Zielsetzung Der Latissimus-dorsi-Lappen (LDF) ist eine etablierte Operationstechnik zur Brust- bzw. Thoraxwandrekonstruktion unter Verwendung von Eigengewebe aus dem Rückenbereich. Das Ziel der vorliegenden Analyse war die Evaluation der LDF-basierten Operationen mit Fokus auf Frühkomplikationen und Rekonstruktionsversagen.

A 62-year-old Caucasian male presented at the certified Breast Cancer Center with a newly diagnosed large, symptomatic mass in the left breast. Clinical examination showed a not movable mass of 16 cm diameter, deforming the whole breast; the overlying skin was livid and hypervascularized. Enlarged lymph nodes were palpable in the axillary pit. He had no concomitant diseases at time of presentation; his previous surgeries included circumcision as a child and he was a nonsmoker. He denied any first- or second degree family medical history of cancer of any type and he never received radiotherapy. At ultrasound, the lesion was scored BI-RADS 5. Axillary lymph nodes were suspicious on sonography. Ultrasound guided minimal-invasive 14-gauge core biopsy revealed a moderately differentiated encapsulated papillary carcinoma with high expression of estrogen and progesterone receptors (both > 80%, IRS 12) and HER2-negative. Because of the tumor size a mastectomy with axillary dissection and chest wall reconstruction using a latissimus dorsi flap was performed. Histological analysis showed invasive growth besides typical (non-invasive) solid papillary carcinoma and was classified as invasive solid papillary carcinoma. OncotypeDX Recurrence Score indicated low risk (RS: 2). After discussion in the interdisciplinary tumor board meeting, radiation therapy and tamoxifen were recommended. The patient had an uneventful recovery and is disease-free after one year of follow up.

BACKGROUND:Deletions of chromosome 10q23, including the PTEN (phosphatase and tensin homolog) locus, are known to occur in breast cancer, but systematic analyses of its clinical relevance are lacking.METHODS:We thus analyzed a tissue microarray (TMA) with 2,197 breast cancers by fluorescence in-situ hybridization (FISH) using a PTEN-specific probe.RESULTS:PTEN deletions were detected in 19% of no special type, 9% of lobular, 4% of tubular cancers and 46% in carcinomas with medullary features. 98.7% of deletions were heterozygous and only 1.3% were homozygous. PTEN deletion was significantly linked to advanced tumor stage (p=0.0054), high-grade (p<0.0001), high tumor cell proliferation (Ki67 Labeling Index; p<0.0001), and shortened overall survival (p=0.0090). PTEN deletions were inversely associated with features of luminal type breast cancers (ER/PR positivity; p<0.0001 each, and CCND1 amplification; p=0.0020). PTEN deletions were also strongly linked to amplification of genes involved in the PTEN/AKT pathway such as MYC (p=0.0430) and HER2 (p=0.0065). Remarkably the combined analysis of MYC, HER2, CCND1 and PTEN aberrations suggested that aberrations of multiple PTEN/AKT pathway genes have a strong additive effect on breast cancer prognosis. While cancers with one of these aberrations behaved only marginally different from cancers with none, disease outcome was markedly worse in cancers with two or more aberrations as compared to those with only one aberration (p=0.0002). In addition, the particularly poor prognosis of patients with HER2 amplification and PTEN deletions challenges the concept of PTEN deletions interfering with trastuzumab therapy.CONCLUSION:PTEN deletion occurs in a relevant fraction of breast cancers, and is linked to aggressive tumor behavior. Reduced PTEN function cooperates with MYC and HER2 activation in conferring aggressive phenotype to cancer cells.

Deletions of chromosome 8p occur frequently in breast cancers, but analyses of its clinical relevance have been limited to small patient cohorts and provided controversial results. A tissue microarray with 2,197 breast cancers was thus analyzed by fluorescence in-situ hybridization using an 8p21 probe in combination with a centromere 8 reference probe. 8p deletions were found in 50% of carcinomas with no special type, 67% of papillary, 28% of tubular, 37% of lobular cancers and 56% of cancers with medullary features. Deletions were always heterozygous. 8p deletion was significantly linked to advanced tumor stage (P < 0.0001), high-grade (P < 0.0001), high tumor cell proliferation (Ki67 Labeling Index; P < 0.0001), and shortened overall survival (P < 0.0001). For example, 8p deletion was seen in 32% of 290 grade 1, 43% of 438 grade 2, and 65% of 427 grade 3 cancers. In addition, 8p deletions were strongly linked to amplification of MYC (P < 0.0001), HER2 (P < 0.0001), and CCND1 (p = 0.001), but inversely associated with ER receptor expression (p = 0.0001). Remarkably, 46.5% of 8p-deleted cancers harbored amplification of at least one of the analyzed genes as compared to 27.5% amplifications in 8p-non-deleted cancers (P < 0.0001). In conclusion, 8p deletion characterizes a subset of particularly aggressive breast cancers. As 8p deletions are easy to analyze, this feature appears to be highly suited for future DNA based prognostic breast cancer panels. The strong link of 8p deletion with various gene amplifications raises the possibility of a role for regulating genomic stability.

Primary liposarcomas of the breast are an extremely rare pathological entity. We report a case of liposarcoma in a 51-year-old woman who was treated at our Breast Cancer Center.

Determination of oestrogen receptor alpha (ER) represents at present the most important predictive factor in breast cancers. Data of ours and of other authors suggest that promising predictive/prognostic factors may also include pS2, metallothionein (MT) and CD24. Present study aimed at determining prognostic and predictive value of immunohistochemical determination of ER, pS2, MT, and CD24 expression in sections originating from 104 patients with breast cancer. An univariate and multivariate analysis was performed. Both univariate and multivariate analyses demonstrated that cytoplasmic-membranous expression of CD24 (CD24c-m) represents a strong unfavourable prognostic factor in the entire group and in most of the subgroups of patients. In several subgroups of the patients also a prognostic value was demonstrated of elevated expression of pS2 and of membranous expression of CD24. Our studies demonstrated that all patients with good prognostic factors (higher ER and pS2 expressions, lower MT expression, CD24c-m negativity) survived total period of observation (103 months). The study documented that cytoplasmic-membranous expression of CD24 represented an extremely strong unfavourable prognostic factor in breast cancer. Examination of the entire panel of the studied proteins permitted to select a group of patients of an exceptionally good prognosis.

BACKGROUND:The metallothioneins (MTs) are a group of proteins which, due to their unique structure, fulfil numerous functions in the cell. They participate in growth, differentiation, and reparative processes, protect cells against free radicals, and are responsible for heavy metal homeostasis. Their involvement has been reported in the multidrug resistance to cytostatic drugs. Numerous reports document MT presence in cells of various tumors, including breast cancer. Augmented expression of MTs has been reported in less differentiated tumors. MT expression used to be linked to higher proliferative activity of tumor cells, shorter survival of the patients, and tamoxifen-resistance. The present study aimed at examining the relation between MT expression and the manifestation of proliferation exponents (Ki67, nucleolar organizers--AgNORs) in cells of ductal breast cancer of G2 grade of malignancy.MATERIAL/METHODS:Reactions were performed to detect MTs (clone E9), Ki67 (clone MIB-1) (immunocytochemistry), and AgNORs (silver impregnation) in paraffin sections of breast cancers in G2 grade originating from 60 females. Results of the reactions were subjected to statistical analysis using Statistica 98 PL software.RESULTS:Statistical analysis (Spearman's rank correlation) demonstrated no relationships between the studied markers (p>0.05).CONCLUSIONS:There is no correlation between metallothionein expression and proliferation and between Ki67 and AgNORs in ductal breast cancers of G2 grade of differentiation.