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The aim of this study was to develop a new method to check of the viability of an extraabdominally transplanted omental flap. We performed free omental transplantation to the left lateral neck region in the frame of a formerly published new esophageal resection series on 5 dogs. Intraoperative laser Doppler flowmetry was performed, before and after isolation, after transplantation, and 14 days after the operation. From the 5 transplanted flaps, 4 survived the transplantation. The flap microcirculation deteriorated immediately after the transplantation, but at the time of re-operation the measurements showed similar microcirculation as control tissues, which proves the viability of the transplanted flaps. In our opinion, in dogs for the intraoperative monitoring of viability and microcirculation of free transplanted omental flaps, laser Doppler flowmetry is a feasible method.

Summary Background Data: The purpose of this study was to determine the type of relationship between tumor size and mortality in early breast carcinoma., Methods: The data was abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results Program of women diagnosed with primary breast carcinoma between 1988 and 1997 presenting with a T1-T2 lesion and no metastasis in whom axillary node dissection was performed: 58,070 women were node-negative (N0) and 25,616 were node-positive (N+). End point was death from any cause. Tumor size was modeled as a continuous variable by proportional hazards using a generalized additive models procedure., Results: Functionally, a Gompertzian expression exp(-exp(-(size-15)/10)) provided a good fit to the effect of tumor size (in millimeters) on mortality, irrespective of nodal status. Quantitatively, for tumor size between 3 and 50 mm, the increase of crude cumulative death rate (number of observed deaths divided by the number of patients at risk) increased with size from 10% to 25% for N0 and from 20% to 40% for N+., Conclusions: The functional relationship of tumor size with mortality is concordant with current knowledge of tumor growth. However, its qualitative and quantitative independence of nodal status is in contradiction with the prevailing concept of sequential disease progression from primary tumor to regional nodes. This argues against the perception that nodal metastases are caused by the primary tumor.

Background: The latest edition of the tumor-lymph node-metastasis (TNM) classification of malignant tumors distinguishes between isolated tumor cells (pN0) and micrometastases (pN1mi). The reproducibility of these categories has not been assessed previously., Methods: Digital images from 50 cases with low-volume lymph node involvement from axillary sentinel lymph nodes were circulated twice for evaluation (Evaluation Rounds 1 and 2) among the members of the European Working Group for Breast Screening Pathology, and the members were asked to categorize lesions as micrometastasis, isolated tumor cells, or something else and to classify each case into a pathologic lymph node (pN) category of the pathologic TNM system. Methods for improving the low reproducibility of the categorizations were discussed between the two evaluation rounds. kappa Statistics were used for the assessment of interobserver variability., Results: The kappa value for the consistency of categorizing low-volume lymph node load into micrometastasis, isolated tumor cells, or neither of those changed from 0.39 to 0.49 between Evaluation Rounds 1 and 2, but it was slightly lower for the pN categories (0.35 and 0.44, respectively). Interpretation of the definitions of isolated tumor cells (especially with respect to their localization within the lymph node), lack of guidance on how to measure them if they were multiple, and lack of any definitions for multiple simultaneous foci of lymph node involvement were listed among the causes of discordant diagnoses., Conclusions: The results of the current study indicated that the definitions available have minor contradictions and do not permit a reproducible distinction between micrometastases and isolated tumor cells. Refinement of these definitions, therefore, is required. One refinement that may improve reproducibility is suggested in this report., ((c) 2004 American Cancer Society.)

After a positive sentinel lymph node (SLN) biopsy, some patients may be considered to have a very low risk of non-SLN involvement and could be candidates for axillary sparing. The aim of this study was to validate the nomogram created at the Memorial Sloan-Kettering Cancer Center (MSKCC) for the prediction of non-SLN involvement in an independent set of 140 patients with both positive SLNs and axillary dissection. The predicted proportions of positive non-SLNs were compared with the observed percentages of non-SLN metastasis. Although the SLN metastasis size and tumor size did influence the risk of non-SLN involvement, the correlation between the predicted and observed proportions was weaker for our patients (R: 0.84) than for the patients assessed at the MSKCC (R: 0.97). Differences were noted in the intraoperative assessment and in the final histology of the SLNs (imprints vs frozen sections and more detailed vs less detailed, respectively), and these could partly explain the lower level of the correlation. The nomogram could not be validated and was found to be of only limited use for the prediction of non-SLN involvement in patients operated on under similar, though not fully identical conditions. We therefore warn against the unvalidated use of this prediction tool.

Background: Many researchers are interested to know if there are any improvements in recent treatment results for metastatic breast cancer in the community, especially for 10- or 15-year survival., Methods: Between 1981 and 1985, 782 and 580 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries of the Surveillance, Epidemiology, and End Results (SEER) database. The lognormal statistical method to estimate survival was retrospectively validated since the 15-year cause-specific survival rates could be calculated using the standard life-table actuarial method. Estimated rates were compared to the actuarial data available in 2000. Between 1991 and 1995, further 752 and 632 female patients with metastatic breast cancer were extracted respectively from the Connecticut and San Francisco-Oakland registries. The data were analyzed to estimate the 15-year cause-specific survival rates before the year 2005., Results: The 5-year period (1981-1985) was chosen, and patients were followed as a cohort for an additional 3 years. The estimated 15-year cause-specific survival rates were 7.1% (95% confidence interval, CI, 1.8-12.4) and 9.1% (95% CI, 3.8-14.4) by the lognormal model for the two registries of Connecticut and San Francisco-Oakland respectively. Since the SEER database provides follow-up information to the end of the year 2000, actuarial calculation can be performed to confirm (validate) the estimation. The Kaplan-Meier calculation for the 15-year cause-specific survival rates were 8.3% (95% CI, 5.8-10.8) and 7.0% (95% CI, 4.3-9.7) respectively. Using the 1991-1995 5-year period cohort and followed for an additional 3 years, the 15-year cause-specific survival rates were estimated to be 9.1% (95% CI, 3.8-14.4) and 14.7% (95% CI, 9.8-19.6) for the two registries of Connecticut and San Francisco-Oakland respectively., Conclusions: For the period 1981-1985, the 15-year cause-specific survival for the Connecticut and the San Francisco-Oakland registries were comparable. For the period 1991-1995, there was not much change in survival for the Connecticut registry patients, but there was an improvement in survival for the San Francisco-Oakland registry patients.

Background: After completion of axillary dissection, many breast cancer patients with axillary sentinel nodal involvement are found to have regional disease limited to the sentinel nodes. These patients are exposed to the morbidity of axillary clearance without any expected therapeutic benefit., Methods: Sentinel node biopsy was performed either with Patent blue dye or with a combined dye, radiocolloid and gamma-probe-guided method involving peritumoral tracer administration. For a series of 150 consecutive patients with involved axillary sentinel nodes and axillary dissection, factors associated with non-sentinel nodal involvement were analysed in a multivariate analysis based on logistic regression with the use of fractional polynomials., Results: The following variables were found to be potentially associated with non-sentinel node metastases: tumour size, sentinel node metastasis size, number of examined sentinel nodes, percentage of involved sentinel nodes (the latter two were found to be significant only when in combination), and extracapsular perinodal spread., Conclusions: Isolated tumour cells and micrometastases in axillary sentinel nodes carry a low risk of non-sentinel node metastasis. The risk of metastasis to further echelon nodes is higher with macrometastases, especially if there is extracapsular growth and the proportion of involved sentinel nodes is high.

Axillary nodal status assessed by traditional histological methods is a proven independent prognostic factor in breast cancer. Sentinel lymph node biopsy is a surgical pathologic staging procedure that not only allows the selective removal of the most likely sites of lymphogenic metastases, but also enables upstaging of breast carcinoma by detecting nodal involvement undetected by standard methods of nodal staging. This review highlights the upstaging potential of sentinel node biopsy. It also suggests that incomplete reporting of the pathological methods may make the comparisons of results from different studies difficult. The article also describes a few methods that have been claimed optimal but are probably not, and it formulates basic considerations for building up a histological protocol that can identify all metastases larger than 2 mm, which are of unquestionable prognostic relevance. These considerations are also useful for the detection of micrometastases. Issues of pathological reporting of sentinel nodal findings are also highlighted, with emphasis on the lack of standardization and on the differentiation of isolated tumor cells from micrometastases. Finally the stepwise building up of our current histology protocol and our experience gained since the introduction of sentinel node biopsy in 1997 is also briefly summarized.

Introduction: The number of lymph nodes found to be involved in an axillary dissection is among the most powerful prognostic factors in breast cancer, but it is confounded by the number of lymph nodes that have been examined. We investigate an idea that has surfaced recently in the literature (since 1999), namely that the proportion of node-positive lymph nodes (or a function thereof) is a much better predictor of survival than the number of excised and node-positive lymph nodes, alone or together., Methods: The data were abstracted from 83,686 cases registered in the Surveillance, Epidemiology, and End Results (SEER) program of women diagnosed with nonmetastatic T1-T2 primary breast carcinoma between 1988 and 1997, in whom axillary node dissection was performed. The end-point was death from breast cancer. Cox models based on different expressions of nodal involvement were compared using the Nagelkerke R2 index (R2N). Ratios were modeled as percentage and as log odds of involved nodes. Log odds were estimated in a way that avoids singularities (zero values) by using the empirical logistic transform., Results: In node-negative cases both the number of nodes excised and the log odds were significant, with hazard ratios of 0.991 (95% confidence interval 0.986-0.997) and 1.150 (1.058-1.249), respectively, but without improving R2N. In node-positive cases the hazard ratios were 1.003-1.088 for the number of involved nodes, 0.966-1.005 for the number of excised nodes, 1.015-1.017 for the percentage, and 1.344-1.381 for the log odds. R2N improved from 0.067 (no nodal covariate) to 0.102 (models based on counts only) and to 0.108 (models based on ratios)., Discussion: Ratios are simple optimal predictors, in that they provide at least the same prognostic value as the more traditional staging based on counting of involved nodes, without replacing them with a needlessly complicated alternative. They can be viewed as a per patient standardization in which the number of involved nodes is standardized to the number of nodes excised. In an extension to the study, ratios were validated in a comparison with categorized staging measures using blinded data from the San Jose-Monterey cancer registry. A ratio based prognostic index was also derived. It improved the Nottingham Prognostic Index without compromising on simplicity.

Introduction: The TNM classification of breast carcinomas has substantially changed. Both the newly implemented Hungarian breast cancer screening programme and the national cancer registry require the adequate reporting of the disease with particular emphasis on its extent., Aims: The purpose of this article is to introduce the new TNM classification., Methods: Description of the breast cancer related definitions and of the general guidelines that have to be applied for the staging of breast carcinomas. The TNM categories are presented in a practical, partly tabulated format with examples and background information., Conclusion: Breast cancers are advised to be reported according to the new TNM classification from January 2003.

Background: Uterine adenomatoid tumors may be present in up to 1% of hysterectomy specimens, and their infiltrative pattern may simulate that of adenocarcinomas., Case: This is a report on the coexistence of a uterine adenomatoid tumor and an endometrial adenocarcinoma, both chance findings in a 41-year-old woman undergoing hysterectomy because of a preoperative diagnosis of metrorrhagia due to leiomyomas., Conclusion: Although uterine adenomatoid tumors are believed to be rare, they may pose a differential diagnostic problem in the pathologic staging of endometrial carcinomas, because they form gland-like lumina and infiltrate the myometrium. To our knowledge, no previous coexistence of these two tumors has been reported.

A case of eosinophilic gastritis is reported in a 65-year-old woman. The disease presented with signs of delayed emptying, vomiting and substantial thickening of the antrum. Partial gastrectomy was performed because of the suspicion of gastric cancer and pyloric stenosis. Histopathology established the diagnosis of eosinophilic gastritis of mural type. Clinicopathological features of the disease, as well as its differential diagnosis are summarised in the discussion.

This review summarizes data related to the pathological assessment and interpretation issues of sentinel lymph nodes in melanoma patients. After a short description of conventional nodal staging of melanoma, separate sections deal with detailed analysis of sentinel nodes, the use of immunohistochemistry, molecular analysis of occult metastases and the possibilities and limitations of intraoperative assessment. Possible pitfalls of each method are also discussed. Finally, research areas related to sentinel nodes are highlighted, too.

Unlabelled: Sentinel lymph node mapping has already been accepted as part of the treatment for malignant melanomas of the skin and in breast carcinomas. The status of lymph nodes is an important prognostic marker in colorectal carcinoma as well. The authors tried the feasibility of this technique in colorectal carcinomas. The technique is analogous to the one used in breast cancer and melanoma: 2 ml of 2.5% Patentblau dye was given subserosally around the tumor. After resection the specimen was immediately sent to pathology where the lymph nodes were removed. This technique has been tried on 31 patients, 22 with colonic and 9 with rectal tumors. Of these patients, 15 were Dukes stage C, 14 were Dukes stage B and 2 were Dukes stage A. An average 4.3 blue lymph nodes were found in colon tumors and 5.4 in rectal tumors and an average 14 unstained lymph nodes were found in colon tumors, and 7 in rectal tumors. The blue nodes were predictive of the nodal status in 9 of the 15 Dukes stage C patients. In these cases the blue lymph nodes contained metastases and there were 2 cases where metastases were limited to the blue lymph nodes., Summary: The authors found a high false negative rate for lymphatic mapping with the vital dye technique, therefore they try to change the method according to that used by Saha et al. The aim of sentinel node identification in colorectal carcinomas would be improved staging rather than reducing of the extent of lymphadenectomy. The role of lymphatic mapping in large bowel cancers needs further investigations. Until the results are reliable, as many lymph nodes as possible have to be excited and sent for histology.

Polymiositis/scleroderma autoantibody positive scleroderma with dermatomyositis connected to interstitial lung fibrosis is reported. The recently observed overlap syndrome is characterised by the presence of special autoantibodies, HLA-type association and benign course. A new skin symptom (mechanic's hands) is described which may indicate the syndrome and one of its important internal manifestations, the interstitial lung disease.

Background and Objectives: Because of the existing controversy, we searched for a cutoff value for the number of lymph nodes (LNs) to be examined in order to establish a reliable node-negative stage in colorectal carcinomas (CRCs)., Methods: From the SEER database, 8,574 T3N0M0 first, single, histologically confirmed, surgically treated CRCs, with at least 1 LN examined histologically, were considered. As a first approach, the relationships between number of examined LNs and 5- and 10-year overall survival (OS) rates, computed by the Kaplan-Meier method, were assessed. Next, multivariate analysis was performed; a proportional hazards model was fitted to the data and used to obtain a smoothed plot of the martingale residuals vs. the number of negative LNs., Results: Both OS rates displayed an improvement with an increase of number of LNs examined. The smoothed plot of the martingale residuals against the number of negative LNs was reasonably linear., Conclusions: Both approaches suggest that there is no cutoff value for the number of LNs to be examined for an adequate nodal staging; for a reliable pN0 staging, as many LNs should be assessed as possible. However, qualitative features of lymph nodes (e.g., those identified by sentinel lymphadenectomy) may alter this recommendation., (Copyright 2002 Wiley-Liss, Inc.)

Purpose: Recent evidence from our laboratory suggests that the factors of tumor site, patient gender, microsatellite instability, and mutations are important determinants in the survival benefit associated with adjuvant chemotherapy in Stage III colorectal carcinoma. In the present study we investigated whether these factors, as well as Ki- mutations, were also associated with the extent of nodal involvement in Stage III cancers., Methods: Nodal involvement was retrospectively evaluated in a series of 645 patients with Stage III colorectal cancer from Sir Charles Gairdner Hospital. The number of involved nodes was correlated with the clinicopathologic features of gender, age, tumor site, and histologic grade, as well as to the genetic alterations of mutation, Ki- mutation, and microsatellite instability., Results: The median number of nodes examined per tumor was 11 (range, 1-53). Forty-nine percent of cases had one or two involved nodes and 51 percent had three or more involved nodes, the latter feature being associated with significantly reduced patient survival. No differences in the extent of nodal involvement were apparent with respect to tumor site, patient gender, or or Ki- mutation status. Tumors from younger patients (P = 0.025) or with poorly differentiated histology (P = 0.007), were associated with significantly higher nodal burden, whereas the microsatellite instability phenotype was associated with less extensive nodal involvement (P = 0.020). Survival benefits from the use of chemotherapy were apparent for both the low and high nodal involvement groups, although the latter seemed to obtain relatively more benefit. Multivariate analysis of patients treated with chemotherapy found that gender, grade, and microsatellite instability, but not nodal involvement, were independently prognostic for survival., Conclusion: The extent of nodal involvement in Stage III colorectal cancer is related to patient age, tumor grade, and microsatellite instability status, but not to tumor site, patient gender, or Ki- mutation. These results indicate that differences in metastatic nodal burden cannot explain previously observed site, gender, and mutation differences in the response to chemotherapy.

The optimal technique for sentinel lymph node biopsy (SLNB) is still debated. SLNB with peritumoral injection of Patent blue dye was performed in 129 clinically T1-T2 and N0 breast cancers in 127 patients (group A); it was later replaced by combined dye and radiocolloid-guided SLNB preceded by lymphoscintigraphy in 72 breast cancer patients (group B). This study compares these two methods. All patients underwent completion axillary dissection. Means of 1.4 and 1.3 SLNs were identified in groups A and B, respectively. The mean number of non-SLNs for the whole series was 14.9 (range 5-42). The first 53 cases of lymphatic mapping (dye only) comprised the institutional learning period during which the identification rate of at least 1 SLN in 30 consecutive attempts reached 90%. The identification rate for the subsequent 76 group A patients was 92%. The accuracy rate of SLNBs for overall axillary nodal status prediction and the false-negative rate for group A patients (after excluding the learning-phase cases) were 93% and 10%, respectively. All 72 group B cases had at least one SLN identified, and only one false-negative case occurred in this group (accuracy and false-negative rates of 99% and 3%, respectively). Both the dye-only and the combined SLNB methods are suitable for SLN identification, but the latter works better and results in higher accuracy, a higher negative predictive value, and a lower false-negative rate. It is therefore the method of choice.

Introduction: The optimal technique of sentinel node biopsy (SNB) is still debated., Aims: To compare two methods of SNB, describe the learning phase, the validation of the methods and the first results after implementing SNB as standard of care in selected breast cancer patients., Patients and Methods: SNB with peritumoral or intratumoral injection of Patent blue dye only was performed in 129 clinically T1-T2 and N0 breast cancers in 127 patients (Group A); it was later replaced by combined dye and radiocolloid-guided SNB preceded by lymphoscintigraphy in 72 breast cancer patients (Group B). All patients underwent completion axillary dissection. Group C, to date, comprises 50 patients, in whom axillary dissection was performed on the basis of the SNB. Intraoperative imprint cytology was performed, and whenever positive, the axillary dissection was completed in the same step, whereas in cases of negative cytology findings but positive final histology, the dissection was done as a second operation. Histopathological assessment of SNs involved step sectioning and immunohistochemistry., Results: Means of 1.4 and 1.3 SNs were identified in Groups A and B, respectively. The mean number of non-SNs for the whole series was 14.7 (range 5-42). The first 53 cases of lymphatic mapping with patent blue dye comprised the institutional learning period, during which the identification rate of at least 1 SN in 30 consecutive attempts reached 90%. The identification rate for the subsequent 76 Group A patients was 92%. The accuracy of SNB for overall axillary nodal status prediction and the false-negative rate for Group A patients (after exclusion of the learning-phase cases) were 93% and 10%, respectively. All 72 Group B cases had at least 1 SN identified, and only 1 false-negative case occurred in this group, i.e. the accuracy and false-negative rate were 99% and 3%, respectively. The identification rate in Group C was 98%; axillary dissection could be avoided in 25 patients, it was performed at the same time as the SNB in 15 and as a second operation in 10. Till now, no axillary recurrence was detected in Group C patients, although the follow-up period is short for the moment., Conclusions: The dye only and the radioguided SNB methods are complementary, their combination improves the performance, and can be the basis of performing axillary dissection on the basis of SNB results. After the technique of SNB has been validated in a given institution, it can become standard of care in a well selected group of patients, but requires a close follow up.

A case of invasive carcinoma of mixed papillary and not otherwise specified ductal type with areas of solid papillary ductal carcinoma in situ(DCIS) is reported. The solid papillary areas were predominantly of low nuclear grade, but a small area of intermediate-grade solid papillary neoplasm was also seen within the tumor, together with an area suggestive of microinvasion. The massive regional nodal tumor load consisted of invasive papillary carcinoma and revertant low-grade solid papillary carcinoma with no myoepithelial cells around the circumscribed solid papillary areas. This is the first report of a solid papillary pattern simulating intraductal carcinoma in lymph nodes, and the first time that a solid papillary carcinoma is reported in association with invasive papillary carcinoma. The case suggests that mammary carcinomas with a solid papillary pattern may sometimes be of higher grade than usual, and do not always represent a DCIS, but may be invasive.

Objective: To report a rare case of tumour-to-tumour metastasis with differential diagnostic considerations., Methods and Results: We report the operation of a Sylvian fissure secretory meningioma in a 48 year-old woman. The tumour was suspicious of a metastasis related to a pulmonary adenocarcinoma operated 4 months before. Histopathology confirmed metastatic adenocarcinoma in a secretory meningioma., Conclusions: Both secretory meningioma and tumour-to-tumour metastasis are rare, and to our knowledge this is the first report of such a rare coincidence. Secretory meningioma can simulate metastases both clinically (extensive oedema, space occupation, carcinoembryonic antigen secretion) and pathologically (secretory inclusions, positivity for cytokeratin 7 and carcinoembryonic antigen and negativity for vimentin), and therefore may cause a special differential diagnostic dilemma.

Purpose: Ductal carcinoma in situ (DCIS) of the breast is defined as stage 0 disease, but its diagnosis is subject to sampling errors. This study was conducted to assess the usefulness of sentinel lymph node biopsy (SLNB) for furnishing indirect evidence of the invasion of tumors diagnosed as DCIS., Methods: A total of 201 SLNB procedures performed using a peritumoral tracer, being either dye alone or dye plus 99mTc-labeled colloidal albumin, were reviewed. The cases of DCIS were selected for analysis, and the results were compared with published data., Results: Among ten cases of DCIS studied by SLNB, only one had micrometastatic nodal involvement, which was revealed by cytokeratin immunostaining, and was limited to the sentinel node. This was a large intermediate-grade micropapillary/cribriform-type DCIS., Conclusion: These findings indicate that while SLNB may be a valuable tool for the staging of tumors diagnosed as DCIS, it should not be performed in all cases, but probably restricted to large, high-grade, or comedo-type intraductal carcinomas.

Both chromophobe carcinoma and sarcomatoid carcinoma of the kidney are rare. The former is characterized by a relatively good prognosis, while the latter is a highly aggressive tumor. Coexistence of the two components in one renal tumor, which has been reported only rarely, is therefore paradoxical. Both sarcomatoid and chromophobe renal carcinoma were diagnosed in a 52-year-old woman following nephrectomy and resection of metastases in the right lobe of the liver. She died of the disease two months after the first operation; only the sarcomatoid component of her tumor was seen in the liver metastasis and the recurrent carcinoma. Differences in phenotype, immunophenotype and DNA-ploidy patterns of the two components are reported. The intensive p53 staining observed only in the sarcomatoid area supports the role of the TP53 gene in the transformation of chromophobe renal carcinoma to sarcomatoid carcinoma.

We report a single case of chronic granulomatous lobular mastitis following metoclopramide-related galactorrhea and a blunt trauma in a young parous woman who underwent two conservative operations before becoming symptom-free. We have found only two other literature cases associated with hyperprolactinemia, and our case could be another of this etiologic group. The absence of well-formed granulomas in the first histology specimen in the present case was misleading; it was reinterpreted as granulomatous mastitis only after the second specimen was examined. Reinterpretation was based on the lobular distribution of a lymphoplasmocytic infiltrate (nonspecific chronic lobulitis) and the presence of epithelioid cell sheets and neutrophils in the absence of well-formed granulomas. The case lends further support to the theory of a local immune response initiated by the secreted material or by one of its components in the formation of granulomas. However, contributory factors such as the trauma in this case (a blow from a shovel handle) or systemic disease in others may play a role in the development of the disease, which in some instances may represent a pattern of tissue reactions to different noxious agents.

Cystic hypersecretory carcinoma (CHC) is a rare variant of intraductal carcinoma. A CHC in a 50-year-old woman was excised and processed for light and electron microscopy and immunohistochemistry. The tumor had a marked cystic appearance. The walls of the cysts consisted of epithelial and myoepithelial cells and a well-developed basement membrane. The epithelial cells contained well-developed rough-surfaced endoplasmatic reticulum and Golgi apparatus. Secretory granules were not detected, with the exception of a few mucus-producing cells. The secretion was predominantly homogenous, reminiscent of thyroid colloid, and demonstrated distinct PAS positivity. The cells displayed a strong labeling with epithelial membrane antigen (EMA) and EMA-positive structures were observed within the intraluminal secretion, too. Some of these were stained by alcian blue. In addition, the colloid-like material was admixed with mucus showing a filamentous internal structure and lipid droplets resulting in some heterogenity of the secretion. Intraductal micropapillary proliferation in some of the cysts and adjacent nondistended ducts was a further defining feature of the tumor. Steroid hormone receptor and Ki-67 proliferation marker immuno his Tochemistry showed scattered positivity among the tumor cells. These results are in agreement with previous observations and further clarify the nature of this low-grade in situ cancer.

The benign to malignant ratio (BMR) of open surgical biopsies is often used to monitor the efficacy of diagnostic workup of breast lesions. Avoiding the unnecessary removal of benign lesions is of recognized importance. Histopathology archives of the Department of Pathology of the Bács-Kiskun County Hospital were retrieved for breast lesions and the BMR of surgical specimens was determined for each year between the period of 1965-1996. The introduction of mammography and especially fine-needle aspiration cytology was paralleled by a reduction in the benign to malignant ratio from 1.7 to 0.7. Only the introduction of breast aspiration cytology seemed to have a significant effect on the BMR, but the more adequate diagnostic approach to breast lesions (mostly palpable in their nature) was in part masqueraded by the late shift in attitude of both surgeons and patients towards breast lumps. This is why the BMR can give a basic information on preoperative diagnostic workup of breast lesions, but in itself it is not able to monitor them.