Maja Nielsen

Breast cancer and atypia among young and middle-aged women: a study of 110 medicolegal autopsies.

In 110 consecutive, medicolegal autopsies of young and middle-aged women (range 20-54 years) the breasts were examined by an extensive histopathologic method and by correlative specimen radiography. Malignancy was found in 22 women (20%) of which only one was known to have had clinical invasive breast cancer (IBC). At autopsy 2 women had IBC (2%), the remaining in situ carcinoma (in situ BC) of microfocal type (18%), i.e. 15 (14%) intraductal carcinomas (DCIS), 4 (3%) lobular carcinoma in situ (LCIS) and one (1%) both DCIS and LCIS. Forty-five per cent of the women with malignancy had multicentric and 41% had bilateral lesions. Forty-five per cent of all histologically confirmed malignant lesions were identified by specimen radiography. Adenosis, benign epithelial hyperplasia, papilloma and duct ectasia were positively associated with malignancy. In addition malignancy was significantly more frequent among women aged more than 40 years, with late age at first full-term pregnancy, with alcohol abuse and with steatosis or cirrhosis of the liver. The results suggest that clinically occult in situ BC are frequent in young and middle-aged women.

Precancerous and cancerous breast lesions during lifetime and at autopsy. A study of 83 women

Among 83 consecutive, unselected female autopsy cases, 6 had been treated for invasive breast carcinoma (IBC) during lifetime. At autopsy, of these six women, two had IBC in the contralateral breast, and another two had in situ carcinoma. Among the 77 women without previous clinical breast cancer, one case of IBC and 14 cases of in situ carcinoma were found at autopsy. Thus, the total occurrence of primary malignant breast lesion was as high as 25.4%. Assuming that all IBCs evolve from in situ forms and that in situ carcinomas do not undergo total regression, our results seem to indicate that about one third of all in situ carcinomas develop into IBC.

An autopsy study of radial scar in the female breast

In a study of breasts from 83 consecutive, unselected female autopsies, 23 women (28%) were found to have radial scars. The lesion was multicentric in 67% and bilateral in 43%. The frequency of radial scar was significantly increased among women with fibrocystic disease (43%) compared to women without this lesion (17%). No difference in the frequency of radial scar was registered between women with primary breast malignancy and women with either normal breasts or benign breast abnormalities. No radial scar demonstrated transition to invasive or in situ carcinoma. No evidence was found of any association between radial scar and breast carcinoma.

Radial scars in women with breast cancer

In 84 consecutive autopsies of women with a clinical diagnosis of invasive breast cancer, radial scars were found in the contralateral breast in 35 cases (42%) by an extensive histopathologic method. Four women had radial scars on the ipsilateral side in the breast tissue available from the primary surgical procedure or at autopsy. One woman had an invasive breast cancer with morphologic features compatible with but not diagnostic of transition from a radial scar. Of the six radial scars with carcinoma in situ occurring in three women, three were of ductal and three of lobular type. In the remaining cases only radial scars with a benign appearance were found except for two with atypical hyperplasia. The frequency of radial scars was significantly higher in women with fibrocystic disease (55%) compared to women without (24%). Contralateral primary invasive and in situ breast cancer occurred in 68%. No difference in the frequency of radial scars in women with and without breast cancer was found and radial scars were not associated with any specific type of breast cancer. Our findings do not indicate a higher malignant potential of radial scars than of fibrocystic disease. It is suggested that only radial scars containing high‐risk epithelial changes such as atypical hyperplasia and carcinoma in situ are associated with an increased risk of subsequent breast cancer development. Cancer 59:1019‐1025, 1987.

Essential Histological Findings in the Female Breast at Autopsy

The entity of breast cancer includes in situ and invasive carcinoma according to morphological criteria. Furthermore, proliferative lesions such as atypical ductal hyperplasia and atypical lobular hyperplasia, multiple papillomas, radial scar, juvenile papillomatosis, and cysts have all in some way been reported to be associated with breast cancer.

Effect of 1α-Hydroxyvitamin D3 and Dietary Calcium and Phosphate on the Aortic Mineral Content in Rabbits with Mild Azotemia

The effect of treatment with 1 alpha-hydroxycholecalciferol (1 alpha-OH-D3) and different diets on uremic arterial disease was studied. Three groups of rabbits with chronic renal failure (CRF) were kept on three diets with a low, medium or high content of calcium and phosphate. Half the rabbits in each group were treated for 18 weeks with 1 alpha-OH-D3, 0.02 micrograms/kg/day, without any significant changes in the serum concentrations of calcium or phosphate compared to placebo treatment. In the thoracic aorta, the content of calcium and phosphate was significantly increased in placebo-treated CRF rabbits on medium and high calcium and phosphate intakes compared to rabbits with normal renal function (p less than 0.05). The cholesterol content was unchanged. Treatment with 1 alpha-OH-D3 caused a further increase in the aortic content of calcium and phosphate in the CRF rabbits on medium and low calcium and phosphate intakes (p less than 0.05). No increase in the aortic cholesterol content was observed. The histological changes in the abdominal aorta consisted of medial proliferations with calcifications and intimal proliferations. The severity of these changes paralleled the mineral content of the thoracic aorta. Aggravation of uremic arterial disease may be a hitherto unrecognized side-effect of treatment with 1 alpha-OH-D3 in CRF.

Carcinoma of the parotid gland following sialography with thorotrast. Report of two cases.

Two cases are presented of malignant tumour of the parotid gland following sialography with Thorotrast, 28 and 45 years previously. Both cases were histologically established as squamous cell carcinoma and the presence of Thorotrast in the tumours was confirmed by autohistoradiography. It is suggested that the tumours may have developed from metaplastic ductal epithelium after many years of exposure to the alpha radiation from Thorotrast deposits in the gland.

Axillary lymph node morphology in women with in situ breast carcinoma. An autopsy study.

Axillary lymph nodes in 184 female autopsy cases were studied using morphological criteria. Special attention was paid to the morphology in 34 women with in situ breast carcinoma (in situ BC) compared to the remaining women without malignant breast lesions, who served as controls. Sinus histiocytosis (SH) and diffuse cortical hyperplasia (DCH) were significantly more frequent among women with in situ BC compared to controls. No significant association was found between unilateral in situ BC and these lymph node patterns on the contralateral side. Germinal center and follicular hyperplasia (GCH/FH), lymphocyte depletion (LD), fibrosis, hyalinization, calcifications and lipomatosis were not associated with in situ BC. The results indicate that in situ BC provokes reactive morphological changes of the regional axillary lymph nodes similar to the changes associated with a good prognosis in women with invasive breast cancer (IBC).

Contributions to the Diagnosis of Contralateral Malignancies in Women with Invasive Breast Cancer

Women with breast cancer are at a high risk of developing a new primary or metastatic lesion in the contralateral breast (Robbins and Berg 1964; Haagensen 1971; Leis 1980). The magnitude of this risk and the prognostic significance of the occurrence of such lesions, however, remain controversial. Discriminants of predictive value for the development of contralateral malignancies are a matter of debate as well and there is no general agreement on the management of the contralateral breast (Leis 1980; Fisher et al. 1984).

Effect of chronic renal failure and methylprednisolone treatment on the uptake of labelled plasma cholesterol into the aorta of normocholesterolemic rabbits.

The effects of chronic renal failure (CRF) and corticosteroid treatment on the aortic uptake of labelled free and esterified cholesterol (FC and EC) were investigated in normocholesterolemic rabbits. Methylprednisolone, 0.4 mg/day, or placebo was administered for 14 weeks to rabbits with normal renal function and with CRF. Then [3H]- and [14C]cholesterol were administered intravenously and orally, respectively. The radioactivity levels of FC and EC in plasma were measured at regular intervals. After 48 h the accumulation of 3H and 14C radioactivity of FC and EC in the intima-media of the thoracic aorta was determined. An aortic uptake coefficient was calculated by dividing the tissue radioactivity (dpm/cm2/h) by the mean plasma radioactivity (dpm/ml). The mean uptake coefficient of EC in normal rabbits was 6 nl/cm2/h, the value for FC being 180 nl/cm2/h. In normal rabbits treated with methylprednisolone the uptake coefficients of both FC and EC were significantly decreased to about 50% of the values in normal rabbits receiving placebo. A similar significant decrease in the uptake coefficients was found in the CRF rabbits receiving placebo. No further decrease was observed in the CRF rabbits treated with methylprednisolone. The cholesterol content of the aortic intima-media was significantly decreased only in CRF rabbits on methylprednisolone treatment. The results do not indicate an acceleration of uremic arterial disease by steroid treatment in the rabbit.