Positive margins in breast conserving therapy (BCT) specimens are a risk factor for local recurrence in ductal carcinoma in situ (DCIS). As DCIS often bears microcalcifications, intraoperative specimen or slice radiograms are widely used to guide BCT surgery. However, as in some DCIS parts microcalcifications may be absent, margin widths based on microcalcifications alone may differ from final histological DCIS margin status. Our aim was to compare radiological margin widths measured on slice radiograms with respective histological DCIS margins of BCT specimens.

Extent is an independent risk factors for local recurrence in ductal in situ carcinoma (DCIS) of the breast. Surgical strategies mainly depend on extent of microcalcifications in mammograms, but as not all ducts containing DCIS bear microcalcifications, the final extent of DCIS may differ from the radiologically suspected volume. Our aim was to analyse the correlation between radiological estimation and pathological extent of DCIS in breast conserving therapy (BCT) specimens.

Positive or narrow margins in breast conserving therapy (BCT) specimens are a risk factor for local recurrence in invasive breast cancer with extratumoral ductal in situ carcinoma (DCIS). Intraoperative specimen radiograms are widely used to assure margins free of suspicious microcalcifications. Since not all DCIS bear microcalcifications, final histopathological margin status may differ from radiological margin status. Our aim was to compare radiological and pathological DCIS margin status in slice radiograms of BCT specimens.

Tumor extent in breast conserving therapy (BCT) specimens is a major risk factor for local recurrence in invasive breast cancer with extratumoral ductal in situ carcinoma (DCIS) components. Surgical strategies mainly depend on extent of tumor and microcalcifications in mammograms, but since not all ducts containing in situ carcinoma bear microcalcifications, final extent of DCIS may differ from the radiologically suspected volume. Our aim was to compare radiological and pathological extent of DCIS associated with invasive cancer in BCT specimens.

Das Low-grade adenosquamöse Karzinom (LGASC) der Brust gehört zu den metaplastischen Mammakarzinomen und ist mit einer Häufigkeit von < 1% aller Mammakarzinome sehr selten. Seit der Erstbeschreibung von Konjentzny (1912) und dem ersten modernen Review mit Bezeichnung als LGASC von Rosen und Ernsberger (1987) finden sich 19 Publikationen mit insgesamt 124 beschriebenen Fällen. Diagnostik und therapeutisches Management des LGASC sollen anhand einer Kasuistik und des Literatur-Reviews diskutiert werden.

Nodal negative luminale G1 Karzinome ≤20 mm sind Tumoren mit einem tumorspezifischen 10-Jahres-Überleben von > 95%, die keine adjuvante Chemotherapie benötigen. Unter ihnen sind Niedrigrisikotumoren, bei denen auch der Verzicht auf endokrine Therapie und lokale Strahlentherapie zurzeit in Studien kritisch überprüft wird. Trotz der exzellenten Prognose können Lokalrezidive die Lebensqualität und das kosmetische Ergebnis beeinträchtigen. Radiologisch okkulte (nicht-mikrokalktragende) DCIS-Komponenten gelten als Hauptrisikofaktor und sind deshalb eine Herausforderung für eine Brusterhaltende Therapie (BET).

Assessing prognostic and predictive factors like the Ki67 labelling index (Ki67-LI) in breast cancer core needle biopsies (CNB) may be hampered by undersampling. Our aim was to arrive at a representative assessment of Ki67-LI in CNB of luminal breast cancers by defining optimal cutoffs and establishing the minimum CNB volume needed for highest concordance of Ki67-LI between CNB and subsequent surgical excision biopsy (SEB).

Medical History: In February 2007, a 13-year old boy presented with a livid tumour in the lower conjunctival fornix of the left eye. Ophthalmological Findings: The tumor was salmon-coloured, bulging and elastic and filled the whole lower conjunctival fornix of the left eye. There was no other pathological finding in the left eye. Uncorrected visual acuity was 20/20. Intraocular pressure was 12 mmHg. The eye was fully motile. Treatment: Incisional biopsy was performed in February 2007. The tumor was histologically an extranodal MALT lymphoma. DNA testing for Chlamydophila trachomatis and Chlamydophila pneumonia was negative. Systemic treatment was started with doxycycline (200 mg daily). After six weeks, the tumour was slightly smaller. Azithromycin 500 mg once a week was added. 18 months after initiation of the treatment, the tumour had completely regressed. A second sample taking in the former tumor area showed tumor-free conjunctiva and subconjunctival tissue. As a precaution, the combined antibiotic therapy was continued for 10 months and the patient was followed for five more years. The lymphoma did not relapse in the conjunctiva and orbit or in the whole body. Conclusion: We showed that extranodal MALT lymphomas of the conjunctiva can be successfully treated with antibiotics alone. At the start of therapy, the child was 13 years old. To our knowledge, this patient is the first child in Germany and one of the first in the world with ocular adnexal lymphoma who could be successfully treated with combined antibiotic therapy and who could be followed up for 5 years without relapse. Thus, we could avoid radiotherapy or chemotherapy in childhood and eliminate the risk of a therapy-induced secondary malignancy.

Der St. Gallen Consensus empfiehlt die Subtypisierung von NST- und lobulären Mammakarzinomen (MK) in Luminal A, B, Her2 und Triple negativ (TN) mittels Immunhistochemie bzw. in situ-Hybridisierung. Für Luminal A MK wird Chemotherapie (CT) wegen geringerem Ansprechen als weniger nützlich angesehen. Der Luminal A-Definition (ER positiv, Her2 negativ und niedrige Proliferation) wurde 2013 eine PgR-Expression von ≥20% zugefügt. Wir untersuchten den Einfluss auf Subtypisierung und Therapieempfehlung.

Hintergrund: Im Februar 2007 stellte sich ein 13-jähriger Junge mit einem Tumor im unteren konjunktivalen Fornix des linken Auges vor. Ophthalmologische Befunde: Der schmerzfreie, lachsfarbene, prall elastische Tumor kleidete bei ansonsten unauffälligem Augenbefund den gesamten kaudalen Bindehautfornix des linken Auges aus. Die Sehschärfe betrug 1,0, der Augeninnendruck lag bei 12 mmHg. Die Motilität war in keine Richtung eingeschränkt. Behandlung: Eine Probeexzision erfolgte im Februar 2007. Histologisch zeigte sich ein extranodales MALT-Lymphom. Der DNA-Nachweis von Chlamydophila trachomatis und Chlamydophila pneumoniae war negativ. Die systemische Therapie wurde mit Doxycyclin-Tabletten (200 mg täglich) begonnen. Nach 6 Wochen zeigte sich eine partielle Tumorregression. Die Therapie wurde mit Azithromycin-Tabletten (500 mg) 1× die Woche erweitert. 18 Monate nach Behandlungsbeginn zeigte sich eine vollständige Rückbildung des Tumors. Eine 2. Probeexzision zeigte eine tumorfreie Bindehaut. Die kombinierte antibiotische Therapie wurde zur Sicherheit noch 10 Monate fortgeführt und der Patient 5 weitere Jahre nachbeobachtet. Weder in der Augenhöhle noch in anderen Teilen des Körpers zeigte sich ein Rezidiv des MALT-Lymphoms. Zusammenfassung: Ein extranodales MALT-Lymphom der Bindehaut kann auch bei Kindern mit ausschließlich antibiotischer Therapie erfolgreich behandelt werden. Unseres Wissens ist der zu Therapiebeginn 13-jährige Junge das erste Kind Deutschlands und eines der ersten weltweit, das mit einer kombinierten antibiotischen Therapie bei okulärem MALT-Lymphom erfolgreich behandelt und 5 Jahre rezidivfrei nachbeobachtet werden konnte. So konnte dem Kind eine Strahlen- oder Chemotherapie erspart werden und damit auch das Risiko der Entwicklung eines Zweittumors.

Etwa 10-20% aller im Mammografie-Screening entdeckten Malignome sind die duktalen Karzinome in situ (DCIS). Wir wollen aufzeigen, wie sich Grad und Größe dieser im Mammografie-Screening entdeckten DCIS auf die Operationsmethode (Brusterhaltung oder Mastektomie) auswirken.

Vergleich der Langzeitergebnisse von brusterhaltender Therapie (BET) ohne adjuvante Bestrahlung und Mastektomie (ME) bei Frauen mit DCIS.

Zielsetzung: Risikoeinschätzung von Biopsieergebnissen der histologischen Kategorie B3 (unklares malignes Potential) im populationsbezogenen, digitalen Mammografie-Screening. Untersuchung der Verteilung histologischer B3 Läsionstypen, ihrer Assoziation mit mammographischen Auffälligkeiten sowie der synchronen Malignitätsrate.

Abstract Background: The role of keratin (K) 5/14+ progenitor cells as precursor cells of the breast epithelium has been demonstrated both in culture and in situ. This cell model opens a new field in which distinct cell subtypes can be evaluated in terms of their functional state and describes how these cells may give rise to either benign or malignant tumors. Material and Methods: In this study, we used modern triple immunofluorescent labeling experiments to visualize directly different cell types and their functional status applying, as a reference, antibodies to basal (K5/14) and glandular (K8/18) keratins and a myoepithelial marker in combination with antibodies to ER-alpha, Ki67, BCL2 and c-kit in normal resting breast epithelium and in 30 cases of ductal neoplasia of low grade pathway and 8 cases of epithelial hyperplasia. Different cell types were quantitatively assayed. Immunolabeling results were supported with quantitative real time PCR. Results: Basal and glandular keratins in the normal luminal breast epithelium were found to be expressed in highly specific sequential pattern from K5/14+progenitor cells to K8/18+ glandular cells. ER alpha, Ki67, c-kit and BCL2 were found differentially expressed in various subtypes of the breast epithelium, ER-alpha was expressed only in a subset of glandular cells thus subdividing the glandular lineage into ER-alphapositive and negative subcategories. The highest Ki67-proliferation was found in phenotypically glandular cells which are ER-alpha negative. BCL2 was characteristically co-expressed in glandular cells, whereas c-kit was detected mainly in earlier glandular cells. Benign epithelial hyperplasia showed a striking similarity to normal luminal breast epithelium. In terms of functional differentiation these cells disclosed the same ER-alpha, BCL2 and c-kit expression as that observed in normal epithelium. In contrast to UDH, all types of low-grade in-situ neoplasia of ductal type are characterized by expression of only glandular keratins 8/18. The tumour cells co-expressed ER-alpha, BCL2 and Ki67. On the other hand, c-Kit was not expressed in these lesions. Discussion: From our data, it is evident that basal (K5/14) and glandular keratins (K8/18) are expressed in highly specific hierarchical patterns related to stage of glandular differentiation. This phenotypic hierarchy of cells is furthermore bound to a differential expression of ER, Ki67, c-kit and BCL2 in a very specific manner. Usual ductal hyperplasia disclosed a striking similarity to the resting glandular epithelium. In contrast, all types of low grade intraepithelial neoplasia not only retain the keratin patterns of their (normal) glandular counterpart but show the same functional differentiation with a positive expression of ER and BcL2 and lack of c-kit. This similarity indicates that these lesions may derive from more differentiated glandular cells of the lobular breast epithelium. The data presented here confirm that the K5/14+ progenitor cell concept provides important insight into the functional nature of normal breast epithelium and in proliferative diseases. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-01-08.

To define a set of quality indicators that should be routinely measured and evaluated to confirm that the clinical outcome reaches the requested standards, Eusoma has organised a workshop during which twenty four experts from different disciplines have reviewed the international literature and selected the main process and outcome indicators available for quality assurance of breast cancer care. A review of the literature for evidence-based recommendations have been performed by the steering committee. The experts have identified the quality indicators also taking into account the usability and feasibility. For each of them it has been reported: definition, minimum and target standard, motivation for selection and level of evidence (graded according to AHRO). In overall 17 main quality indicators have been identified, respectively, 7 on diagnosis, 4 on surgery and loco-regional treatment, 2 on systemic treatment and 4 on staging, counselling, follow-up and rehabilitation. Breast Units in Europe are invited to comply with these indicators and monitor them during their periodic audit meetings.