Sabato 27 ottobre 2012 - Pacini Editore

COmuNiCaziONi ORali
Fig. 3.
fibromatosis and may be expressed occasionally in metaplastic
carcinomas or in stroma cells of fibroepithelial lesions. If we
obtain a history of trauma of or previous surgery we can think to
a scar. It may be very difficult to recognize the presence of recurrence
of fibromatosis after surgery.
Nodular fasciitis has a more diffuse inflammatory infiltrate and
is more mitotically active. Myofibroblastoma usually has a non
infiltrative margin and contains thick bands of collagen. Spindle
cell metaplastic carcinoma can mimic fibromatosis but it is positive
with cytokeratins. Fibrosarcoma is more cellular, with a significant
degree of nuclear pleomorphism and abundant mitotic activity.
Fibromatosis lacks metastatic potential but is locally aggressive,
with recurrence seen in up to 27% of lesions, within the first 2
or 3 years.Recurrence is more common in younger patients but;
histological features do not predict for likeliness of recurrence.
Wide local excision is the treatment of choice.
references
1 Majid A, Fatemi A, Olusegun A, et al. Fibromatosis of the breast. Am
J Surg Pathol 1079;3:501-6.
2 Wargotz E, Norris HJ, Austin RM, et al. Fibromatosis of the breast:
A clinical and pathological study of 28 cases. Am J Surg Pathol
1987;11:38-45.
3 Magro G, Gurrera A, Scavo N, et al. La fibromatosi della mammella:
studio clinico, radiologico e patologico di sei casi. Patologica
2002;94:238-46.
4 Balzer BL, Weiss SW. Do biomaterial causes implant associated
mesenchymal tumours of the breast? Analysis of 8 cases and review of
the literature. Hum Pathol 2009;40:1564-70.
5 Neuman HB, Brogi E, Ebrahim A, et al. Desmoid tumours (fibromatoses)
of the breast. A 25 years experience. Ann Surg Oncol
2008;15:274-80.
6 Povoski SP, Jimenez RE. Fibromatosis (desmoid tumour) of the breast
mimicking a case of ipsilateral metachronous breast cancer. World J
Surg Oncol 2006;4:57.
Comparative evaluation of three different
approaches of sentinel lymph node assessment
in breast cancer patients: the regina Elena national
Cancer Institute experience
S. Buglioni, B. Casini, E. Gallo, L. De Salvo, A. Russo, F. Marandino,
A. Di Benedetto, E. Melucci, B. Antoniani, C. Ercolani,
V. D’Alicandro, V. Dimartino, C.A. Amoreo, M. Mottolese,
E. Pescarmona
Pathology Department, Regina Elena National Cancer Institute, Rome, Italy
Background. In our Institution from 2000 to 2007 the detection
of sentinel lymph node (SLN) metastasis in breast cancer patients
337
had been performed postoperatively by a combined histological
and immunohistological approach. In 2008 the molecular diagnostic
tool “One Step Nucleic Acid Amplification” (OSNA) was
adopted in our Institute as routine intraoperative test 1 2 . During
the first three years, (2008-2010) we evaluated the feasibility
of OSNA system within our department and we investigated
whether the performance of the OSNA method was comparable
to our postoperative histological standard procedures. To this end
a prospective series of 903 consecutive SLNs from 709 breast
cancer patients was evaluated. The overall concordance rate for
OSNA versus histopathology was 96%, with a sensitivity of 94%
and specificity of 96%.
After this challenging results and in agreement with other italian
and european OSNA users in 2011 we decided to analyze the
whole sentinel node with the OSNA assay.
Aims. The aim of the present study is to evaluate comparatively
the results of these three different approaches of SLN assessment
in order to test their diagnostic sensitivity in the definition of
the SLN “status” and in the prediction of axillary lymph nodes
involvement.
Material and methods. In order to carry out this study we have
selected three one-year representative periods.
Period 1 (2008): the whole SLN was analyzed postoperatively by
standard histological work-out consisting of 6 levels of Haematoxylin
& Eosin (H&E) and cytokeratin 19 (CK19) immunostaining.
All SLNs were classified into 4 categories according to the
seventh edition of the AJCC Staging Manual: positive, macrometastasis
(> 2.0 mm); positive, micrometastasis (> 0.2 mm to ≤ 2
mm); negative, ITCs (≤ 0.2 mm); and negative no tumour cells.
Period 2 (2010): half SLN analyzed by OSNA and half by standard
histology. The SLNs were cut in 4 equal slices two of these
slices were analyzed intraoperatively by OSNA method and the
remaining 2 slices were formalin fixed and paraffin embedded in
a single block for standard in-house histological method. OSNA-
CK19 involves a short manual sample preparation step and
subsequent fully automated amplification of CK19 mRNA based
on reverse transcription loop-mediated isothermal amplification,
with results available within 40-50 min. The OSNA results
were classified as negative (-) (< 250 copies/_l), micrometastasis
(+) (from ≥ 250 to < 5000 copies/__l) or macrometastases (++)
(≥ 5000 copies/__l).
Period 3: (2011): the whole SLN was analyzed by the OSNA assay
according to the same procedure described above.
All the patients included in this study with a positive SLN, for
both micrometastases and macrometastases, underwent axillary
lymph node dissection (ALND).
Results. The results are reported in Fig. 1 and Tab. I.
Period 1: 220 SLNs of 181 patients were analyzed postopera-
Fig. 1.