Pure primary osteosarcoma of the breast: a case report.

INTRODUCTION: Mammary sarcomas are relatively uncommon and they represent less than one percent of all primary breast malignancies. Osteosarcoma of the breast, unassociated with other tumors, is distinctly rare, with published references generally limited to case reports and occasional cases in several series encompassing a heterogeneous group of mammary sarcomas and extraosseous osteosarcomas at various sites. The authors present a patient with pure osteosarcoma of the breast, osteoblastic type, with biologically aggressive pattern. CASE REPORT: A 79-year-old lady became aware of a rapidly enlarging lump in the lateral part of the right breast. Clinical examination revealed a firm to hard, mobile, irregular, and painful breast lump measuring about six by four cm. On examination there was no axillary or supraclavicular lymphadenopathy. After initial diagnosis, excisional biopsy without dissection of the axillary lymph nodes was performed. Therefore, the histological and immunohistochemical findings established the diagnosis of pure primary osteosarcoma of the breast. CONCLUSION: Pure osteosarcoma of the breast is extremely rare and needs to be distinguished from a variety of benign and malignant breast lesions producing metaplastic bone. Less than a hundred cases of pure osteosarcoma of the breast were reported, but diagnostic confirmation with immunohistochemistry has been performed in relatively few of these cases.

Cisplatin monotherapy with concurrent radiotherapy versus combination of cisplatin and 5-fluorouracil chemotherapy with concurrent radiotherapy in patients with locoregionally advanced cervical carcinoma.

PURPOSE: To compare the efficacy, toxicity and survival of cisplatin monotherapy with concurrent radiotherapy ver-sus combination of cisplatin and 5-fluorouracil (5-FU) with concurrent external beam radiotherapy (EBRT) in patients with locoregionally advanced cervical carcinoma FIGO stages IIB-IV. METHODS: 134 patients with locoregionally advanced, histologically confirmed carcinoma of the uterine cervix were analysed. The first group of patients (n=70; 52.24%) started concomitant chemotherapy on the second day of radiotherapy with single-agent cisplatin 40 mg/m(2) given 2 h before radiotherapy, once a week for 6 courses. The second group of patients (n=64; 47.76%) started concomitant chemotherapy on the second day of radiotherapy with cisplatin 75 mg/m(2). Treatment was continued with 96-h infusion of 5-FU 4 g/m(2) (1 g/ m(2) per day for 5 consecutive days). The patients were irradiated by EBRT followed by intracavitary brachytherapy (ICB). RESULTS: 24- and 42-month survival in the first group were 71.9 and 57.81% and 52.5 and 35.4% in the second group, respectively (p=0.012). Mean time to progression in the first group was 24 months and in second group it was 15.9 months (p=0.012). After 2 years progression was noted in 38.3% of the first and in 62.9% of second group patients (p=0.003). After 40 months 60 patients were without relapse, 35 (57.81%) patients in the first group and 25 (37.147percnt;) patients in the second group (p=0.018). CONCLUSION: Treatment with combined cisplatin and 5-FU with concurrent EBRT was more efficient in comparison to cisplatin monotherapy with concurrent radiotherapy in patients with locoregionally advanced cervical carcinoma, in terms of 12- and 24-month overall survival and disease relapse after 2 years.

The possible role of Bcl-2 expression of tumors of the uterine cervix.

PURPOSE: To assess the expression of Bcl-2 protooncogene in premalignant and malignant uterine cervix lesions. METHODS: To establish the role of this protooncogene in uterine cervix carcinogenesis, we examined 69 tissue samples of low grade cervical squamous intraepithelial lesions (SIL) (n=16), high grade SIL (n=11), portio vaginalis uteri (PVU) carcinoma in situ (n=11) and PVU invasive carcinoma, stage IA-IIA (n=13) (study group) and 18 samples without SIL or malignancy (control group). The expression of Bcl-2 was detected immunohistochemically using a monoclonal antibody. Fisher's exact test (p <0.05) was used to assess statistical significance. By establishing the sensitivity and specificity of the test, the level of reliability of these analyses was determined as a possible screening method for early detection of changes in the uterine cervix. RESULTS: Overexpression of Bcl-2 was found to increase in direct relation to the grade of the cervical lesions. Statistically significant difference was found in the frequency of overexpression in patients with high grade SIL (6/11, p=0.006), PVU carcinoma in situ (5/11, p=0.018) and PVU invasive carcinoma (6/13, p=0.012), in relation to the control group. High sensitivity was of great diagnostic significance for the detection of these types of changes in the uterine cervix. On the basis of high predictive values it can be said that in patients with Bcl-2 overexpression there is a great possibility that they have premalignant or malignant changes in the uterine cervix. CONCLUSION: Our results indicate that overexpression of Bcl-2 may play an important role in cervical carcinogenesis. However, more extensive series of samples is required to establish the prognostic significance of Bcl-2 in cervical carcinogenesis.

HER-2 expression in uterine cervix carcinogenesis.

PURPOSE: To assess the expression and clinical significance of HER-2 protooncogene in the uterine cervix carcinogenesis. PATIENTS AND METHODS: We examined 69 tissue samples of low grade cervical squamous intraepithelial lesions (SIL) (n=16), high grade SIL (n=11) portio vaginalis uteri (PVU) carcinoma in situ (n=11) and PVU invasive carcinoma, stage IA-IIA (n=13; study group) and 18 samples without SIL or malignancy (control group). The expression of HER-2 was detected immunohistochemically using a monoclonal antibody. Fisher's exact test was used to assess statistical significance. By establishing sensitivity and specificity of the test, the level of reliability of these analyses was determined as a possible screening method for early detection of changes in the uterine cervix. RESULTS: Overexpression of HER-2 was found to increase in direct relation to the grade of the cervical lesions. Statistically significant difference was found in the frequency of overexpression in patients with high grade SIL, PVU carcinoma in situ and PVU invasive carcinoma compared with the control group. High sensitivity was of great diagnostic significance for the detection of these types of changes in the uterine cervix. On the basis of high predictive values it can be concluded that in patients with HER-2 overexpression there is a great possibility that they have premalignant or malignant changes in the uterine cervix. CONCLUSION: Our results indicate that overexpression of HER-2 oncogene may play an important role in cervical carcinogenesis. However, more extensive series of samples is required to establish the prognostic significance of HER- 2 in cervical carcinogenesis.

Co-overexpression of bcl-2 and c-myc in uterine cervix carcinomas and premalignant lesions.

To establish the role of co-overexpression of bcl-2 and c-myc protooncogenes in uterine cervix carcinogenesis, we examined 138 tissue samples of low grade cervical squamous intraepithelial lesions (SIL), high grade SIL, portio vaginalis uteri (PVU) carcinoma in situ and PVU carcinoma invasive, stage IA-IIA (study group) and 36 samples without SIL or malignancy (control group). The expression of bcl-2 and c-myc was detected immunohistochemically using a monoclonal antibody. Fisher’s exact test (P<0.05) was used to assess statistical significance. Overexpression of bcl-2 was found to increase in direct relation to the grade of the cervical lesions. High sensitivity was of great diagnostic significance for the detection of these types of changes in the uterine cervix. On the basis of high predictive values it can be said that in patients with bcl-2 overexpression there is a great possibility that they have premalignant or malignant changes in the uterine cervix. Co-overexpression of bcl-2 and c-myc oncogenes was found only in patients with PVU invasive carcinoma (6/26-23.0%). Statistically significant difference was not found in the frequency of co-overexpression in patients with PVU invasive carcinoma in relation to the control group (Fisher’s test; P=0.064). The method's sensitivity of determining these oncogenes with the aim of detecting PVU invasive carcinoma was 23%, while specificity was 72.2%. On the basis of high predictive values (100%), speaking in statistical terms, it can be concluded that all patients with co-overexpression of bcl-2 and c-myc oncogenes will have PVU invasive carcinoma. We confirmed in our research that co-overexpression of bcl-2 and c-myc oncogenes was increased only in PVU invasive carcinoma. However, a more extensive series of samples and additional tests are required to establish the prognostic significance of bcl-2 and c-myc co-overexpression in cervical carcinogenesis.