Alexandre Henrique Macchetti

Tumor-infiltrating CD4+ T lymphocytes in early breast cancer reflect lymph node involvement

BACKGROUND The role of immune system in the pathogenesis and progression of breast cancer is a subject of controversy, and this stimulated us to investigate the association of the immunophenotype of tumor-infiltrating lymphocytes in early breast cancer with the spread of tumor cells to axillary lymph nodes. METHODS Tumor samples from 23 patients with early breast cancer from the Department of Gynecology and Obstetrics of Ribeirão Preto Medical School (USP) were obtained at the time of biopsy and submitted to an enzyme-digestion procedure for the extraction of tumor-infiltrating lymphocytes. The lymphocytes extracted were analyzed by dual-color flow cytometry with monoclonal antibodies in these combinations: CD3 FITC/CD19 PE, CD3 FITC/CD4 PE, CD3 FITC/CD8 PE, and CD16/56 PerCP, which are specific for immunophenotyping of T and B lymphocytes, helper and cytotoxic T lymphocytes, and natural killer (NK) cells. The mean percentage of these cells was used for comparing groups of patients with or without lymph node metastasis. RESULTS The mean value for T-lymphocyte infiltration was 24.72 +/- 17.37%; for B-lymphocyte infiltration, 4.22 +/- 6.27%; for NK-cell infiltration, 4.41 +/- 5.22%, and for CD4(+) and CD8(+) T-lymphocyte infiltration, 12.43 +/- 10.12% and 11.30 +/- 15.09%, respectively. Only mean values of T- and CD4(+) T-lymphocyte infiltration were higher in the group of patients with lymph node metastasis, while no differences were noted in the other lymphocyte subpopulations. CONCLUSION The association of tumor-infiltrating CD4(+) T lymphocytes with lymph node metastasis suggests a role for these cells in the spread of neoplasia to lymph nodes in patients with early breast cancer.

Fibromatosis of the male breast: a case report with immunohistochemistry study and review of the literature

mitted to the Outpatient Breast Oncology Service, Department of Health of Sao Carlos, Brazil, with a 3-month history of a painless subcutaneous mass with rapid growth. Clinical examination revealed an ill-defined mass located in the upper inner quadrant of his left breast tissue measuring of 3.5 cm in diameter. The mass was firm and was fixed to the pectoral fascia and to skin. There was no axillary or cervical lymphadenopathy or nipple discharge. At ultrasound, the lesion manifested as an irregular, hypoechoic mass with posterior acoustic shadowing, suggestive of malignancy. Fine-needle aspiration cytology was performed, but the result was inconclusive because the aspirate did not yield sufficient epithelial cells for diagnosis. The tumor was removed by en bloc resection with wide excision, the greater pectoral muscle being spared. During surgery the lesion was found to be firmly adherent to the underlying pectoralis major. The appearance was that of an infiltrative tumor, and the diagnosis of epithelial neoplasm was considered in the differential diagnosis. There was no history of trauma to the chest wall, so that a fibrous reaction to trauma was not considered in the differential diagnosis. The surgical specimen was fixed in 4% formalin. Se