P9Mistletoe should be reserved for Christmas only and not usedas anti-cancer drugZ Alshiekhali 1 , DFish 21 Darent and Valley Hospital, Dartford, Kent, 2 Preston Hall Hospital,Maidstone, KentA 42 year old women with previous history <strong>of</strong> breast cancer, presented withchest wall subcutaneous mass. <strong>The</strong> possibility <strong>of</strong> metastatic breast cancer wasraised.Core biopsy was performed and two cores <strong>of</strong> pale brown tissue was send to thehistopathology department. Microscopically, we identified cores <strong>of</strong> adiposetissue and part <strong>of</strong> lymph node with focal necrosis and perinodal acuteinflammation (lymphadenitis). <strong>The</strong>se changes were interpreted as secondary tochemotherapy and radiotherapy treatment. In summary we found no evidence<strong>of</strong> malignancy, confirmed by immunohistochemistry. After discussion the caseat the multidisciplinary meeting, it transpired that the patient had been receivingsubcutaneous injections <strong>of</strong> mistletoe extract as complementary therapy.Discussion:Mistletoe is a semi parasitic perennial, it is used as a Christmas decoration withthe traditional <strong>of</strong> kissing any person who lingers under it.Mistletoe has been tested extensively as a treatment for cancer, but the mostreliable randomised controlled trails fail to show benefit, and some reportsshow considerable potential harm. Today, despite the lack <strong>of</strong> robust datasupporting the use <strong>of</strong> mistletoe as an anticancer drug, it is widely used inmiddle Europe. Wide ranges <strong>of</strong> serious adverse reactions have been noted, suchas anaphylaxis, dyspnoea and lymphengitis.This case taught us the importance <strong>of</strong> good communication, and the honestworking relationship between the pathologist and the surgeon, and between thesurgeon and the patient. This story also shows that patients sometime withholdinformation from us and may assume that alternative therapies have norelevance in conventional medical consultation.P11Beta-catenin is Expressed within the Nuclei <strong>of</strong> Fibroblasts inBreast CancerE Verghese 1,2 ,JHowarth 1 , HG Shenoy 1,2 , AM Shaaban 1,2 ,A Waterworth 2 , MB Peter 1,2 ,KHorgan 1 ,VSpeirs 2 , AM Hanby 1,2 ,TA Hughes 21 <strong>Leeds</strong> Teaching Hospital NHS Trust,<strong>Leeds</strong>, UK, 2 <strong>Leeds</strong> University, <strong>Leeds</strong>,UKBackground-catenin, when located within the nucleus, acts as an oncoprotein by activatingTCF/LEF transcription factors. Nuclear -catenin is frequently seen in epithelialcancer cells. However, breast tumours are unusual in that nuclear -catenin isrelatively rare in epithelial breast cancer cells. On the other hand, nuclear -catenin expression has been documented in fibroblasts within breastfibroadenomas and benign phyllodes tumours. Preliminary observations withinour laboratory indicated that stromal fibroblast in and around breast carcinomasalso frequently express nuclear -catenin. Our aim in this work was to validatethis observation, and correlate its expression with other biological parametersand survival.MethodsWe performed immunohistochemistry for -catenin on whole sections <strong>of</strong>breast cancers from 200 individual cases. A scoring system based on thenumber <strong>of</strong> fibroblasts expressing nuclear -catenin was devised and fibroblastswithin tumour and normal breast tissue were scored by two observers. Survivaldata and biological indicators <strong>of</strong> prognosis including size, grade and lymphnode status were obtained. Data were analysed using SPSS statistical s<strong>of</strong>tware.ResultsWe found that fibroblasts expressing nuclear -catenin are frequent in andaround breast tumours, while they are very rare in normal breast tissue. Initialsurvival analysis has shown that an increased number <strong>of</strong> fibroblast expressingnuclear beta-catenin correlated with a decrease survival. Further multivariateanalysis will be undertaken to investigate the relationship between nuclear betacateninexpression in fibroblast and tumour size, grade and lymph node status.P10Reduced transforming growth factor beta induced gene andprotein in breast cancerDTouma 1 ,SLambe 1 ,JA Shaw 1 , RA Walker 11 University <strong>of</strong> LeicesterWe have previously reported that breast cancers in women 35yrs have moreaggressive features than those <strong>of</strong> older women. To examine this further a pilotcDNA microarray comparing cancers from women 35yrs and normal breast wasperformed. Of the genes upregulated in cancers several were selected for furtherstudy, including Transforming Growth Factor Beta Induced (TGFBI). <strong>The</strong>re isconflicting evidence about the role <strong>of</strong> TGFBI in tumourigenesis, and itsadhesive and proliferative functions.Expression <strong>of</strong> TGFBI in 6 breast cell lines, normal breast organoids and 21frozen breast cancers (10 35 yrs; 11>35 yrs) was analysed by quantitative RT-PCR. Protein analysis was by western blotting <strong>of</strong> the same cell lines and furtherorganoids, and by immunohistochemistry <strong>of</strong> normal breast and 55 cancers (17 35yrs; 17 36-49 yrs; 21 50 yrs).In contrast to the microarray data there was reduced expression by qPCR inyounger (P=0.026) and older (P=0.001) breast cancer cases compared tonormal. HBL100 had high RNA expression but low level protein, whereas bothwere absent in cancer cell lines. TGFBI was present in normal breast organoidsand by immunohistochemistry as strong nuclear staining. 37/55 cancers had noor low level staining. <strong>The</strong>re was a significant correlation between lack <strong>of</strong>staining and grade III (P=0.008). <strong>The</strong> cancers from women 36-49 yrs had lowerstaining in comparison to 50yrs group (P=0.039). Further studies are needed todetermine the role <strong>of</strong> TGFBI in breast cancer.P12<strong>The</strong> Prognostic Significance <strong>of</strong> Medullary-Like HistologicalType and Inflammation in Invasive Carcinoma <strong>of</strong> <strong>The</strong> BreastEA Rakha 1 , M Al-Eskandarany 1 , ME El-Sayed 1 , A Evans 1 ,RBlamey 1 , CW Elston 1 , IO Ellis 1 ,AH Lee 11 Nottingham University<strong>The</strong> molecular classification <strong>of</strong> breast cancer recognises medullary carcinomaas a member <strong>of</strong> the basal group. <strong>The</strong> basal group is considered to have a poorprognosis, but medullary carcinoma is believed to have a better prognosis thanother grade 3 carcinomas. Furthermore the prognostic significance <strong>of</strong>inflammation, an important feature <strong>of</strong> medullary carcinomas, is controversial.This study analysed a large well-characterised series <strong>of</strong> breast cancers from1974 to 1988 with up to 30 years follow. No patients received adjuvantsystemic treatment. <strong>The</strong> aim was to assess the prognostic importance <strong>of</strong>medullary histological type and inflammation. Typical and atypical medullarycarcinomas (n = 140) had similar survival, so were grouped together. Almost allrecurrences and deaths from medullary carcinoma occurred in the first 10 years.Medullary carcinoma had a better prognosis than grade 3 ductal carcinoma withprominent inflammation, which in turn had a better prognosis than grade 3ductal carcinoma without prominent inflammation. <strong>The</strong>se differences wereindependent <strong>of</strong> other prognostic factors. <strong>The</strong>se results suggest that typical andatypical medullary carcinomas have a similar prognosis, which questions thecurrent strict diagnostic criteria. Prominent inflammation is associated with abetter prognosis, but it cannot explain the better prognosis in medullarycarcinoma compared with grade 3 ductal carcinoma with prominentinflammation. <strong>The</strong> good prognosis <strong>of</strong> medullary carcinoma emphasises theheterogeneity <strong>of</strong> basal type carcinomas. Further studies are needed toinvestigate the these issues.34 <strong>Summer</strong> <strong>Meeting</strong> (194 th ) 1–4 July <strong>2008</strong> Scientific Programme
P13Can we Improve our Margin Involvement Rate in BreastCancer Excisions? An Audit.HYuen 1 ,CGraham 2 ,JLoane 11 Western General Hospital, Edinburgh, 2 Wellcome Trust ClinicalResearch Facility, EdinburghWe audited our reporting <strong>of</strong> breast cancer excision specimens with particularreference to tumour involvement <strong>of</strong> margins. As our gold standard we usednational figures for Scotland from the British Association <strong>of</strong> SurgicalOncologists which indicate a re-excision rate <strong>of</strong> 14.5% following breastconservation surgery.All breast excision specimens with a diagnosis <strong>of</strong> invasive carcinoma and / orductal carcinoma in-situ (DCIS) over a six month period (July to December2007) were identified from our computer records (n=287) and their reportsreviewed. 273 <strong>of</strong> these had had a pre-operative core biopsy in ourdepartment the results <strong>of</strong> which were reviewed similarly.While 22.6% (65/287) <strong>of</strong> our excision specimens had one or more involvedradial margin, 18.5% (53/287) underwent subsequent re-excision whichcompared favourably with the gold standard.On excision specimens the whole tumour size (p
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