A new automatic image analysis method for assessing estrogen receptors' status in breast tissue specimens.

Manual assessment of estrogen receptors' (ER) status from breast tissue microscopy images is a subjective, time consuming and error prone process. Automatic image analysis methods offer the possibility to obtain consistent, objective and rapid diagnoses of histopathology specimens. In breast cancer biopsies immunohistochemically (IHC) stained for ER, cancer cell nuclei present a large variety in their characteristics that bring various difficulties for traditional image analysis methods. In this paper, we propose a new automatic method to perform both segmentation and classification of breast cell nuclei in order to give quantitative assessment and uniform indicators of IHC staining that will help pathologists in their diagnostic. Firstly, a color geometric active contour model incorporating a spatial fuzzy clustering algorithm is proposed to detect the contours of all cell nuclei in the image. Secondly, overlapping and touching nuclei are separated using an improved watershed algorithm based on a concave vertex graph. Finally, to identify positive and negative stained nuclei, all the segmented nuclei are classified into five categories according to their staining intensity and morphological features using a trained multilayer neural network combined with Fisher's linear discriminant preprocessing. The proposed method is tested on a large dataset containing several breast tissue images with different levels of malignancy. The experimental results show high agreement between the results of the method and ground-truth from the pathologist panel. Furthermore, a comparative study versus existing techniques is presented in order to demonstrate the efficiency and the superiority of the proposed method.

Ovarian ALK+ diffuse large B-cell lymphoma: a case report and a review of the literature.

Through this case presentation and a review of the literature, we aim to describe clinical and pathologic features and to distinguish the outcome of these tumors. A 25-year-old woman presented with pelvic pain and an iliac mass. Workup revealed a 53-mm cystic partitioned mass of the left ovary infiltrating the left sacrum. She underwent a left adnexectomy. Gross examination revealed a ruptured ovarian mass. When dissected, it showed grayish cerebroid aspects. Histologic examination revealed a malignant tumor proliferation of the diffuse large cells. An immunohistochemical analysis showed negative results for PLAP, αFP, ßHCG, CD117, CK20, and CD30. It also showed lack of B markers and T marker (CD3) and an expression of CD138 and anaplastic lymphoma kinase. The patient was treated by 6 cycles of CHOP chemotherapy and a pelvic radiotherapy. She presented with a 15-cm splenomegaly 26 months later and died of febrile neutropenia. Most patients follow an aggressive disease and are unlikely to respond to the standard.

CD99 and HLA-II immunostaining in breast cancer tissue and their correlation with lymph node metastasis.

In an attempt to better unfold the antitumor immune response and invasion strategies perused by tumor cells, markers such as CD99 and HLA-II have been stained in breast tumors, some of them turned out to be important for prognosis and its outcome. CD99 is involved in the intracellular transport of HLA-II proteins. The expression of HLA-II and CD99 molecules has been demonstrated in a broader range of neoplastic tissues, including some epithelial tumors. In the present work, we stained CD99 and HLA-II in breast malignant and non-malignant tissues sections obtained from biopsies resected surgically from 80 Tunisian women. Data implied that CD99 marks malignant tissue significantly as compared to non-malignant breast tissue. HLA-II staining allowed determining the correlation between breast cancer and HLA-II with cytoplasmic localization. CD99 and HLA-II immunostaining was also examined in correlation with two of the most important breast cancer prognostication in routine clinical practice, the lymph node stage and the histological assessment. Results let suggest that CD99(+)HLA-II(-) is a marker of worst prognostic since this phenotype is strongly linked to lymph node metastasis in breast cancer.

Assessment of Aurora A kinase expression in breast cancer: a tool for early diagnosis?

Aurora A kinase is overexpressed in many cancers but the status of this protein in the breast cancer often varies. We investigate the expression and localization of Aurora A protein in relation with tumor emergence and progression in breast cancer. Aurora A kinase status was evaluated in 107 patients using immunohistochemistry. The experimental findings showed that high expression of the Aurora A protein was correlated with elevated nuclear grade, low expression of progesterone receptor and positive nodal status. The experimental results showed also that the localization of this kinase shifts from cytoplasm in non malignant adjacent tissue to both cytoplasmic and nuclear compartments in tumoral tissue, suggesting an oncogenic role of the nuclear accumulation. We have, furthermore, detected the overexpression of this protein in non malignant adjacent tissue. The expression of the Aurora A kinase in non malignant tissue may represent an earlier diagnosis tool for breast cancer.

[Atypical presentations of internal mammary chain involvement in breast cancer]. / Les aspects trompeurs de l'atteinte de la chaîne mammaire interne dans les cancers du sein.

BACKGROUND: Breast cancer is the first cancer in women. Lymphatic involvement in breast cancer is common, especially in our patients because of the frequency of locally advanced forms. This contrast with a weak rate of diagnosed internal mammary chain invasion. METHODS: We present observations of patients presenting atypical forms of internal mammary chain involvement. AIM: To clarify the atypical presentations of internal mammary chain involvement in breast cancer. RESULTS: The invasion of internal mammary chain is often underestimated. Indeed, this site of lymphatic spread is not accessible to the clinical exam and its radiological exploration is not systematic. Otherwise, different clinical, pathological and radiological presentations have to attract our attention to a potential internal mammary chain invasion. CONCLUSION: Our misrecognition of this site of spread and its different presentations can partly explain the lack of diagnosis.

Ascitic fluid cytology in malignant Brenner tumor: a case report.

BACKGROUND: Peritoneal effiusion is rare in malignant Brenner tumors and has been found in only 10% of patients. CASE: A 77-year-old woman presented with malignant Brenner tumor and ascites. The cytology of the ascitic fluid revealed many activated mesothelial cells intermingled with squamous tumoral cells. These cells were either isolated or arranged in small clusters. They were often round or oval with irregular and moderately hyperchromatic nuclei. CONCLUSION: Presence of squamous cells in ascitic fluid associated with an ovarian tumor should raise the possible diagnosis of malignant Brenner tumor in addition to malignant transformed teratoma and secondary squamous carcinoma of the ovary.

[Internal mammary lymph node invasion in breast cancer: myth or reality?]. / L'atteinte de la chaîne mammaire interne dans le cancer du sein: mythe ou réalite?

The internal mammary nodes are often underestimated as breast cancer lymphatic pathway spread. It is yet the first site of lymphatic invasion in central or internal tumors and the second site in external tumors. The intra-thoracic situation of internal mammary nodes explains partly, the difficulty of its exploration. To evaluate the risk of internal mammary node invasion, some predictive factors are established (tumor size, internal or central tumor location, axillary node invasion and young age). Prognostic and therapeutic impact of invasion justifies its systematic research. Without exploring internal mammary nodes status, TNM classification remains, incomplete. CT scanner, magnetic resonnance imaging, positron emission tomography scanner and sentinel node exploration technique are helpful to explore this region and to adapt its irradiation.

Are HLA DQB1 alleles correlated with breast cancer histopronostic parameters in Tunisia?

BACKGROUND: Tumor cells express surface structures different from normal cells. These structures may be recognized by the immune system, which ensure anti-tumoral surveillance. Antigenic presentation requires HLA molecules role. Since, these molecules are encoded by a high polymorphic system, immune response can be modulated according to HLA genotype. So, HLA polymorphism could be correlated with tumor escape from anti-tumor immunosurveillance. AIM: We have aimed to search for possible associations between HLA DQB1 alleles and the histoprognostical parameters in breast cancer in the Tunisian population. METHODS: DQB1 alleles were determined by PCR-SSO molecular typing in 100 healthy matched and unrelated Tunisian female and 87 Tunisian women with breast cancer. RESULTS: Allelic distribution between the two studied groups showed no significant associations between this locus and the occurrence, the EE grade and the lymph node invasion of breast cancer in the Tunisian population. CONCLUSION: This result may be explained by the fact that cancer is a multifactoral disease due to several interacting factors that might change from one population to another.

[Endometrial atypical complex hyperplasia with extensive squamous metaplasia: two cases]. / L'hyperplasie complexe atypique (HCA) de l'endomètre avec métaplasie malpighienne (MM) extensive. A propos de deux observations.

We report two cases of endometrial atypical complex hyperplasia with an extensive squamous hyperplasia occurring in two women aged 48 and 31 years old. The histological study showed an increase in the gland to stroma ratio with a false crowding aspect due to an extensive area of squamous metaplasia; some metaplastic areas were centered by necrosis. There was glandular cytologic atypia. Histologic examination is necessary to confirm the diagnosis and to definitively rule out adenocarcinoma.