sentinel lymph nodes (e.g. imprint cytology) also appeared, which significantly reduced the number of surgeries performed in the two sessions, thereby significantly reducing patient burden and surgical costs. The results of our study indicate that axillary block dissection is required in the treatment of axilla in an ever-decreasing group of patients and this proportion will decrease further in the future, with the increasing use of alternative axillary radiotherapy. The imprint cytological examination of sentinel lymph nodes taking into account current guidelines, no longer provides demonstrable benefits and its routine use is not justified. According to the latest international recommendations, intraoperative examination of the sentinel lymph node may be indicated in connection with mastectomy (when postoperative radiotherapy is not planned) and after neoadjuvant treatment. Our results suggest that the detection of suspected lymph nodes during preoperative axillary ultrasound may predict the stage of the disease. Based on our research results confirm that in patients receiving neoadjuvant therapy, in addition to the preoperative size of the tumour (≤20 mm, P = 0.002), the preoperative size of the lymph node (≤15 mm, P = 0.04) may also be used to predict that the stage of the disease is N0-1.
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Affiliation(s)
- Zoltán Horváth
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Attila Paszt
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Zsolt Simonka
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - Melinda Látos
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
| | - László Kaizer
- 2 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Pathológiai Intézet, Szeged, Magyarország (tanszékvezető: Prof. Dr. Tiszlavicz László)
| | - Sándor Hamar
- 2 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Pathológiai Intézet, Szeged, Magyarország (tanszékvezető: Prof. Dr. Tiszlavicz László)
| | - András Vörös
- 2 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Pathológiai Intézet, Szeged, Magyarország (tanszékvezető: Prof. Dr. Tiszlavicz László)
| | - Katalin Ormándi
- 3 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Radiológiai Klinika, Szeged, Magyarország (tanszékvezető: Dr. Kincses Zsigmond Tamás)
| | - Zsuzsanna Fejes
- 3 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Radiológiai Klinika, Szeged, Magyarország (tanszékvezető: Dr. Kincses Zsigmond Tamás)
| | - Judit Oláh
- 4 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Onkoterápiás Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Oláh Judit)
| | - György Lázár
- 1 Szegedi Tudományegyetem Szent-Györgyi Albert Orvostudományi Kar, Sebészeti Klinika, Szeged, Magyarország (tanszékvezető: Prof. Dr. Lázár György)
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Cserni B, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Cserni G. ONEST (Observers Needed to Evaluate Subjective Tests) suggests four or more observers for a reliable assessment of the consistency of histological grading of invasive breast carcinoma: A reproducibility study with a retrospective view on previous studies. Pathol Res Pract 2022; 229:153718. [DOI: 10.1016/j.prp.2021.153718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 11/21/2021] [Accepted: 11/25/2021] [Indexed: 11/15/2022]
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12
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Cserni B, Bori R, Csörgő E, Oláh-Németh O, Pancsa T, Sejben A, Sejben I, Vörös A, Zombori T, Nyári T, Cserni G. The additional value of ONEST (Observers Needed to Evaluate Subjective Tests) in assessing reproducibility of oestrogen receptor, progesterone receptor, and Ki67 classification in breast cancer. Virchows Arch 2021; 479:1101-1109. [PMID: 34415429 PMCID: PMC8724065 DOI: 10.1007/s00428-021-03172-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 11/28/2022]
Abstract
The reproducibility of assessing potential biomarkers is crucial for their implementation. ONEST (Observers Needed to Evaluate Subjective Tests) has been recently introduced as a new additive evaluation method for the assessment of reliability, by demonstrating how the number of observers impact on interobserver agreement. Oestrogen receptor (ER), progesterone receptor (PR), and Ki67 proliferation marker immunohistochemical stainings were assessed on 50 core needle biopsy and 50 excision samples from breast cancers by 9 pathologists according to daily practice. ER and PR statuses based on the percentages of stained nuclei were the most consistently assessed parameters (intraclass correlation coefficients, ICC 0.918-0.996), whereas Ki67 with 5 different theoretical or St Gallen Consensus Conference-proposed cut-off values demonstrated moderate to good reproducibility (ICC: 0.625-0.760). ONEST highlighted that consistent tests like ER and PR assessment needed only 2 or 3 observers for optimal evaluation of reproducibility, and the width between plots of the best and worst overall percent agreement values for 100 randomly selected permutations of observers was narrow. In contrast, with less consistently evaluated tests of Ki67 categorization, ONEST suggested at least 5 observers required for more trustful assessment of reliability, and the bandwidth of the best and worst plots was wider (up to 34% difference between two observers). ONEST has additional value to traditional calculations of the interobserver agreement by not only highlighting the number of observers needed to trustfully evaluate reproducibility but also by highlighting the rate of agreement with an increasing number of observers and disagreement between the better and worse ratings.
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Affiliation(s)
| | - Rita Bori
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Erika Csörgő
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | | | - Tamás Pancsa
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Anita Sejben
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - István Sejben
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Tibor Nyári
- Department of Medical Physics and Informatics, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary. .,Department of Pathology, University of Szeged, Szeged, Hungary.
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Palásti P, Zombori T, Kaiser L, Magony S, Kakuja F, Vörös A, Morvay Z, Kincses ZT, Palkó A, Fejes Z. “Gap in the shield” – imaging of the thyroid gland from the multidisciplinary perspective. Orv Hetil 2021; 162:530-541. [PMID: 33784246 DOI: 10.1556/650.2021.32001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/26/2020] [Indexed: 11/19/2022]
Abstract
Összefoglaló. A pajzsmirigy az első szervek közé tartozik, melyek megjelenítésében, betegségeinek felfedezésében az ultrahang-diagnosztikának fontos szerepe van. A pajzsmirigybetegségek a lakosság jelentős részét érintik, és a technika fejlődésével egyre több pajzsmirigyeltérés, göb kerül felfedezésre. A pajzsmirigy rosszindulatú folyamatainak nincs egy bizonyos specifikus jele, viszont az ultrahangkép alapján meghatározhatók a malignitásra gyanús eltérések. Erre az elmúlt években több összefoglaló rendszer is született. Jelen összefoglaló tanulmányunknak az a célja, hogy bemutassuk a pajzsmirigy ultrahangdiagnosztikájának fejlődését; összehasonlítsuk az egyes leletezési rendszereket, úgymint TIRADS, EU-TIRADS, K-TIRADS, melyek célja a feltehetőleg rosszindulatú göbök kiszűrése, azonosítása a mindennapi rutinmunka során; vizsgáljuk a különböző rendszerek kapcsolatát a patológia által használt Bethesda-pontrendszerrel. Az ultrahangvizsgálat megfelelő értékelése, a pontrendszerek ismerete segíthet a pajzsmirigygöb differenciáldiagnózisában, a követési frekvencia meghatározásában, csökkentheti az aspirációs citológiák számát, ezzel támogatva a klinikai döntéshozatalt. Orv Hetil. 2021; 162(14): 530-541. Summary. The thyroid gland was one of the first organs, the ultrasound (US) examination of which has played an important role. The thyroid diseases affect a large part of the population, and with the development of imaging technology, more and more thyroid abnormalities, nodules and malignant lesions are being discovered. There are no specific signs of thyroid cancer, but the suspicious signs could be determined by US. In recent years, several systems have been developed. The aim of our review is to demonstrate the development of US diagnostics of the thyroid gland; to compare the different reporting systems, such as TIRADS, EU-TIRADS, K-TIRADS, which should help to identify the questionable lesions in the daily routine work. We examine the relationship between the different US systems and the Bethesda point score used by pathologists. The literature review shows that the US examination supports the clinical decisions, helps to select, who should have a fine-needle biopsy, and allows to determine the frequency of follow-up. The number of unnecessary fine-needle biopsies could be reduced, too. Our paper is part of a bigger research, the ethical license number is 23/2020, University of Szeged. Orv Hetil. 2021; 162(14): 530-541.
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Affiliation(s)
- Péter Palásti
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
| | - Tamás Zombori
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged
| | - László Kaiser
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged
| | - Sándor Magony
- 3 Szegedi Tudományegyetem, Általános Orvostudományi Kar, I. Belgyógyászati Klinika, Szeged
| | - Flóra Kakuja
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
| | - András Vörös
- 2 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Patológiai Intézet, Szeged
| | - Zita Morvay
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
| | - Zsigmond Tamás Kincses
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
| | - András Palkó
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
| | - Zsuzsanna Fejes
- 1 Szegedi Tudományegyetem, Általános Orvostudományi Kar, Radiológiai Klinika, Szeged, Semmelweis u. 6/A, 6725
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Sejben A, Vörös A, Golan A, Zombori T, Cserni G. The Added Value of SOX10 Immunohistochemistry to Other Breast Markers in Identifying Cytokeratin 5-Positive Triple Negative Breast Cancers as of Mammary Origin. Pathobiology 2021; 88:228-233. [PMID: 33567441 DOI: 10.1159/000512006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 10/05/2020] [Indexed: 11/19/2022] Open
Abstract
AIMS Triple-negative breast cancer (TNBC) represents a specific group that lacks the expression of estrogen receptors, progesterone receptors, and human epidermal growth factor receptor-2 and might also lack the expression other breast markers like GATA3, mammaglobin (MG), GCDFP15 (growth cystic disease fluid protein 15), and NYBR1; when this occurs, proving the breast origin of a metastasis is a challenging task. In the present study, we assessed the added value of SOX10 immunohistochemistry to known GATA3, MG, GCDFP15, and NY-BR-1 statuses in a series of CK5-positive primary TNBCs. METHODS Tissue microarrays were made from the formalin-fixed and paraffin-embedded blocks of 120 TNBCs, and 3-4-mm-thick sections were immunostained for SOX10. The cut-off for a positive reaction was at least 10% of tumor cells staining. RESULTS In our cohort, SOX10 positivity was seen in 82/119 cases, 61, 74, 76, and 82 all of which were GATA3, MG, GCDFP15, and NY-BR-1 negative, respectively. Of the SOX10 negative cases, 12 stained with at least another breast marker. Nevertheless, 25/119 (21%) cases remained negative with all markers assessed. DISCUSSION SOX10 proved to be the most commonly positive breast marker in our CK5 expressing TNBCs, but the other markers also had some additive value to SOX10.
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Affiliation(s)
- Anita Sejben
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary,
| | - András Vörös
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Arbel Golan
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Zombori
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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Cserni G, Francz M, Járay B, Kálmán E, Kovács I, Krenács T, Tóth E, Udvarhelyi N, Vass L, Vörös A, Kulka J. [Pathological diagnosis, work-up and reporting of breast cancer. Recommendations from the 4th Breast Cancer Consensus Conference]. Magy Onkol 2020; 64:301-328. [PMID: 33313608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/30/2020] [Indexed: 06/12/2023]
Abstract
There have been some relevant changes in the diagnosis and treatment of breast cancer to implement the updating of the 2016 recommendations made during the 3rd national consensus conference on the disease. Following a wide interdisciplinary consultation, the present recommendations have been finalized after their public discussion at the 4th Hungarian Breast Cancer Consensus Conference. The recommendations cover non-operative, intraoperative and postoperative diagnostics, the determination of prognostic and predictive markers and the content of the cytology and histology reports. Furthermore, it touches some special issues such as the current status of multigene molecular markers, the role of pathologists in clinical trials and prerequisites for their involvement, some relevant points about the future. The most important changes include the integration of the TNM 8th edition, the WHO classification of breast tumors 5th edition, the ASCO/CAP HER2 assessment guidelines from 2018, and the Yokohama terminology for cytology reporting; a more detailed text on tumor-infiltrating lymphocytes and size determination after neoadjuvant therapy and a broader discussion of molecular tests.
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Affiliation(s)
- Gábor Cserni
- Patológiai Osztály, Bács-Kiskun Megyei Kórház, Kecskemét, Hungary.
| | - Monika Francz
- Patológiai Osztály, Szabolcs-Szatmár-Bereg Megyei Kórházak és Egyetemi Oktatókórház, Jósa András Oktatókórház, Nyíregyháza, Hungary
| | | | - Endre Kálmán
- Patológiai Intézet, Pécsi Tudományegyetem, Pécs, Hungary
| | - Ilona Kovács
- Kenézy Gyula Egyetemi Kórház, DE, Patológia, Debrecen, Hungary
| | - Tibor Krenács
- I. Sz. Patológiai és Kísérleti Rákkutató Intézet, Semmelweis Egyetem, Budapest, Hungary
| | - Erika Tóth
- Országos Onkológiai Intézet, Budapest, Hungary
| | | | - László Vass
- Patológiai Osztály, Pest Megyei Flór Ferenc Egyetemi Oktatókórház, Kistarcsa, Hungary
| | - András Vörös
- Patológiai Intézet, Szegedi Tudományegyetem, Szeged, Hungary
| | - Janina Kulka
- II. Sz. Patológiai Intézet, Semmelweis Egyetem, Budapest, Hungary
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16
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Cserni D, Zombori T, Vörös A, Stájer A, Rimovszki A, Daru K, Baráth Z, Cserni G. A Clinicopathological Approach to Odontogenic Cysts: the Role of Cytokeratin 17 and bcl2 Immunohistochemistry in Identifying Odontogenic Keratocysts. Pathol Oncol Res 2020; 26:2613-2620. [PMID: 32632899 PMCID: PMC7471163 DOI: 10.1007/s12253-020-00866-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 06/23/2020] [Indexed: 11/30/2022]
Abstract
Odontogenic keratocysts (OKCs) are developmental cysts of the jaws that require proper diagnosis due to their potential for local aggressive growth and recurrences. OKCs have a typical parakeratotic epithelium demonstrating transepithelial cytokeratin 17 (CK17) and basal bcl2 staining on immunohistochemistry (IHC), which distinguishes them from other common jaw cysts. Secondary to inflammation, the epithelial lining may be altered and loses the typical IHC phenotype. The aim of the present study was to analyse a series of consecutive jaw cysts for their expression of CK17 and bcl2 and assess how these IHC stains may help in their diagnosis. All cysts were retrospectively assessed for available clinical, radiological and pathological findings and diagnoses were revised whenever needed. 85 cysts from 72 patients were collected from two departments. The series had 21 OKCs, the remaining non-OKCs included radicular/residual, dentigerous, paradental, lateral periodontal, botryoid odontogenic cysts. OKCs with typical epithelium showed the typical IHC phenotype, which was generally lost in inflammation-associated altered epithelium. Contrarily to earlier descriptions, a wide variety of CK17 positivity was seen in the majority of non-OKCs, including focal transepithelial staining. Basal bcl2 staining was also seen in 16 non-OKCs. These stainings were never as strong in intensity as seen in OKCs. One case was histopathologically identified as OKC due to focally maintained IHC profile. CK17 and bcl2 IHC may help in the diagnosis of OKCs, but must be interpreted with caution and is not a yes or no tool in the diagnostic puzzle.
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Affiliation(s)
- Dorottya Cserni
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos krt 64-66, Szeged, H-6720, Hungary
| | - Tamás Zombori
- Department of Pathology, University of Szeged, Állomás u. 1, Szeged, H-6725, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, Állomás u. 1, Szeged, H-6725, Hungary
| | - Anette Stájer
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos krt 64-66, Szeged, H-6720, Hungary
| | - Annamária Rimovszki
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, Kecskemét, H-6000, Hungary
| | - Krisztián Daru
- Department of Pathology, University of Szeged, Állomás u. 1, Szeged, H-6725, Hungary
| | - Zoltán Baráth
- Department of Prosthodontics, Faculty of Dentistry, University of Szeged, Tisza Lajos krt 64-66, Szeged, H-6720, Hungary
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Állomás u. 1, Szeged, H-6725, Hungary. .,Department of Pathology, Bács-Kiskun County Teaching Hospital, Nyíri út 38, Kecskemét, H-6000, Hungary.
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17
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Boda Z, Elmer T, Vörös A, Stadtfeld C. Short-term and long-term effects of a social network intervention on friendships among university students. Sci Rep 2020; 10:2889. [PMID: 32076003 PMCID: PMC7031228 DOI: 10.1038/s41598-020-59594-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/30/2020] [Indexed: 11/24/2022] Open
Abstract
Informal social relations, such as friendships, are crucial for the well-being and success of students at all levels of education. Network interventions can aim at providing contact opportunities in school settings to prevent the social isolation of individuals and facilitate integration between otherwise segregated social groups. We investigate the short-term and long-term effects of one specific network intervention in an undergraduate cohort freshly admitted to an engineering department (\documentclass[12pt]{minimal}
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\begin{document}$${\bf{N}}{\boldsymbol{=}}{\bf{226}}$$\end{document}N=226). In this intervention, we randomly assigned students into small groups at an introduction event two months prior to their first day at university. The groups were designed to increase mixed-gender contact opportunities. Two months after the intervention, we find a higher rate of friendships, common friends, and mixed-gender friendships in pairs of students who were assigned to the same group than in pairs from different groups (short-term effects). These effects gradually diminish over the first academic year (long-term effects). Using stochastic actor-oriented models, we investigate the long-term trajectory of the intervention effects, while considering alternative network processes, such as reciprocity, transitivity, homophily, and popularity. The results suggest that even though the induced friendship ties are less stable than other friendships, they may serve as early seeds for complex social network processes. Our study shows that simple network interventions can have a pronounced short-term effect and indirect long-term effects on the evolution and structure of student communities.
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Affiliation(s)
- Zsófia Boda
- Chair of Social Networks, Department of Humanities, Social and Political Sciences, ETH Zürich, Weinbergstrasse 109, Zürich, 8006, Switzerland. .,Institute of Education, University College London, 20 Bedford Way, London, WC1H 0AL, United Kingdom.
| | - Timon Elmer
- Chair of Social Networks, Department of Humanities, Social and Political Sciences, ETH Zürich, Weinbergstrasse 109, Zürich, 8006, Switzerland
| | - András Vörös
- Chair of Social Networks, Department of Humanities, Social and Political Sciences, ETH Zürich, Weinbergstrasse 109, Zürich, 8006, Switzerland.,Department of Social Statistics and Mitchell Centre for Social Network Analysis, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom
| | - Christoph Stadtfeld
- Chair of Social Networks, Department of Humanities, Social and Political Sciences, ETH Zürich, Weinbergstrasse 109, Zürich, 8006, Switzerland.
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18
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Horváth Z, Paszt A, Simonka Z, Látos M, Kaizer L, Hamar S, Vörös A, Ormándi K, Fejes Z, Lázár G. Is axillary lymph node dissection necessary for positive preoperative aspiration cytology lymph node results? Eur J Surg Oncol 2019; 46:504-510. [PMID: 31708307 DOI: 10.1016/j.ejso.2019.10.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 10/17/2019] [Accepted: 10/31/2019] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Based on international guidelines, axillary lymph node dissection (ALND) is recommended in cases of breast cancer if preoperative examinations confirm axillary metastasis. We examined which set of preoperative parameters might render ALND unnecessary. PATIENTS AND METHODS Preoperative examinations (axillary ultrasound and aspiration cytology) confirmed axillary metastasis in 190 cases out of 2671 patients with breast cancer; primary ALN dissection was performed on these patients with or without prior neoadjuvant therapy. The clinicopathological results were analysed to determine which parameter might predict the presence of no more than 2 or 3 metastatic ALNs. RESULTS The final histological examination confirmed 1-3 metastatic lymph nodes in ALND samples in 116 cases and over 3 metastatic lymph nodes in 74 cases. For patients receiving neoadjuvant therapy (59 out of the 190 cases), if the size of the primary tumour was 2 cm or smaller and/or the metastatic ALN was 15 mm or smaller, then the patient was likely to have no more than 3 positive ALNs (stage N0-1 disease) (p < 0.001). If the patient did not receive neoadjuvant therapy, stage N2 or N3 disease was very likely. No correlation was found between other clinicopathological characteristics of the tumour and involvement of the ALNs. CONCLUSION Axillary lymph node dissection is not necessary for selected breast cancer patients with axillary metastasis receiving neoadjuvant therapy. In these cases, sentinel lymph node biopsy with or without radiation therapy and close follow-up may serve as adequate therapy.
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Affiliation(s)
- Z Horváth
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - A Paszt
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - Z Simonka
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - M Látos
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
| | - L Kaizer
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - S Hamar
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - A Vörös
- Department of Pathology, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Állomás u. 2, Hungary.
| | - K Ormándi
- Affidea Hungary - Szeged, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 6/A, Hungary.
| | - Z Fejes
- Affidea Hungary - Szeged, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 6/A, Hungary.
| | - G Lázár
- Department of Surgery, University of Szeged, Albert Szent-Györgyi Clinical Centre, H-6725, Szeged, Semmelweis u. 8, Hungary.
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19
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Tőkés AM, Rusz O, Cserni G, Tóth E, Rubovszky G, Tőkés T, Vízkeleti L, Reiniger L, Kószó R, Kahán Z, Kulka J, Donia M, Vörös A, Szallasi Z. Influence of mutagenic versus non-mutagenic pre-operative chemotherapy on the immune infiltration of residual breast cancer. Acta Oncol 2019; 58:1603-1611. [PMID: 31271119 DOI: 10.1080/0284186x.2019.1633015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Chemotherapeutic agents are often mutagenic. Induction of mutation associated neo-epitopes is one of the mechanisms by which chemotherapy is thought to increase the number of tumor-infiltrating lymphocytes. It is not known, however, whether treatment with various chemotherapeutic agents with different mutagenic capacity induce a significantly different number of stromal tumor-infiltrating lymphocytes (StrTIL) in residual cancer.Methods: One hundred and twenty breast carcinoma cases with residual disease that were treated with one of three types of pre-operative chemotherapy regimens were selected for the study. The percentage of StrTIL was evaluated in pretreatment core biopsies (pre-StrTIL) and post-treatment surgical tumor samples (post-StrTIL). TIL changes (ΔStrTIL) were calculated from the difference between post-StrTIL and pre-StrTIL.Results: When analyzing the pre-StrTIL and post-StrTIL among the three treatment groups, we detected significant StrTIL increase independently of the treatment applied. Based on distant metastases-free survival analysis, both post-StrTIL and ΔStrTIL was found to be independent prognostic factor in HR negative cases. Conclusions: Significant increase of StrTIL in the residual disease was observed in patients treated with the highly (platinum), moderately (cyclophosphamide) and marginally mutagenic chemotherapeutic agents (taxane, anthracycline). Increase in StrTIL in residual cancer compared to pretreatment tumor tissue is associated with improved distant metastasis-free survival in cases with HR negative breast carcinoma.
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Affiliation(s)
- Anna-Mária Tőkés
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Orsolya Rusz
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Szeged, Hungary
- Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
| | - Erika Tóth
- National Institute of Oncology, Budapest, Hungary
| | | | - Tímea Tőkés
- Oncology Center, Semmelweis University, Budapest, Hungary
| | - Laura Vízkeleti
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
- 2nd Department of Pathology, SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
| | - Lilla Reiniger
- 2nd Department of Pathology, SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
- 1st Department of Pathology and Experimental Cancer Research, Semmelweis University, Budapest, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsuzsanna Kahán
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Janina Kulka
- 2nd Department of Pathology, Semmelweis University, Budapest, Hungary
| | - Marco Donia
- Department of Hematology, Center for Cancer Immune Therapy, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Oncology, Herlev Hospital, University of Copenhagen, Copenhagen, Denmark
| | - András Vörös
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Zoltan Szallasi
- 2nd Department of Pathology, SE-NAP Brain Metastasis Research Group, Semmelweis University, Budapest, Hungary
- Danish Cancer Society Research Center, Copenhagen, Denmark
- Computational Health Informatics Program, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
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20
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Subicz I, Sztanó B, Krasznai G, Vörös A, Tiszlavicz L, Borkó R, Rovó L. Diagnostic Difficulties in Evaluation of Neck Masses - Idiopathic Lymph Node Infarction. J Med Life 2019; 11:269-273. [PMID: 30894881 PMCID: PMC6418319 DOI: 10.25122/jml-2018-0047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Palpable neck masses are often the only signs of patients visiting their ENT specialists. Lymphadenopathy may be a primary or secondary manifestation of numerous benign and malignant disorders. The medical history, physical examination, imaging and pathological examination may help to set the appropriate diagnosis. Lymph node infarction is a very rare entity among the various pathologies involving the lymph nodes. We hereby present three cases, in which infarction was the only symptom, no associated condition occurred.
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Affiliation(s)
- Imre Subicz
- Department of Oto-Rhino-Laryngology, Jász-Nagykun-Szolnok County Hospital, Szolnok, Hungary
| | - Balázs Sztanó
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, University of Szeged, Hungary
| | - Géza Krasznai
- Department of Pathology, Jász-Nagykun-Szolnok County Hospital, Szolnok, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, Hungary
| | | | - Rezsö Borkó
- Department of Oto-Rhino-Laryngology, Jász-Nagykun-Szolnok County Hospital, Szolnok, Hungary
| | - László Rovó
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, University of Szeged, Hungary
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21
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Kővári B, Ormándi K, Simonka Z, Vörös A, Cserni G. Apocrine Encapsulated Papillary Carcinoma of the Breast: The First Reported Case with an Infiltrative Component. J Breast Cancer 2018; 21:227-230. [PMID: 29963120 PMCID: PMC6015972 DOI: 10.4048/jbc.2018.21.2.227] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 04/18/2018] [Indexed: 01/24/2023] Open
Abstract
Apocrine encapsulated papillary carcinoma (EPC) of the breast is a rare neoplasm, and only 10 cases have been reported in the literature to date. Although EPC by definition lacks a peripheral myoepithelial layer, all previously published apocrine EPC cases were clinically indolent and lacked a conventional invasive component. Herein, we report the 11th case of apocrine EPC, which had a conventional invasive carcinoma component and provides evidence of the malignant potential of this entity. We postulate that apocrine EPC is most likely a morphological variant of conventional EPC, with the same unpredictable malignant potential as non-apocrine cases.
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Affiliation(s)
- Bence Kővári
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Katalin Ormándi
- Department of Radiology, University of Szeged, Szeged, Hungary.,Affidea Diagnostics-Szeged, Szeged, Hungary
| | - Zsolt Simonka
- Department of Surgery, University of Szeged, Szeged, Hungary
| | - András Vörös
- Department of Pathology, University of Szeged, Szeged, Hungary
| | - Gábor Cserni
- Department of Pathology, University of Szeged, Szeged, Hungary.,Department of Pathology, Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary
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22
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Vizvári E, Skribek Á, Polgár N, Vörös A, Sziklai P, Tóth-Molnár E. Conjunctival melanocytic naevus: Diagnostic value of anterior segment optical coherence tomography and ultrasound biomicroscopy. PLoS One 2018; 13:e0192908. [PMID: 29444155 PMCID: PMC5812659 DOI: 10.1371/journal.pone.0192908] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 01/13/2018] [Indexed: 11/23/2022] Open
Abstract
Purpose Conjunctival naevi are the most frequently diagnosed primary melanocytic lesions of the conjunctiva. The clinical manifestations are greatly variable which may result in diagnostic difficulties and differential diagnostic confusions. Therefore aims of the present study were: 1) to assess the morphologic features of conjunctival naevi; 2) to delineate the anterior segment optical coherence tomography (AS-OCT) characteristics of these lesions; 3) to compare AS-OCT and ultrasound biomicroscopy (UBM) as diagnostic tools in these alterations and 4) to correlate histological results with the AS-OCT pictures in case of surgically excised naevi. Methods All lesions were photo-documented. AS-OCT and UBM (over the age of 18 years) were performed. Surgically excised lesions were admitted to histological examinations. Results In our series of 57 conjunctival naevi, 54.4% were highly pigmented, 15.8% proved to be amelanotic. AS-OCT could detect intralesional cysts in 61.4% of the naevi, while slit-lamp and UBM proved to be less sensitive (40.3% vs. 28.5%). UBM could visualize the posterior margins of all naevi, while AS-OCT proved to be less sensitive with the detection of 89.4% of posterior naevus margins. Thickness of the conjunctival epithelial layer could be measured with AS-OCT in case of subepithelial naevi, while no distinct epithelial layer could be detected in compound and junctional naevi. Conclusions Superiority of AS-OCT over UBM was demonstrated in visualizing internal structures of conjunctival naevi. UBM proved to be a better tool in highly pigmented and remarkably elevated naevi. Correlation was found between the histological type of the naevus and the thickness of the epithelial layer covering the lesion.
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Affiliation(s)
- Eszter Vizvári
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Ákos Skribek
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Nóra Polgár
- “Szemambulancia” Ophthalmology Private Practice, Szeged, Hungary
| | - András Vörös
- University of Szeged, Department of Pathology, Szeged, Hungary
| | - Pál Sziklai
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
| | - Edit Tóth-Molnár
- University of Szeged, Department of Ophthalmology, Szeged, Hungary
- * E-mail:
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23
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Rusz O, Vörös A, Varga Z, Kelemen G, Uhercsák G, Nikolényi A, Ormándi K, Simonka Z, Kahán Z. One-Year Neoadjuvant Endocrine Therapy in Breast Cancer. Pathol Oncol Res 2015; 21:977-84. [PMID: 25753983 DOI: 10.1007/s12253-015-9911-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 02/16/2015] [Indexed: 12/14/2022]
Abstract
The evaluation of the effects of 1-year endocrine therapy (NET) was aimed at. A retrospective analysis of 42 cases with 46 stage II-III invasive, hormone receptor-positive, HER2-negative breast cancers was performed. One-year NET was planned with letrozole (n = 33, postmenopausal group), or with goserelin plus letrozole (n = 7) or with goserelin plus tamoxifen (n = 2) (premenopausal group). Surgery was performed in accordance with the initial stage and the response to therapy. With regard to the tumor remaining in the surgical specimen, risk groups were constructed: Group 1: stage 0, pathological complete regression (pCR); Group 2: stages IA-IIA; Group 3: stages ≥ IIB + cases with clinical progression. Due to local progression, NET was replaced by neoadjuvant chemotherapy in three patients (four tumors). In two postmenopausal patients, letrozole was replaced by tamoxifen because of the insufficient treatment effect. In 19/42 cases, breast-conserving surgery was performed. Within Group 1, there was no cancer in four cases, while only DCIS remained in 2 (pCR: 13 %); Groups 2 and 3 comprised 25 and 15 cases, respectively. The likeliness of a good response (Groups 1 and 2 vs. Group 3) to NET was increased by 7 % for every 1 % increase of the expression of ER (OR = 1.070; 95 % CI: 1.007-1.138, p = 0.029). Progression-free survival differed according to treatment response (p = 0.001). The post-therapy Ki67 value of ≤ 15 % had only a marginal effect on survival. No other associations were detected between the tumor characteristics and the therapeutic response or survival. Long-duration NET is effective and safe in cases of hormone-sensitive breast cancer.
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Affiliation(s)
- Orsolya Rusz
- Department of Oncotherapy, University of Szeged, Korányi fasor 12, 6720, Szeged, Hungary
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24
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Gamal EM, Szabó A, Szüle E, Vörös A, Metzger P, Kovács G, Kovács J, Oláh A, Rózsa I, Kiss J. Percutaneous video choledochoscopic treatment of retained biliary stones via dilated T-tube tract. Surg Endosc 2014; 15:473-6. [PMID: 11353964 DOI: 10.1007/s004640000274] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2000] [Accepted: 03/30/2000] [Indexed: 11/24/2022]
Abstract
BACKGROUND Retained biliary stones is a common clinical problem in patients after surgery for complicated gallstone disease. When postoperative endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy are unsuccessful, several percutaneous procedures for stone removal can be applied as alternatives to relaparotomy. These procedures are performed either under fluoroscopic control or with the use of choledochoscopy, but it is also possible to combine these methods. METHODS Since 1994, we have used the percutaneous video choledochoscopic technique for the removal of difficult retained biliary stones via dilated T-tube tract in 17 patients, applying the technique of percutaneous stone extraction used in urology. While waiting for the T-tube tract to mature and after the removal of the T-tube, the dilatation of its tract was 26-30 Fr. Stone removal was carried out using a flexible video choledochoscope and a rigid renoscope under fluoroscopic control, with the aid of Dormia baskets, rigid forceps, and high-pressure irrigation. RESULTS We performed 23 operative procedures, and the clearance of the biliary ducts was successful in all cases. There were no major complications or deaths. CONCLUSION Percutaneous video choledochoscopic-assisted removal of large retained biliary stones via the T-tube tract is a highly effective and safe procedure. Its advantages over other procedures include the ability to visualize the stones and noncalculous filling defects; it also guarantees that the stones can be removed under visual video endoscopic control. It has no problems related to tract or stone size.
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Affiliation(s)
- E M Gamal
- Department of Surgery, Faculty of Health Sciences, Semmelweis University, Szabolcs u. 35, 1135 Budapest, Hungary.
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Cserni G, Vörös A, Liepniece-Karele I, Bianchi S, Vezzosi V, Grabau D, Sapino A, Castellano I, Regitnig P, Foschini MP, Zolota V, Varga Z, Figueiredo P, Decker T, Focke C, Kulka J, Kaya H, Reiner-Concin A, Amendoeira I, Callagy G, Caffrey E, Wesseling J, Wells C. Distribution pattern of the Ki67 labelling index in breast cancer and its implications for choosing cut-off values. Breast 2014; 23:259-63. [PMID: 24613255 DOI: 10.1016/j.breast.2014.02.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 01/13/2014] [Accepted: 02/14/2014] [Indexed: 01/08/2023] Open
Abstract
The Ki67 labelling index (LI - proportion of staining cells) is widely used to reflect proliferation in breast carcinomas. Several cut-off values have been suggested to distinguish between tumours with low and high proliferative activity. The aim of the current study was to evaluate the distribution of Ki67 LIs in breast carcinomas diagnosed at different institutions by different pathologists using the method reflecting their daily practice. Pathologists using Ki67 were asked to provide data (including the LI, type of the specimen, receptor status, grade) on 100 consecutively stained cases, as well as details of their evaluation. A full dataset of 1709 carcinomas was collected from 19 departments. The median Ki67 LI was 17% for all tumours and 14% for oestrogen receptor-positive and HER2-negative carcinomas. Tumours with higher mitotic counts were associated with higher Ki67 LIs. Ki67 LIs tended to cluster around values ending with 5 or 0 both in cases where the values were obtained by counting the proportion of stained tumour cell nuclei and those where the values were obtained by estimation. On the basis of the distribution pattern described, some currently used Ki67 LI cut off values are not realistic, and it is proposed to select more realistic values ending with 0 or 5.
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Affiliation(s)
- Gábor Cserni
- Bács-Kiskun County Teaching Hospital, Kecskemét, Hungary; Department of Pathology, University of Szeged, Hungary.
| | - András Vörös
- Department of Pathology, University of Szeged, Hungary
| | | | - Simonetta Bianchi
- Section of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - Vania Vezzosi
- Section of Pathological Anatomy, Department of Surgery and Translational Medicine, University of Florence, AOU Careggi, Largo GA Brambilla 3, 50134 Florence, Italy
| | - Dorthe Grabau
- Department of Pathology, Skåne University Hospital, Lund, Sweden
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Italy
| | | | - Peter Regitnig
- Medical University of Graz, Institute of Pathology, Auenbruggerplatz 25, A-8036 Graz, Austria
| | - Maria Pia Foschini
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Anatomic Pathology at Bellaria Hospital, Via Altura, 3, 40139 Bologna, Italy
| | - Vassiliki Zolota
- Department of Pathology, Medical School, University of Patras, Rion, Patras, Greece
| | - Zsuzsanna Varga
- Institute of Surgical Pathology, University Hospital Zurich, Zurich, Switzerland
| | - Paulo Figueiredo
- Lab Histopatologia, Av Bissaya Barreto, Apartado 2005, 3001-651 Coimbra, Portugal
| | - Thomas Decker
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestraße 30, D-17036 Neubrandenburg, Germany
| | - Cornelia Focke
- Department of Pathology, Dietrich Bonhoeffer Medical Centre, Allendestraße 30, D-17036 Neubrandenburg, Germany
| | - Janina Kulka
- 2nd Department of Pathology, Semmelweis University Budapest, Üllői út 93, H-1091 Budapest, Hungary
| | - Handan Kaya
- Marmara University School of Medicine, Department of Pathology, Istanbul, Turkey
| | | | - Isabel Amendoeira
- Department of Pathology, Centro Hospitalar de S. João and Instituto de Patologia e Imunologia Molecular da Universidade do Porto (IPATIMUP), Portugal
| | - Grace Callagy
- Discipline of Pathology, NUI Galway, Galway, Ireland
| | - Emer Caffrey
- Discipline of Pathology, NUI Galway, Galway, Ireland
| | - Jelle Wesseling
- Department of Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands; Department of Molecular Pathology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands
| | - Clive Wells
- Department of Pathology, University College Hospital, London, United Kingdom
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Cserni G, Bori R, Sejben I, Vörös A, Kaiser L, Hamar S, Csörgő E, Kulka J. Unifocal, multifocal and diffuse carcinomas: A reproducibility study of breast cancer distribution. Breast 2013; 22:34-8. [DOI: 10.1016/j.breast.2012.05.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2012] [Revised: 05/06/2012] [Accepted: 05/14/2012] [Indexed: 11/26/2022] Open
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Vörös A, Csörgő E, Nyári T, Cserni G. An intra- and interobserver reproducibility analysis of the Ki-67 proliferation marker assessment on core biopsies of breast cancer patients and its potential clinical implications. Pathobiology 2012; 80:111-8. [PMID: 23258384 DOI: 10.1159/000343795] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2012] [Accepted: 09/18/2012] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The Ki-67 proliferation index has received an important role in treatment tailoring and molecular classification of estrogen receptor-positive breast carcinomas. The aim was to analyze the reproducibility of assessing proliferation on the basis of Ki-67 immunohistochemistry. METHODS Thirty core biopsy samples of breast cancer patients were analyzed after immunostaining with B56, SP6 and MIB-1 monoclonal Ki-67 antibodies. All samples were evaluated twice and independently by 3 pathologists, with each observer performing his daily routine practice. The ratio of Ki-67-positive cells was estimated with 5% accuracy. Correlation was calculated for the results of each investigator for all pairs of antibodies and for the results of each antibody for all pairs of investigators. Ki-67 scores were divided into categories of either 4 quarters or into 3 groups reflecting the St. Gallen consensus recommendations with 15 and 30% as cutoff values. The reproducibility of classifying the tumors into these categories was assessed with ĸ statistics. RESULTS Altogether, 540 evaluations were made. Good to excellent correlation (Spearman's and Pearson's coefficient range 0.74-0.92 and 0.73-0.93, respectively) was noted for the pairwise comparison of antibodies by observer and of observers by antibody. The inter- and intraobserver reproducibility of the Ki-67 score classification into equal quarters (1-25, 26-50, 51-75 and 76-100%) or into 3 categories with cutoffs at 15 and 30% was fair to poor in the middle categories, but moderate to substantial in the low and high ranges. Interobserver differences in practice potentially impacted on less consistent classification. CONCLUSION Our results indicate that the three different Ki-67 antibodies tested do not substantially influence the reproducibility of the estimated proliferation rates. Although reproducibility is better in the clinically more relevant distinction of high versus low proliferation, without standardization, the current practice of Ki-67 assessment in many laboratories does not allow proper and consistent therapeutic decision-making.
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Affiliation(s)
- András Vörös
- Department of Pathology, University of Szeged, Szeged, Hungary.
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Takács T, Paszt A, Simonka Z, Ábrahám S, Borda B, Ottlakán A, Ormándi K, Lázár M, Vörös A, Kahán Z, Lazar G. Radioguided Occult Lesion Localisation Versus Wire-Guided Lumpectomy in the Treatment of Non-Palpable Breast Lesions. Pathol Oncol Res 2012; 19:267-73. [DOI: 10.1007/s12253-012-9578-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 09/24/2012] [Indexed: 10/27/2022]
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Cserni G, Boross G, Maráz R, Leidenius M, Meretoja T, Heikkila P, Regitnig P, Luschin-Ebengreuth G, Zgajnar J, Perhavec A, Gazic B, Lázár G, Takács T, Vörös A, Audisio R. Multicentre validation of different predictive tools of non-sentinel lymph node involvement in breast cancer. Surg Oncol 2012; 21:59-65. [DOI: 10.1016/j.suronc.2011.12.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 12/01/2011] [Accepted: 12/02/2011] [Indexed: 01/17/2023]
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Nikolényi A, Sükösd F, Kaizer L, Csörgo E, Vörös A, Uhercsák G, Ormándi K, Lázár G, Thurzó L, Brodowicz T, Kahán Z. Tumor topoisomerase II alpha status and response to anthracycline-based neoadjuvant chemotherapy in breast cancer. Oncology 2011; 80:269-77. [PMID: 21734419 DOI: 10.1159/000329038] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 04/01/2011] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Individualized chemotherapy for breast cancer improves the outcome. Anthracyclines target the enzyme topoisomerase IIα (TOP2A). We set out to perform a retrospective study of the presence of gene abnormalities and the expression of TOP2A in a cohort of breast cancer patients treated with neoadjuvant anthracycline-based chemotherapy. METHODS Forty-three patients with 45 breast cancers were treated with neoadjuvant docetaxel-epirubicin with/without capecitabine chemotherapy. The TOP2A status of the cancers, determined retrospectively by fluorescent in situ hybridization and immunohistochemistry, was analyzed in relation to the standard clinical and pathological data. RESULTS Clinically and pathologically complete remission (pCR) was achieved in 15 (33.3%) and 9 (20%) cases, respectively. The TOP2A gene was amplified in 2 human epidermal growth factor receptor 2 (HER2)-positive cancers (8%), and 32 (84.2%) overall exhibited TOP2A expression in >15% of the cells. The expression of TOP2A exhibited a strong correlation with the expression of Ki67 (R = 0.743, p < 0.001), and was negatively correlated with estrogen receptors (ER; R = 0.404, p = 0.012) and progesterone receptors (R = 0.430, p = 0.007). The expression of TOP2A was not related to the amplification of the TOP2A gene or the HER2 status of the tumor. The proportions of Ki67- and TOP2A-positive tumor cells were significantly reduced after chemotherapy (56.1 ± 23.6 vs. 19.0 ± 27.7%, p = 0.004, and 41.0 ± 27.9 vs. 12.7 ± 24.8%, p < 0.001, respectively). The development of pCR was related to a high grade (p = 0.054), ER negativity (p = 0.027) and high TOP2A expression (p = 0.037). The expression of TOP2A was an independent predictor of pCR (OR = 1.460, for every 10% increase, 95% CI: 1.016-2.096, p = 0.041). After a median follow-up time of 31.0 months, neither relapse-free survival nor overall survival was related to the tumor response. CONCLUSIONS TOP2A expression is a marker of the tumor's proliferation rate and sensitivity to anthracycline-based chemotherapy, and does not depend on the amplification of its gene.
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Affiliation(s)
- Alíz Nikolényi
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
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Willing B, Vörös A, Roos S, Jones C, Jansson A, Lindberg JE. Changes in faecal bacteria associated with concentrate and forage-only diets fed to horses in training. Equine Vet J 2010; 41:908-14. [PMID: 20383990 DOI: 10.2746/042516409x447806] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
REASONS FOR PERFORMING STUDY Diets rich in readily fermentable carbohydrates, fed traditionally to meet the increased energy requirements of the performance horse, are associated with a number of gastrointestinal disorders that involve disturbances in the intestinal microbiota, however, these changes are poorly understood. OBJECTIVES With the long-term objective of improving intestinal health and to increase understanding of the relationship between diet and microbiota, the effect of feeding Standardbred horses a high-energy forage-only (F) diet was studied compared to a more traditional forage-concentrate (C) diet on faecal microbiota. METHODS Diets were fed in a cross-over design to 6 mature geldings on a scheduled training regime, both periods consisting of 29 days. DNA was extracted from faecal samples collected at 4 time points from each period, bacterial 16S rRNA genes were amplified and community composition assessed by terminal-restriction fragment length polymorphism, cloning and sequencing. Faecal pH and cultivable lactic acid bacteria (LAB) and enterobacteria were also assessed on the final collection day of each period. RESULTS Diet F resulted in a microbial composition that was more stable between sampling periods and had lower counts (P < 0.05) of cultivable LAB and specifically members of the Streptococcus bovislequinus complex. Motile and swarming Lactobacillus ruminis was present in all horses on diet C and not in horses on diet F. Diet C also resulted in the increase (P < 0.05) in members of Clostridiaceae cluster III and a concomitant reduction (P < 0.05) in an unknown group of Bacteroidales. CONCLUSIONS AND POTENTIAL RELEVANCE The greater microbial stability and reduction in LAB and members of the Streptococcus bovis/equinus complex on diet F indicate an opportunity to develop feeding strategies that support equine health and welfare. Novel changes identified in the faecal microbiota that resulted from carbohydrate inclusion merit further investigation.
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Affiliation(s)
- B Willing
- Department of Microbiology, P.O. Box 7025, Swedish University of Agricultural Science, 75007 Uppsala, Sweden
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Vörös A, Kaiser L, Somfay A, Pálinkás A. [Primary lung cancer causing pulmonary artery microembolization and pulmonary hypertension]. Orv Hetil 2007; 148:1281-5. [PMID: 17604265 DOI: 10.1556/oh.2007.28067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The authors present a rare cause of pulmonary hypertension, which occurred in a 57-year-old woman. Postmortem examination discovered an adenocarcinoma with bronchioloalveolar growth pattern as a cause of severe dyspnoea, extreme pulmonary hypertension, and chronic cor pulmonale. The tumour involved all lobes of the lung. In the hilar lymph node metastasis was detectable. Histology showed tumour cell emboli in branches of the pulmonary arteries, intimal fibrosis, which was associated with fibrin precipitation and involvement of lymphatic vessels showing lymphangiosis carcinomatosa. The intrapulmonary dissemination of the adenocarcinoma could be caused by the isolated haematogenous dissemination via the thoracic duct. The authors discuss the possible pathomechanism of pulmonary hypertension and the way of tumour cell dissemination in the lung. They highlight the histological changes, which accompany the syndrome of pulmonary tumour thrombotic microangiopathy. In this case, which can be regarded rarely published in the literature, they emphasise the differential diagnostic questions.
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Affiliation(s)
- András Vörös
- Szegedi Tudományegyetem Szent-Györgyi Albert Orvos- és Gyógyszerésztudományi Centrum, Altalános Orvostudományi Kar, Patológia Intézet, Allomás u. 2, 6720 Szeged.
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Grabham JA, Kelly JM, Kiss J, Vörös A, Altorjay Á, Rózsa I, Fass J. Conversion operation for alkaline reflux after total gastrectomy and Schloffer reconstruction. Br J Surg 2005. [DOI: 10.1002/bjs.1800831058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- J A Grabham
- Department of Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - J M Kelly
- Department of Surgery, Queen Alexandra Hospital, Portsmouth PO6 3LY, UK
| | - J Kiss
- Department of Surgery, Postgraduate Medical School, Szabolcs u. 33. Pb. 112., Budapest, H-1389, Hungary
| | - A Vörös
- Department of Surgery, Postgraduate Medical School, Szabolcs u. 33. Pb. 112., Budapest, H-1389, Hungary
| | - Á Altorjay
- Department of Surgery, Postgraduate Medical School, Szabolcs u. 33. Pb. 112., Budapest, H-1389, Hungary
| | - I Rózsa
- Department of Surgery, Postgraduate Medical School, Szabolcs u. 33. Pb. 112., Budapest, H-1389, Hungary
| | - J Fass
- Department of Surgery, RWTH Aachen, Pauwelsstrasse 30, D-52074 Aachen, Germany
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Abstract
Among a total of 143 patients examined for diagnosis of adenocarcinoma of the cardia, intramural esophageal metastases were verified in six patients (4.19 %). In each case the diagnosis was confirmed by histological examination. The histological structure of the primary tumors and metastases was the same. Metastases were detected by endoscopic ultrasound examination in three cases. All the cardia tumors proved to be well advanced. As well as endoscopic identification of the primary tumor, thorough examination of the proximal part of the esophagus is of great importance.
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Affiliation(s)
- I Szántó
- Department of Surgery, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
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Szántó I, Vörös A, Gonda G, Nagy P, Cserepes E, Gamal EM, Kiss J. [Esophageal implantation metastasis from adenocarcinoma of the cardia]. Magy Seb 2001; 54:393-6. [PMID: 11816140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 74 years old male patient was admitted to our department suffering from dysphagia for five months. Gastric Barium studies showed a cardia tumour with polypoid lesions in the wall of the esophagus, and gastro-esophageal reflux disease was also diagnosed. Endoscopy verified a cardia tumour with esophageal metastasis, and biopsy was obtained from the two lesions. Histology showed that both tumours were adenocarcinomas. Endoscopic ultrasonography classified the cardia tumour as grade T2. As observed during endoscopy, the wall of the esophagus at the level of the polypoid lesion was hypo-echogenic and thick which was result of thickened mucosa. Total gastrectomy and oesophagectomy was performed. Pathology showed that the cardia tumour was pT2N2 and type Siewert-Stein II. The esophageal polypoid lesion was also proved an adenocarcinoma, which was localized only to the mucosa. No tumour cells were found in the blood- or in lymph vessels between the tumour and the esophageal adenocarcinoma. We think that the polypoid adenocarcinoma in the esophagus is an esophageal metastasis implantation from the cardia adenocarcinoma. It is based on the exclusion of other possible tumour dissemination routes. Probably the gastro-esophageal reflux is responsible for the implantation of tumour cells.
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Affiliation(s)
- I Szántó
- Semmelweis Egyetem Egészségtudományi Kar, Sebészeti Klinika, 1389 Budapest, Pf. 112, Szabolcs u. 35.
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Vörös A, Altorjay A, Nagy P, Jakkel T, Bohák A, Szántó I, Gamal EM, Kiss J. [What kind of surgical radicality is justified in the treatment of esophageal and cardial carcinoma?]. Zentralbl Chir 2001; 126:756-62. [PMID: 11727183 DOI: 10.1055/s-2001-18253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
In the period from January 1, 1973 to November 30, 1994, a total number of 1 856 patients had been admitted to our Department of Surgery because of cancer of the esophagus and esophago-gastric junction. We divided our activities into two study periods. In the first study period from 1973 to 1984 only so called "conventional operations" were performed. Since 1985 new oncological aspects were introduced into our operative tactics:1. the subtotal esophagectomy combined with the two-field lymphadenectomy,2. the total gastrectomy with extended lymph node dissection. The analysis of our results with respect to the survival parameters (TNM staging, histological type, grade of differentiation, gross pathology) showed that the best chances were obtained by curative resection and lymphadenectomy in tumours of low-grade biologic malignancy. In esophageal cancers the former 6 % 5-year cumulative survival rate increased to 26 %, and in cardia tumours from 9 to 27 %, because of enhancement of radicality and extension of lymphadenectomy.
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Affiliation(s)
- A Vörös
- Department of Surgery, Semmelweis University, Faculty of Health Sciences, Budapest, Hungary
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Szántó I, Vörös A, Gonda G, Nagy P, Altorjay A, Banai J, Gamal EM, Cserepes E. [Siewert-Stein classification of adenocarcinoma of the esophagogastric junction]. Magy Seb 2001; 54:144-9. [PMID: 11432164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
Nowadays the terminology used for the definition of adenocarcinomas at the oesophagogastric junction is "cardiac carcinoma", which can be easily misunderstood. This definition of adenocarcinomas of the oesophagogastric junction does not allow correct comparison of diagnosis (endoscopic, radiological and pathologic), epidemiology and surgical therapy in national and international aspects, because different tumours can develope in the same area, and all called cardia tumors. Siewert and Stein recommended a classification to solve this problem. The classification of the tumours is morphological/topographical. Type I is adenocarcinoma of the distal part of the oesophagus. Type II is adenocarcinoma of the real cardia and type III is subcardial gastric adenocarcinoma. At classification, we always consider results of endoscopy (ortograde and retroflexed view of the oesophago-gastric junction), the x-rays of the oesophagus and stomach, findings at the operation and pathohistologic results. Between 1/1/1974 and 31/12/2000, a total number of 50,878 upper panendoscopic examinations were performed at the Endoscopic Laboratory of the Surgical Department. Adenocarcinoma of the cardia was diagnosed in 488 patients. According to the Siewert-Stein classification, type I tumour was found in 123 (25.2%), type II in 240 (49.18%), and type III was present in 125 (25.61%) patients. The importance of this classification is it enables unified pre-operative assessment and it can also help to decide the type of the surgical intervention. In our patients with type I cancer--depending of the size of the tumour--distal 2/3 oesophagectomy with the resection of the proximal lesser curve of the stomach or total gastrectomy were performed. In the first group oesophago-jejuno-gastrostomy, in case of total gastrectomy Roux-en-Y loop anastomosis was created. In patients with types II and III cancers total gastrectomy was performed. In every patient lymphadenectomy was performed. We suggest the use of this new classification in clinical, gastroenterology--with special regard to the endoscopy--and pathology.
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Affiliation(s)
- I Szántó
- Semmelweis Egyetem, ETK, Sebészeti Klinika, 1389 Budapest, Pf 112. Szabolcs u. 35.
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Jakkel T, Vörös A, Garcia J, Altorjay A, Szabolcs I, Góth M, Kovács L, Gamal EM. [Laparoscopic adrenalectomy with transperitoneal approach]. Magy Seb 2001; 54:162-7. [PMID: 11432168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
UNLABELLED The feasibility, safety, and results of 52 laparoscopic transperitoneal adrenalectomies were evaluated. METHODS A total of 52 patients were included in the study based on thorough endocrinological and imaging assessment. 15 patients with Conn syndrome, 3 with Cushing syndrome, 15 with nonfunctioning adenoma, 14 with pheochromocytoma, 2 with adrenocortical cyst, 2 with adrenocortical lipoma and 1 with metastasis were considered eligible for adrenalectomy. Lesion size ranged from 1 to 12 cm (mean 4.53 cm). Concurrent surgical procedures were performed in 6 patients (11%). RESULTS There was one conversion (during a left adrenalectomy), because of our learning curve. After we changed the technique, there was no more conversion. There were two (3.8%) postoperative complications: postoperative pancreatitis, one of the patients required re-operation (lavage and drainage). There was one wound infection. We had no postoperative mortality. Mean postoperative hospital stay was 6 days (range, 2-27 days). CONCLUSION Patients with secreting and non-secreting adrenal lesions can be treated safely and effectively by laparoscopic adrenalectomy.
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Affiliation(s)
- T Jakkel
- Semmelweis Egyetem Egészségtudományi Kar Sebészeti Klinika, 1135 Budapest, Szabolcs u. 33.
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Vörös A, Ender F, Jakkel T, Cserepes E, Tóta J, Szántó I, Ereifej S, Seli A, Farsang Z, Kesserú B, László S, Polányi C. [Esophageal anastomosis--based on the experience with 1460 operations]. Magy Seb 2001; 54:132-7. [PMID: 11432162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
The authors reviewed the clinical records of 1460 patients with esophageal anastomoses, the operations performed in their institute between 1973 and 2000. Surgical outcome was assessed with incidence of anastomotic leaks and overall mortality. Hand-sewn anastomoses were performed by inserting single layer interrupted monofil steel wire (507), PDS (232) or Vicryl (65) sutures and circular stapler (EEA, Ethicon) was used in 656 patients. 453 (65 cervical, 293 thoracic, and 95 abdominal) anastomoses performed between 1995 and 2000 were analyzed separately. During this 6-year period, the majority of operations (88%) were performed because of esophageal malignancy (squamous cell carcinoma of the esophagus or adenocarcinoma of the cardia). Surgery was performed for benign disease (e.g. stricture, perforation, and stage IV achalasia) in 12%. The incidence of anastomotic leak was the highest (20%) after cervical anastomosis, compared to a 4.4% or 1% associated with thoracic or abdominal anastomoses. These differences are statistically significant (p < 0.001). The rate of anastomotic leakage was strongly connected to surgical technique: it was 15% in hand-sewn anastomoses and only 4.4% with stapled anastomosis. During the 6-year period overall mortality was 6.6%t.
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Affiliation(s)
- A Vörös
- Semmelweis Egyetem Egészségtudományi Kar Sebészeti Klinika, Budapest.
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Farsang Z, Vörös A, Szántó I, Gonda G, Ender F, Altorjay A. [Rare late complication after subtotal esophagectomy]. Magy Seb 2001; 54:191-3. [PMID: 11432173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
We report a case of a peptic ulcer developed in the stomach tube used for the replacement of the esophagus. The patient was a 60 years old female who had undergone subtotal esophagectomy for mid esophageal malignancy, with intrapleural stomach replacement. Urgent endoscopy revealed an excavated, bleeding ulcer in the thoracic part of the stomach. After unsuccessful medical treatment urgent operation was performed via right thoracotomy. Opening the stomach an ulcer was found on the posterior wall of the stomach, it was penetrating to the right atrium of the heart. The bleeding was controlled by suturing the atrium wall. The patient treated with i.v. Omeprazol in the postoperative period. On the 21st postoperative day a rebleeding occurred causing shock. After reoperation the patient died. This complication is very rare. We emphasise the importance of postoperative pH measurement investigations showing the presence of duodenogastric reflux disease.
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Affiliation(s)
- Z Farsang
- Semmelweis Egyetem Egészségtudományi Kar Sebészeti Klinika, 1135 Budapest, Szabolcs u. 33-35.
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Ereifej S, Lestár B, Vörös A, Kisfaludy N, Arató G. [Isolated gastroduodenal Crohn's disease: a case report]. Magy Seb 2001; 54:194-5. [PMID: 11432174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
Although it can involve any segment of the gastrointestinal tract, Crohn's disease confined to the gastroduodenum is extremely rare. We report the story of a 20-years old male patient admitted for pyloric obstruction that developed despite medical treatment. Clinical manifestations necessitated operative treatment; Polya-gastrectomy was performed. Histology identified Crohn's disease and inflammatory changes as the cause of pyloric obstruction. Postoperative recovery was uneventful. The lesson of this case is, that if duodenal Crohn's disease would have been recognized preoperatively, gastrectomy could have been avoided. We review the literature and discuss treatment options for gastroduodenal Crohn's disease.
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Kovács L, Góth MI, Vörös A, Hubina E, Szilágyi G, Szabolcs I. Changes of serum calcium level following thyroid surgery--reasons and clinical implications. Exp Clin Endocrinol Diabetes 2001; 108:364-8. [PMID: 10989956 DOI: 10.1055/s-2000-8130] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The reasons of transient hypocalcemia, frequently occurring after thyroid surgery, were investigated. Serum total calcium (seCa) and phosphorus (seP) levels were determined in 185 patients with benign nodular goiter before and after thyroid surgery. Beside these, in 27 additional patients, serum magnesium (seMg), total protein, albumin, calcitonin, parathormone (PTH) and 25-OH-D3 vitamin (25-OH-D3) levels were determined; corrected calcium (cCa) values, reflecting ionized calcium concentrations, were calculated. The daily changes of seCa and protein levels were measured in 20 patients. Another twenty patients, undergoing non-endocrinological surgery served as controls. Transient, mild but significant decrease of seCa was observed after surgery, while seP values were increased. Mild hypocalcemia (seCa<2.12 mmol/l) developed in 18.4%, severe hypo-calcemia (seCa<1.9 mmol/l) in 5.4% of the patients. The reduction of seCa levels was more pronounced in elderly, female patients. SeMg, total protein and albumin decreased, while cCa, PTH, calcitonin and 25-OH-D3 values did not change. Positive correlation was demonstrated between the change of seCa and albumin levels. Similar results were obtained in the general surgery group. In the thyroid operated group, in case of severe hypocalcemia, PTH levels decreased significantly into the pathological range. It may be concluded that transient, mild postoperative hypocalcemia is not a thyroid surgery-dependent phenomenon; it can also be observed after other operations accompanied by similar blood loss; in its development hypoalbuminemia plays a role. The causal role of PTH, calcitonin and 25-OH-D3 could not be proved in this study. Hypoparathyroidism can be responsible for the development of severe, prolonged hypocalcemia occurring at rare occasions.
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Affiliation(s)
- L Kovács
- 1st Department of Internal Medicine, Haynal Imre University of Health Sciences, Budapest, Hungary
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Abstract
BACKGROUND Despite the many advancements made in thoracic surgery, the management of patients with esophageal perforation remains problematic and controversial. METHODS Between 1985 and 1995, 27 esophagectomies were performed for perforation of the thoracic esophagus. A retrospective review of the records of these patients was carried out, and a scoring scale developed by Elebute and Stoner to grade the severity of sepsis was applied. RESULTS Among the 27 patients undergoing esophagectomy for a perforation, the interval between rupture and esophagectomy was less than 24 hours in only 11 patients (40.7%). Postoperative surgical complications occurred in 4 patients (14.8%) and nonsurgical complications, in 7 (25.9%). The hospital mortality rate was 3.7% (1/27). In 14 patients, primary reconstruction was performed in the bed of the excised esophagus. There were no anastomotic leaks in this subgroup. This suggests that an anastomosis between viable, well-vascularized tissues is more important for successful healing than avoidance of some degree of contamination of the adjacent mediastinum. On follow-up, which averages 41 months, 73% of patients (16/22) have neither symptoms nor complaints. CONCLUSIONS Esophageal resection definitively eliminates the source of intrathoracic sepsis, the perforation, and the affected esophagus. Reconstruction carried out in one stage does not increase operative morbidity. Esophageal resection and reconstruction is a valid approach even in cases of spontaneous perforation in which the diagnosis is markedly delayed.
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Affiliation(s)
- A Altorjay
- Department of Surgery, Postgraduate Medical University, Budapest, Hungary
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Szántó I, Altorjay A, Kiss J, Vörös A, Nagy P. [Determination of the upper margin of superficial esophageal cancer by intraoperative endoscopic examination and toluidine blue staining]. Orv Hetil 1998; 139:127-9. [PMID: 9467295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Authors describe a new application of intraoperative endoscopic examination. At operation it is difficult to define the border of a superficial esophageal cancer. The female patient aged 69 years was operated on because of squamous cell cancer. During the operation endoscopic examination was done and the esophageal mucosa was stained with 1% toluidine blue solution. The squamous cancer stained blue. The upper border ot the tumour was determined so that the esophageal wall was palpated from the outside with a probe and the same time the manipulation was being watched on the monitor of the videoendoscope. Subtotal esophagectomy and lymphadenectomy were performed. Authors claim that by the intraoperative use of endoscopic staining the risk recurrence in an anastomosis may be diminished and leaving behind of multifocal carcinoma may be eliminated.
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Affiliation(s)
- I Szántó
- Haynal Imre Egészségtudományi Egyetem, Sebészeti Klinika, Budapest
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Affiliation(s)
- I Szántó
- Dept. of Surgery, Postgraduate Medical School, Budapest, Hungary
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Szántó I, Vörös A, Nagy K, Kiss J, Vimláti L, Bohák A. [Postoperative percutaneous endoscopic gastrostomy/jejunostomy]. Orv Hetil 1997; 138:1133-6. [PMID: 9182283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In order to cure complications appeared in the postoperative period two patients were treated with percutaneous endoscopic gastrostomy/jejunostomy (PEG, PEGJ) with the purpose of long-lasting enteral feeding and decompression. The indications of PEG/PEGJ were the following: external gastric fistula in one case and anastomotic leakage in one case. In the patients the PEG was located by intraoperative X-ray examination, this method was not published earlier. Regarding complications of the early postoperative period the PEG and the PEGJ are considered useful and expedient procedures with the aim of lasting enteral feeding and decompression.
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Affiliation(s)
- I Szántó
- Haynal Imre Egészségtudományi Egyetem Sebészeti Klinika, Budapest
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Abstract
OBJECTIVE Experiences obtained with nonoperative treatment (NOT), i.e. total prohibition of per oral food intake for a minimum of 7 days, administration of combinations of broad-spectrum antibiotics, and parenteral hyperalimentation, are described in the management of esophageal perforations. SUMMARY BACKGROUND DATA The place, value, and indication of NOT in the management of esophageal perforation has not yet been unequivocally defined. As a result, contradictory data have been published regarding the outcome of NOT. METHODS During the past 15 years (1979 to 1994), 20 of 86 patients (23.3%) with esophageal perforation have been treated nonoperatively from the outset. In this group, perforations were located to the upper, middle, and lower third of the esophagus in 50%, 30%, and 20%, respectively. In the operative management group (OT)--in which conservative (drainage, endeprothesis), reconstructive (suture, reinforced suture), and radical (resection) surgical methods were applied--lesions were preponderantly located in the lower one third of the esophagus (56.1%--37/66). As to the interval between the perforation and the onset of treatment, 14 patients had been diagnosed within 24 hours, whereas in 6 cases treatment had been begun beyond 24 hours. RESULTS NOT could be successfully carried out in 16 patients; the decision to use NOT had to be revised in 4 other cases (Table 1). Two patients were lost; the mortality rate was 10% (2 of 20). The rate of complications was lower in the NOT group (20%, or 4 of 20) than in the OT group (50%, or 33 of 66). CONCLUSIONS NOT can be suggested for the treatment of intramural perforations. In the case of transmural perforation, this approach should be taken into consideration if the esophageal lesion is circumscribed, is not in neoplastic tissue, is not in the abdominal cavity, and is not accompanied by simultaneous obstructive esophageal disease; in addition, symptoms and signs of septicemia should be absent.
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Affiliation(s)
- A Altorjay
- Department of Surgery, Postgraduate Medical University, Budapest, Hungary
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Affiliation(s)
- I Szántó
- Dept. of Surgery, Postgraduate Medical School, Budapost, Hungary
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Affiliation(s)
- I Szántó
- Dept. of Surgery, Postgraduate Medical School, Budapest, Hungary
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