Myoepithelial cell cocktail (p63+SMA) for the evaluation of sclerosing breast lesions.

Sclerosing breast lesions may sometimes mimic the appearance of infiltrating carcinoma due to the entrapment of ductular structures in a fibrotic core. The immunohistochemical detection of the outer myoepithelial cell layer that is indicative of a non-infiltrating lesion is a valuable clue for the diagnosis of such ambiguous cases. The myoepithelial cell markers smooth muscle actin (SMA) and p63 are most commonly used since their specificity and sensitivity are well established. However, recent studies have indicated that some morphologically distinct myoepithelial cells fail to stain for SMA and that p63 positivity can be rarely expressed by a subset of malignant epithelial cells. Moreover, SMA can also be positive in stromal myofibroblastic cells and normal vessels that can be found close to the entrapped ductules and might be erroneously interpreted as myoepithelial cells. In this study, we used a double-immunolabeling technique combining both SMA and p63 antibodies (myoepithelial cell cocktail), in order to investigate whether this technique is advantageous over either marker used alone, in diagnosing sclerosing breast lesions. Our results indicate that p63 alone is not a useful myoepithelial cell marker if applied in large sclerosing breast lesions, however, in smaller lesions it is still of high value. On the contrary, SMA proved significantly useful in the evaluation of myoepithelial cells in larger but not in smaller complex sclerosing lesions. The myoepithelial cell cocktail has a staining sensitivity identical to that of SMA. Nevertheless, in a certain number of cases the cocktail might be useful in differentiating myoepithelial cells from stromal myofibroblasts or vascular smooth muscle cells due to the false impression of a higher staining intensity of the cocktail resulting from the expression of both nuclear and cytoplasmic/membranous antibodies that occupy a wider area of the cell under control.

Clinical course and treatment results of breast cancer patients with ten or more positive axillary nodes.

Two-hundred and fifty-nine women with operable breast cancer, having more than 10 involved nodes without a distant metastasis, were treated with radical, modified radical or partial mastectomy with complete axillary dissection. Survival at 5 years was 63% and at 7 years 54%. Fifty-six per cent and 52% were disease free 5 and 7 years after initial therapy. Postmenopausal women had an overall survival rate of 64% and disease free survival rate of 61% while premenopausal women had an overall survival of 58% and disease free survival of 52%. Survival and disease free survival rate for those with 10-20 positive nodes were 65% and 69% respectively, while for those with more than 20 positive nodes the rates were 49% and 52% respectively; a statistically better survival in the 2nd group. Although the observational time of patients having adjuvant CEF is short, a better survival rate and disease free survival rate is possible in women treated with CEF.

[Late cervical pregnancy (author's transl)]. / Zervikale Gravidität in der Spätschwangerschaft.

A cervical pregnancy which develops into the last trimester of gestation with a viable infant is a very dangerous and rare condition. A personal observation of such a case at 31 weeks gestation is added to the 8 cases known in the literature. Extreme dilatation of the cervical wall with extensive vascularization is typical for this condition associated with placenta increta or accreta. The uterine body tops the cervical pregnancy like a cap. Cesarean section followed by hysterectomy is the management of choice.