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The study was undertaken to define the capabilities of cytological assay in the detection of metastatic lymph node lesions. A total of 6794 lymph nodes, including 5206 fine-needle biopsy specimens of and 1588 scrapes and imprints of the lymph nodes taken from the patients operated on at the P. A. Herzen Moscow Oncological Research Institute, were analyzed. Cytological specimens were stained using the modified Pappenheim procedure (azur-eosin mixtures). The results of the cytological assay were compared with those of a planned histological examination of the lymph nodes. Overall, the accuracy of the cytological technique was 99%; false-negative and false-positive results were 0.8 and 0.2%, respectively. That of intraoperative cytological diagnosis of metastatic lymph node lesions was 99.2%. The cytological technique for examining the lymph nodes is a simple, available, and valid method of morphological diagnosis. Errors can be made in cases of micrometastases, sinus histiocytosis. There may be problems in the differential diagnosis of tumor cells and inflammatory elements.

A hundred and twenty-nine cytograms of benign tumors of the breast with different degrees of its dysplasia were morphometrically analyzed, by using a "MECOS-Ts" set for digital microscopy. The informative differentially diagnostic morphometric signs of nuclei were identified in mild, moderate, and severe epithelial dysplasias of the breast. The derived quantitative decision rules may reduce the error of a differential diagnosis of severe dysplasia by 2-3.5 times, as compared with a visual microscopy-based diagnosis.

The most informative for differential diagnosis parameters (surface and nucleus polarization) were determined on the basis of morphometric analysis of 42 cytograms of invasive duct cancer (IDC) and 39 cytograms of invasive lobular breast cancer (ILC) using the computer analyzer MEKOC-C. Combination of these two parameters allowed the authors to elaborate a decisive rule for differential diagnosis of these two cancers (the mistake is reduced to 8.6%). The analysis of 8 informative morphometric nuclear parameters has shown that in ILC the nuclei are more monomorphic, less in square and perimeter, nucleoli are less numerous than in IDC. The study gives objective criteria for preoperative differential cytological diagnosis between IDC and ILC.

186 cases of intraductal carcinoma have been analyzed. Twelve morphological variants and three degrees of differentiation are distinguished. Different results of the treatment of patients with the same clinical diagnosis "carcinoma in situ" may be explained by heterogeneity of intraductal carcinoma.

Primary multiplicity (PM) of mammary carcinoma is found in 669 (39%) cases of 1690 invasive tumors. PM is more typical for invasive ductal carcinoma with predominance of the intraductal component (67%), Paget cancer (61%), invasive lobular carcinoma (55.5%) and tubular carcinoma (52%). Invasive PM develops in the presence of the corresponding background with areas of grave dysplasia and intraepithelial carcinoma. True PM does not influence the disease prognosis.

With the use of antibodies against factor VIII, vascular bed (number, surface and caliber of vessels) was studied in 64 cases of invasive ductal carcinoma and in normal breast tissue. The trend to a decrease of the vessels number with growing size of the tumor and emergence of lymph node metastases was observed. No difference was found in the development of vascular bed depending on the degree of malignancy, clinical course, tumor or normal breast tissue.

Primary and recurring breast carcinomas do not differ in the expression of proliferating cell nuclear antigen (PCNA), C-erb-2 oncoprotein, carcinoembryonic antigen and trophoblastic antigen. The content of PCNA and C-erb-2 oncoprotein is twice as high in tumors with an unfavorable prognosis and the frequency of combination of these markers is much higher comparing to tumors with a good prognosis.

3 groups are distinguished among 219 cases of the breast carcinoma with mucus formation: one-component colloid carcinoma, combined colloid carcinoma and signet ring cell carcinoma. Morphological features and prognosis for each group are listed. One-component colloid carcinoma has the most favourable prognosis: incidence of distant metastases 15% versus 27% and 33% in combined colloid and signet ring cell carcinoma, respectively. Signet ring cell carcinoma should obviously be regarded as a variant of invasive lobular carcinoma.

Mammary carcinoma (MC) of various histological structure are studied immunomorphologically. Positive reaction with proliferative cells nuclear antigen (PCNA) oncoprotein cerbB-2, carcinoembryonic antigen (CEA), trophoblastic beta 1 globulin (TBG) and tissue protein ferritin (Fe) was observed in one third, and with cyprein in half of MC cases. Clear-cut dependence of immunomorphological parameters upon histologic structure and degree of malignancy was not established. An increase of PCNA content with the tumor size increase was observed. There is a tendency to more frequent observation of CEA, Fe, TBG in the presence of the lymph nodes metastases. Most unfavourable for the prognosis are combinations of positive reactions of CEA with TBG, CEA with OCNA, CEA with cerbB-2 as well as PCNA, cerbB-2, CEA.

Three groups of metaplastic mammary carcinoma are distinguished: squamous cell carcinoma, invasive ductal carcinoma with partial squamous metaplasia and carcinoma with formation of heterologous elements. Squamous cell carcinoma is subdivided into 5 variants: solid and spindle cell variants, carcinoma in preexisting cyst and fibroadenoma; carcinoma resulting from total squamous metaplasia of invasive ductal carcinoma. Squamous cell mammary carcinoma has a relatively favourable prognosis. Partial squamous metaplasia has minimal influence on the course of the disease.

844 observations of mammary carcinoma special forms were analyzed. In 48% of cases there was a combined structure, primary multiple carcinoma was in 23.6%, bilateral in 2.8% cases. Morphological and immunohistochemical investigation with use of monoclonal antibodies to the membrane antigen of lipid globules were performed. The clinical features of different forms are described.

One hundred and ten cases of precancer and early ductal breast cancer were analysed. Patterns of non-invasive ductal cancer were identified. Multicentric growth was observed in 55.8% of patients with intraductal cancer and invasive ductal cancer with predominant intraductal component. Early ductal cancer proved to have favorable prognosis, with only 2.2% of patients with disseminated tumor and 4.4% of those with recurrence identified during the mean follow-up period of 53.5 months.

In 1989 the P. A. Hertzen Moscow Research Cancer Institute initiated a trial of high-energy CO2-laser in surgical treatment of breast cancer. Altogether 180 operations were performed. The data are presented on specific features of the laser incision and related breast tissue destruction, factors responsible for variations in the above parameters, laser scalpel advantages.

Combined treatment was used in 380 patients with breast cancer stage IIB, IIIA and IIIB. Preoperative therapy included large-fraction radiation (213 patients) or CMP chemotherapy course (176 patients). It was followed by radical mastectomy and postoperative chemotherapy, radiation. Cytograms of the specimens from the removed tumors were compared to pretreatment findings. This served the basis for recognition of 4 degrees of breast cancer pathomorphosis. The scheme can be used as additional morphological information on the degree of the breast cancer destruction and should be taken into consideration together with other data.

Features of pathomorphism of mammary carcinoma were studied in 177 women after a course of drug therapy. Qualitative and quantitative morphologic changes in the tumor were poorly manifest: they were detected in only 54 percent of patients and only in 9 percent the effect was manifest (third-fourth stage of involvement). Characteristic findings here were augmentation of cellular dystrophy, necrotic changes, enhanced nuclear polymorphism; significant injury to tumor parenchyma was paralleled by development of xanthomatosis foci and lymphoid histiocytic infiltration.

Histology and ultrastructure of human granular cell tumors (GCT) are studied. Apart from "granular" cells which are the main component of the tumor, GCT contain the cells of ordinary structure with signs of neurogenic differentiation, cell processus typical for the nervous tissue and peripheral nervous tissue tumors (these processus are in a close space connection with "granular" cells) as well as structurally transitional cells. This implies that "granular" cells are likely to originate from the ordinary lemmocytes as a result of disturbance and hypertrophy of intracellular processus. Preoperative diagnosis of this rare peculiar neurogenic tumor is difficult and the diagnosis is possible only after the operative material examination. If other signs of malignancy are lacking, infiltrative growth typical for these tumors allows one to consider them locally-destructive neoplasms.

Basing on a comparative study of the results of combined treatment (irradiation + operation) and surgery alone provided to patients with extra-abdominal desmoid (ED) the authors reach a conclusion that preoperative gamma-beam therapy can be regarded as an important means of recurrence prevention. In incomplete resection of tumors the treatment should be supplemented by postoperative irradiation, because in radiotherapy alone cure can be achieved with high summary doses only. It is still difficult to judge of the advantages of irradiation of ED under the conditions of hyperbaric oxygenation by the frequency of recurrences.

The following four types of tubular carcinoma of the breast were identified as a result of the study of 39 cases: typical tubular carcinoma of the breast; tubular mammary carcinoma with ductal invasion; ductal invasive carcinoma with tubular structures predominating over more than half the area of section; ductal invasive carcinoma incorporating few tubular structures. A specific clinico-morphological picture and prognosis are peculiar to each type of carcinoma. Tubular carcinoma of the breast and ductal invasive tumor with predominant tubular structures have a favorable prognosis and a regional metastasis frequency of 23-28%, practically without distant metastases. Tubular carcinoma of the breast is considered an early form of ductal invasive carcinoma which develops into other histological patterns as tumor growth progresses.

A total of 93 patients were assigned to receive either radiation treatment alone (group 1) or in combination with local microwave-induced hyperthermia (group 2) prior to mastectomy. The treatment results were compared. Within a two-year follow-up period, all patients of group 2 remained free of relapse, metastases being registered in 2 (6.2%) cases. In group 1, relapse was observed in 1 case, whereas metastasis--in 7 (11.5%). The study failed to establish drug-induced tumor pathomorphosis in 12.5% in group 2 and 73.8% in group 1. The procedure did not interfere with surgery, nor was it followed by an increased postoperative complication rate.