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COMPARISON OF GROSS CYSTIC DISEASE FLUID PROTEIN (GCDFP-15) EXPRESSION IN PRIMARY AND METASTATIC BREAST CARCINOMA
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COMPARISON OF GROSS CYSTIC DISEASE FLUID PROTEIN (GCDFP-15) EXPRESSION IN PRIMARY AND METASTATIC BREAST CARCINOMA

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  • also inhibits apoptosis by T-cells. It the most reproducibly present in breast

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  • 1. Dr. Imrana Tanvir
  • 2.  Breast carcinoma is a leading cause of cancer death in women. It is the most common malignant neoplasm, with more than 1,000,000 cases occurring worldwide annually Breast cancer may present as occult primary or as a metastatic lesion.
  • 3.  Metastatic adenocarcinomas of unknown origin makes around 3% of all the cancer patients It is among the 10 most common malignancies. The prognosis and therapy of the patients with metastatic adenocarcinomas are linked to the site of origin.
  • 4.  Origin of metastatic adenocarcinoma by morphology alone is difficult. The primary may be from any of the many possible sites, including breast, lung, gastrointestinal tract, endometrium and ovaries. Studies have shown that Gross cystic disease fluid protein 15 (GCDFP-15) is a specific and sensitive marker for breast cancer.
  • 5.  First identified in the fluid of breast cysts and in the serum of patients with mammary carcinomas. The major constituents in breast cyst fluid being GCDFP-15, GCDFP-24 and GCDFP-44. Encoded on chromosome 7.
  • 6.  It also inhibits apoptosis by T-cells. It the most reproducibly present in breast carcinomas This protein is induced by prolactin and androgen.
  • 7.  Non-neoplastic serous salivary gland acini, bronchial serous glands, seminal vesicles and apocrine skin adnexa are immunoreactive. Renal tubules, ovarian surface epithelium and urothelium are negative Staining is cytoplasmic, often with paranuclear enhancement in mammary carcinomas.
  • 8.  To assess the immunohistochemical expression of GCDFP-15 in Primary Breast Tumors To compare this expression with expression of GCDFP-15 in known Metastatic breast adenocarcinoma Carcinomas. To assess the utility of GCDFP-15 as a diagnostic marker for metastatic breast cancer
  • 9. SETTING: Pathology Department of Shaukat Khanum Cancer Hospital LahoreINCLUSION CRITERIA:Mastectomy specimens from female patients with primary tumor and corresponding lymph node metastases were included in the study.Control were known cases of adenocarcinoma lung, kidney, colon, endometrium and ovraies.EXCLUSION CRITERIA:The specimens with poorly preserved tumors were excluded.
  • 10.  50 Mastectomy cases were included -Tissue from primary tumor -Tissue from involved lymph nodes. 50 controls were included from known adenocarcinomas - Lung, ovary, colon endometrium and kidney.
  • 11.  Representative sections were taken, processed and stained with hematoxylin and eosin to see the tumor morphology.
  • 12. The immunohistochemical stain GCDFP-15 wasperformed simultaneously in the same batch,according to the specifications given by themanufacturer, on sections made from - Primary breast carcinomas. - Metastatic breast adenocarcinoma in regional axillary lymph nodes from respective mastectomy specimens. - Study Controls
  • 13.  Expression of biomarker (GCDFP-15) in primary tumors was compared - With the expression of this biomarker in metastatic carcinoma. - On the study controls. 
  • 14. Intensity of cytoplasmic staining  Negative  Weak  Moderate  Strong% of cytoplasmic staining  Negative: No tumor cell  Focal positive: Less than 10%  Diffusely positive: More than 10%
  • 15. Distribution of Cases Accordingto Age Age of the patients No. of patients (Years) (%) 20-29 3(6%) 30-39 9(18%) 40-49 16(32%) 50-59 12(24%) 60-69 7(14%) 70-79 3(6%) Mean 47.76years +_SD 13.05 Median 48years Range 21- 76years
  • 16. Distribution of cases according to pathologic characteristics Pathological characteristics Findings Total no of patients 50 Tumor Size Range 1.0cm to 12.cm Mean 4.44cm +- SD 2.48 Tumor Type Invasive ductal carcinoma (NOS) 47(94%) Invasive lobular carcinoma 3(6%) Lymph node status No of lymph nodes isolated in each case Range 2.0 to 24 Mean 12.62 +_ SD 4.94 No of involved lymph nodes Range 1.0 to 24 Mean 6.14 +- SD 4.40 Size of metastatic deposit Range 0.4cm to 2.2cm Mean 1.2cm +_ SD 0.49
  • 17.  GCDFP-15 positivity was observed in - 92% of the primary tumors. - 88% of metastatic breast carcinomas (p= 0.000). The concordance value of GCDFP-15 expression between the primary and metastatic tumors was found to be significant i.e. 96%.
  • 18.  No statistically significant difference of GCDFP- 15 expression was seen between primary and their respective metastatic tumors (p=0.251). All 50 study control cases of adeno- carcinomas were negative for GCDFP-15.
  • 19. Sensitivity, specificity and positivepredictive values were calculated byapplying table of 2x2 taking histopathologyas gold standard.
  • 20.  These values found in primary tumors were 92% (sn), 84% (sp) and 77.7% (pp) respectively. In metastatic tumors, these values were 88% (sn), 84% (sp) and 87.7%(pp)respectively. The sensitivity, specificity and predictive values are comparable in both primary and metastatic tumors.
  • 21.  Gross cystic disease fluid protein (GCDFP-15) is a sensitive and a specific marker for detection of primary and as well as metastatic breast adenocarcinomas. It shows significant concordance between primary and metastatic breast carcinoma to the corresponding lymph nodes. It can be used to identify breast primary in metastatic tumors of unknown origin.