Discrepancy in pathology reports upon second review of radical orchiectomy specimens for testicular germ cell tumors.

INTRODUCTION: We sought to evaluate the discrepancies between primary pathology report and second pathology review of radical orchiectomy (RO) specimens. METHODS: A retrospective review was performed of RO specimens from the Ontario Cancer Registry. All cases required both a primary pathology report and a second pathology review from another institution. Histopathological variables assessed included histological subtype and components of mixed germ cell tumor (GCT), pathological tumor (pT) stage, lymphovascular invasion (LVI), spermatic cord invasion, and surgical margin. RESULTS: Between 1994 and 2015, 5048 ROs were performed with 2719 (53.9%) seminoma and 2029 (40.2%) non-seminoma. Of these, 519 (10.3%) received a second pathology review. There was concordance between primary pathology report and second pathology review in 326 (62.8%) cases. The most common discrepancies involved a change in pT stage (n=148, 28.5%), with upstaging in 83 (16%) and downstaging in 65 (12.5%) cases relative to the original pT stage. The second most common discrepancy regarded the reporting of LVI (n=121, 23.3%), with 62 (11.9%) reporting presence of LVI when the primary pathology report did not. Other discrepancies included a change in the histological subtype in 28 (5.4%) cases and spermatic cord margin status in five (9.6%) cases. CONCLUSIONS: Only 10% of orchiectomy specimens underwent a second pathology review, with nearly 40% of reviews leading to a meaningful change in parameters. Such variation could lead to incorrect tumor staging, estimate of relapse risk, and inappropriate treatment decisions. Expert pathology review of RO specimens should be considered, as it has significant implications for decision-making.

[Clinical features and prognosis of 25 cases of breast carcinosarcoma].

OBJECTIVE: To improve the recognition, appropriate diagnosis and treatment of breast carcinosarcoma through analysis of their clinical features, diagnosis, management and prognosis. METHODS: The clinicopathological data from 25 patients with breast carcinosarcoma treated in our hospital between January 1976 and January 2008 were retrospectively reviewed. The correlation between prognosis and age, tumor size, axillary node status, and treatment modality was analyzed using the statistical software SPSS 13.0. The survival rate was calculated by Kaplan-Meier analysis and compared using log-rank test. Univariate and multivariate factors for survival were analyzed using Cox proportional hazards regression model. RESULTS: All patients were female and their median age was 56-years. The median tumor diameter was 5.1 cm. The misdiagnosis rate was high by mammography, B-ultrasound and pathological examination of needle aspiration biopsy before operation. So that the diagnosis primarily depended on postoperative histopathologic examination. The ER/PR and HER-2 positive rate of the breast carcinosarcomas was 8.3% and 7.7%, respectively. Invasive ductal carcinoma was the main malignant component accounting for 92.3%, while the sarcoma element was constitutive of fibrosarcoma with a proportion of 46.2%. The overall 5-year survival rate was 57.9% with a median survival time of 86 months after a median follow-up of 52 months. Univariate factor analysis showed that the tumor size (P = 0.012) and treatment methods (P = 0.028) were impact factors, while age and axillary lymph node status were not significantly related with prognosis. Cox multivariate analysis validated that the therapy modality was an independent prognostic factor for breast carcinosarcoma (P = 0.047). CONCLUSIONS: Breast carcinosarcoma is rare and its clinical features are not specific, so that its final diagnosis is mainly based on the postoperative pathology. Tumor size and treatment modality are independent prognostic factors, so the comprehensive therapy mainly based on radical resection is the best treatment modality. The positive expression of ER/PR and HER-2 in breast carcinosarcoma is low, while exploring new target is one of future research directions.

[Application of pedicle fat flap for defect repair in breast-conserving surgery of breast cancer].

OBJECTIVE: To evaluate the cosmetic outcomes of applying pedicle fat flap below breast fold for repairing inferior quadrant defect in breast-conserving surgery. METHODS: From May 2009 to July 2011, 18 cases of breast cancer at our hospital were recruited. All cases underwent breast-conserving procedures and achieved negative margin by frozen section examination. Then pedicle fat flap below breast fold was applied to reshape breast defect. All of them were of females with a median age of 43 years (range: 33 - 59). The median tumor size was 2.5 cm (range: 2.0 - 3.0). All tumors were located at the inferior quadrant of breast. All of them received whole breast radiotherapy and adjuvant chemotherapy. And 10 cases with positive estrogen receptor had adjuvant endocrine therapy. They were followed up at one-month postoperatively. Upon the completion of chemotherapy and radiotherapy, then follow-up was once every 4 months. The cosmetic outcomes and disease relapse were observed. RESULTS: All pedicle fat flaps survived without necrosis. After a median follow-up period of 15 months, all survived disease-free. Fat liquefaction was observed in 2 cases. The whole breast radiotherapy had no significant effect on pedicle fat flap. The rate of good cosmetics was 88.9%. And their subjective satisfactory rate was 100.0%. CONCLUSION: Both satisfactory aesthetic outcome and good efficacy are obtained with pedicle fat flap below breast fold for tumors located at the inferior quadrant of breast.

[Application of latissimus dorsi muscle flap for breast conservation in breast cancer].

OBJECTIVE: Breast conserving surgery (BCS) is one of standard treatment approaches in early breast cancer. Although most defect after BCS can be repaired, the cosmetic outcomes are unsatisfactory in the patients with poor tumor/breast ratio. Oncoplastic surgery (OPS) has emerged as a new approach for providing adequate tumor resection without compromise of aesthetic outcomes in BCS. Our purpose is to explore the cosmetic outcomes of applying latissimus dorsi (LD) muscle flap to reshape severe breast conservation deformities in breast cancer. METHODS: Totally 24 cases of breast cancer were studied. The tumor size was 3.0 - 5.5 cm (median 3.5 cm). All the cases underwent BCS and achieved negative margin by frozen sections examination. Then LD flap reshaping were performed. All the patients received whole breast radiotherapy ± chemotherapy ± endocrine therapy. RESULTS: All the LD flaps were alive without skin necrosis. After a median 23-month follow-up, all the cases were disease-free surviving. The whole breast radiotherapy had no significant effect on the LD flaps. The rate of good cosmetic results was 79.2%. The subjective satisfactory rate of the patients was 96%. CONCLUSIONS: Both satisfactory aesthetic outcome and good treatment effect were obtained using LD flap to reshape severe breast conservation deformity. OPS offers tools for breast conservation in patients otherwise destined for mastectomy or poor aesthetic outcome, such as large tumor/breast ratio, nipple-areola complex tumor, ductal carcinoma in situ, neoadjuvant chemotherapy cases and so on.

Long-term results of breast conservation in Chinese women with breast cancer.

Between July 1989 and December 2002, 172 women with Stage I/II breast cancer were treated by breast conservation therapy (BCT). All underwent quadrantectomy and axillary node clearance. Minimum follow-up was 5 years and 79 (52%) were followed for >10 years. At 5 years, local relapse-free and overall survival rates were 98.3% and 98.3%. The 10-year rates were 95% and 94%, respectively. The 10-year local recurrence rate was higher in patients with involved margins (33.3% versus 2.7%, p = 0.0272). Furthermore 10-year death rates in margin positive patients were higher (18.2% versus 2.5%, p = 0.0486). Excellent or good cosmetic results were achieved in 54%. BCT is a reasonable option for early stage breast cancer in Chinese women but margin status is the most important determinant of local recurrence. Negative margins are required for optimal local control and minimization of distant metastasis.

[Correlations of centrosome abnormality and genomic instability to tumor].

Genomic instability, including whole chromosome loss or gain, ploidy change, and a variety of chromosome aberration, is a characteristic of tumor cells. Centrosome abnormality is also found in several kinds of tumors. Abnormal centrosome can cause multipolar spindle formation, chromosome mis-segregation, and unequal distribution, and finally leads to cancers. Therefore, abnormal centrosome is common in tumor cells, and centrosome amplification is probably an early event in the origination and development of cancer.

[Clinical characteristics of bilateral primary breast cancer: a report of 100 cases].

BACKGROUND & OBJECTIVE: Women with breast cancer have an increased risk of new primary tumors of the contralateral breast. This study was to analyze the clinical characteristics of bilateral primary breast cancer (BPBC), and explore risk factors of BPBC. METHODS: Clinical data of 100 patients with BPBC and 200 patients with unilateral primary breast cancer (UPBC) were compared. RESULTS: The age of disease and age of menarche of BPBC patients were significantly younger than those of UPBC patients (P<0.05). Compared with UPBC patients, BPBC patients had a significantly greater prevalence of family history (15% vs. 5%, P<0.01); incidence rate of breast cancer before menopause was significantly higher in BPBC patients than in UPBC patients (70% vs. 58%, P<0.05). Pathologically positive rate of ipsilateral axillary lymph nodes was not significantly different between the 2 groups. The radiation treatment proportion in metachronous BPBC patients was not significantly different from that in UPBC patients (69% vs. 58%, P>0.05). CONCLUSIONS: Compare with UPBC patients, BPBC patients have a significantly greater prevalence of family history, and are younger. The estrogen might be closely related to BPBC, but the lymphatic metastasis ability of the first tumor in BPBC is similar to that of UPBC.

[Randomized trial on adjuvant radiotherapy for postoperative breast cancer: a 15 year experience].

OBJECTIVE: To evaluate the long term effects of adjuvant radiotherapy for postoperative breast cancer. METHODS: From 1985 to 1986, 162 patients with operable breast cancer were randomly given adjuvant radiotherapy according to clinical stage and involving condition of axillary lymph nodes (LN). The radiotherapy group (RG) was irradiated in the supraclavicular area and/or internal mammary area to 50 Gy, while the control group (CG) was not. RESULTS: The overall 5-, 10- and 15-year survival rates of the RG were 72.0%, 56.1% and 54.3%, while they were 66.3%, 51.3% and 49.4% in the CG (P > 0.05). Clinical stage I-IIIa and positive or negative LN showed no significant difference in the two groups. But in patients with LN(+) > or = 4, the 5-, 10- and 15-year survival rates of the RG were 55.6%, 38.9% and 37.1%, which were higher than the CG of 29.0%, 16.1% and 16.1% (P < 0.05). CONCLUSION: Adjuvant radiotherapy can improve the prognosis for breast cancer patients with LN(+) > or = 4, but not for LN(-).