PL1PL2Triple negative (ER, PR and HER2 negative) breast cancer:an appraisal <strong>of</strong> morphology and its prognostic markers{P} E Rakha, A Green, I EllisNottingham University, Nottingham, United KingdomBackground: Triple negative (TN) breast cancer (estrogen receptor (ER),progesterone receptor (PR) and HER2 negative) is a high risk group <strong>of</strong> breastcancer that lacks the benefit <strong>of</strong> specific therapy which targets these proteins.<strong>The</strong> aim <strong>of</strong> this study is to characterize this group and to identify prognosticmarkers which can identify tumours with the more aggressive behaviour.Methods: we have examined a large and well characterized series <strong>of</strong> invasivebreast carcinoma (n=1944) with a long term clinical follow-up (median 56months) using tissue microarray. <strong>The</strong> series were also stained with concurrentimmunohistochemical prognostic biomarkers. Results: TN phenotypeconstituted 16.3% <strong>of</strong> the informative cases. <strong>The</strong>re were positive associationswith larger size, higher grade, pushing margins, poorer Nottingham PrognosticIndex, development <strong>of</strong> recurrence and distant metastasis and shorter survival.In addition, associations were found with loss <strong>of</strong> expression <strong>of</strong> androgen (AR),and E-cadherin and positive expression <strong>of</strong> basal CKs (BP), P-cadherin, p53 andEGFR. In all TN series, tumour size, lymph node (LN) stage and AR were themost useful prognostic markers. In the LN positive subgroup, both size and ARretained their prognostic significance. However, in the LN-negative tumours,BP was the sole prognostic marker identified in this subgroup. Conclusion: TNphenotype is a specific subgroup <strong>of</strong> breast cancer associated with aggressivebehaviour and poor outcome. Assessment <strong>of</strong> AR and BP, in addition to theestablished pathologic variables mainly LN and size, can be used to select highandlow-risk patients at the time <strong>of</strong> primary surgery and can provide valuableinformation on treatment options in these TN tumoursThis abstract is not availablefor publicationuntil after presentationat the <strong>Meeting</strong>PL3Post-Mortem Investigation <strong>of</strong> Sudden Unexpected Death inInfancy: 10-year Experience from a Single Specialist Centre{P} MA Weber, I Brooke, K Wingrove, RA Risdon, M Malone,NJ SebireUCL Institute <strong>of</strong> Child Health and <strong>Great</strong> Ormond Street Hospital forChildren, <strong>London</strong>, United KingdomIntroduction: Sudden unexpected death in infancy (SUDI) constitutes the mostcommon cause <strong>of</strong> non-neonatal death in the first year <strong>of</strong> life. Several autopsyprotocols have been suggested, all <strong>of</strong> which include a range <strong>of</strong> ancillaryinvestigations.Methods: Retrospective analysis <strong>of</strong> >1,500 consecutively performed postmortemexaminations, all <strong>of</strong> which were carried out by specialist paediatricpathologists at a single centre. SUDI was defined as death <strong>of</strong> an infant aged 7 to365 days that was sudden and unexpected. A local autopsy protocol wasfollowed that included the use <strong>of</strong> detailed ancillary investigations. To ensureconsistency for data analysis and interpretation, all data extraction, data entryand classification was carried out by a single paediatric pathologist according toclearly defined criteria.Results: Of 1,516 post-mortem examinations overall, 546 cases presented asSUDI. In a third <strong>of</strong> infants (180 cases) death was explained by the autopsyfindings (“explained SUDI”). <strong>The</strong> other 366 cases (67%) remainedunexplained. Of these, more than 40% were co-sleeping associated deaths.Most deaths occurred in the first 3 months <strong>of</strong> age, and there was no significantseasonal variation. Of the explained deaths, just over half were infective, mostcommonly due to pneumonia, whilst the commonest non-infective causes <strong>of</strong>death included congenital abnormalities, and accidental and non-accidentaldeaths.Discussion: This constitutes the largest single institution autopsy study <strong>of</strong>SUDI. Ten years on from the CESDI study, the ascertainment <strong>of</strong> a cause <strong>of</strong>death at autopsy has not changed, with two thirds <strong>of</strong> SUDI deaths remainingunexplained even after detailed post-mortem examination by a specialistpaediatric pathologist in accordance with current guidelines.PL4Quality <strong>of</strong> surgical resection and short course radiotherapyreduce local recurrence and improve disease free survival inrectal cancer. Preliminary results from the MRC CR07 trial.{P} P Quirke, D Sebag-Montefiore, L Thompson, B Steele,B Grieve, S Khanna, J Monson, Richard Stephens, MRC CR07Trial InvestigatorsMRC Clinical Trials Unit, <strong>London</strong>, United KingdomMRC CR07 randomised to surgery alone with chemoradiotherapy for patientswith an involved circumferential margin (CRM) or 5x5 radiotherapy. Results at3 years are local recurrence (LR) dropped from 11% to 5% (p
PL5Modelling the expansion <strong>of</strong> mutated clones within humancolonic crypts and their migration through the colon{P} SAC McDonald 1 , P. Tadrous, M Bjerknes 5 , M Deheragoda 2 ,SJ Leedham 2 , M Rodriguez-Justo 3 , L Greaves 4 , G Elia 2 ,M Novelli 3 , DM Turnbull 4 , JAZ Jankowski 1 ,NA Wright 61 Oxford University, Oxford, United Kingdom, 2 Cancer Research UK,<strong>London</strong>, United Kingdom, 3 University College Hospitals <strong>London</strong>, <strong>London</strong>,United Kingdom, 4 University <strong>of</strong> Newcastle upon Tyne, Newcastle, UnitedKingdom, 5 University <strong>of</strong> Toronto, Toronto, Canada, 6 Barts and the <strong>London</strong>School <strong>of</strong> Medicine and Dentistry, <strong>London</strong>, United KingdomRecent data from our laboratory has shown that mitochondrial DNA (mtDNA)mutations can spread through the human colon by a process <strong>of</strong> crypt fission,where one crypt is able to divide into two daughters(Proc. Natl. Acad. Sci.103:714-19).Here we show how such mutated cells expand through the human colonic cryptby 3D modelling from serial sections throughout single crypts. This highlightsthat cellular migration within crypts is more complex than originally thoughtand gives insights into actual stem cell location.Furthermore, the rate at which normal human crypts undergo fission isunknown. Bjerknes (J. <strong>The</strong>or. Biol. 179:381-5) developed a mathematicalmodel by which he calculated the rate at which crypts within aberrant crypt fociwere able to expand. This predicts that if an aberrant crypt population wasexpanding at the same rate as normal crypts then the number <strong>of</strong> single aberrantcrypts should be half <strong>of</strong> the number <strong>of</strong> those within foci.Here we use this model to show that crypts deficient in mitochondrialcytochrome c oxidase (CoxSU1) expand at the same rate as those with normalCoxSU1 expression. We have counted the total number <strong>of</strong> deficient cryptswithin tissue sections stained with CoXSU1 from normal colons <strong>of</strong> 35 patients.1298 deficient crypts were observed <strong>of</strong> which 597 were single. This gives aratio <strong>of</strong> singletons to patches <strong>of</strong> 0.46 which are expanding only at 1.15 timesfaster than positive crypts.<strong>The</strong>se data suggest that crypts with or without mtDNA mutations expand at thesame rate and that this is an appropriate model to calculate the crypt fission rate<strong>of</strong> the human colon.PL6Mitochondrial DNA Mutations to Investigate Cell LineageRelations in Human Liver{P} TG Fellous, M Brittan, L Mears, S Bhattacharya, H Kocher,MR AlisonInstitute <strong>of</strong> Cell and Molecular Science, QMUL, <strong>London</strong>, United KingdomCurrent research on human liver regeneration and stem/progenitor cell biologyis hampered by lack <strong>of</strong> a clonal marker. It is now clear that mitochondrial (mt)DNA mutations occur in human liver stem and progenitor cells, and that thesemutations have much potential as a stem cell marker for looking at both theexpansion <strong>of</strong> mutated clones in the liver and for providing a platform forlineage analysis in humans for really the first time. Studying cells withmutations in the cytochrome c oxidase gene (as a cell lineage marker), largelyencoded by mtDNA, has revealed patches <strong>of</strong> COX -ve cells in liver, which arefrequently in close proximity to the portal tract and are present in serial sectionsat least 330µm deep into the tissue. This suggests that clonogenic cells in thenormal human liver may proliferate en masse from a common niche close to theportal tract. This study highlights a novel means <strong>of</strong> tracing patterns <strong>of</strong> celldivision and migration in human liver that can be used to study changes in cellbehaviour during hepatitis, cirrhosis and neoplasia.<strong>Winter</strong> <strong>Meeting</strong> (191 st ) 3–5 January <strong>2007</strong> Scientific Programme25