BACKGROUND: Occurrence of gastric metastasis as the first symptom of breast carcinoma with a long period of latency before presentation of the primary breast carcinoma is rare. CASE REPORT: A patient with gastric metastasis as the first symptom of lobular breast carcinoma, treated by neoadjuvant preoperative chemoradiotherapy and total gastrectomy, with complete local control. Fourteen months after presentation of the gastric metastasis a primary lobular breast carcinoma was discovered, treated by radiotherapy, chemotherapy and hormonal treatment with complete local response. Twenty-three months after diagnosis of breast cancer multiple colorectal metastases from the breast cancer occurred, which were treated by chemotherapy and hormonal treatment. Eighty-six months after diagnosis of gastric metastasis the patient died due to progression of cancer. CONCLUSIONS: Metastases to gastrointestinal or gynaecological tracts are more likely in invasive lobular carcinoma than invasive ductal cancer. The pathologist should determine whether or not they check estrogen and progesterone receptor status not simply by signet ring cell morphology but also by consideration of clinic-pathological correlation of the patient, such as the presence of a past history of breast cancer, or the colorectal localization of poorly differentiated carcinoma, which may occur less frequently than in the stomach.

• MeSH
• chemoradioterapie metody   MeSH
• fatální výsledek MeSH
• gastrektomie MeSH
• kolorektální nádory sekundární   terapie   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lobulární karcinom sekundární   terapie   MeSH
• nádory prsu patologie   terapie   MeSH
• nádory žaludku sekundární   terapie   MeSH
• předoperační péče MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH

The aim of this study is to determine the combination of characteristics in early breast cancer that could estimate the risk of occurrence of metastatic cells in axillary sentinel lymph node(s). If we were able to reliably predict the presence or absence of axillary sentinel involvement, we could spare a considerable proportion of patients from axillary surgery without compromising therapeutic outcomes of their disease. The study is based on retrospective analysis of medical records of 170 patients diagnosed with primary breast cancer. These women underwent primary surgery of the breast and axilla in which at least one sentinel lymph node was obtained. Logistic regression has been employed to construct a model predicting axillary sentinel lymph node involvement using preoperative and postoperative tumor characteristics. Postoperative model uses tumor features obtained from definitive histology samples. Its predictive capability expressed by receiver operating characteristic curve is good, area under curve (AUC) equals to 0.78. The comparison between preoperative and postoperative results showed the only significant differences in values of histopathological grading; we have considered grading not reliably stated before surgery. In preoperative model only the characteristics available and reliably stated at the time of diagnoses were used. The predictive capability of this model is only fair when using the data available at the time of diagnosis (AUC = 0.66). We conclude, that predictive models based on postoperative values enable to reliably estimate the likelihood of occurrence of axillary sentinel node(s) metastases. This can be used in clinical practice in case surgical procedure is divided into two steps, breast surgery first and axillary surgery thereafter. Even if preoperative values were not significantly different from postoperative ones (except for grading), the preoperative model predictive capability is lower compared to postoperative values. The reason for this worse prediction was identified in imperfect preoperative diagnostic.

• MeSH
• axila MeSH
• biopsie sentinelové lymfatické uzliny * MeSH
• chorobopisy MeSH
• dospělí MeSH
• duktální karcinom prsu metabolismus   sekundární   chirurgie   MeSH
• imunoenzymatické techniky MeSH
• lidé středního věku MeSH
• lidé MeSH
• lobulární karcinom metabolismus   sekundární   chirurgie   MeSH
• lokální recidiva nádoru metabolismus   patologie   chirurgie   MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny metabolismus   patologie   chirurgie   MeSH
• nádorové biomarkery metabolismus   MeSH
• nádory prsu metabolismus   patologie   chirurgie   MeSH
• následné studie MeSH
• plocha pod křivkou MeSH
• pooperační péče MeSH
• prognóza MeSH
• receptor erbB-2 metabolismus   MeSH
• receptory pro estrogeny metabolismus   MeSH
• receptory progesteronu metabolismus   MeSH
• retrospektivní studie MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• staging nádorů MeSH
• statistické modely * MeSH
• stupeň nádoru MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

• MeSH
• abnormality vyvolané léky * epidemiologie   MeSH
• Apgar skóre * MeSH
• dospělí MeSH
• duktální karcinom diagnóza   farmakoterapie   patologie   sekundární   MeSH
• incidence MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• lobulární karcinom diagnóza   farmakoterapie   chirurgie   patologie   sekundární   MeSH
• lymfatické metastázy MeSH
• mladý dospělý MeSH
• multivariační analýza MeSH
• nádorové komplikace v těhotenství farmakoterapie   MeSH
• nádory prsu * diagnóza   farmakoterapie   chirurgie   patologie   MeSH
• nemoci novorozenců epidemiologie   chemicky indukované   MeSH
• novorozenec MeSH
• porodní hmotnost * účinky léků   MeSH
• přežití po terapii bez příznaků nemoci MeSH
• protokoly antitumorózní kombinované chemoterapie * terapeutické užití   škodlivé účinky   MeSH
• registrace MeSH
• retrospektivní studie MeSH
• staging nádorů MeSH
• těhotenství MeSH
• uchovávání orgánů MeSH
• vedení porodu statistika a číselné údaje   MeSH
• výsledek těhotenství epidemiologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• novorozenec MeSH
• těhotenství MeSH
• ženské pohlaví MeSH
• Publikační typ
• klinické zkoušky MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Evropa MeSH

PURPOSE: Sentinel lymph node biopsy (SLNB) has become a safe and accurate alternative to axillary lymph node dissection (ALND) in the surgical management of early breast cancer. The aim of this study was to determine the false negative rate of SLNB in patients with advanced breast cancer after neoadjuvant chemotherapy. METHODS: Forty-eight patients with 49 advanced breast cancers (one patient had bilateral disease) underwent neoadjuvant chemotherapy. All of them had SLNB, followed by standard level I/II ALND. SLNs were identified in 47 out of 49 tumors (detection rate 95.9%). RESULTS: Axillary nodal metastases were detected in 28 patients; SLNs were positive only in 14 patients. Four sentinel internal mammary nodes were removed in 4 patients, while one of them was positive with micrometastasis but axillary nodes were negative. False-negative results occurred in 2 (7.14%) patients. The results of our study confirm that SLNB in patients with advanced breast cancer is not significantly altered by the preoperative chemotherapy. Biopsy results were very similar to those without any neoadjuvant chemotherapy. CONCLUSION: ALND, known for its serious complications, can be replaced in some cases by SLNB.

• MeSH
• axila MeSH
• biopsie sentinelové lymfatické uzliny MeSH
• duktální karcinom prsu farmakoterapie   sekundární   chirurgie   MeSH
• falešně negativní reakce MeSH
• lidé MeSH
• lobulární karcinom farmakoterapie   sekundární   chirurgie   MeSH
• lymfadenektomie MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny patologie   chirurgie   MeSH
• mikrometastázy MeSH
• nádory prsu farmakoterapie   patologie   chirurgie   MeSH
• následné studie MeSH
• neoadjuvantní terapie MeSH
• předoperační péče MeSH
• prognóza MeSH
• prospektivní studie MeSH
• staging nádorů MeSH
• studie proveditelnosti MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH

MiR-34a acts as a candidate tumour suppressor gene, and its expression is reduced in several cancer types. We aimed to study miR-34a expression in breast cancer and its correlation with tumour characteristics and clinical outcome, and regulatory links with other genes. We analysed miR-34a expression in 1,172 breast tumours on TMAs. 25% of the tumours showed high, 43% medium and 32% low expression of miR-34a. High miR-34a expression associated with poor prognostic factors for breast cancer: positive nodal status (p = 0.006), high tumour grade (p<0.0001), ER-negativity (p = 0.0002), HER2-positivity (p = 0.0002), high proliferation rate (p<0.0001), p53-positivity (p<0.0001), high cyclin E (p<0.0001) and H2AX (p<0.0001). However, multivariate analysis adjusting for conventional prognostic factors indicated that high miR-34a expression in fact associated with a lower risk of recurrence or death from breast cancer (HR = 0.63, 95% CI = 0.41-0.96, p = 0.031). Gene expression analysis by differential miR-34a expression revealed an expression signature with an effect on both the 5-year and 10-year survival of the patients (p<0.001). Functional genomic analysis highlighted a novel regulatory role of the transcription factor MAZ, apart from the known control by p53, on the expression of miR-34a and a number of miR-34a targets. Our findings suggest that while miR-34a expression activation is a marker of aggressive breast tumour phenotype it exerts an independent effect for a lower risk of recurrence or death from breast cancer. We also present an expression signature of 190 genes associated with miR-34a expression. Our analysis for regulatory loops suggest that MAZ and p53 transcription factors co-operate in modulating miR-34a, as well as miR-34a targets involved in several cellular pathways. Taken together, these results suggest that the network of genes co-regulated with and targeted by miR-34a form a group of down-stream effectors that maybe of use in predicting clinical outcome, and that highlight novel regulatory mechanisms in breast cancer.

• MeSH
• cyklin E genetika   MeSH
• DNA vazebné proteiny genetika   MeSH
• duktální karcinom prsu * genetika   mortalita   sekundární   MeSH
• histony genetika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lobulární karcinom * genetika   mortalita   sekundární   MeSH
• mikro RNA * genetika   MeSH
• nádory prsu * genetika   mortalita   patologie   MeSH
• staging nádorů MeSH
• stanovení celkové genové exprese MeSH
• stupeň nádoru MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• ženské pohlaví MeSH

Východiska: Metastatický karcinom prsu je nevyléčitelné onemocnění, cílem léčby je prodloužení života pacientky při zachování či zlepšení jeho kvality. Tři studie fáze III (E2100, AVADO a RIBBON-1) prokázaly přínos přidání bevacizumabu ke standardní chemoterapii 1. linie. V těchto studiích bylo dosaženo zvýšení četnosti odpovědí a prodloužení přežití bez progrese. Přidání bevacizumabu nezvyšuje toxicitu chemoterapeutických režimů. Bevacizumab je od roku 2007 registrován k léčbě nemocných s metastazujícím karcinomem prsu. Případ: Uvádíme kazuistiku naší pacientky léčené bevacizumabem, u které bylo dosaženo výborného léčebného efektu. V roce 2003 byl u tehdy 40leté pacientky diagnostikován lobulární karcinom prsu pT2pN0M0, ER negativní, PgR negativní, HER2 negativní. Byla podána adjuvantní chemoterapie FAC. Po šesti letech, v březnu 2009, došlo k relapsu onemocnění s postižením mediastinálních uzlin, plic, pleury a skeletu. V květnu 2009 byla zahájena léčba týdenním režimem paklitaxelu (ukončen v listopadu 2009) v kombinaci s bevacizumabem, který byl ukončen v dubnu 2010 po 11 měsících léčby při dosažení úplné remise, a to jak v plicích a mediastinu, tak ve skeletu. Léčba pokračuje pouze podáváním bisfosfonátu. Závěr: I naše zkušenost ukazuje, že bevacizumab je přínosem pro léčbu metastatického karcinomu prsu.

Backgrounds: Metastatic breast cancer is a disease which is not curable. Thus, prolongation of survival with preserved or improved quality of life is the aim of the treatment. Three phase III studies (E2100, AVADO and RIBBON-1) showed the benefi t of adding bevacizumab to the standard 1st line chemotherapy. Higher response rate and longer progression-free survival were achieved in these studies. Bevacizumab does not increase toxicity of the chemotherapy regimens. Since 2007 bevacizumab has been registered for the treatment of patients with metastatic breast cancer. Observation: Here we present the case of a patient in which bevacizumab treatment led to excellent results. Lobular breast cancer, pT2N0M0, ER-negative, PR-negative, HER2-negative was diagnosed in a 40-year-old woman in 2003. FAC adjuvant chemotherapy was used. Six years later, in March 2009, a relapse in mediastinal lymphatic nodes, the lungs, pleura and bones was detected. A weekly regimen of paclitaxel in combination with bevacizumab started in May 2009. Paclitaxel treatment fi nished in November 2009, bevacizumab continued for 11 months till April 2010, when complete remission in the lungs, mediastinum and bones was confi rmed. Now only bisphosphonate is being continued. Conclusion: our experience also confi rms the contribution of bevacizumab in the treatment of metastatic breast cancer.

• Klíčová slova
• metastatický karcinom prsu,
• MeSH
• antitumorózní látky fytogenní aplikace a dávkování   MeSH
• dospělí MeSH
• indukce remise MeSH
• inhibitory angiogeneze aplikace a dávkování   MeSH
• lobulární karcinom farmakoterapie   sekundární   MeSH
• lymfatické metastázy MeSH
• mediastinum MeSH
• monoklonální protilátky aplikace a dávkování   MeSH
• nádory kostí farmakoterapie   sekundární   MeSH
• nádory plic farmakoterapie   sekundární   MeSH
• nádory prsu metabolismus   patologie   MeSH
• paclitaxel aplikace a dávkování   MeSH
• receptor erbB-2 analýza   MeSH
• receptory pro estrogeny analýza   MeSH
• receptory progesteronu analýza   MeSH
• Check Tag
• dospělí MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• kazuistiky MeSH

Recent studies have suggested that genetic polymorphisms in the TP53 pathway influence tumour formation, progression and response to therapy. We analysed the three most common TP53 gene polymorphisms as potential genetic markers to predict the development and prognosis of breast cancer. The incidence of R72P, PIN3 Ins 16bp and PIN6 G13494A polymorphisms was determined in a cohort of 117 breast cancer tissues and 108 control specimens by PCR-RFLP. No significant difference was observed in the polymorphism variants in breast cancer specimens compared to controls. Furthermore, no statistically significant association of these polymorphisms with the outcome of the patients was observed. On the other hand we found positive correlation of lymph node metastases with both PIN3 Ins 16bp and PIN6 G13494A polymorphisms. The association of intronic TP53 variants with an aggressive breast cancer phenotype may represent a useful predictive biomarker, particularly in patients of clinical stage I with low or intermediate risk.

• MeSH
• dospělí MeSH
• duktální karcinom prsu genetika   metabolismus   sekundární   MeSH
• frekvence genu MeSH
• imunoenzymatické techniky MeSH
• introny genetika   MeSH
• lidé středního věku MeSH
• lidé MeSH
• lobulární karcinom genetika   metabolismus   sekundární   MeSH
• lymfatické metastázy MeSH
• mladý dospělý MeSH
• mutace genetika   MeSH
• nádorové biomarkery genetika   metabolismus   MeSH
• nádorový supresorový protein p53 genetika   MeSH
• nádory prsu genetika   metabolismus   patologie   MeSH
• polymerázová řetězová reakce MeSH
• polymorfismus délky restrikčních fragmentů MeSH
• polymorfismus genetický MeSH
• prognóza MeSH
• prsy metabolismus   patologie   MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• senioři nad 80 let MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• práce podpořená grantem MeSH

• MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• duktální karcinom prsu diagnóza   sekundární   MeSH
• lidé MeSH
• lobulární karcinom diagnóza   sekundární   MeSH
• lymfatické metastázy MeSH
• nádory prsu patologie   MeSH
• Check Tag
• lidé MeSH
• ženské pohlaví MeSH

In women with breast cancer, sentinel-lymph-node biopsy (SLNB) provides information that allows surgeons to avoid axillary-lymph-node dissection (ALND) if the SLN does not have metastasis, and has a favourable effect on quality of life. Results of our previous trial showed that SLNB accurately screens the ALN for metastasis in breast cancers of diameter 2 mm or less. We aimed to update this trial with results from longer follow-up. METHODS: Women with breast tumours of diameter 2 cm or less were randomly assigned after breast-conserving surgery either to SLNB and total ALND (ALND group), or to SLNB followed by ALND only if the SLN was involved (SLN group). Analysis was restricted to patients whose tumour characteristics met eligibility criteria after treatment. The main endpoints were the number of axillary metastases in women in the SLN group with negative SLNs, staging power of SLNB, and disease-free and overall survival. FINDINGS: Of the 257 patients in the ALND group, 83 (32%) had a positive SLN and 174 (68%) had a negative SLN; eight of those with negative SLNs were found to have false-negative SLNs. Of the 259 patients in the SLN group, 92 (36%) had a positive SLN, and 167 (65%) had a negative SLN. One case of overt clinical axillary metastasis was seen in the follow-up of the 167 women in the SLN group who did not receive ALND (ie, one false-negative). After a median follow-up of 79 months (range 15-97), 34 events associated with breast cancer occurred: 18 in the ALND group, and 16 in the SLN group (log-rank p=0.6). The overall 5-year survival of all patients was 96.4% (95% CI 94.1-98.7) in the ALND group and 98.4% (96.9-100) in the SLN group (log-rank p=0.1). INTERPRETATION: SLNB can allow total ALND to be avoided in patients with negative SLNs, while reducing postoperative morbidity and the costs of hospital stay. The finding that only one overt axillary metastasis occurred during follow-up of patients who did not receive ALND (whereas eight cases were expected) could be explained by various hypotheses, including those from cancer-stem-cell research.

• MeSH
• axila MeSH
• biopsie sentinelové lymfatické uzliny metody   MeSH
• dospělí MeSH
• duktální karcinom prsu sekundární   MeSH
• incidence MeSH
• lidé středního věku MeSH
• lidé MeSH
• lobulární karcinom sekundární   MeSH
• lymfatické metastázy MeSH
• lymfatické uzliny patologie   MeSH
• míra přežití MeSH
• nádory prsu patologie   MeSH
• prediktivní hodnota testů MeSH
• senioři MeSH
• staging nádorů MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• senioři MeSH
• ženské pohlaví MeSH