[Diagnostic problems in local recurrence after breast saving therapy of breast cancer]. / Das diagnostische Problem des Lokalrezidivs nach brusterhaltender Therapie des Mammakarzinoms.

From 1970 to 1987, 331 breast cancer patients of the Department of Gynaecology of the University of Erlangen were treated by conservative breast surgery. Adjuvant radiotherapy of the remaining breast was applied to only one-third of the patients. 30 patients (9.8%) had a local recurrence. This study analyses the 21 patients with local recurrence after breast conserving therapy, treated afterwards again in our hospital. 60% of the recurrences occurred within 2 years after the primary treatment. In 18 cases, the recurrences were located in the vicinity of the segmental resection area, in 3 cases the recurrences were diagnosed as new second primaries in the ipsilateral breast. 19 of the 21 recurrences were diagnosed by palpation, 2 cases were detected by mammography examination only. The palpable recurrences could only be shown in the mammography in 14 cases. We conclude, that for patients with breast conserving therapy, a mammographic examination need not be increased in frequency, but a quarterly examination by palpation should be extended over more than 2 years.

Expression of oncogenes in human breast cancer specimens.

More than 60 breast cancer specimens were screened for their expression status of 25 different proto-oncogenes. The screening method is based on in vitro synthesis of a radioactive cDNA copied from the total cellular RNA of tumor tissue. This cDNA is hybridized to cloned oncogene probes which are immobilized to a GeneScreen membrane. Frequently multiple oncogenes were found expressed although expression levels were rather moderate. 25-30% of the analyzed tumors showed significant expression of either erbB, src, raf1, lck or H-ras. Although neu expression--an oncogene believed to be particular relevant as prognostic parameter for mamma carcinoma--was screened for most of the tumors with a heterologous gene probe, expression signals could be detected in about 20% cases. The only notable correlation with classical clinical parameters such as tumor size and proliferation stage, hormone receptor status and different DNA indices was the observation that tumors lacking the progesterone receptor frequently express multiple oncogenes. Advantages and limitations of the cDNA/dot-blot screening for oncogene expression are discussed.

Immunohistochemical identification of CA125 and the F(ab')2 fragments of the murine monoclonal antibody OC125 in ovarian cancer tissue.

Benign and malignant tissue samples of 19 ovarian cancer patients who received an intravenous infusion of radiolabelled F(ab')2 fragments of OC125 were examined for expression of CA125 and the cellular location of the injected antibodies. CA125 could be detected by immunohistochemistry in 47 of 71 biopsies containing cancer cells, but not in 258 biopsies with benign tissue. F(ab')2 fragments were found in 34 of these 47 biopsies. The diffuse intracytoplasmic staining pattern seemed to indicate that the injected antibodies had crossed the membranes of the cancer cells. Since the antibody could not be detected in benign tissues, further applications of OC125 for diagnostic and therapeutic purposes seems to be justified.

Resection guided by antibodies (REGAJ): a diagnostic procedure during second-look operation in ovarian cancer patients.

A hand-held probe has been used to localise the 131I-labelled antibody OC125 during second-look operation (SLO) in 22 ovarian cancer patients. In six patients microscopic cancer was detected with the procedure and a further six patients with areas of increased radioactivity during SLO developed recurrent disease within 1-4 months. We suggest examining resection guided by antibodies as a possible means of removing antigen-producing cancerous tissues during surgery.

[Immunohistochemical and serologic detection of Ca-125 in patients with peritoneal tuberculosis and ascites]. / Immunhistochemischer und serologischer Nachweis des CA-125 bei Patientinnen mit Peritonealtuberkulose und Aszites.

We report on two young patients with massively elevated CA-125 serum level of 290 and 264 U/ml respectively, who clinically exhibited suddenly occurring ascites. The diagnosis of ovarian carcinoma or ruptured ovarian cystoma led to a laparotomy. During the operation, a disseminating granulomatous inflammation was evident, which was identified histologically and microbiologically as miliary tuberculosis with peritoneal invasion. CA-125 was immunohistochemically localised, sharply demarcated around the tuberculous granuloma. A possible explanation for this finding is the inflammatory mesothelial proliferation. A similarity in antigenic structures of membrane components of M. tuberculosis and CA-125 cannot be excluded. Serum CA-125 levels tested 6 months after the treatment of the tuberculosis showed a value within the normal range (less than 35 U/ml).

[The role of mammography in the diagnosis of simultaneous second cancers in the contralateral breast]. / Die Rolle der Mammographie bei der Diagnose von simultanen Zweitkarzinomen in der kontralateralen Brust.

In 1048 breast cancer patients, operated in the period 1969-1985 at the University of Erlangen Clinic of Obstetrics and Gynecology, estimations were made to determine the relative contribution of mammography and meticulous histology to the diagnosis of simultaneous contralateral cancer. The incidence of a bilateral simultaneous disease was 17% (6.1% invasive forms, 10.6% in situ). Complete histological examination of the extirpated tissue as well as the occurrence of discrete radiological signs could account for the detection of 41% of all invasive and 39% of all in situ forms respectively. Those contralateral breast cancer cases detected just by means of mammography, but without any presence of clinical signs, recorded an average diameter of 9 mm and in 20% had metastacised to the axillary lymph nodes. Comparatively, clinically and radiologically diagnosed cases were 17 mm on average and the occurrence of axillary lymph node involvement was 41%. The conclusion is drawn, that a meticulous diagnostic effort is necessary in view of the high incidence of occurrence of simultaneous cancer on the other breast and the prognostic importance of an early diagnosis for many patients. Every minute radiologically detected sign in the other breast of patients with mammary carcinoma requires careful diagnostic clarification. However, it should be considered that the data presented were gathered in a situation in which the radiologist performed the X-ray examination, knowing that an excision would have been carried out in 85 percent of all cases even without his specific localisation. The presence of additional risk factors (lobular cancer, multicentricity and family history of breast cancer) make such an effort justified and obligatory as well.

A contribution to the natural history of breast cancer. V. Bilateral primary breast cancer: incidence, risks and diagnosis of simultaneous primary cancer in the opposite breast.

Tissue from contralateral breast was taken from 505 patients with invasive breast cancer. Every 5th patient had simultaneous carcinoma in the opposite breast, 7.7% (39/505) had invasive cancer, and 13.1% (66/505) had carcinoma in situ. Invasive cancers in the opposite breast were diagnosed at an earlier stage as compared with the neoplasm of the primary breast. However, 26% of the patients already had positive axillary nodes. The following risk indicators of the bilateral disease were found: age at time of diagnosis, histologic type of tumours, familial breast cancer, suspicious mammography, P2/DY-breast parenchymal pattern (Wolfe) and multicentric cancer of primary breast. Our findings support the proposal to consider bilaterality of breast cancer as a sign of systemic disease of the breasts, involving the ductal and lobular system within eight quadrants of a paired organ (Ober).

Autoradiographic localization of androgen-concentrating cells in the brain of the male domestic fowl.

Cells in the male fowl brain which accumulate radioactivity following 3H testosterone (T) administration were identified by autoradiography. Labelled cells were found principally in hypothalamic, limbic and midbrain structures. Marked uptake was observed in the preoptic area (POA) and in the anterior and posterior hypothalamus. There was also a significant amount of labelling in the archistriatum (ARCH), particularly in the nucleus taeniae (Tn), and in the lateral septum. In the midbrain, substantial uptake of labelled hormone was found in the nucleus intercollicularis (ICo). The pattern of accumulation of T in the male fowl was comparable to that for sex hormone uptake in vertebrates in general. Furthermore, accumulation was generally found in areas known to be concerned with sex hormone-dependent functions.