K. Horgan

The satisfaction and savings of early discharge with drain in situ following axillary lymphadenectomy in the treatment of breast cancer

A pilot study was performed to determine if early discharge with the drain in situ following axillary lymphadenectomy is feasible and safe. One hundred and one women who had axillary lymphadenectomy as part of their breast cancer treatment were studied. Ninety-six were offered early discharge with the axillary drain in situ, five were unsuitable for early discharge. The cohort who opted for early discharge (n = 39) had a lower rate of seroma formation (18% vs 34%) and a reduction in median hospital stay of 5 days. Patient satisfaction was high in both groups and there were no complications associated with early discharge or drain displacement. Early discharge after axillary lymphadenectomy with the axillary drain in situ is safe, feasible, popular with patients and offers considerable resource savings.

Dual immunocytochemical analysis of oestrogen and epidermal growth factor receptors in human breast cancer.

Recent studies have demonstrated a consistent inverse relationship between oestrogen receptor (ER) and epidermal growth factor receptor (EGFR) levels in female human breast cancer. Serial cross-section studies have suggested that separate populations of ER+/EGFR- and ER-/EGFR+ cancer cells exist in tumours deemed by immunocytochemical assay (ICA) to be positive for both. We have developed a dual ICA that is able to stain for both ER and EGFR on a single 5 microns frozen section sample of breast tissue. Twenty-two samples of female human breast cancer tissue that exhibited positivity for ER and EGFR by ER-ICA using the H222 monoclonal antibody and EGFR-ICA using the EGFR1 monoclonal antibody underwent the dual ICA. There was a significant correlation in receptor positivity between the single and dual assays for both ER (rs = 0.801, P < 0.001) and EGFR (rs = 0.831, P < 0.001). Individual cancer cells exhibited one of three staining patterns: nuclear staining only (ER+/EGFR-), membrane-associated and cytoplasmic staining only (ER-/EGFR+) or no staining (ER-/EGFR-). No cancer cells exhibited both nuclear and membrane/cytoplasmic staining. This is the first description of a simultaneous dual immunocytochemical assay system for ER and EGFR in clinical breast cancer specimens. The results suggest that ER and EGFR expression are mutually exclusive within an individual breast cancer cell in vivo with separate populations of ER+/EGFR- cells, ER-/EGFR+ cells and ER-/EGFR- cells coexisting.

Fibroblast stimulation of breast cancer cell growth in a serum-free system.

Conditioned media from 14 short term fibroblast cell lines were mitogenic for human breast cancer cells with different steroid receptor profiles in serum-free culture. Fibroblast-conditioned medium stimulated tritiated thymidine incorporation in short term culture and growth in a longer proliferation study as measured by the MTT colorimetric assay. Conditioned media from benign and malignant epithelial cells were non-stimulatory for breast cancer cells but that derived from endothelial cells showed similar stimulation to fibroblasts. Partial purification of fibroblast-conditioned medium identified a peptide with a molecular weight of approximately 8 kDa that showed no affinity for heparin and was mitogenic for MCF-7 breast cancer cells.

Demonstration of a positive feedback loop of paracrine growth stimulation in a new co-culture model of breast cancer

Abstract A serum-free co-culture model of breast cancer was established using primary cultures of human fibroblasts and the breast cancer lines MCF-7, T47D and MDA-MB-231. The model was used to test the hypothesis that there is a positive feedback loop of paracrine growth stimulation between stromal fibroblasts and cancer cells. Cancer cell growth was dependent on co-culture with fibroblasts and fibroblast growth, in turn, was dependent on co-culture with cancer cells. Platelet derived growth factor (PDGF) was mitogenic for fibroblasts in mono-culture but not mitogenic for cancer cells. However, addition of PDGF to a co-culture of cancer cells with fibroblasts resulted in increased growth of the cancer cells, as predicted by the paracrine loop hypothesis. This model demonstrates one way in which benign stromal cells may be actively recruited into the malignant process.

Malignant melanoma of the penis.

A case of malignant melanoma of the penis is herein reported. Malignant melanoma of the penis is rare and accounts for a small percentage of malignant melanomas and of malignant penile lesions. The diagnosis is often delayed by the patients reluctance to consult a physician and by the intrinsic difficulty in clinical diagnosis of such a rare neoplasm. The surgical treatment is not standardized and is shortly discussed. In general, prognosis is poor and most patients die within a few years due to distant metastasis.

Mechanisms responsible for oestrogen receptor expression in primary human breast cancer

Oestrogen receptor (ER) status in human breast cancer provides the best parameter available at present to determine the likely response to endocrine therapy. However, the precise mechanisms responsible for ER expression have yet to be fully elucidated. In order to examine this we have quantitatively analysed the mRNA and protein levels of ER in 61 patients with primary breast cancer using the techniques of ribonucleic acid (RNA) slot blotting and immunocytochemistry. Using the H222 monoclonal antibody, ER staining was observed in 40 cases (65.5%) following immunocytochemical assay. RNA slot blotting using a complimentary deoxyribonucleic acid probe (HEO) revealed ERmRNA to be present in 46 cases (75.4%). The mRNA and protein levels of ER were found to be significantly correlated (rs = 0.753, P < 0.0001). Exclusion of 15 cases where neither mRNA nor protein was detected still revealed a significant correlation in the remaining 46 cases (rs = 0.529, P = 0.0002). In 39 cases sufficient RNA was obtained to allow further filters to be prepared containing larger amounts of RNA. The results obtained in these filters showed high concordance with those obtained originally for these patients (rs = 0.915, P < 0.0001), validating the results. Our results suggest that ER expression in primary breast cancer is determined either by transcriptional modulation or by increased transcript stability.