'Pure' invasive apocrine carcinoma of the breast: a new clinicopathological entity?

Invasive apocrine carcinoma (IAC) of the breast has a similar prognosis to infiltrating ductal carcinoma not otherwise specified (IDC-NOS). The existence of a pure IAC subtype (PIAC) and its possible prognostic implications have not been fully investigated. To this end, pathological inclusion criteria for the diagnosis of PIAC were defined and three pathologists reviewed their slides blind to identify it. To assess its clinical behavior, a case-control evaluation was performed, for which 122 cases were selected. There was 100% agreement among the pathologists on the diagnosis: PIAC was identified in 37 cases and IDC-NOS, in 68, while 17 cases were categorized as complex IAC. The probability of 6-year survival was 0.72 for PIAC and 0.52 for IDC-NOS (P=0.02), and was still better after adjustment for tumor grade and axillary status. PIAC may be a distinct clinicopathological entity with a less aggressive behavior than high-grade IDC-NOS and might be regarded as an independent prognostic factor in early breast cancer.

Primary vulvar neoplasia: a review of in situ and invasive carcinoma, 1935-1972.

This survey reports the past 38 years of experience with 192 cases of carcinoma of the vulva seen and treated at the Johns Hopkins Hospital. The review stresses the increased incidence of in situ neoplasia and the importance of individualization of therapy. Also the changing concepts in terminology (eg, the leukoplakic vulvitis of the past is the dystrophy of the present) suggest that the precursory alterations of previous discussions must be reviewed in the light of such an altered nomenclature. Features of epidemiologic and histologic importance are discussed.

PIP: Vulvar neoplasia as seen at the Johns Hopkins Hospital during a 38-year period (1935-1972) is reviewed. Of 1385 tissue specimens, 1053 were benign and 332 were malignant lesions. Of the malignant lesions, 246 were squamous cell carcinoma, both in situ and invasive. Of these, 192 were treated and followed and are reported on. There were 71 cases of in situ and 121 of invasive cancer. Of the patients, 64% were white and 36% were nonwhite, which corresponds to the patient population treated at the hospital. Ages of patients ranged from 21 to 86 years, with a median of 50 years. Of those with invasive cancer, 75% were postmenopausal and none was under the age of 30 years. There was a 29% incidence of nulliparity and a 64% incidence of obesity. Diabetes was noted in 64%. Syphilis was discovered in 26%. These patients had a high risk of being exposed to other venereal infections, particularly herpes which is suspect as a precursor of neoplasia. Vurrucous carcinoma are also likely to be of viral origin. Other malignancies were also present in 20% of patients. There was 1 case of chronic clyphocytic leukemia. Presenting symptoms were a lump, a white patch, pruritus, or bleeding. Pruritus was present in 46%. A leukoplakialike appearance was noted in most of the in situ lesions. Multicentric foci of origin were demonstrated in 35%, mostly in the in situ cases. Of the invasive cancers 60% were well differentiated and 11% were verrucous. Multiple histologic patterns were present in many cases. In 167 patients (67%), the initial treatment was surgical. Postoperative radiation was used in 30% of those with invasive cancer. Local recurrences followed in 22%. In those with multicentric foci the recurrence rate was 48%. 44 patients were known to have died, mostly from other causes. Survival was directly related to the stage of the disease at the time of initial diagnosis and treatment.

Verrucous carcinoma of the vulva: study of 24 cases.

The clinicopathologic features of 24 cases of vulvar verrucous carcinoma were reviewed. Based on the absence of lymph node metastasis in 27 patients who underwent radical vulvectomy with lymph node dissection (10 in previous series, 17 in present series), a conservative approach consisting of wide local excision is suggested. Radiotherapy did not aid in prolonging survival.

[Epithelial changes in the anal canal associated with hemorrhoids, fissures and fistulas]. / Cambios epiteliales en el canal anal asociados con hemorroides, fisuras y fístulas.

A retrospective study of 118 cases of haemorrhoids (77 cases), fissures (7 cases) and fistulas (34 cases) was done to demonstrate epithelial changes in each of the three microscopic components (transitional, rectal mucosa and keratinized squamous epithelium) of the anal canal. Histopathologically the three main lesion were metaplasia (16.9%), dysplasia (13.5%) and Koilocytotic changes (11.8%). On the other hand, the metaplastic lesion was found only on the rectal mucosa (100%), dysplasia was demonstrated on the rectal mucosa (9.8%) and on the transitional zone (21.5%). Finally koilocytosis was diagnosed only on the anal skin. The authors believe that the histopathology study (biopsy) is the best choice for the establishment of the preneoplastic lesions (dysplasia) in terms of an early detection of malignancy on the anal canal.

Cambios epiteliales en el canal anal asociados con hemorroides, fisuras y fístulas. / [Epithelial changes in the anal canal associated with hemorrhoids, fissures and fistulas]

A retrospective study of 118 cases of haemorrhoids (77 cases), fissures (7 cases) and fistulas (34 cases) was done to demonstrate epithelial changes in each of the three microscopic components (transitional, rectal mucosa and keratinized squamous epithelium) of the anal canal. Histopathologically the three main lesion were metaplasia (16.9

), dysplasia (13.5

) and Koilocytotic changes (11.8

). On the other hand, the metaplastic lesion was found only on the rectal mucosa (100

), dysplasia was demonstrated on the rectal mucosa (9.8

) and on the transitional zone (21.5

). Finally koilocytosis was diagnosed only on the anal skin. The authors believe that the histopathology study (biopsy) is the best choice for the establishment of the preneoplastic lesions (dysplasia) in terms of an early detection of malignancy on the anal canal.