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  Anatomic Abstracts

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June 2002

Histopathologic types of benign breast lesions and risk of breast cancer To identify the risk inherent within different morphologic lesions, the authors analyzed the data from 674 benign breast biopsy specimens from 120 subjects who subsequently developed breast cancer and 382 controls (matched for age and date of biopsy) spanning up to 20 years of followup (mean, 66.95 months). The authors confirmed an increased risk associated with certain types of benign breast lesions. Atypical lobular hyperplasia was the most significant risk factor for breast cancer, with more unfavorable outcome in patients younger than 50 years old (P=0.003) and a relative risk of 4.55 (confidence interval, 1.77 to 11.69). Hyperplasia of usual type had a relative risk of 1.53 (CI, 1.10 to 2.13) with a statistically worse probability of survival (cancer-free time) for patients older than 50 years. For atypical ductal hyperplasia, the relative risk was 2.03 (CI, 0.80 to 1.39). Blunt duct adenosis was significantly more common in cases progressing to breast cancer than in controls, showing a relative risk of 2.08 (CI, 1.12 to 2.85).

Shaaban AM, Sloane JP, West CR, et al. Histopathologic types of benign breast lesions and the risk of breast cancer: case-control study. Am J Surg Pathol. 2002;26:421-430.

Reprints: Dr. Christopher S. Foster, University of Liverpool, Dept. of Pathology, Daulby St., Duncan Bldg., Liverpool, L69 3GA United Kingdom; csfoster@liv.ac.uk

Sentinel lymph nodes in early vulvar cancer
Approximately 20 percent of patients with clinically node-negative vulvar carcinoma will have lymph node metastases. Complications of radical groin lymph node dissection prompt an evaluation of sentinel lymph node mapping to avoid unnecessary extensive lymph node resection. The authors studied 26 patients with vulvar carcinoma, stage T1/T2, without clinically suspicious lymph nodes. Sentinel lymph nodes were identified by lymphoscintigraphy and using technetium99 and a handheld gamma probe. After resection of suspected sentinel lymph nodes, a standard unilateral or bilateral groin dissection was performed, followed by wide local excision of the tumor or radical vulvectomy. The sentinel lymph nodes were cut at 2- to 3-mm intervals, and each paraffin block was sectioned and stained with routine hematoxylin and eosin. All negative sentinel lymph nodes on H&E stain were examined immunohistochemically for cytokeratin. Nine cases with positive SNLs were identified on H&E stain. Immunohistochemical staining did not reveal any additional positive sentinel lymph nodes. All 17 cases with negative sentinel lymph nodes also had negative groin lymph nodes. The study suggests that evaluating such nodes may be useful in subjects with vulvar carcinoma, however additional larger studies may be required to confirm this finding.

Sliutz G, Reinthaller A, Lantzsch T, et al. Lymphatic mapping of sentinel nodes in early vulvar cancer. Gynecol Oncol. 2002;84:449-452.

Reprints: G. Sliutz, Dept. of Gynecology, University of Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria; gerhard.sliutz@akh-wien.ac.at

Breast ductal carcinoma in situ with microinvasion
The significance of microinvasion is still debated, and clinical management is controversial. The authors of this study defined ductal carcinoma in situ with microinvasion (DCIS-MI) as DCIS with infiltration of the periductal stroma by a few tumor cells, singly (type 1) or in clusters (type 2). Using this definition, they attempted to evaluate the clinical significance of microinvasion. The authors compared the clinical and pathologic features and survival (median followup, 7.3 years) of 1,248 patients with DCIS (722 patients), DCIS-MI with microinvasion type 1 and type 2 (243 patients), and invasive ductal carcinoma in situ with a predominant DCIS component greater than or equal to 80 percent of the tumor (IDC-DCIS, 283 patients). Microinvasion was associated with DCIS histologic type, grade, and extent (respectively, P<10-8, P<10-3, P<10-4). Axillary lymph node metastases were observed in a few patients with DCIS and DCIS-MI type 1 (respectively, 1.4 percent and none), in 10.1 percent with DCIS-MI type 2, and in 27.6 percent with IDC-DCIS. Metastasis-free and overall survival probabilities differed significantly between the three groups. The group comprising DCIS and DCIS-MI type 1 had the best prognosis, followed by the DCIS-MI type 2 group, and then the IDC-DCIS group. The authors' findings suggest that there are two types of DCIS-MI: type 1, which behaves like DCIS and should be managed as such, and type 2, which is less aggressive than IDC-DCIS but more so than type 1.

De Mascarel I, MacGrogan G, Mathoulin-Pelissier S, et al. Breast ductal carcinoma in situ with microinvasion: a definition supported by a long-term study of 1248 sectioned ductal carcinomas. Cancer. 2002;94:2134-2142.

Reprints: Dr. Isabelle de Mascarel, Dept. of Pathology, Institut Bergonie, Regional Cancer Center, 180 rue de Saint-Genes, 33076 Bordeaux Cedex, France; mascarel@bergonie.org

Villous adenomas of the urinary tract
The authors described 18 cases of villous adenomas arising in the urinary bladder, urachus, and prostatic urethra. Three of these cases also had an associated in situ or infiltrating urothelial carcinoma, or both. Interestingly, the associated urothelial carcinoma elements were often merged imperceptibly with the glandular villous adenomas. Three cases had an associated in situ adenocarcinoma and six cases had in situ and infiltrating adenocarcinoma. Analysis of the eight cases with followup data (range, two to 11 years) revealed no recurrence in two cases with pure villous adenoma and two with an associated in situ adenocarcinoma treated by nonradical excision. Recurrent cases included two with infiltrating adenocarcinoma and one with villous adenoma associated with non-invasive urothelial carcinoma (low-grade papillary, micropapillary), which progressed to sarcomatoid urothelial carcinoma following partial cystectomy. The epitope for mAbDas1 that is usually expressed by normal and neoplastic colonic epithelium and urinary tract lesions with glandular epithelial differentiation was detected in 80 percent of villous adenomas. The expression of this marker did not correlate with histology or clinical course.

Seibel JL, Prasad S, Weiss RE, et al. Villous adenoma of the urinary tract: a lesion frequently associated with malignancy. Hum Pathol. 2002;33:236-241.

Reprints: Dr. Jonathan I. Epstein, Johns Hopkins Hospital, Weinberg Bldg., Rm. 2242, 401 N. Broadway St., Baltimore, MD 21231