Juarez Antônio de Sousa

Evaluation of Monoclonal Antibody MIB-1 in the Mammary Epithelium Adjacent to Fibroadenomas in Premenopausal Women Treated with Tamoxifen

The purpose of this study was to study the monoclonal antibody MIB‐1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle who were treated with tamoxifen at doses of 10 and 20 mg for 22 days. The proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry on the basis of the monoclonal antibody MIB‐1 (Immunotech, catalog No. 0505, lot 001). The study was randomized and double blind and was conducted on 44 women with fibroadenomas divided into three groups: A (n = 16, placebo), B (n = 15, tamoxifen, 10 mg), and C (n = 13, tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle, and a biopsy was taken on the 23rd day. Serum estradiol, progesterone, sex hormone binding globulin, follicle‐stimulating hormone, luteinizing hormone, and prolactin were measured before treatment (21st and 24th day of the previous menstrual cycle) and on the day of the biopsy. The mean percentage of stained nuclei per 1,000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. The Fishers test revealed that tamoxifen significantly reduced MIB‐1 at doses of 10 and 20 mg compared with the placebo group (p < 0.0001), with no significant differences between doses in terms of proliferative activity (p = 0.21). Groups B and C presented a significant increase in progesterone (p = 0.038), estradiol (p < 0.001), and sex hormone binding globulin (p = 0.001) levels. Elevation of serum follicle‐stimulating hormone concentration (p = 0.0045) and a fall in prolactin levels (p = 0.0055) were observed. We conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.

Doctor, I am 81 years old and have been diagnosed with various breast cysts. Should I be concerned?

To the Editor: Breast cysts are common findings that are generally asymptomatic (1), resulting from the terminal duct lobular unit or an obstructed ectatic duct (2). Breast cysts form a heterogeneous group of lesions with different probabilities of malignancy, including simple cysts, complicated and complex cysts, and clustered microcysts. The American College of Radiology Breast Imaging Reporting and Data System (BI-RADS) classifies simple cysts as benign findings (BI-RADS 2), in which no further investigation is needed and routine follow-up is recommended (3). Complex cysts are classified as suspicious abnormality (BI-RADS 4) and a biopsy should be considered (3). Nonpalpable complicated cysts and clustered microcysts are classified as probably benign (BI-RADS 3). In the presence of complicated cysts, management remains a gray area, raising doubts and determining different approaches. A woman sought the Breast Clinic following routine mammography and sonography of the breast. At the beginning of consultation, the patient asked the physician: “Doctor, I am 81 years old and have been diagnosed with various breast cysts. Should I be concerned?” She was asymptomatic and her past medical history included six deliveries, a negative personal and family history for breast cancer and no previous use of oral or topical hormone replacement therapy (HRT). At 80 years of age, the patient underwent left breast biopsy and histopathologic findings included usual ductal hyperplasia, small intraductal papilloma, adenosis, microcalcifications, and apocrine metaplasia, without atypia. Physical examination showed no alterations in the breasts or axilla. Mammography detected breasts with vascular calcifications and multiple oval, partially bilateral circumscribed masses of varying sizes (Fig. 1a). Ultrasonography revealed a 5-mm complicated cyst in the left breast and another 8-mm complicated cyst in the right breast (Fig. 1b), in addition to multiple bilateral simple cysts (Fig. 1c). Fineneedle aspiration (FNA) was performed and both complicated cysts were completely emptied. A nonbloody aspirate was obtained, sent for cytology, and the result was negative for malignancy. The present case is noteworthy because of patient age (81 years old). The incidence of simple and complicated cysts peaks in women aged 35–50 years (1). Most cyst alterations regress after menopause (4,5). Simple cysts are more common among postmenopausal users of HRT than in those not using HRT (1). In this age group, cysts are an uncommon finding. Lack of exposure to estrogen by food intake or drug ingestion was also highlighted. Therefore, the patient asked an extremely opportune question. The main question is how often do complicated cysts exhibit malignancy? (6). In a review of six studies (6–11), Berg et al. (1) reported that 2 of 868

Avaliação da Atividade Proliferativa no Epitélio Mamário Adjacente a Fibroadenoma em Mulheres Tratadas com Tamoxifeno

Purpose: to study the monoclonal antibody MIB-1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle treated with tamoxifen. Patients and methods: the proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry based on immunoexpression of the monoclonal antibody MIB-1. The study was randomized and double blind and was conducted on 44 women with fibroadenomas, divided into 3 groups: A (n = 16; placebo), B (n = 15; tamoxifen, 10 mg), and C (n = 13; tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle and a biopsy was taken on the 23rd day. Results: the mean percentage of stained nuclei per 1000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. Fishers test revealed that tamoxifen significantly reduced the immunoexpression of MIB-1 at the doses of 10 and 20 mg compared to the placebo group (p<0.0001), with no significant differences between doses in terms of proliferative activity (p = 0.21). Conclusion: we conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.

Carcinoma Primário de Mama Acessória Axilar: Relato de Caso

A polimastia e uma ocorrencia comum nos ambulatorios de Mastologia e a possibilidade de malignizacao deve ser considerada, assim como em qualquer tecido mamario. Neste trabalho e relatado o caso de uma paciente de 48 anos que foi submetida a exerese da mama axilar acessoria esquerda por motivos esteticos, tendo sido encontrado, no exame histopatologico, um carcinoma ductal invasor, associado a um componente intraductal extenso, com margens livres. A paciente foi submetida a excisao ampla com esvaziamento axilar a esquerda e radioterapia. Neste trabalho sao discutidos aspectos referentes a frequencia da ocorrencia de câncer em mama acessoria, as dificuldades diagnosticas, ao prognostico e as estrategias terapeuticas.

Evaluation of monoclonal antibody MIB-1 in the mammary epithelium adjacent to fibroadenomas in premenopausal women treated with tamoxifen

The purpose of this study was to study the monoclonal antibody MIB-1 in the normal breast epithelium adjacent to a fibroadenoma in women in the luteal phase of the menstrual cycle who were treated with tamoxifen at doses of 10 and 20 mg for 22 days. The proliferative activity of the mammary epithelium adjacent to the fibroadenoma was studied by immunohistochemistry on the basis of the monoclonal antibody MIB-1 (Immunotech, catalog No. 0505, lot 001). The study was randomized and double blind and was conducted on 44 women with fibroadenomas divided into three groups: A (n=16, placebo), B (n=15, tamoxifen, 10 mg), and C (n=13, tamoxifen, 20 mg). Tamoxifen was administered for 22 days starting on the 2nd day of the menstrual cycle, and a biopsy was taken on the 23rd day. Serum estradiol, progesterone, sex hormone binding globulin, follicle-stimulating hormone, luteinizing hormone, and prolactin were measured before treatment (21st and 24th day of the previous menstrual cycle) and on the day of the biopsy. The mean percentage of stained nuclei per 1,000 cells was 9.2 in group A, 4.5 in group B, and 3.2 in group C. The Fishers test revealed that tamoxifen significantly reduced MIB-1 at doses of 10 and 20 mg compared with the placebo group (p < 0.0001), with no significant differences between doses in terms of proliferative activity (p=0.21). Groups B and C presented a significant increase in progesterone (p=0.038), estradiol (p < 0.001), and sex hormone binding globulin (p=0.001) levels. Elevation of serum follicle-stimulating hormone concentration (p=0.0045) and a fall in prolactin levels (p=0.0055) were observed. We conclude that tamoxifen significantly reduced the proliferative activity of the mammary epithelium at the doses of 10 and 20 mg/day.

Gravidez e Tumor Filodes Bilateral: Uma Associação Rara

E apresentado um caso de tumor filodes bilateral benigno diagnosticado durante a gravidez, que apresentou crescimento rapido, atingindo grandes dimensoes. O tratamento foi mastectomia bilateral total na 20a semana de gestacao. Houve boa evolucao pos-operatoria e o parto ocorreu na 40a semana, com recem-nascido vivo do sexo masculino. Sao discutidos os achados clinicos e anatomopatologicos e a evolucao de gravidez.