Expression of estrogen receptors in melanoma and sentinel lymph nodes; a "female" clinical entity or a possible treatment modality?

PURPOSE: The natural history of human malignant melanoma suggests that steroid hormones may affect the biological behavior of this tumor. The purpose of the current study was to investigate the specific immunostaining patterns of estrogen receptors in malignant melanomas and their sentinel lymph nodes (SLNs), as well as to examine any possible association with patients' prognosis and overall survival. MATERIALS AND METHODS: A retrospective analysis of prospectively collected data was conducted during a 12-year period (2001-2012). Sixty patients with mean age of 54.4 ± 14.5 years diagnosed with melanomas of varying depth (Clark) and thickness (Breslow) after excision biopsy of pre-existing melanocytic lesions, were included in the study. All patients underwent wide excision of the primary tumor and SLN identification. Determination of estrogen receptor alpha (ERa) and beta (ERb) status by immunohistochemistry on tumor and nodal paraffin blocks was performed in all feasible cases. RESULTS: ERb but not ERa was the predominant estrogen receptor found in all primary tumors and SLNs examined. The most intense ERb immunostaining was seen in negative SLNs associated with thinner, less invading melanomas. ERb expression in the primary tumor seems to correlate with the cellular microenvironment, possibly altering the process of SLN invasion. CONCLUSIONS: ERb expression is down-regulated in aggressive melanomas with sentinel nodal metastatic disease, suggesting its possible usefulness as a surrogate marker for metastatic potential and prognosis in malignant melanoma.

Is sentinel node biopsy reliable in large breast tumors?

PURPOSE: The value of sentinel lymph node biopsy (SNB) in patients with larger breast tumors (diameter > 3 cm) has been questioned due to high false-negative rates reported from initial studies. The aim of this study was to analyze the safety and prognostic reliability of SNB in this group of patients. METHODS: During a 6-year period (2001-2007), 84 women with mean age 51.7 +/- 11.6 years diagnosed with a breast tumor larger than 3 cm in diameter on pathological analysis were retrospectively identified from the database of our institution. Sentinel node identification was performed after injection of blue dye subcutaneously at the subareolar area. The sentinel node specimen was sent for frozen section analysis. Regardless of the SNB results, all patients underwent completion axillary clearance. RESULTS: Breast surgery consisted of mastectomy in 62 patients (73.8%) and partial mastectomy in 22 patients (26.2%). There were 69 invasive ductal cancers (82.1%), 14 lobular cancers (16.6%) and one case of anaplastic carcinoma (1.3%). Nine tumors (10.7%) were identified to be multifocal after the histopathological report. The mean number of sentinel nodes removed was 1.5 +/- 0.7 (range 1-4) while SNB detection was not feasible in three patients (3.6%). Of 56 positive SNBs, seven (12.5%) were not identified by routine hematoxylin and eosin staining during frozen section analysis but were detected by subsequent immunohistochemistry on the final histopathological report. All patients with multifocal tumors presented nodal metastases on pathological analysis (100%), while the rate of nodal metastatic disease in patients with unifocal tumors was 16% (12 patients), although no statistical significance was documented. The overall false-negative rate, defined as the percentage of all node-positive tumors in which the SNB was negative, was 14.3%. The false-negative rate was significantly higher for the group of patients with multifocal tumors (55.5%) compared to the group with unifocal tumors (9.3%) (p < 0.001). CONCLUSIONS: The present study indicates that sentinel node biopsy is feasible in patients with larger breast tumors (max. diameter > 3 cm), with comparable false-negative and sentinel detection rates (14.3% and 96.4%, respectively). Larger tumor size seems to be associated with increased incidence of nodal metastases while multifocality appears to be related to increased false-negative rates; hence completion axillary clearance should be initially considered for these cases.

Lipid changes in breast cancer patients on exemestane treatment: final results of the TEAM Greek substudy.

BACKGROUND: The Greek substudy of the Tamoxifen and Exemestane Adjuvant Multicenter International trial compared the effect of exemestane on the lipid profile of postmenopausal, breast cancer patients to that of tamoxifen in the adjuvant setting. PATIENTS AND METHODS: Lipidemic profile changes were studied in 142 postmenopausal patients randomized to receive either adjuvant exemestane (n=77) or tamoxifen (n=65). Total cholesterol (TC), high-density lipoprotein (HDL), low-density lipoprotein (LDL) and serum triglyceride (TRG) levels were measured at baseline and then every 3 months for the first 12 months of treatment and at 18 and 24 months. RESULTS: A trend for a reduction in TC was found in both treatment arms; however, TC and LDL levels were consistently and significantly decreased in tamoxifen arm only. The mean HDL level was higher for the tamoxifen arm compared with the exemestane arm across time. No significant trend was detected throughout the study period on TRG levels on either arm. CONCLUSIONS: Unlike tamoxifen's beneficial effect on TC and LDL levels, exemestane appears to have a neutral effect on lipidemic profile of postmenopausal, breast cancer patients. These data offer additional information with regard to the safety and tolerability of exemestane treatment in the adjuvant setting.

Correlation of mammographic appearance and molecular prognostic factors in high-grade breast carcinomas.

The aim of our study was to evaluate the association between the mammographic appearance and the biologic characteristics of high-grade breast carcinomas. Three hundred and twenty patients with breast carcinomas were studied. Histological examination showed 83 (26%) high-grade ductal carcinomas. Immunohistochemistry was carried out by using antibodies against estrogen receptor (ER), progesterone receptor (PR), HER-2/neu, p53 and cathepsin D. In 60/83 high-grade carcinomas we studied the mammographic appearance. Asymmetric density with poorly defined margins without microcalcifications was the major mammographic finding in 49/60 (approximately 82%) high-grade ductal carcinomas. HER-2/neu positivity (68.7%) and p53 positivity (48.2%) were statistically correlated with asymmetric density with poorly defined margins without microcalcifications in high-grade carcinomas. We observed loss of ER and PR receptors in 50%, whereas loss of PR receptors was observed in 65% of high-grade breast carcinomas. Cathepsin D (> 20%) was detected in 38.5% of high-grade carcinomas. Our findings suggest a significant relationship between mammographic appearance and biologic markers in high-grade breast carcinomas.

Hepatic artery pseudoaneurysm following laparoscopic cholecystectomy: transcatheter intraarterial embolization.

We present a case of hepatic artery injury with pseudoaneurysm formation following laparoscopic cholecystectomy. A 29-year-old man was referred to our hospital with right upper quadrant pain, jaundice and upper gastrointestinal bleeding one month after laparoscopic cholecystectomy. Gastroscopy showed mucosal erosions at the gastroesophageal junction. The patient did well after medical treatment only and was discharged one week later. However, ten days later he was readmitted with recurrent upper gastrointestinal bleeding. Usual laboratory tests, routine imagine diagnostic procedures and selective hepatic arteriogram were performed. Usual laboratory tests and routine imagine diagnostic procedures were inconclusive, but selective hepatic arteriogram showed a right hepatic artery pseudoaneurysm. The diagnosis of hemobilia was established. Embolization of the aneurysm with coils was carried out. Bleeding was controlled, the patient was discharged one week later and since then he remains under close follow up without any evidence of bleeding recurrence. We believe that the intraarterial embolization of a pseudoaneurysm is a safe and effective method to manage some complications such as bleeding or hemobilia.