Secondary involvement of breast with non-Hodgkin's lymphoma in a patient with HIV infection -- case report.

Secondary lymphoma of the breast is a rare entity in patients with non-Hodgkin's lymphoma (NHL). HIV infection is associated with an increased risk for developing NHL, however lymphomatous involvement of the breast in AIDS patients has rarely been reported. We present the case of a 33-year-old HIV-infected female patient with diffuse NHL who presented with a unilateral breast mass. Histologic examination of the biopsy specimen revealed a highly-malignant diffuse large B-cell lymphoma.

Germ line BRCA1 & BRCA2 mutations in Greek breast/ovarian cancer families: 5382insC is the most frequent mutation observed.

BRCA1 and BRCA2 genes were screened for loss-of-function mutations in a series of 85 patients having at least one first- or second-degree relative affected by breast and/or ovarian cancer. All BRCA1 exons and BRCA2 exons 10 and 11 were screened with a combination of methods including SSCP, PTT and direct sequencing. We have found disease-associated mutations in 14 families (16.5%), eleven in BRCA1 and three in BRCA2. The known founder mutation 5382insC of BRCA1 was identified in seven unrelated families. The other mutations identified include the non-sense R1751X, the splice junction variant 5586G>A of BRCA1 and three frameshifts, 2024del5, 3034del4, and 6631del5, of BRCA2. Nine out of these 14 families had a family history of three or more breast/ovarian cancer cases. A large number of polymorphic or unclassified variants is also reported. Combined with our previously published data 5382insC was found in nine out of 20 families (45%), suggesting that this mutation may represent a common founder mutation in the Greek population.

Pilot study on the treatment of cyclical mastodynia with Quinagolide.

In a pilot clinical trial on 52 patients, 75 microg Quinagolide given once per day was administered for the treatment of cyclical mastodynia. Linear analogue charts were used for the assessment of response. Decrease in breast pain, heaviness, tenderness and serum prolactin level on the one hand, and increases in the serum estradiol and progesterone levels on the other hand were noted after 3 and 6 months administration, and were statistically significant. Statistical analysis was performed by Paired t-test or Wilcoxon test. One-Way Anova Repeated Measures and Wilcoxon test and analysis of Covariance model. The beneficial effect of Quinagolide also lasted after the cessation of treatment. Fourteen patients dropped out during treatment. Adverse effects like nausea, low blood pressure, dizziness and constipation were rarely reported.

PAPNET for cervical cytology screening. Experience in Greece.

OBJECTIVE: To validate the efficacy of PAPNET for cervical cytology screening. STUDY DESIGN: From a total of 50,000 gynecologic cases we selected 24 primarily negative smears from patients who, during follow-up, developed a precancerous lesion or cancer in a short time, ranging from a few months to two years. These negative smears were rescreened by the PAPNET automated system and reevaluated by two observers. A third observer blindly reevaluated the same cases manually. RESULTS: Reevaluation after PAPNET screening showed one false negative smear, for a rate comparable to that of manual reevaluation, which also reclassified the same case. The time required to interpret a smear using the PAPNET system was approximately one minute, while the time required for conventional manual screening was approximately five. CONCLUSION: PAPNET is an efficient and fast screener for the detection of precancerous cervical lesions and cancer.

Senology-the urgent need for a specialty.

Expert physicians from many European and Latin American countries are engaged in a systematic effort to persuade influential colleagues and government officials to recognize senology as a well-defined scientific discipline and establish it as an independent specialty. The task is complex, as the establishment of a new specialty always is. Senology is not a superfluous specialty; it is similar in characteristics and indications to many other single organ-targeted specialties such as cardiology, hematology, nephrology, neurology, and others. The quest for its recognition may be a long effort that will require vigor, intelligence, firmness, persistence, and the establishment of a dialogue between interested physicians and government representatives, leaving personal interests aside. To take the care of patients with breast diseases to its optimal stage, it will be imperative to create specialized breast centers governed by principles of unity of place and action. Gathering under the same roof all specialists skilled and interested in the diagnosis and management of benign and malignant diseases of the breast and all the diagnostic and therapeutic equipment to deliver care to these patients will bring us much closer to our goal.

Molecular aspects of breast and ovarian cancer.

Extensive research has led to accumulation of common hereditary evidence concerning ovarian and breast cancer, suggesting that these two cancers can be considered as one type. Subsequently, women with breast cancer are susceptible to the risk of developing ovarian cancer. Highly expressed oncogenes such as bcl-2, HER2/neu and others or mutated suppressor genes such as p53 or BRCA1 have been characterised as hereditary susceptibility genes leading to syndromes such as breast/ovarian cancer syndrome, Li-Fraumeni and others. Furthermore, these genetic alterations can cause potent chemoresistance by inhibiting induction of apoptosis after DNA damage caused by chemotherapy and/or radiotherapy. Presently, molecular onco-biology has enabled us not only to detect susceptibility to ovarian and breast cancer but also ways to inhibit their further progression or even circumventing chemoresistance mechanisms after their development by gene therapy using delivery vectors such as liposomes or viruses, by which we can replace wild-type tumour suppressor genes or by using antigene, antisense oligonucleotides and antisense RNA leading to reduced oncogene expression, enabling induction of apoptosis after DNA damage into chemoresistant tumour cells. Furthermore efflux-genes such as MDR-1 or MRP can be circumvented, suicide-genes can be employed which can facilitate sensitivity by encoding enzymes capable of converting inactive forms of a drug into toxic antimetabolites and immunotherapy can be achieved, by transfection of tumour cells with adenoviral vectors encoding immunomodulators such as IL-2 or MHC molecules. Thus, molecular biology appears to be a very strong element for the screening, diagnosis, therapy and prognosis of ovarian and breast cancer. However, consistent future research is greatly needed because many points concerning ovarian and breast cancer genetics are still unknown. Finally, we strongly believe that gene therapy could be extremely useful when is combined with conventional therapy against ovarian and breast tumours.

Imprint cytology. A rapid, reliable method of diagnosing breast malignancy.

OBJECTIVE: To compare imprint cytology with fine needle aspiration biopsy and histology for the intraoperative diagnosis of breast malignancy. STUDY DESIGN: We evaluated imprint cytology, comparing it with other diagnostic techniques. Three hundred fifty-one cases (180 benign and 171 malignant) were studied by fine needle aspiration cytology, imprint cytology and histopathology. RESULTS: Imprint cytology, as compared to histopathology, had 98.3% accuracy, with 97.1% sensitivity and 99.4% specificity. Aspiration cytology was less accurate than imprint cytology as compared to histopathology (accuracy 94.9%, sensitivity 93.9%, specificity 96.2%). CONCLUSION: These data confirm the value of imprint cytology and suggest that it could be used intraoperatively as an alternative to frozen section if a pathology laboratory is not available.

[Breast cancer in adipose breasts]. / Cancer mammaire des seins adipeux.

The authors have studied breast cancer in fatty breasts in an attempt to prove their observations that Wolfe's classification "N1" on mammography was not necessarily "normal". Two groups of women, the first called group "A" consisting of 384 women with cancer of the breast, and group "B", the control group of 400 women who had no abnormality in the breast, were studied and correlated for epidemiological, thermographic, mammographic, and anatomo-pathological parameters. The following epidemiological factors were studied: age, marital status, profession, age at menarche and at menopause, menstrual behaviour, age at the first pregnancy that went to term, parity (live and still births), type of delivery, length of breast feeding, number of abortions, use of hormones, and family history of cancer of the breast. In the thermographic studies: the topography of the heat pattern, the primary pathological signs and the thermic state were studied. In mammography: the mammographic appearance after Wolfe and the presence of microcalcifications was studied. In group "A" the following histological group parameters were studied: which breast, in which quadrant the nodule was situated, the type of breast the contour and size of the tumour, the number of axillary nodes removed, the histological type of the cancer, the histological grade of the malignancy, vascular invasion, details about the skin and the areola, calcifications, lymphocytic infiltration of the stroma, multicentricity, the co-existence of cystic disease of the breast and invasion of the axillary nodes. All these above-mentioned parameters were correlated with: the age, the existence of previous pregnancies at term, the macroscopic type of the breast and the mammographic type according to Wolfe. The breasts were divided into three macroscopic types: fatty, fibrous and intermediate. The correlation of the mammographic type according to Wolfe showed that types N1 and P1 corresponded to fatty and partially intermediate types. In group "A" the macroscopically fatty as compared with the other type of breasts showed a more extensive degree of infiltrations: vascular (76.5%), skin (90.3%), areolae (88.9%) and lymphocytic (80.1%), as well as a higher percentage of axillary metastases (57.7%).

[Is prolonged psychological stress an etiological factor in breast cancer?]. / Le surmenage psychique prolongé est-il un facteur étiologique du cancer mammaire?

1,088 women with cancer were seen in a period of 4 1/2 years at the Cancer Centre of the Greek Social Security Department in Athens. The authors present their results as far as psychological stress influences the development of cancer of the breast in 813 patients (Group A) and in 685 women who did not have cancer of the breast (Group B). They were able to show that Group A had a positive correlation which was statistically very significant (p less than 0.001) with the following parameters: the death of a much-loved person; the negative behaviour of the husband; an unexpected change in life style; continual conflicts in the family; financial problems; unsatisfactory sex life; consultations with a psychiatrist and allergy. There was a positive correlation which was statistically significant (p less than 0.01) with the parameters: disappointment in sentiment; a lowering in life style; a family history of cancer of the breast; hypertension; late start in the menarche and the onset of the menopause. The authors conclude that they believe that it is useful to look at all the factors that are known as risks for cancer of the breast, including the influence of psycho-traumatic factors.

Breast masses in young girls. Report of five cases.

The pubertal breast may be the seat of lesions comparable to those of the adult female breast. Of the five girls referred to in this report, aged 11 to 15 years, three had fibrocystic disease, one had a huge intracystic papilloma and the last one had multiple papillomas. The two girls with fibrocystic disease and the one girl with multiple papillomas had a family history of breast cancer which had appeared in their grandmothers. The possible relationship between the breast diseases of the two generations is discussed.