Tamás Zombori

Evaluation of grading systems in stage I lung adenocarcinomas: a retrospective cohort study

Aims There is no internationally accepted grading system for lung adenocarcinoma despite the new WHO classification. The architectural grade, the Kadota grade and the Sica score were evaluated and compared with overall (OS) and disease-free survival (DFS). Methods Comprehensive histological subtyping was used in a series of resected stage I lung adenocarcinoma to identify subtypes of adenocarcinomas, the architectural grade, the Kadota grade, the Sica grade, the mitotic count, nuclear atypia, the presence of lymphovascular, vascular and airway propagation, necrosis, and micropapillary or solid growth pattern in any percentage. Statistical models fitted included Kaplan-Meier estimates and Cox proportional hazard regression models. Results 261 stage I adenocarcinomas were included. The 5-year survivals of different subtypes were as follows: lepidic (n=40, OS: 92.5%; DFS 91.6%), acinar (n=54, OS: 81.8%; DFS: 68.6%), papillary (n=49, OS: 73.6%; DFS: 61.0%), solid (n=95, OS: 64.7%; DFS: 57.8%) and micropapillary (n=23, OS: 34.8%; DFS: 33.5%). Concerning the architectural grade, there were significant differences between OS and DFS of low and intermediate (pOS=0.005, pDFS<0.001), low and high (pOS<0.001, pDFS<0.001) and intermediate and high grades (pOS=0.002, pDFS<0.001). Low-grade and intermediate grade tumours did not differ in survival according to Kadota grade and Sica grade. In the multivariable model, architectural grade was found to be an independent prognostic marker. In another model, architectural pattern proved to be superior to architectural grade. Conclusions Of the three grading systems compared, the architectural grade makes the best distinction between the outcome of low-grade, intermediate-grade and high-grade stage I adenocarcinomas.

Emlőrákok TNM-8 szerinti anatómiai és prognosztikai stádiumainak retrospektív vizsgálata elhunyt, valaha emlőrákos betegek adatai alapján

Absztrakt: Bevezetes: A tumor-nodus-metastasis (TNM) alapu stadiumbesorolas uj, nyolcadik valtozata a hagyomanyos T, N es M kategoriakon alapulo anatomiai stadium mellett egy biomarkereket figyelembe vevő prognosztikai stadiumot is definialt emlőrakban. Celkitűzes: A nyolcadik stadiumbesorolasban figyelembe vett prognosztikus valtozok, valamint az anatomiai es prognosztikai stadiumok megoszlasanak vizsgalata elhunyt, de korabban emlőrakkal diagnosztizalt beteganyagban a teljes tuleles alapjan. Modszer: Retrospektiv vizsgalatunkba a 2010 es 2015 kozott a Bacs-Kiskun Megyei Korhazban műtott, reszekcios mintabol korismezett, dokumentalt okok miatt elhunyt emlőrakos betegeket vontuk be. A prognosztikus markerek adatait a betegek korszovettani leleteiből nyertuk. Statisztikai modelljeink az egyutas ANOVA, a Dunn-fele post hoc teszt, valamint a Kaplan–Meier-analizis voltak. Eredmenyek: 303 beteg adatait vizsgalva a legtobb prognosztikus tenyezőben, igy az anatomiai es prognosztikai stadiumok vonatkozasaban is, ...

Elastic stains in the evaluation of DCIS with comedo necrosis in breast cancers

As concerns the microscopic morphology of ductal carcinoma in situ (DCIS), neoplastic cells are surrounded by both a myoepithelial cell layer and a basement membrane as expected from the outer structure of ducts and lobules. However, in some cases, it is impossible to state whether the structures involved by the disease are ducts or lobules. Altogether 1220 anatomic structures involved by DCIS displaying comedo necrosis from 27 slides of 21 patients (seen on both haematoxylin and eosin-stained and orcein-stained slides) were identified as representing ducts, likely ducts, unclassifiable structures, likely acini or acini on the basis of their distribution and resemblance to normal anatomic structures. All structures were then rated as having a circumferential elastic layer (as normal ducts), a partial elastic layer around more or less than half of the periphery or having no peripheral elastic layer at all (as normal acini). Structures classified as ducts or likely ducts were likely to have an elastic coating, whereas acini and likely acini had no such coating. Unclassifiable structures were generally devoid of an elastic layer. Structures (and cases) that were likely to represent neoductgenesis as proposed by Zhou et al. (Int J Breast Cancer 2014;2014:581706) were generally unclassifiable and devoid of outer elastic layer. Many duct-like structures in DCIS with comedo necrosis are devoid of elastic layer typical of normal ducts, suggesting that these structures are abnormal despite conservation of the myoepithelium and the basement membrane.

The more the micropapillary pattern in stage I lung adenocarcinoma, the worse the prognosis—a retrospective study on digitalized slides

Although the majority of lung adenocarcinomas show mixed pattern, only the predominant component is taken into account according to the novel classification. We evaluated the proportion of different patterns and their impact on overall survival (OS) and disease-free survival (DFS). Patterns were recorded according to predominance and their proportions were rated and calculated by objective area measuring on digitalized, annotated slides of resected stage I lung adenocarcinomas. Spearman’s rank correlation, Kaplan-Meier models and the log rank test were used for statistical evaluation. Two hundred forty-three stage I adenocarcinoma were included. Lepidic pattern is more frequent in tumours without recurrence (20 vs. 8%), and lepidic predominant tumours have favourable prognosis (OS 90.5%, DFS 89.4%), but proportions above 25% are not associated with improving outcome. Solid and micropapillary patterns are more frequent in patients with recurrence (48 vs. 5% and 13 vs. 4%) and predominance of each one is associated with unfavourable prognosis (OS 64.1%, DFS 56.3% and OS 28.1%, DFS 28.1%, respectively). Above 25%, a growing proportion of solid or micropapillary pattern is not associated with worsening prognosis. In contrast, tumours having micropapillary pattern as secondly predominant form a different intermediate group (OS 51.1%, DFS 57.8%). Our study was based on measured area of each growth pattern on all available slides digitalized. This is the most precise way of determining the size of each component from the material available. We propose using predominant and secondly predominant patterns for prognostic purposes, particularly in tumours having solid or micropapillary patterns.

Is Regression after Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer Different in Sentinel and Non-sentinel Nodes?

Tumor draining sentinel lymph nodes (SLNs) are the sites of selective changes as compared to non-SLNs. They show features of tumor-reactive lymphadenopathy, including increased total number of functional blood vessels, but a relative immunosuppressed status has also been described in them. We explored the hypothesis of a selective regression or non-regression in SLNs versus non-SLNs in 142 patients with 110 estrogen receptor-positive and 32 estrogen receptor-negative tumors undergoing both SLN biopsy and axillary lymph node dissection after neoadjuvant therapy by assessing the tumoral (metastatic) and regression statuses of SLNs and non-SLNs separately. Of the 89 cases with signs of nodal regression, 22 cases (25%) were in favor of a selective non-regression in SLNs, 18 cases (20%) were supportive of a selective and more pronounced regression in the SLNs and the remaining showed equal degrees of regression or non-regression in SLNs and non-SLNs. The results indicate that there is no obvious difference in the degree of regressive histological changes shown by SLNs and NSLNs. Therefore, this phenomenon may not be a major contributor to the higher false negative rate of SLN biopsy after neoadjuvant treatment.

Immunohistochemical Analysis of the Expression of Breast Markers in Basal-like Breast Carcinomas Defined as Triple Negative Cancers Expressing Keratin 5

Estrogen and progesterone receptors are possible markers for suggesting a mammary origin of metastatic carcinoma, but are useless in cases of triple negative breast cancers (TNBC). Five other potential markers of breast origin were investigated on tissue microarrays in a series of TNBCs showing keratin 5 expression, consistent with a basal-like phenotype. GATA-3 staining was observed in 82 of 115 triple negative cases (71.3%) including 23 cases with >5% staining. Mammaglobin staining was detected in 30 cases (26.0%) including 12 with >5% staining. GCDFP-15 was seen in 23 cases (20.0%) including 9 with >5% staining. NY-BR-1 positivity was present in 7 cases (6.0%) including 3 patients with >5% staining. BCA-225 staining was observed in 74 cases (64.3%); however this latter marker lacks also specificity owing to the reported widespread staining in other malignancies. GATA-3, mammaglobin and GCDFP-15 coexpression was seen in one case (0.9%), whereas GATA-3 and mammaglobin or mammaglobin and GCDFP-15 coexpression was present in 2 and 2 cases (1.7%), respectively. Using at least 5% staining as cut-off, the expression of any of the last 4 markers was 34.7%. The expression of GATA-3, mammaglobin, GCDFP-15 and NY-BR-1 is lower in TNBC-s than in breast carcinomas in general, and this may be even lower in basal-like carcinomas. Although these markers are not fully specific, by using them, a subset of basal-like TNBC-s can be identified as of mammary origin. However, a substantial proportion will not show any staining with any of these markers.

Tumor a hátulsó gátorban – az extramedullaris myelolipoma ritka esete

Absztrakt Esetismertetes: A 71 eves ferfi beteget kronikus bronchitis heveny exacerbatioja miatt 2015 nyaran kivizsgaltak. A mellkasi CT-vizsgalat soran a thoracalis XI. csigolya jobb oldalan, a paravertebralis zsirszovetben egy eles konturu, a kontrasztanyagot minimalisan halmozo, a tudő fele eles konturral abrazolodo lagyresz-terimet eszleltek. A radiologus az elvaltozas szovettani vizsgalatat javasolta. 2015 augusztusaban uniportalis video-assisted thoracic surgery (VATS) feltarasbol tortent a tumor eltavolitasa. A beteget esemenytelen posztoperativ időszak utan hazabocsatottak. A szovettani vizsgalat myelolipomat allapitott meg. Egyeves utankovetesi időszakban kiujulast nem eszleltek. Megbeszeles: A myelolipoma erett lobulalt zsirszovetből es verkepző csontvelőből folepulő benignus daganat, amely rendszerint a mellekveseből indul ki. Progressziv novekedesi hajlama miatt sebeszeti eltavolitasa ajanlott. Az extraadrenalis myelolipoma ritka entitas, azonban mediastinalis, tokos, lassan novekvő, terfoglal...

The role of preoperative axillary ultrasound and fine-needle aspiration cytology in identifying patients with extensive axillary lymph node involvement

INTRODUCTION In the recent past, both clinically node-positive and node-negative but sentinel node-positive patients underwent axillary lymph node dissection (ALND), although the two groups seem to have substantially different degree of nodal involvement. METHODS Data on consecutive primary breast cancer patients with documented axillary ultrasound (AXUS) results who underwent ALND between January 2003 and December 2015 either because of AXUS-guided fine needle aspiration (A-FNAC) results or because of a positive sentinel lymph node were retrospectively analysed. RESULTS After exclusions, 316 patients staged by SNB and ALND with negative AXUS or A-FNAC (group A) were compared with 159 patients having positive A-FNAC results (group B). Tumour size and the proportion of mastectomies were greater, histological grade higher and lymphovascular invasion more frequent in Group B, where palpable lymph nodes were also more common. The proportion of cases with extensive nodal involvement (pN2 and pN3 cases) was about 3 times as much in Group B (63%) than in Group A (18%). Removal of the 50 patients with palpable lymph nodes from the analysis did not greatly influence these proportions: 60% and 19% extensive nodal involvements were noted, respectively. In this series, patients with suspicious AXUS and negative A-FNAC had more often extensive nodal involvement (25%) than AXUS negative patients (17%). CONCLUSIONS Patients in whom axillary metastases are detected by ultrasound-guided biopsy have significantly more involved nodes than SLNB-positive patients, and therefore are likely to benefit from axillary treatment.