Cushman D. Haagensen

Expression of GCDFP‐15 in breast carcinomas. Relationship to pathologic and clinical factors

A retrospective immunoperoxidase staining study for a glycoprotein isolated from human breast gross cystic disease fluid (GCDFP‐15) in 562 primary breast carcinomas in 539 patients was conducted to correlate its immunohistochemistry with pathologic and clinical factors. Overall, 55% of the carcinomas studied stained positively for GCDFP‐15. In certain histologic subtypes, the percentage of carcinomas that stained positively was greater: those subtypes with apocrine histologic features (75%), intraductal carcinoma (70%), and infiltrating lobular carcinoma with signet‐ring cell differentiation (90%). In contrast, only 5% of medullary carcinomas exhibited positive staining. Only 23% of breast carcinomas without apocrine features stained positively for GCDFP‐15. Carcinomas that stained positively were more likely to have involved axillary lymph nodes (P < 0.054). The staining was independent of nuclear grade, mitotic index, tumor size, and estrogen receptor status. Positive staining was related to a history of gross cystic disease but not to age, parity, menopausal status, or age at first birth. A positive stain was not related to risk of recurrence or survival.

A personal experience with Halsted's radical mastectomy.

This is a summary of Haagensens experience with radical mastectomy over a 51-year period at the Columbia Presbyterian Medical Center. His prospective, experimental study includes 1036 patients with a follow-up of 47 years. These data are unequalled for any single method of treatment for breast carcinoma.

Nuclear grade and sinus histiocytosis in cancer of the breast

The survival of a uniform series of 318 cases of Columbia Clinical Classification stage A breast carcinoma for 10 or more years postmastectomy was analyzed, with particular reference to influence of the nuclear grade of the cancer and sinus histiocytosis of the axillary lymph nodes. No statistically significant effect of these two factors on survival was found in this stage of the disease.

Re-evaluation of blood-vessel invasion as a prognostic factor in carcinoma of the breast

A series of 328 women who had radical mastectomy operations for stage A carcinoma was investigated for blood vessel invasion by the tumor, which was found in 21%. In the relatively favorable stage A carcinomas, 33% had microscopic axillary lymph node metastases. The over‐all 10‐year survival rate was 69%. In the 10 patients with both blood vessel invasion and lymph node metastases only 33% survived ten years, compared to 78% of patients without either vascular invasion or node metastases. Blood vessel invasion significantly reduced the 10‐year survival rate in the presence but not in the absence of lymph node metastases.

Coexisting lobular neoplasia and carcinoma of the breast

In a review of 3040 cases of carcinoma of the breast of all types in the files of the Laboratory of Surgical Pathology at Columbia for the years 1960 to 1980, 267 cases were found in which the lobular neoplasia lesion coexisted with one of the usual forms of breast carcinoma. These patients had a separate and distinct, and of course malignant, clinicopathologic entity which is distinguished from benign lobular neoplasia occurring alone. Comparing these findings in lobular neoplasia coexisting with one of the usual forms of carcinoma with our findings in lobular neoplasia occurring alone, it was found that the patients with the latter lesion were younger. Three of the nine microscopic features studied in both forms of lobular proliferation were considerably more frequent in lobular neoplasia coexisting with carcinoma: (1) loss of cohesion of the cells filling up the lobules; (2) macroacini; and (3) a maximal amount of lobular neoplasia. The great majority of the forms of carcinoma that were found coexisting with lobular, neoplasia were well differentiated, small cell, intraductal, and tubular, and metastasized less often than carcinomas usually do. Carcinoma developed in the second breast three times more frequently in patients with lobular neoplasia preceding or coexisting with unilateral carcinoma than it did in patients without lobular neoplasia.