Interval breast cancers are not biologically distinct--just more difficult to diagnose

BACKGROUND

Breast cancer diagnosed within 1 year of a negative annual screening examination is called interval breast cancer (IBC) and is considered to be a more virulent subtype of disease.

METHODS

We reviewed clinical data on 24 women who were diagnosed as having IBC while participating in the Breast Cancer Detection Demonstration Project at Ellis Fischel Cancer Hospital and the Women's Cancer Control Program screening project in Columbia, Missouri, between 1974 and 1992. We reinterpreted mammograms from the visit prior to the diagnosis of IBC for possible misdiagnosis, changes suggestive of malignancy, and Wolfe's patterns. Archival paraffin blocks from 19 patients were used to determine qualitative expression of tumor markers.

RESULTS

Observed 5-, 8-, and 10-year survival rates were identical to published data for patients with non-IBC. Seventy-four percent of the mammograms evidenced dysplastic Wolfe's patterns (P2 and DY), and one patient was found retrospectively to have shown evidence of cancer which was missed. Compared to breast cancers in general, fewer IBC tumors expressed tumor markers associated with poor prognosis.

CONCLUSIONS

Survival rates and tumor marker expressions in this retrospective cohort suggest that IBC tumors are not more biologically aggressive than noninterval tumors. They are more difficult to diagnose both by physical examination and mammography.

Structural analysis of monosulfated side-chain oligosaccharides isolated from human tracheobronchial mucous glycoproteins

To determine the location of some sulfate esters on respiratory mucins, an unambiguous sequencing strategy was developed for a crude, monosulfated oligosaccharide fraction derived from tracheobronchial mucous glycoproteins, isolated from sputum from a patient with cystic fibrosis, and which possessed Ricinus communis-I lectin affinity. Employing fractionation by Bio-Gel P-2 chromatography and high-voltage paper electrophoresis of the pool, eighteen branched and four straight-chained monosulfated oligosaccharides, each possessing at least one neutral D-galactose residue at a nonreducing terminus, were purified. Desulfated analogs of each sulfated oligosaccharide were then produced. Elucidation of their structures and sulfate ester locations was accomplished through a parallel comparative sequencing approach for the sulfated oligosaccharide and its desulfated analog. The method was based on their carbohydrate composition and parallel analysis by sequential exoglycosidase degradations, endoglycosidase digestion, permethylation analyses, and specific lectin affinities. Key to this approach was the inability for specific exoglycosidases and lectins to cleave or bind to, respectively, carbohydrates of their specificity which occupied nonreducing termini and possessed a sulfate ester. Herein we report the structures of twenty-two novel sulfated oligosaccharides. Oligosaccharides ranged from trisaccharides to heptasaccharides, were branched and unbranched, and each possessed a single sulfate ester on either C-6 of a terminal or an internal D-galactose residue or on C-6 of an internal residue of 2-acetamido-2-deoxy-D-glucose (N-acetyl-D-glucosamine).

Inflammatory response to viscoelastic materials

Healon, Amvisc, or Viscoat was injected into the corneal stroma of 36 normal rabbit eyes. Twelve additional rabbit eyes were used as controls by performing a sham procedure. Twelve rabbits were euthanized at one day and the remainder seven days after injection. The eyes were enucleated and examined by light microscopy. No control eyes had detectable inflammation. Only Viscoat produced mild inflammation at seven days, but this was statistically significant only at p = 0.182. There appears to be little difference in the inflammatory response of these three viscoelastic substances.

Structure determination of five sulfated oligosaccharides derived from tracheobronchial mucus glycoproteins

The structure of five sulfated oligosaccharide units of highly anionic tracheobronchial mucous glycoproteins, isolated from a cystic fibrosis patient's sputum, were established. Reduced oligosaccharides (84%) were released under alkaline borohydride conditions, and the acidic oligosaccharides (63%) were isolated by Dowex 1-X2 chromatography. Following the removal of acidic oligosaccharides possessing N-acetylneuraminic acid and L-fucose by lectin affinity chromatography a heterogeneous mixture of sulfated oligosaccharides was obtained. From this fraction, five short chain monosulfated oligosaccharides (S-I to S-V) were purified by sequential separation by SynChroprep AX300 anion exchange high pressure liquid chromatography, gel filtration on Bio-Gel P-2, and high voltage paper electrophoresis. Based on the results of carbohydrate composition, sequential exoglycosidase degradation, permethylation analysis, lectin affinity chromatography, and periodate oxidation, the following structures (where GalNAcol is N-acetylgalactosaminitol) were proposed for these oligosaccharides. (formula; see text)

The clinical significance of the in vivo antinuclear antibody phenomenon

We describe a patient with systemic lupus erythematosus (SLE) with demonstrated direct immunofluorescent staining of epidermal nuclei in a rim pattern, the second case of in vivo antinuclear antibody (ANA) producing a rim pattern in normal epidermis. A review of the literature showed that 258 cases have been reported of in vivo ANA deposition in epidermal nuclei from nonlesional skin. This phenomenon, which is most common in patients with mixed connective tissue disease, SLE, and scleroderma, correlates frequently with antibodies to extractable nuclear antigens. In vivo ANA have also been described in renal and pulmonary tissue from patients with SLE. In most cases, the pathogenic significance of the phenomenon is unknown.

The effect of preoperative subconjunctival triamcinolone administration on glaucoma filtration. I. Trabeculectomy following subconjunctival triamcinolone

Trabeculectomies were performed on 15 eyes because of uncontrolled glaucoma despite the maximum use of tolerated antiglaucoma medication. We considered all of these eyes to be at increased risk for episcleral cicatricial closure for one of the following reasons: neonatal glaucoma, a patient of age 40 years or less, previously failed glaucoma filtration surgery, or aphakia. A standard operation was performed except that triamcinolone acetonide (4 mg) was injected subconjunctivally at the intended trabeculectomy site one week before surgery in 12 eyes, the day of surgery in two eyes, and two days prior to surgery in one eye. During the follow-up period of six to 16 months, 14 of 15 eyes had an intraocular pressure (IOP) of 18 mm Hg or less. The average IOP for these 14 eyes was 12.4 +/- 4.6 (mean +/- 1 SD), and only three of the 14 required any antiglaucoma medication. One eye was a surgical failure. All eyes with controlled IOP had diffuse microcystic filtration blebs by slitlamp examination. The postoperative visual acuity was within one line of the preoperative level in all eyes, except for the one failure. The use of triamcinolone did not appear to add any additional risks to the surgical procedure or to the postoperative period.

Atypical fibrous histiocytoma in the skull of an infant. Case report

This is a report of an atypical fibrous histiocytoma in the skull of an infant, who at the age of 3 months was noted to have a "lump" beneath the scalp in the right parietal region. It was about 2 cm in diameter, and the scalp was movable over it. Physical examination was otherwise normal. Radiographs showed erosion of the scalp deep on the palpable mass. At operation a neoplasm was found, which had destroyed the bone and invaded the adjacent temporal muscle and dura mater. The tumor was removed en bloc after the surrounding bone had been excised. Histological examination using light and electron microscopy revealed the tumor to be an atypical fibrous histiocytoma. Radiation therapy was not given. There has been no recurrence for 7 years.

The effect of chemotherapeutic agents on the ultrastructure of transitional cell carcinoma in tissue culture

Human transitional cell carcinoma was successfully grown in short-term tissue culture in 17 of 29 specimens collected (58 per cent). Morphologic parameters of the explants were studied with light and transmission electron microscopy before and after incubation with either thiotepa or 5-fluorouracil. Thiotepa was found to produce marked acantholysis in 43 per cent of those studied. We postulate that thiotepa acts primarily through breakdown of cell adherence. Changes found with 5-fluorouracil were primarily confined to the nucleus.

Pathology of skeletal muscle in mixed connective tissue disease

To characterize the pathology of muscle involvement in mixed connective tissue disease (MCTD), skeletal muscle biopsies from 13 patients with MCTD were examined by routine light microscopy, histochemistry, and direct immunofluorescence. The histologic and histochemical changes observed corresponded closely to changes seen in idiopathic polymyositis and the myopathy associated with systemic lupus erythematosus. Eight of 13 cases examined by direct immunofluorescence demonstrated immunoglobulin deposition either within normal appearing vessels, within normal fibers, around or on the sarcoplasmic membrane, or within the perimysial connective tissue. The histologic findings support Sharp's observation of the high incidence of focal inflammatory lesions in skeletal muscle biopsies of patients with MCTD. Immunoglobulin deposition in these muscle biopsies suggests an immunologic basis for the muscular symptomatology in MCTD.

Antinuclear antibody with distinct specificity for polymyositis

In the course of studying antinuclear antibodies in the rheumatic diseases, a new precipitin reaction (provisionally referred to as PM-1) was observed between calf thymus nuclear extract and polymyositis sera. Objectives of this study were to further define the immunologic nature of this reaction and to determine its specificity for polymyositis. Immunodiffusion studies using calf thymus nuclear extract revealed the PM-1 precipitin line in 17 of 28 patients with polymyositis. This reaction was not produced by sera of 460 patients with other diseases. Enzyme and heat treatments of the nuclear extract showed that PM-1 was distinct from native DNA, ribonucleoprotein, and Sm antigens. Fractionation of PM-1-positive serum by 30% ammonium sulphate and Sephadex G-200 chromatography revealed that the factor producing the PM-1 precipitin reaction was in a serum fraction which showed only IgG by immunoelectrphoresis against anti-whole human serum. Because of the apparent strong specificity, the PM-1 system may represent a marker antibody for polymyositis.

The chronically reserpinized rat as a possible model for cystic fibrosis. I. Submaxillary gland morphology and ultrastructure

Rats treated for 7 days with reserpine develop structural changes in the submaxillary gland that resemble those that have been reported in cystic fibrosis. The salivary exocrinopathy is characterized by increased amounts of PAS-reactive mucoprotein in the acinar cells and by obstruction and dilatation of ducts by precipitated material with the same staining characteristics as those found in the acinar elements.