摘要:

We have reviewed the histological features and clinical outcome in 32 women with phyllodes tumours of the breast diagnosed in Nottingham between 1975 and 1990. We assessed 23 tumours as histologically benign, four as borderline and five as malignant. After clinical follow up for periods ranging from 36 months to 221 months (median 135 months), six of 23 benign tumours have recurred locally; in all these cases the original tumours had been incompletely excised. There were no recurrences amongst 10 benign tumours in which excision had been complete. Benign tumours which recurred showed a tendency to greater stromal cellularity and more pronounced stromal overgrowth than incompletely excised lesions which did not recur, but these differences were not statistically significant. The recurrent tumours resembled the respective original lesions histologically, except in one case in which two local recurrences were histologically malignant. The recurrent tumours were controlled by further excision or mastectomy in all cases and none have metastasized. All four borderline tumours were completely excised at initial surgery and none have recurred or metastasized. One of the five malignant tumours recurred within two months of incomplete excision, with widespread infiltration of the chest wall, although the patient died of unrelated causes. The other four malignant tumours have not recurred. We conclude that presence of tumour at the margins of the excised specimen is the major determinant of local recurrence in phyllodes tumours and that the histological features are of secondary importance. These findings are discussed in relation to other published series in the literature.

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00212.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

In a study of 1529 patients with primary operable breast carcinoma we have assessed the effect of applying both histological grade and tumour type to determine their comparative value as prognostic factors in human breast cancer. The prognostic group the patient was placed in, based on histological type alone, was less accurate than using grade and type together for many tumours. The importance of performing histological grading of ductal/no special type carcinoma (50% of the women in this series) is confirmed in this series. The 10‐year‐survival varied from 76% for women with grade 1 carcinoma to 39% for those with grade 3 tumours. Some of the ‘special types’ of breast carcinoma including tubular, tubulo‐lobular, invasive cribriform and grade 1 mucinous carcinomas behaved as would be predicted, with a greater than 80% 10‐year‐survival in this series. Others, including grade 2 mucinous carcinomas, however, behaved less well with a 60% to 80% 10‐year‐survival. Indeed, many of the histological tumour types including tubular mixed, ductal/no special type, mixed ductal with special type and lobular carcinomas of classical, solid or mixed types showed a variation in behaviour that could not be predicted by typing alone. Histological grade and tumour type, when used together, more accurately predicted prognosis. In multivariate analysis of a larger group of 2658 cases of primary breast carcinomas (including the 1529 study cases) when histological grade, lymph node status and tumour size were entered, grade was the most important factor in predicting for survival. When histological type of carcinoma was included it was also found to be independently significant, although comparatively of less importance than grade. We conclude that tumours should be typed and graded in order to predict prognosis most accurately and to enable the choice of optimum treatment for women with primary

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00213.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Five smooth muscle tumours presenting as pleural neoplasms are presented. The patients were three women and two men aged between 21 and 69 years (mean = 45 years). Clinically, one patient presented with chest pain, one with empyema and the other three were asymptomatic. Two of the tumours were located in the left side of the chest cavity and three in the right side. In four cases, the lesions presented as solitary pleural‐based masses that varied in size from 10–18 cm in greatest dimension; in two of these cases, involvement of the diaphragm was present in addition to the pleural involvement. In one case, the tumour was seen to totally encase the right lung simulating the growth pattern of malignant mesothelioma. Histologically, three cases displayed an atypical spindle cell proliferation with marked cellular pleomorphism, mitoses and areas of hemorrhage and necrosis. The other two cases were characterized by a bland‐appearing smooth muscle proliferation of uncertain malignant potential composed of elongated cells with a moderate amount of eosinophilic cytoplasm and cigar‐shaped nuclei, lacking significant nuclear pleomorphism or mitotic activity. Immunohistochemical studies showed strong positivity for alpha‐smooth muscle actin in all cases, and for desmin in four of five cases, and a focal positive reaction for keratin in one case. Ultrastructural examination in one of the high‐grade tumours showed features of smooth muscle differentiation. Three of the patients were treated by complete surgical excision while, in the other two patients, the lesions were incompletely resected. Follow‐up ranging from 2–12 months has not shown evidence of recurrence in those patients with complete surgical resection, or metastasis in any of the patients. These cases appear to represent a previously undescribed form of primary pleural neoplasm. Because of the differences in biological behaviour compared with other types of pleural neoplasms, smooth muscle tumours should be included in the differential diagnosis of primary spindle cell tumour

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00214.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

FAS/APO‐1 (CD95) is a membrane glycoprotein belonging to the tumour necrosis factor/nerve growth factor receptor family, and which can trigger apoptosis in some lymphoid cell lines. Immunohistochemistry combined with Northern blotting allowed determination of the pattern of FAS/APO‐1 expression in a series of Ki‐1 [CD30] positive lymphoid malignancies, including 27 Hodgkin's disease and eight anaplastic large cell lymphomas. CD30 negative tumours used as controls included 27 B‐cell non‐Hodgkin's lymphomas, 14 T‐cell non‐Hodgkin's lymphomas, four reactive lymphadenitis, and non‐lymphoid tissues. Immunohistochemistry, performed on frozen sections, revealed a strong FAS/APO‐1 expression in 25 out of 27 (92%) Hodgkin's disease cases, predominantly in Reed Sternberg cells; 50 to 100% of the neoplastic cells in eight out of (100%) anaplastic large cell lymphoma cases were positive. In contrast, positive FAS/APO‐1 immunostaining was observed only in 22 out of 41 (53%) CD30 negative non‐Hodgkin's lymphomas. Northern blot analysis detected variable amounts of theFAS/APO‐1 transcript in the immunohistochemistry‐positive samples. These results suggest possible hyper‐expression of FAS/APO‐1 (CD95) in Hodgkin's disease and an

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00215.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

A case of endovascular papillary angioendothelioma‐like tumour associated with lymphoedema is described. Microscopically, the tumour was composed of anastomosing vascular channels, some of which contained papillary projections, producing tuft‐like or glomeruloid appearances. The dermis also showed moderate lymphoedema and lymphocyic infiltrate. The tumour resembled endovascular papillary angioendothelioma but also had several features that differed from typical examples: occurrence in an old patient and less prominent endothelial hobnail features and lymphocytic infiltrate. Three types of proliferating cells were observed:1mature flattened endothelial cells, which were strongly positive for endothelial markers (factor VIII‐related antigen, CD31, CD34) and bound ulex europaeus agglutinin 1;2immature endothelial cells with round nuclei and vacuolated or pale cytoplasm, which were strongly positive for CD31 and muscle‐specific actin (HHF35) and focally positive for other endothelial markers; and3stromal spindle cells in papillary or glomeruloid areas, which were positive for vimentin, HHF35, and alpha‐smooth muscle actin but negative for desmin. The tumour was diploid by flow cytometry. The patient was well without disease twelve months after the excision. We postulate that this tumour was caused by circulatory disturbance, namely lymphoedema associated with syringomyelia and a Charco

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00216.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The protooncogenebcl‐2 encodes a protein that inhibits apoptosis. The protein is expressed in most epithelial cells of the fetal thymic medulla but, to the best of our knowledge, no data are available on bcl‐2 expression in thymoma. Expression of bcl‐2 protein was analysed in 30 cases of thymoma by immunohistological staining of paraffin‐embedded tissue. All cases were examined and classified according to the Salyer and Eggleston and the Müller‐Hermelink classification. In four cases, the protooncogenebcl‐2 was abnormally expressed in spindle cells of pure medullary thymoma, whereas the non‐spindle cells in mixed and in cortical thymoma were negative. All the lymphocytes were also strongly positive in medullary thymoma while a few lymphocytes showed light staining in

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00217.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Granular cell tumours rarely involve the lower respiratory tract. We report eight cases surgically resected at our institution. There were four females and four males, aged between 18 to 56 years (mean 40). One tumour associated with a peripheral lung adenocarcinoma was asymptomatic. The other lesions presented with obstructive pneumonitis (3 cases), haemoptysis (2), dyspnea (1) or cough (1). These tumours were tracheal (1) or bronchial (6) and one case was located in the lung parenchyma. Four cases were multicentric with associated lesions located in a bronchus (2), the oesophagus (1) or a mediastinal lymph node (1). All tumours, with the largest diameter ranging from 0.5–4.5 cm, were histologically invasive. The tumours were positive for S‐100 protein, neuron specific enolase, KP1 (CD68) and vimentin. No tumour expressed desmin, keratin or p53 oncoprotein. Our study demonstrates that, in spite of marked anatomical and clinical polymorphism, the rare granular cell tumours of the lower respiratory tract have a constant histological appearance. Our observations confirm that large tumours (>8–10 mm) usually extend beyond the tracheo‐bronchial cartilages and, therefore, only surgical treatment may avoid rec

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00218.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

An understanding of the early morphogenesis of hereditary non‐polyposis colorectal cancer is relevant to screening strategies. If most of these cancers were to evolve through the classical adenoma‐carcinoma sequence, screening and removal of adenomas at relatively long intervals might be a safe and cost‐effective approach. We have reviewed 131 cancers from 117 affected members of 34 such families. One hundred and four cancers were initial symptomatic lesions, eight were cancers detected in asymptomatic screened individuals, one was a synchronous cancer and 18 were metachronous cancers. None of the 131 cancers was a small, superficial type. Residual adenoma (contiguous with cancer) was present in three out of three (100%) in situ cancers, eight out of nine (89%) cancers involving only submucosa, four out of 14 (29%) cancers limited to the muscle coat and 13 of 105 (12%) cancers extending beyond the muscle coat. Twenty‐one out of 28 (75%) residual adenomas had a villous component. Only one was flat. Of the eight asymptomatic cancers, seven arose within tubular (two) or tubulovillous adenomas (five). The eighth was not associated with an adenoma but was 35 mm in diameter and extended through the bowel wall. Discrete adenomas (contiguous excluded) were present in 22% of surgical specimens and 31% of specimens from subjects older than 50 years. A relatively high proportion (30%) had a villous component and 43% were at least 10 mm in diameter. Patients with one or more discrete adenomas in their first surgical specimen were more likely to develop multiple cancers. The findings are consistent with the view that adenomas do not occur with increased frequency in hereditary non‐polyposis colorectal cancer but are more likely to be large and adopt a villous configuration. There is little evidence for morphogenetic pathways involving flat adenoma orde novocarcinoma in th

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00219.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

The distinction between invasive and in situ carcinoma of the breast is important with regard to the treatment and prognosis of the patient. When carcinoma in situ involves breast tissue in which the normal architecture is altered by pre‐existing sclerosing adenosis, the resulting histological picture may closely mimic an invasive carcinoma. We record the histopathological features in 13 cases where there was difficulty in identifying the presence or extent of invasive carcinoma. The most useful clue was attention to the low power appearances of distorted lobular units in the areas of malignancy and comparison with surrounding breast tissue which usually showed recognizable sclerosing adenosis. The use of immunohistochemical stains for myoepithelium (α‐actin and S‐100 protein) and for basement membrane (collagen type IV and laminin) proved to be of considerable value in identifying the preservation of these features around glandular structures in areas of sclerosing adenosis containing in situ car

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00220.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY

摘要:

Primary synovial chondromatosis is a disorder of joints, tendon sheaths and bursae characterized by the formation and growth of cartilaginous nodules. It usually presents clinically with joint symptoms and is frequently associated with intra‐articular loose bodies. A large soft tissue mass is an unusual presentation which, both clinically and radiologically, raises the suspicion of malignancy. Nineteen cases of synovial chondromatosis presenting as soft tissue tumours were reviewed. They were all adjacent to joints but with no joint symptoms. Histology showed the typical features of benign synovial chondromatosis, including foci of cartilage cells showing cytological atypia. This is well recognized and does not indicate malignancy. Clinical follow up confirmed this with local recurrence only in three patients. It is important to be aware of this unusual presentation as the alternative diagnosis of a chondrosarcoma, as initially diagnosed in some of these cases, has major implications regarding the treatment of these patient

ISSN:0309-0167    

DOI:10.1111/j.1365-2559.1995.tb00221.x

出版商:Blackwell Publishing Ltd    

年代:1995

数据来源: WILEY