2008 Summer Meeting - Leeds - The Pathological Society of Great ...

P37Eosinophilic Mastitis Associated with Montelukast Treatmentof AsthmaS Weischede 1 , PA Smith 1 ,AJ Waghorn 1 , TR Helliwell 2 .1 Royal Liverpool University Hospital NHS Trust, 2 University of LiverpoolMontelukast is a cysteinyl-leukotriene antagonist that significantly improvesasthma control in corticosteroid-treated asthmatic patients. Some patients whoare treated with montelukast develop eosinophilia, pulmonary infiltrates andvasculitis.A 14-year-old girl with severe asthma, treated with high dose steroids, wasstarted on treatment with montelukast in the summer of 2007 at the same timethat steroid treatment was reduced. She has no other known immunologicaldisorders. By the end of 2007, she had developed a swelling measuring 10x7cm in the left breast, accompanied by a smaller lesion in the right breast.Clinical evaluation suggested the presence of a phyllodes tumour orfibroadenoma. Fine needle aspiration cytology showed numerous eosinophils.Wide bore needle core biopsies showed dilated ducts containing necroticeosinophilic debris, surrounded by an intense infiltrate of eosinophils, plasmacells and mast cells. There was no evidence of granulomatous inflammation orvasculitis. Montelukast was discontinued and there has been partial regressionof the swelling over a two month period.These very unusual findings could represent an idiopathic eosinophilicmastitis but, in the clinical context, a side effect of montelukast seems morelikely. Eosinophilic mastitis appears to be a novel observation in associationwith montelukast treatment. Whether the eosinophilic infiltration represents atrue side effect of the drug or reflects unmasking of a pre-existing Churg-Strauss syndrome following steroid withdrawal, is uncertain.P39The Clinical and Histopathological Significance of PerformingSurgical Cavity Random Biopsies in Breast ConservingSurgerySRahmani 1 ,RGendy 2 .1 Leeds General Infirmary, 2 Staffordshire General HospitalBackgroundSurgical treatment of breast cancer has changed dramatically in recent years.The National Institutes of Health Consensus Panel confirmed that breastconservationsurgery (BCS) is as effective as mastectomy in overall patients’survival. Our aim was to assess the clinical and pathological value ofperforming surgical cavity random biopsies (SCRB) in BCS and their impact onthe subsequent management.Materials and MethodsA retrospective study was conducted on 494 patients who had BCS in our firmbetween 2001 and 2006. Outcome measures were examined at 3,4,5 yearsfollow up period for each patient. Tumour immunohistochemistry, adjuvanttherapy, recurrence rate and Demographic data were collected and representedwith Pearson’s chi-squared test.ResultsThe median age was 59 years. Out of 494, 23 patients (4.65%) had positiveSCRB whom all had subsequent surgical intervention plus adjuvant therapy. 7patients had total mastectomy, 13 had re-excision of positive margins and only3 had axillary node clearance. Recurrence rate was reported in 7 patients only(1.41%) and the overall mean survival time for all patients was 74.585 months(95% C.I 73.839-75.332).ConclusionOur practice of performing SCRB had changed the management of 23 patientsand revealed an excellent recurrence rate of 1.41% which is below the nationalfigures reported in the literatures (7-9%). SCRB is a reliable method ofdetermining margin status, minimising re-excision and reducing overallrecurrence rate.P38Caveolin 1 and Caveolin 2 are associated with breast cancerbasal-like and triple negative immunophenotypeS. El Sheikh 1,2 , A Green 1 ,ERakha 1 , R Samaka 2 , J Reis-Filho 3 ,I Ellis 11 Department of Histopathology, School of Molecular Medical Sciences,Nottingham, 2 Department of Histopathology , Faculty of Medicine,Menoufiya University, Egypt, 3 The Breakthrough Breast Cancer ResearchCentre, Institute of Cancer Research, LondonBackground:Caveolin-1 (CAV1) and caveolin 2 (CAV2) are the principal structural proteinsof caveolae, sphingolipid and cholesterol-rich invaginations of the plasmamembrane involved in vesicular trafficking and signal transduction. Over therecent years there has been controversy about their role in breast cancer andtheir suitability as markers of basal-like phenotype.Material and Methods:CAV1 and CAV2 protein expressions were assessed on a tissue microarraycontaining 880 unselected invasive breast cancer cases, by means ofimmunohistochemistry.Results:CAV1 and CAV2 expression was observed in 13.4% and 5.9% of all breastcancer, respectively. Their expression was strongly associated with highhistological grade, lack of steroid hormone receptor positivity (ER and PR), andexpression of basal markers (basal cytokeratins, P63, P-cadherin). Furthermorethere was a significant association between CAV1 and CAV2 expression andbasal-like phenotype. On univariate analysis only CAV2 had a prognosticimpact on breast cancer-specific survival; however, this was not independentfrom other traditional markers on multivariate analysis.Conclusion:Our results demonstrate that both CAV1 and CAV2 are associated with basallikephenotype. Further studies are warranted to determine whether they play anoncogenic role in basal-like/ triple negative breast cancer development or arejust surrogate markers for this subgroup.P40The Clinical and Histopathological Impact of PerformingSurgical Cavity Random Biopsies On The Long-TermOutcome Of Breast Conserving Surgery, Literatures Review.SRahmani 1 .1 Leeds General InfirmaryBackgroundSurgical treatment of breast cancer has changed significantly in recent years.The significance of recurrence rate following breast-conserving surgery (BCS)and its relationship to long-term outcome remains a matter of debate. The aimof this literature review was to assess the impact of performing tumour-bedsampling to ensure the completeness of surgical excision after BCS.Materials and MethodsA structured literature review was performed from 1987–2007 using Medline,Embase, Cochrane Library and also retrieving original papers cited from relatedreferences. Full papers were compared together with regard to demographics,incidence of positive biopsies, rate of re-operation, adjuvant therapy andrecurrence rate.ResultsLiteratures search has identified a total of 27 papers, 13 of those related to theresection margins, hence only 14 papers were included in this search invlovingthe surgical cavity random biopsy. The total number of patients reviewed were2862 with a mean of 204.4. The median age was 56.23 years. 770 patients(26.89%) had residual tumour and further surgery was performed in 365patients (47.46%) with the rest having adjuvant therapy. Regional and distalrecurrence was noted in 9.35% of patients after tumour resection.ConclusionThe aim of breast-conserving surgery is to excise the tumour completely andachieve an excellent cosmetic result without compromising the degree of localdisease clearance offered by mastectomy. Cavity shaving is a practical andsensitive method of assessing completeness of excision as well as providinguseful prognostic information in BCS.Summer Meeting (194 th ) 1–4 July 2008 Scientific Programme41