Estrogen and Progesterone Receptors as Prognostic Factors in Breast Cancer

The relation between estrogen receptors (ER) and/or progesterone receptors (PgR) and some clinical factors such as tumor size, axillary node involvement, histological tumor grade, and disease-free interval (DFI) in 500 patients with operable (TNM stage I-III) breast cancer was studied. ER-positive (ER+) tumors were commoner in older patients, whereas PgR-positive (PgR+) tumors were similarly distributed within the age groups. The concentration of ER+ protein also increased with age in contrast to PgR+ protein concentration. However, receptor status was not associated with menopausal status independently of age. Axillary node involvement influenced neither ER nor PgR status, but there was a statistically significant relation between tumor size and positivity of ER or PgR. There was no association between histologic tumor grade and either steroid receptor phenotype. DFI was longer in patients with ER+ than those with ER− tumors, independently of axillary nodal status. The positivity of PgR in patients with ER+ tumors contributed to an even longer DFI, suggesting that the combination of ER/PgR is a better indicator of DFI than ER or PgR alone.

Angiogenesis in malignant tumors

Angiogenesis is the formation of new blood vessels from the existing vascular network. It is a complex, multi-step process involving extracellular matrix remodeling, endothelial cell migration and proliferation, capillary differentiation, and anastomoses. Angiogenesis is crucial for tumor progression and metastasizing. Intratumor microvessel density is believed to reflect the degree of angiogenesis in carcinomas. Angiogenesis is also very important in many preneoplastic lesions.

[Prognostic value of determination of the presence and histologic grade of the intraductal component in invasive ductal carcinoma of the breast after conservative treatment]

In recent years, breast-conserving therapy and radiation therapy have become an important treatment option for patients with stage I and II invasive breast cancer. The results of long-term retrospective studies have demonstrated that this treatment can provide a high level of local tumor control with satisfactory cosmetic results. Numerous studies have shown that the presence of extensive intraductal component (prominent intraductal carcinoma) is highly associated with subsequent local recurrence. In this article we have stressed the value of the determination of the presence and the histologic grade of prominent intraductal component of invasive ductal breast carcinoma in the determination of the extent of surgery. We also point out the possibility of determination of prominent DCIS on frozen sections.

[Pathohistologic procedures in encapsulated follicular tumors of the thyroid gland]

Determination of pathohistologic diagnosis of encapsulated thyroid tumors, particularly follicular carcinoma, is sometimes very difficult, even for well-experienced pathologists. The analysis of intraoperative biopsies could be even more difficult. The importance of proper handling of bioptic material for correct interpretation of pathohistologic findings is not adequately stressed in our literature. In this article, we point out necessity of serial sections of encapsulated follicular tumors for correct diagnosis.

Fibromatosis of male breast

Fibromatosis is a relatively benign, though locally invasive neoplasm. About 100 cases of fibromatosis of the breast have been reported to date, none of them in a male. We present a 60-year-old man who was admitted to the University Hospital for Tumors in Zagreb, Croatia, on May 25, 1992, with a 3-month history of gradually enlarging, painless subcutaneous mass, 6 x 5 cm, that was located in the upper outer quadrant and partly beneath the areola of his left breast. The diagnosis was confirmed by immunoperoxidase studies, that showed positivity for vimentin, whereas the staining for cytokeratin AE1, glial fibrillar acid protein (GFAP) and collagen IV was negative. The tumor was removed by en bloc resection, and the greater pectoral muscle was spared. Today, 3 years after the operation, the patient is alive and in good health.

Locally recurring primary myxoma of the breast: an evidence of malignant alteration

Breast is an extremely rare localization of myxoma. To date, only five cases have been reported, including one case of nerve sheath myxoma. In this report, the authors present a 37-year-old female patient who was admitted to the University Hospital for Tumors in Zagreb, Croatia, in 1979, with a 2-month history of gradually enlarging, painless subcutaneous mass in her right breast. On physical examination, a firm, relatively well circumscribed mass measuring 3 x 2 cm was detected in the upper outer quadrant and partly beneath the areola. The mass was freely movable to the overlying skin, causing no retraction. There was no family history of a breast disease or cancer. Patient's past history revealed no major illnesses or trauma. The tumor was removed by simple local excision, but it recurred locally in three episodes between 1981 and 1986. After that, the tumor underwent malignant alteration to myxosarcoma on its fourth (in 1992), and to myxoid liposarcoma on its fifth recurrence (in 1993). No such sequence of events has been reported in the literature so far.

[Relation between grades of histologic differentiation and hormone receptors in breast cancer]

The relationship between the grade of histologic differentiation of the tumor and estrogen (ER) and progesterone (PgR) receptor values was analyzed in 261 patients with breast cancer of the invasive duct type. There was a statistically significant difference in concentration and incidence of positive and negative ER and PgR with regard to histologic grade. The concentration and number of positive hormone receptors increased with better differentiation of the tumor. A statistically significant correlation between histologic grade, hormone receptor values and axillary nodal involvement was obtained only in patients with no metastases to axillary lymph nodes.

[Adenomas of the thyroid gland--criteria for pathohistologic diagnosis]

Adenomas are the frequent tumors of the thyroid gland, which have different histological types, distinct criteria for pathohistological diagnosis, and distinct criteria for differentiation the follicular adenoma from follicular carcinoma of the thyroid gland. Authors have analyzed 63 patients with follicular adenomas of the thyroid gland which were diagnosed and treated at the Central Institute for Tumors and Allied Diseases in Zagreb in the period from 1986 to 1987, and on which had been done serial cuttings of the tumors for pathohistological diagnosis.

[Oncogenes and growth factors in human epithelial tumors: their importance in diagnosis and prognosis]

The accumulation of the genetic alterations, the activation of oncogenes and the inactivation of tumor suppressor genes, play a critical role in the induction of the malignant tumours. In human solid tumors, oncogenes and growth factors are found at any of the different stages in carcinogenesis. The clinical results of these observations are the demonstration of some relations between activation and expression of the oncogenes and growth factors and clinical features or prognosis. Furthermore, they seem to permit definition of premalignant conditions or populations of high risk of disease.

[Strumal carcinoid tumor of the ovary--histologic and electron microscopy characteristics of the tumor]

Strumal carcinoid tumor is a very rare primary tumor of the ovary in which carcinoid is admixed with tissue resembling thyroid follicles. We report a 44-year-old women with benign strumal carcinoid tumor of the ovary and without any clinical symptoms. Histochemical and electron microscopical examinations of the tumor showed intracytoplasmic dense core secretory granules, indicating that this neoplasm is a pure carcinoid tumor with acinar differentiation resembling thyroid tissue.

[The significance of certain histologic parameters in the differentiation and diagnosis of Hürthle cell adenoma and carcinoma of the thyroid gland]

Hürthle cell tumors of the thyroid gland are rare. Their natural history remains incompletely understood what results in their different classification and therapy. The differentiation of benign from malignant Hürthle cell tumors is possible with classical, traditional histologic methods. Authors have analysed 53 patients with Hürthle cell tumor of the thyroid gland which were diagnostically evaluated and treated at the Central Institute for Tumors and Allied Diseases in Zagreb from 1975 to 1988.

[The importance of clinical and histologic variables in the prognosis of medullary carcinoma of the thyroid gland]

Patients with medullary thyroid carcinoma (MTC) have aroused considerable interest ever since Horn (1951), Hazarde et al. (1959) and Williams (1966) described MTC as a separate clinicopathologic entity, because this tumor occurs both in families and in association with neural and endocrine abnormalities. This interest also underlines our clinicohistologic study of 31 patients with a histologically demonstrated MTC. The patients have been analyzed at the Central Institute for Tumors and Allied Diseases in Zagreb from 1969 to 1988. The youngest patient was 17, and the oldest one 85 (average 45 years). None of the patients had thyroid carcinoma in his/her family history, or any association with pheochromocytoma or multiple skin and mucosal neurinoma. The men to women ratio was 1:0.94. The prognostic significance of some clinical and histologic variables in patients affected by medullary thyroid carcinoma have been studied. Treatment involved total thyroidectomy with or without neck dissection. Some of the patients were subsequently irradiated or administered chemotherapeutic agents. The data obtained in the study were statistically processed and the statistical differences between the survival rates of the various patient groups were determined by the logrank-test. Of the studied variables (sex, age, tumor size, cervical metastases, tumor structure, cell type, stroma, calcification, number of mitoses, necrosis, bleeding, amyloid content), the following were found to have a prognostic significance: age, tumor size and regional lymph node metastases.

[Solitary extramedullary plasmacytoma of the larynx]

Solitary extramedullary plasmacytoma (EMP) is histologically rare larynx tumor. Of the 620 treated larynx carcinomas, extramedullary plasmacytoma makes up 0.1% of larynx carcinomas recorded in our case reports. The symptoms of larynx EMP are like other tumor symptoms of the same site. Clinically, solitary extramedullary plasmacytoma is like a cyst. It is epithelialized and radiates grey light. Findings obtained by biopsy and extemporary histology did not confirm plasmacytoma. The diagnosis was made by histochemical procedure.