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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
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