[Breast cancer in puerperium]. / Carcinoma mammae v puerperiu.

AIM: This case study reports an occurence of a mammary gland carcinoma in woman during her pregnancy and puerperium. CASE REPORT: Patient was 29 years old woman, without any familiar or personal history of cancer or cancer risk factors. There was a finding of palpable resistance in the lateral superior quadrant of right breast in 30 week of gestation, which was considered to be hormonal changes in pregnancy. The third day after delivery a breast ultrasonography was performed because of persisting mastodynia, moderate oedema in described area and resistance nonresponding to the typical finding in period of incipient lactation. The result was suspicious of tumor. The core cut biopsy revealed invasive ductal carcinoma grade 3 and the staging was determinated as T4b N2 M1 (liver). Because of the high clinical stage of the disease, primary sugical therapy (modified radical mastectomy) was not indicated and the patient underwent neoadjuvant chemotherapy followed byradiotherapy. There was a control PET scan after the chemotherapy which confirmed only residual tumor in the area of affected breast and no viable tumor cells in the area of the liver. Additional reduction of the primary tumor lesion occured after the radiotherapy. The control examination 3 months after the treatment found the statement of the relapse of disease. At the present time, 14 months after the delivery, the paliative chemotherapy is planned. CONCLUSION: Obstetricians should take care not only for routine examinations of pregnant women, but also of the breast changes and when there are uncertain, they must use appropriate diagnostic methods.

Quantitative determination of telomerase activity in breast cancer and benign breast diseases.

Telomerase plays an important role in maintaining the stability of chromosomes. This ribonucleoprotein prevents chromosome ends (telomeres) from gradual loss with each cell division. It enables tumor cells to maintain telomere length, allowing indefinite replicative capacity. Telomerase activity has been detected in the majority of tumor and germ cells and in immortalized cell lines. Quantitative telomerase PCR-ELISA (TeloTAGGG Telomerase PCR ELISA(PLUS)) was evaluated for distinguishing benign and malignant breast tissue. Activity of telomerase was determined in 27 samples of fibrocystic and dysplastic tissues, 28 fibroadenomas and phylloid tumors, and 154 breast cancer tissues; 59 specimens were analyzed retrospectively. Analytical precision and linearity of the assay was tested using breast carcinoma cell line ZR-75-1 and breast tumor tissue extracts. About 4% of tumor samples were excluded from analysis due to interferences in the PCR reaction. Relative telomerase activity differed significantly in the groups of dysplastic tissues, fibroadenomas and carcinomas. The highest activity was found in breast cancer tissue. This method can identify breast cancer tissue with 73% clinical sensitivity and 93% specificity as compared to benign breast tumors. We did not find a correlation between telomerase activity and the tissue levels of estrogen and progesterone receptors, HER-2/neu oncoprotein concentration, tumor size, and lymph node positivity. Probability of disease-free survival was significantly lower for patients with telomerase activity higher than median value. As the assay for telomerase activity has very high analytical sensitivity and high specificity for cancer cells, this routinely used method may prove useful for distinguishing malignant phenotype of breast tissues.

Detection of Bronchial Neoplasia in Uranium Miners by Autofluorescence Endoscopy (SAFE-1000).

The increase in the detection rate for premalignant changes of bronchial epithelium was studied in 56 symptom-free volunteers from the risk group of Czech uranium miners (mean age 50.69 years, mean WLM 21.06 (1 Working Level Month is equal to the absorption of latent energy of 2.08 x 10(-5) J/m(3) in one month, i.e. 170 working hours)) by the additional employment of the System of Autofluorescence Endoscopy (SAFE-1000 Pentax) to conventional white-light bronchoscopy, comparing results with those of bronchial biopsy histopathology examination. Histopathology using hematoxylin and eosin staining confirmed intraepithelial neoplasias in 15 areas in 10 persons. White-light bronchoscopy sensitivity was 21.05%, and specificity 93.7% which an autofluorescence bronchoscopy sensitivity was 78.95% and specificity 81.89%.

[Regional chemotherapy of liver tumors]. / Regionální chemoterapie nádoru jater.

Based on experience with regional intrahepatic chemotherapy in 67 patients with inoperable primary, and in particular secondary liver tumours, which comprises several hundred administered cycles of mostly continuous regional regimens, the authors summarize briefly the main principles and possibilities of this treatment. In a review of randomized studies they provide evidence for the advantage of regional chemotherapy, as compared with systemic treatment, in particular with regard to the higher percentage of therapeutic responses. In correctly indicated, and if possible early cases of hepatic tumourous affections, it is possible to potentiate the effect of regional chemotherapy by local destruction of tumourous foci by alcoholization, cryodestruction or resection. An integral part of this treatment is also monitoring of the effect by following up the dynamics of serum levels of tumour markers and by imaging methods. Because the most frequent cause of failure of this method are extrahepatic secondaries and secondary chemoresistance of the tumourous foci, improvement of results can be expected in particular from a combination of regional and systemic chemotherapy and the inclusion of cytokines into the therapeutic schemes.

Phylloid breast tumors and three steroid hormone receptors.

The concentrations of three steroid hormones (estrogen, progesteron and 1,25-dihydroxycholecalciferol) receptors (ER, PgR, DR) in tissue cytosol were analyzed in a group of 17 breast phylloid tumors. Comparison with breast carcinoma tissue samples (n = 37) did not reveal significant differences in average values of ER, PgR, and DR. Comparison with another control set of 30 samples of dysplastic tissue of the mammary gland showed significant differences only in PgR values. Only 18% of phylloid tumor samples contained levels above cut-of-line of all three receptors (ER, PgR, DR-5,10,10 resp. fmol/ mg protein). The most frequent combination was ER+PgR+DR-(41%). As far as we know, DR in phylloid breast tumors have never been examined before. In approximately 60% of our samples we found the expression of DR, in 36% the estimated values were above 10 fmol/mg protein. Cells of the tissue not expressing DR seem to belong to a special phenotype. We found no ER+PgR- or ER-PgR-combinations in them. The group which expresses DR is characterized by a higher dispersion of PgR values.

[Therapeutic strategy in colorectal carcinoma]. / Strategie lécby u kolorektálního karcinomu.

The authors review the contemporary optimal approach in the treatment of colorectal carcinoma. They emphasize the necessity of a comprehensive therapeutic approach, i.e. a combination of surgery, radiotherapy and chemotherapy in the treatment of colorectal carcinoma. Possibilities of curative and palliative treatment are presented.

[Initial experience with the fish-shaped incision in mastectomy]. / Nase první zkusenosti s mastektomií rezem ve tvaru ryby.

The authors are showing their early experiences with the modified mastectomy with the use of the fish-shape incision, first published by Nowacki and Towpik in 1988. The fish-shaped incision reduces the amount of the skin in the axilla by adding two triangles on the lateral edge of the incision, prevents the "dog ear" deformity and makes the clearance of the axilla easier.

[Myositis ossificans--a rare complication after axillary dissection]. / Myositis ossificans--vzácná komplikace po disekci axily.

We are showing a case of the myositis ossificans, appearing after the dissection of axilla simulating a metastasis of a malignant melanoma. In these circumstances this is a very rare case. It can, however, lead to an unnecessary operation. For this reason it should be useful to bera this possibility in mind.

[Distant metastasis of malignant melanoma in the small intestine]. / Vzdálená metastáza maligního melanomu do tenkého streva.

The authors describe the case-histories of two patients with rarely encountered secondaries of a malignant skin melanoma into the gastrointestinal tract. One case was revealed before operation, the second one due to symptoms of occult haemorrhage. The paper is supplemented by a review of the world literature of the past five years.

[Distant metastasis of malignant melanoma in the small intestine, 2 case reports]. / Vzdálená metastáza maligního melanomu do tenkého streva, kasuistika dvou prípadu.

The authors present the case history of two patients with metastases of a malignant skin melanoma into the gastrointestinal tract. One case detected on operation, with concurrent affection of the adrenal gland, the second one with the symptomatology of occult haemorrhage. The paper is supplemented by a review of the literature covering the last five years. The authors recommend in the described cases an active surgical approach.

[Partial mastectomy in the treatment of breast cancer]. / Parciální mastektomie v terapii rakoviny mlécné zlázy.

In the submitted paper the authors summarize findings on conservative surgery in the treatment of breast cancer. Based on data in the literature and their own experience with surgical treatment of breast cancer of all stages and a detailed analysis of a group of 52 conservatively treated patients, the authors discuss indications for this treatment which must respect staging, typing and grading of tumours as well as attitudes of patients. In particular in tumours classified as T1, NO, MO (as well as T2, NO, MO up to 3 cm) with a non-central localization it is possible by using conservative surgery to avoid somatic mutilation and psychic sequelae of radical procedures. When an individual approach is used and the correct indication is selected, partial mastectomy with dissection of the axilla and postoperative radiotherapy is equivalent to therapeutic results of radical operation.

[A surgical technique for partial mastectomy]. / Operacní technika parciální mastektomie.

The authors are describing the technique of the partial mastectomy for the breast cancer in this work, as used in the Masaryk oncological institute. For easy understanding they are adding illustrations of the singular phases of this operation. They are also discussing the indications and are showing a short historical review of the authors having published the results of this surgery.

Carcinoembryonic antigen and alpha-lactalbumin in phylloid tumor tissues.

The concentration of carcinoembryonic antigen and alpha-lactalbumin in tumor tissue cytosol were analyzed in a group of 19 tumors of cystosarcoma phyllodes type. Both antigens were also localized in the tissue of identical tumors by means of immunohistochemical procedure. The cytosol levels of both proteins were found to be higher in the histologically defined malignant type of phylloid tumors. This group was also characterized by the simultaneous occurrence of both antigens. We did not manage to prove any relationship between the presence of alpha-lactalbumin and the steroid hormone receptor positivity in tumor tissue.

[Cystosarcoma phyllodes]. / Cystosarcoma phyllodes.

From a total number of 31 patients with the diagnosis of cystosarcoma phyllodes recorded by the authors, in two thirds the benign and proliferating form of the tumour was involved, in one third a malignant type of tumour. In benign tumours it is sufficient to extirpate the tumour completely, incl. capsule of the tumour. In malignant forms radical modified mastectomy with revision of the axilla must be performed. When the histological findings have a high grading (non-differentiated anaplastic), adjuvant radiotherapy or a combination of radiotherapy and chemotherapy must be used. Dispensarization of patients with the diagnosis of cystosarcoma phyllodes is essential.

Immunohistochemical localization of alpha-lactalbumin in human breast cancer tissue.

One hundred and eleven formalin-fixed breast cancer tissue samples were examined for the presence of alpha-lactalbumin using our polyclonal antibodies to this specific milk protein. Alpha-lactalbumin was shown to be present in 67 tumor samples (60%), in 15% of cases the occurrence of alpha-lactalbumin was questionable. No relationship was found between alpha-lactalbumin positivity and the histological type of the tumor, differentiation grading, type of invasivity, or stromal reactivity. Disease progression occurred in an equal number of patients with tumors either alpha-lactalbumin positive or negative. However, negativity was often connected with a disease-free interval shorter than 24 months after primary operation.

Occurrence of carcinoembryonic antigen in tumor tissue and serum of breast cancer patients.

In 116 breast cancer patients, the levels of carcinoembryonic antigen (CEA) were determined before operation in the serum using RIA, and after operation in sections of breast tumor tissue using the immunohistological PAP technique. CEA circulating in the serum was found in 49 patients (42%). Elevated values (over 10 micrograms/l) were found in only 12 patients (10%). In histological specimens CEA positivity was found in 94 tumors (81%), however, in a majority of them the number of positive cells per section was low (1-10%). A comparison of positive and negative findings both in the serum and in the tumor specimens of individual patients showed that both serum and tumor sections were CEA positive in 40 patients (35%) and both localizations were CEA negative in 13 patients (12%). Although most patients had positive histological sections but negative sera (46%). Only 7% of patients had negative sections and positive sera. In 41 patients CEA could be examined both qualitatively (immunohistologically), and quantitatively in the cytosol of the same homogenized tumor. Of them, 30 patients (72%) had in the cytosol a CEA concentration exceeding 5 micrograms/g proteins, in 11 of the 41 patients (28%) no CEA was found. Immunohistological examination of CEA in this group gave positive results in 35 out of the 41 patients (85%), and only 6 tumors (15%) were completely negative. CEA was shown to be present in each histological type of the tumors studied, invasive ductal tumors being slightly more frequent and more positive than the lobular ones. No relation was observed to the structure of the tumors, nor to the degree of their differentiation. Thus, the examination of CEA levels can hardly contribute to the improvement of histological classification.

Expression of HLA-DR antigens on tumour cells does not contribute to skin reactivity to autologous cholesteryl hemisuccinate (CHS)-treated tumour cells in patients with metastatic melanoma.

Skin tests with autologous cholesteryl hemisuccinate (CHS)-treated and untreated cells were performed in ten metastatic melanoma patients. In the majority of cases evident reaction was noted with CHS-treated cells (9/10) while the reaction with untreated cells was mostly negative (7/10). Tumour cell suspensions used for skin tests were characterized for reactivity with monoclonal antibody TAL 1B5 detecting the HLA-DR alpha chain. There were no differences between CHS-treated and untreated cells with respect to HLA-DR expression and no correlation was found between grade of skin reaction to CHS-treated cells and the proportion of HLA-DR positive cells in the injected cell sample.