Cleonice Battista

Axillary Lymph Node Echo-Guided Fine-Needle Aspiration Cytology Enables Breast Cancer Patients to Avoid a Sentinel Lymph Node Biopsy. Preliminary Experience and a Review of the Literature

PurposeFor many years, the status of the axillary lymph nodes has been determined by an axillary lymphadenectomy. However, a sentinel lymph node biopsy has been shown to effectively replace the need for an axillary lymphadenectomy in order to determine the axillary staging. This study presents the preliminary results regarding the efficacy of fine-needle aspiration cytology (FNAC) to identify metastatic axillary lymph nodes in the pre-operative phase.MethodsOne hundred lymph nodes from 100 patients with histologically and cytologically confirmed breast cancer (cT1–2 cN0) underwent echo-guided FNAC. The diagnostic accuracy (sensitivity, specificity, positive predictive value [PPV], negative predictive value [NPV]) for the axillary metastases was evaluated based on the histological findings of either a sentinel lymph node biopsy or an axillary lymphadenectomy as a reference standard.ResultsIt was possible to avoid a sentinel lymph node biopsy in 30% of the cases; the sensitivity was 68%, specificity 100%, PPV 100%, and NPV 65%. Echo-guided FNAC of the axillary lymph nodes should thus be included among the regular diagnostic procedures of presurgical staging.ConclusionThis simple, inexpensive, and minimally invasive technique makes it possible to avoid the additional cost of a sentinel lymph node biopsy while also sparing the patient the stress of undergoing a second surgery.

Caveolin-1 expression in human breast lobular cancer progression

Caveolin-1 is the principal structural protein of caveolae, and caveolin-1 gene plays a role as a tumour suppressor gene in human mammary cancer-derived cells. However, limited data are available concerning caveolin-1 expression in human breast cancer tissue. We evaluated caveolin-1 expression in normal lobular epithelial cells and in the whole human lobular neoplasia spectrum disease, with the aim to examine differences of caveolin-1 expression in human lobular neoplasia progression. We selected 147 cases of pure lobular lesions, ie lobular intraepithelial neoplasia and invasive lobular carcinoma, from 112 patients. Presence of caveolin-1 was evaluated by immunohistochemistry. Among 81 lobular intraepithelial neoplasia lesions studied, 43% were associated with invasive lobular carcinoma, with positive correlation between lobular intraepithelial neoplasia grade and presence of invasive component (P=0.01). In total, 64% of lobular lesions were positive for caveolin-1 (81% lobular intraepithelial neoplasia and 42% invasive lobular carcinoma), and a significant difference in terms of caveolin-1 expression was present between lobular intraepithelial neoplasia and invasive lobular carcinoma (P=0.0001). Variations in caveolin-1 expression were evident among the different lobular intraepithelial neoplasia grades (91% grade 1, 68% grade 2, 35% grade 3); the difference was significant comparing lobular intraepithelial neoplasia grade 3 vs 1 (P=0.0001) and grade 3 vs 2 (P=0.007) but not grade 1 vs 2. Furthermore, significant differences were found between lobular intraepithelial neoplasia grades 1 and 2 vs invasive lobular carcinoma (P=0.0001), but not between lobular intraepithelial neoplasia grade 3 and invasive lobular carcinoma (P=0.196). In conclusion, variations of caveolin-1 expression may have an important role in the progression of human breast lobular cancer; in addition, they confirm the powerful clinical impact of the lobular intraepithelial neoplasia classification for lobular intraepithelial neoplasia, supporting the direct origin of invasive lobular carcinoma from clonal expansion of the lobular intraepithelial neoplasia lesions cells.

COX-2 localization within plasma membrane caveolae-like structures in human lobular intraepithelial neoplasia of the breast

Cyclooxygenase-2 (COX-2) is highly expressed in human intraepithelial neoplasia of the breast and takes part in the molecular pathway implicated in progression of breast cancer. Recently, we demonstrated that COX-2 protein is mainly located in plasma membrane of lobular intraepithelial neoplasia (LIN) cells suggesting a localization in caveolae-like structures. The aim of the present study is to establish subcellular locations of COX-2 and its colocalization with caveolin-1 (CAV-1) to caveolae structures in LIN. To establish a relationship between COX-2 and CAV-1, 39 LINs were studied by immunohistochemistry and confocal microscopy analysis. COX-2 and CAV-1 expression was observed respectively in 79.5 and in 94.9% of LIN studied. A positive correlation was found between membrane COX-2 staining pattern and CAV-1 expression, while no correlation was found between cytoplasm COX-2 staining pattern and CAV-1. Confocal analysis showed that COX-2 localized to plasma membrane was strictly associated to CAV-1 suggesting that an amount of COX-2 protein is placed in caveolae-like structures. Our results show that COX-2 is localized within caveolae compartment and colocalized with CAV-1 protein in LIN lesions. Because caveolae are rich in signaling molecules, this COX-2 compartment may play an important role in diverse breast cancer carcinogenesis processes.

Unusual complication after radiotherapy for breast cancer bronchiolitis obliterans organizing pneumonia case report and review of the literature.

Breast-conserving surgery and postoperative radiotherapy play an important role in the treatment of early breast cancer. Bronchiolitis obliterans with organizing pneumonia (BOOP) is an uncommon syndrome reported to be one of the complications of adjuvant radiotherapy. We report the case of a 71-year-old woman who developed cough, dyspnea and fever three weeks after radiation therapy to the left breast for breast carcinoma. Chest X-ray and computed tomography scan demonstrated alveolar opacities within both lungs. Antibiotic therapy against any probable septic pathology did not improve the symptoms, while corticosteroid treatment resulted in rapid clinical improvement together with regression of the pulmonary opacities. Irradiation was thought to be the cause of the migratory pneumonitis, hence this case was clinically diagnosed as radiation-induced migratory pneumonitis similar to BOOP, without lung biopsy. The present case suggests that one should be mindful of this disease when treating patients with a history of irradiation to the breast. BOOP promptly responds to systemic corticosteroid therapy with rapid improvement of symptoms and regression of the pulmonary opacities.

Alexithymia–A Disorder of the Regulatory Mechanism of the Emotion Elaboration–and Quality of Life in Gynecologic Surgery

STUDY OBJECTIVE Alexithymia is a disorder of the regulatory mechanism of the emotion elaboration. To verify the influence of the personality trait in the evaluation of quality of life (QoL), we analyzed the effect of alexithymia on the outcome of gynecologic surgery. The purpose of this study was to investigate the presence of alexithymia by using the Toronto Alexithymia Scale (TAS)-20, and to examine the relationship between alexithymia and self-reported descriptors of QoL in a gynecologic population. DESIGN All patients were evaluated in a semistructured interview in which personal, medical, and social data were collected. They were provided with a set of questionnaires that included both measure of alexithymia (TAS-20) and QoL perception (the Medical Outcomes Study short-form general health survey-36 [SF-36]). The patients were assessed before the surgical procedure and 1 month postoperatively. SETTING Campus BioMedico Hospital in Rome, Italy. PATIENTS In all, 40 consecutive patients with benign gynecologic pathology were enrolled in the study. INTERVENTIONS A total of 20 of the patients underwent laparoscopy (LPS) and 20 underwent laparotomy (LPT). MEASUREMENTS AND MAIN RESULTS Patients were separated into 2 groups, with respect to the TAS questionnaire score: the high-level alexithymia (HA) group, with scores above 59, and the low-level alexithymia group, with scores below 59. The HA group represented 61% in patients who underwent LPS and 50% in patients who were submitted to LPT. Patients who underwent LPS showed a slight decrease in the QoL score after the surgical procedure. Patients who underwent LPT showed different QoL scores depending on the high or low TAS level: high-level TAS group showed higher SF-36 domain scores compared with the presurgical scores, whereas low-level TAS group showed lower scores compared with the presurgical scores. CONCLUSION Our data show that the subjective QoL tested with SF-36 in patients with gynecologic conditions undergoing surgery is clearly influenced by the level of alexithymia. This influence is clearly detectable when a more invasive surgery is performed. In this case, patients with low-level alexithymia show a worsening of QoL. Contrarily, patients with HA have a better perception of QoL after more invasive surgery.

Squamous cell carcinoma of the breast diagnosis by vacuum-assisted core biopsy

Squamous cell breast carcinoma is a rare occurrence. Often the tumor is metastatic from an extramammary primary tumor. In order to determine the nature of the lesion, extensive sampling is necessary. We report a case of primary squamous cell carcinoma of the breast diagnosed by vacuum-assisted core biopsy.