In total, 80 breast lumps were sampled by fine needle aspiration for analysis. 30 breast lump aspirates were used to prepare direct smears, while 50 aspirates were prepared using a double embedding technique to create histological sections. Immunoperoxidase staining was performed on all samples for markers including CEA, EMA, Cytokeratin, DD9, and Estrogen Receptor Protein. Positive results were found in 52/80 samples for EMA, 16/80 for Estrogen Receptor Protein, 20/80 for CEA, and 56/80 for Cytokeratin. The double embedding method provided unequivocal results, while direct smears sometimes gave equivocal results due to technical issues
This document discusses sonographic criteria for uterine curettage when endometrial neoplasia is suspected. Eight premenopausal and perimenopausal women underwent transvaginal ultrasounds and uterine curettage due to abnormal bleeding or discharge. Histopathology found hyperplasia in polycystic ovary syndrome patients and cancer in a patient on tamoxifen therapy. Key ultrasound findings associated with hyperplasia or cancer included thick irregular endometrium, ill-defined endometrial-myometrial junction, intrauterine fluid collections, adnexal masses, and cystic endometrial areas. The document concludes that endometrial stripe abnormalities on ultrasound, in addition to thickness, are important
Awareness and current knowledge of breast cancerMehwish Iqbal
Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe.
Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact
on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading
cause of mortality among women population. For the previous two decades, studies related to the breast cancer
has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient
treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in
post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in
their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the
breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast
cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted
therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell
therapy etc for breast cancer.
This document summarizes research on effective interventions for managing primary breast cancer. Key points include:
- Triple assessment (clinical exam, mammography, and biopsy) accurately diagnoses breast cancer in 95-100% of cases and reduces unnecessary biopsies.
- Mastectomy and breast-conserving surgery have similar survival rates, but breast-conserving surgery leads to better preservation of body image.
- Adjuvant therapies like tamoxifen, chemotherapy, and ovarian ablation improve survival and recurrence rates for most patients and are highly cost-effective.
- Patients experience less anxiety when given full verbal and written information about their condition and treatment options. However, doctors may overestimate how much they communicate.
Critical Remarks to Endoscopic Surgery for Endometrial Cancer and Sarcoma, Ce...CrimsonpublishersCancer
The document discusses critical issues with endoscopic surgery for gynecological cancers. It summarizes the development of endoscopic surgery for cancers and highlights concerns. For endometrial cancer and sarcoma, it notes the risks of morcellation potentially spreading tissue. It also discusses the challenges of diagnosing leiomyosarcoma preoperatively. For cervical cancer, it outlines the history of surgical approaches and recent randomized trials showing lower survival rates with minimally invasive versus open radical hysterectomies, calling into question the equivalency of cancer outcomes between the two approaches.
CLINICAL-CYTOGENETIC CORRELATIONS IN UTERINE LEIOMYOMASAboubakr Elnashar
This study aimed to determine the prevalence of chromosomal abnormalities in uterine leiomyomas and their correlation with patient age, tumor size, and location. The results showed that 38% of uterine leiomyomas had clonal chromosomal abnormalities, with deletion of chromosome 7 being most common. No correlation was found between karyotype and age or size in premenopausal women, but a significant correlation between abnormal karyotype and smaller size was seen in postmenopausal women. Submucous leiomyomas had significantly fewer abnormalities than intramural or subserous leiomyomas. The study supports the hypothesis that chromosomal abnormalities can alter hormone dependence and growth of uterine leiomyomas.
Neoadjuvant and hormonal therapy in Breast cancer - Yousef El-Aymansurgizag
This document discusses hormonal and neoadjuvant therapy for breast cancer. It begins with breast cancer statistics globally and in the US. It then covers clinical presentation, imaging, pathology, diagnosis, receptor testing, staging, selection criteria for neoadjuvant therapy, and treatment approaches for HER2-positive and triple negative breast cancers. Neoadjuvant therapy aims to improve surgical outcomes or allow for breast conservation by shrinking tumors. HER2-positive and triple negative subtypes have higher response rates to neoadjuvant chemotherapy.
The role of Hysterectomy on BRCA mutation carriersValentina Cará
Hysterectomy may reduce the risk of uterine cancer for BRCA mutation carriers taking tamoxifen, by allowing estrogen-only hormone therapy and eliminating the uterine cancer risk from tamoxifen. However, the risks of hysterectomy, such as surgical complications, need to be weighed against the uncertain increased uterine cancer risk from tamoxifen. Studies have found both increased and similar uterine cancer rates in BRCA carriers taking tamoxifen compared to the general population. The decision to perform hysterectomy should be individualized based on risk factors and treatment options.
This document provides guidelines for the management of endometrial cancer from several European medical societies. It covers epidemiology, risk assessment, surgery, lymph node staging, adjuvant therapy, and management of early, advanced, and recurrent disease. Key points include recommending total hysterectomy and bilateral salpingo-oophorectomy for staging without vaginal cuff resection for early-stage disease. It also supports consideration of sentinel lymph node biopsy for staging in select cases and ovarian preservation in certain low-risk premenopausal patients. Molecular testing is encouraged to further stratify prognosis, especially in high-grade tumors.
This document discusses sonographic criteria for uterine curettage when endometrial neoplasia is suspected. Eight premenopausal and perimenopausal women underwent transvaginal ultrasounds and uterine curettage due to abnormal bleeding or discharge. Histopathology found hyperplasia in polycystic ovary syndrome patients and cancer in a patient on tamoxifen therapy. Key ultrasound findings associated with hyperplasia or cancer included thick irregular endometrium, ill-defined endometrial-myometrial junction, intrauterine fluid collections, adnexal masses, and cystic endometrial areas. The document concludes that endometrial stripe abnormalities on ultrasound, in addition to thickness, are important
Awareness and current knowledge of breast cancerMehwish Iqbal
Breast cancer remains a worldwide public health dilemma and is currently the most common tumour in the globe.
Awareness of breast cancer, public attentiveness, and advancement in breast imaging has made a positive impact
on recognition and screening of breast cancer. Breast cancer is life-threatening disease in females and the leading
cause of mortality among women population. For the previous two decades, studies related to the breast cancer
has guided to astonishing advancement in our understanding of the breast cancer, resulting in further proficient
treatments. Amongst all the malignant diseases, breast cancer is considered as one of the leading cause of death in
post menopausal women accounting for 23% of all cancer deaths. It is a global issue now, but still it is diagnosed in
their advanced stages due to the negligence of women regarding the self inspection and clinical examination of the
breast. This review addresses anatomy of the breast, risk factors, epidemiology of breast cancer, pathogenesis of breast
cancer, stages of breast cancer, diagnostic investigations and treatment including chemotherapy, surgery, targeted
therapies, hormone replacement therapy, radiation therapy, complementary therapies, gene therapy and stem-cell
therapy etc for breast cancer.
This document summarizes research on effective interventions for managing primary breast cancer. Key points include:
- Triple assessment (clinical exam, mammography, and biopsy) accurately diagnoses breast cancer in 95-100% of cases and reduces unnecessary biopsies.
- Mastectomy and breast-conserving surgery have similar survival rates, but breast-conserving surgery leads to better preservation of body image.
- Adjuvant therapies like tamoxifen, chemotherapy, and ovarian ablation improve survival and recurrence rates for most patients and are highly cost-effective.
- Patients experience less anxiety when given full verbal and written information about their condition and treatment options. However, doctors may overestimate how much they communicate.
Critical Remarks to Endoscopic Surgery for Endometrial Cancer and Sarcoma, Ce...CrimsonpublishersCancer
The document discusses critical issues with endoscopic surgery for gynecological cancers. It summarizes the development of endoscopic surgery for cancers and highlights concerns. For endometrial cancer and sarcoma, it notes the risks of morcellation potentially spreading tissue. It also discusses the challenges of diagnosing leiomyosarcoma preoperatively. For cervical cancer, it outlines the history of surgical approaches and recent randomized trials showing lower survival rates with minimally invasive versus open radical hysterectomies, calling into question the equivalency of cancer outcomes between the two approaches.
CLINICAL-CYTOGENETIC CORRELATIONS IN UTERINE LEIOMYOMASAboubakr Elnashar
This study aimed to determine the prevalence of chromosomal abnormalities in uterine leiomyomas and their correlation with patient age, tumor size, and location. The results showed that 38% of uterine leiomyomas had clonal chromosomal abnormalities, with deletion of chromosome 7 being most common. No correlation was found between karyotype and age or size in premenopausal women, but a significant correlation between abnormal karyotype and smaller size was seen in postmenopausal women. Submucous leiomyomas had significantly fewer abnormalities than intramural or subserous leiomyomas. The study supports the hypothesis that chromosomal abnormalities can alter hormone dependence and growth of uterine leiomyomas.
Neoadjuvant and hormonal therapy in Breast cancer - Yousef El-Aymansurgizag
This document discusses hormonal and neoadjuvant therapy for breast cancer. It begins with breast cancer statistics globally and in the US. It then covers clinical presentation, imaging, pathology, diagnosis, receptor testing, staging, selection criteria for neoadjuvant therapy, and treatment approaches for HER2-positive and triple negative breast cancers. Neoadjuvant therapy aims to improve surgical outcomes or allow for breast conservation by shrinking tumors. HER2-positive and triple negative subtypes have higher response rates to neoadjuvant chemotherapy.
The role of Hysterectomy on BRCA mutation carriersValentina Cará
Hysterectomy may reduce the risk of uterine cancer for BRCA mutation carriers taking tamoxifen, by allowing estrogen-only hormone therapy and eliminating the uterine cancer risk from tamoxifen. However, the risks of hysterectomy, such as surgical complications, need to be weighed against the uncertain increased uterine cancer risk from tamoxifen. Studies have found both increased and similar uterine cancer rates in BRCA carriers taking tamoxifen compared to the general population. The decision to perform hysterectomy should be individualized based on risk factors and treatment options.
This document provides guidelines for the management of endometrial cancer from several European medical societies. It covers epidemiology, risk assessment, surgery, lymph node staging, adjuvant therapy, and management of early, advanced, and recurrent disease. Key points include recommending total hysterectomy and bilateral salpingo-oophorectomy for staging without vaginal cuff resection for early-stage disease. It also supports consideration of sentinel lymph node biopsy for staging in select cases and ovarian preservation in certain low-risk premenopausal patients. Molecular testing is encouraged to further stratify prognosis, especially in high-grade tumors.
1) The study examined risk factors and tumor histopathology of 224 uninsured female breast cancer patients in Pakistan.
2) Results showed patients had higher rates of early marriage, abortion, stress, family cancer history, and diseases like diabetes and hypertension.
3) Histopathological analysis found patients aged 40 and under had higher rates of grade III tumors, 1-3 lymph node metastases, and hormone receptor negative status, indicating more advanced disease.
Breast cancer screening-2021 chan hio tongjim kuok
This document discusses breast cancer screening and provides guidance on screening strategies based on risk level. It covers:
1) Screening modalities like mammography, ultrasound, MRI and their limitations. Mammography is the primary screening tool for average risk women aged 50-74.
2) Risk assessment factors like family history, genetic mutations, breast density, reproductive history which determine screening frequency and additional tests. Women at high risk start screening earlier and more frequently.
3) Two case studies where mammography limitations are demonstrated. Early detection through clinical exams and additional tests led to cancer diagnosis in both cases. Regular screening tailored to risk level can improve early detection.
Introduction: Ovarian reserve is defi ned as the existent quantitative and qualitative follicular supply found in the ovaries which may turn into mature follicles and assigns a woman’s reproductive potential. The commonly appointed tests of ovarian reserve can be divided into static markers (FSH, estradiol, inhibin-B and [AMH] Anti-Mullerian Hormone), dynamic markers (clomiphene citrate, gonadotrophins and Gonadotrophin Releasing Hormone [GnRh] analogue stimulation tests) and ultrasonographic markers (Antral Follicle Count [AFC],
ovarian volume and ovarian blood fl ow). Leiomyomas are the most common genital tract tumors of benign nature and the most frequent benign uterine disorder in women of reproductive period.
Primary small cell breast carcinoma represents less than 1% of breast cancers. Due to its rarity, there are no uniformly accepted guidelines for treatment. Its prognosis is varied being generally regarded as worse than that of most breast cancers and it poses unique diagnostic challenges. We present a case of primary small cell breast cancer, rationale for our management strategies with reference to the published literature to serve as a guide to the management of this rare cancer of the breast.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
This document discusses various topics related to breast cancer risk assessment and management, including:
1. It describes several risk assessment tools used to evaluate a patient's risk of developing breast cancer based on factors like family history, age, biopsy history, and genetic factors.
2. It discusses various imaging modalities used in breast cancer screening and diagnosis, such as mammography, MRI, and molecular breast imaging.
3. It provides an overview of surgical options for breast cancer, including lumpectomy techniques, mastectomy approaches, and the use of breast-conserving therapy when possible.
Cancer complicates approximately 1 in 1,000 pregnancies. The most commonly diagnosed cancers during pregnancy are breast cancer, cervical cancer, melanoma, and thyroid cancer. Diagnostic delay is not uncommon when cancer is diagnosed during pregnancy due to concerns about protecting the fetus. Treatment options must balance saving the mother's life with protecting the fetus and maintaining the mother's reproductive system.
Pregnancy-associated breast cancer (PABC) refers to breast cancer diagnosed during pregnancy or within one year postpartum. Breast cancer is one of the most common malignancies affecting pregnancy, with incidence increasing as more women delay childbearing. Diagnosis and treatment of PABC presents many challenges due to protecting both the mother and fetus. Surgery is generally safe during any trimester, while chemotherapy should be avoided in the first trimester and radiation therapy given only after delivery. Treatment requires a multidisciplinary approach tailored to the individual considering disease extent, gestational age, and minimizing harm to the pregnancy and fetus.
Topic-Driven Round Table on Ovarian Cancer: Understanding Genetics and Ovaria...bkling
Women with ovarian cancer joined Julie Larson, LCSW, guest speaker Dr. Kathryn Pennington of UW Medicine, and peers via video or phone to discuss genetics and ovarian cancer.
All the guidelines recommend co testing as the modality of choice for cervical cancer screening.
However, Cobas test was approved by FDA as primary screening modality in 2014.
Breast cancer can occur in 1 in 3000 pregnant women. It usually presents with a breast lump and lymph node involvement. Treatment depends on cancer stage and pregnancy age. Options include surgery such as mastectomy, chemotherapy after the first trimester, and radiation delayed until after delivery. Prognosis is similar to non-pregnant women and depends on cancer stage, type, and hormone status. While challenging, modifying treatment can achieve outcomes similar to non-pregnant women with appropriate care.
Cancer during pregnancy can present challenges for balancing treatment of the mother's cancer while protecting the fetus. Key points include:
- Treatment should not differ between pregnant and non-pregnant women when feasible, and aim to benefit the mother's life while protecting the fetus from harmful effects.
- The most common cancers in pregnant women are melanoma, breast cancer, thyroid cancer, and gynecological or blood cancers.
- For imaging, ultrasound and MRI are preferred over X-rays, CT scans, and PET scans to minimize radiation exposure to the fetus.
- For breast cancer, surgery is usually the initial treatment. Chemotherapy can be used in the 2nd and 3rd trimesters for
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
Cancer diagnosed during pregnancy presents complex management challenges due to risks to both the mother and fetus. Treatment options are limited and none are ideal. For early-stage cancers detected in the first trimester, termination may be recommended to allow standard treatment. For late-stage or aggressive cancers, delaying treatment could risk the mother's life but termination is not acceptable to all. Collaboration between medical specialists is needed to determine the safest individualized approach.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
The document summarizes treatment options for cancer during pregnancy. Radiation exposure should be limited to less than 100 mGy to avoid risks to the fetus like growth restriction and malformations. Ultrasound is the preferred imaging method, while CT and PET scans should be avoided. Surgery can be done at any time, and chemotherapy is usually postponed until the second trimester to reduce fetal risks. Radiotherapy poses risks and its timing depends on fetal dose, gestational age, and tumor location. Carbon ion therapy may allow localized dose deposition while minimizing fetal exposure. Outcomes for pregnancy after cancer generally depend on cancer type.
CPD for Inservice Computing Teachers - the story of PLAN CPeter Donaldson
Case study presented at the Scottish Learning Festival 2015 on trying to implement some of the professional learning recommendations contained in Graham Donaldsons report "Teaching Scotland's Future".
The PLAN C (Professional Learning And Networking for Computing) is a national network of lead teachers and local hubs that explore learning and teaching of Computing Science. It aims to bridge the gap between CS education research findings and their wider adoption by teaching professionals.
Li Fi uses visible light communication technology to transmit data wirelessly using light. It provides higher bandwidth than Wi Fi and can be used in environments where Wi Fi is not available or restricted. Li Fi works by varying the intensity of light from LED bulbs to transmit digital signals and uses photodiodes to receive the signals. It has applications in airways, hospitals, and underwater communications and provides advantages like green IT and use of existing lighting infrastructure for internet access. However, it requires line of sight and does not work in dark or outdoor environments unlike Wi Fi.
1) The study examined risk factors and tumor histopathology of 224 uninsured female breast cancer patients in Pakistan.
2) Results showed patients had higher rates of early marriage, abortion, stress, family cancer history, and diseases like diabetes and hypertension.
3) Histopathological analysis found patients aged 40 and under had higher rates of grade III tumors, 1-3 lymph node metastases, and hormone receptor negative status, indicating more advanced disease.
Breast cancer screening-2021 chan hio tongjim kuok
This document discusses breast cancer screening and provides guidance on screening strategies based on risk level. It covers:
1) Screening modalities like mammography, ultrasound, MRI and their limitations. Mammography is the primary screening tool for average risk women aged 50-74.
2) Risk assessment factors like family history, genetic mutations, breast density, reproductive history which determine screening frequency and additional tests. Women at high risk start screening earlier and more frequently.
3) Two case studies where mammography limitations are demonstrated. Early detection through clinical exams and additional tests led to cancer diagnosis in both cases. Regular screening tailored to risk level can improve early detection.
Introduction: Ovarian reserve is defi ned as the existent quantitative and qualitative follicular supply found in the ovaries which may turn into mature follicles and assigns a woman’s reproductive potential. The commonly appointed tests of ovarian reserve can be divided into static markers (FSH, estradiol, inhibin-B and [AMH] Anti-Mullerian Hormone), dynamic markers (clomiphene citrate, gonadotrophins and Gonadotrophin Releasing Hormone [GnRh] analogue stimulation tests) and ultrasonographic markers (Antral Follicle Count [AFC],
ovarian volume and ovarian blood fl ow). Leiomyomas are the most common genital tract tumors of benign nature and the most frequent benign uterine disorder in women of reproductive period.
Primary small cell breast carcinoma represents less than 1% of breast cancers. Due to its rarity, there are no uniformly accepted guidelines for treatment. Its prognosis is varied being generally regarded as worse than that of most breast cancers and it poses unique diagnostic challenges. We present a case of primary small cell breast cancer, rationale for our management strategies with reference to the published literature to serve as a guide to the management of this rare cancer of the breast.
Dr. Jennifer Mueller, gynecologic cancer surgeon at Memorial Sloan Kettering Cancer Center, will share research updates on uterine/endometrial cancer and other new developments in treatment and surgery.
This document discusses various topics related to breast cancer risk assessment and management, including:
1. It describes several risk assessment tools used to evaluate a patient's risk of developing breast cancer based on factors like family history, age, biopsy history, and genetic factors.
2. It discusses various imaging modalities used in breast cancer screening and diagnosis, such as mammography, MRI, and molecular breast imaging.
3. It provides an overview of surgical options for breast cancer, including lumpectomy techniques, mastectomy approaches, and the use of breast-conserving therapy when possible.
Cancer complicates approximately 1 in 1,000 pregnancies. The most commonly diagnosed cancers during pregnancy are breast cancer, cervical cancer, melanoma, and thyroid cancer. Diagnostic delay is not uncommon when cancer is diagnosed during pregnancy due to concerns about protecting the fetus. Treatment options must balance saving the mother's life with protecting the fetus and maintaining the mother's reproductive system.
Pregnancy-associated breast cancer (PABC) refers to breast cancer diagnosed during pregnancy or within one year postpartum. Breast cancer is one of the most common malignancies affecting pregnancy, with incidence increasing as more women delay childbearing. Diagnosis and treatment of PABC presents many challenges due to protecting both the mother and fetus. Surgery is generally safe during any trimester, while chemotherapy should be avoided in the first trimester and radiation therapy given only after delivery. Treatment requires a multidisciplinary approach tailored to the individual considering disease extent, gestational age, and minimizing harm to the pregnancy and fetus.
Topic-Driven Round Table on Ovarian Cancer: Understanding Genetics and Ovaria...bkling
Women with ovarian cancer joined Julie Larson, LCSW, guest speaker Dr. Kathryn Pennington of UW Medicine, and peers via video or phone to discuss genetics and ovarian cancer.
All the guidelines recommend co testing as the modality of choice for cervical cancer screening.
However, Cobas test was approved by FDA as primary screening modality in 2014.
Breast cancer can occur in 1 in 3000 pregnant women. It usually presents with a breast lump and lymph node involvement. Treatment depends on cancer stage and pregnancy age. Options include surgery such as mastectomy, chemotherapy after the first trimester, and radiation delayed until after delivery. Prognosis is similar to non-pregnant women and depends on cancer stage, type, and hormone status. While challenging, modifying treatment can achieve outcomes similar to non-pregnant women with appropriate care.
Cancer during pregnancy can present challenges for balancing treatment of the mother's cancer while protecting the fetus. Key points include:
- Treatment should not differ between pregnant and non-pregnant women when feasible, and aim to benefit the mother's life while protecting the fetus from harmful effects.
- The most common cancers in pregnant women are melanoma, breast cancer, thyroid cancer, and gynecological or blood cancers.
- For imaging, ultrasound and MRI are preferred over X-rays, CT scans, and PET scans to minimize radiation exposure to the fetus.
- For breast cancer, surgery is usually the initial treatment. Chemotherapy can be used in the 2nd and 3rd trimesters for
Neoadjuvant chemotherapy uses chemotherapy drugs to shrink tumors before surgery. It has several advantages, including allowing previously inoperable tumors to become operable, preserving organs, and improving long-term survival. Some studies have found higher rates of pathological complete response and progression-free survival with neoadjuvant chemoradiotherapy compared to chemotherapy alone for some cancers. Neoadjuvant chemotherapy has been shown to be as effective as adjuvant chemotherapy for some cancers. However, it can also be more difficult for patients due to its cumulative toxicity and longer duration before definitive surgery. It may be recommended as an alternative to adjuvant therapy for operable breast cancers where breast conservation is desired or surgery is not immediately possible.
Cancer diagnosed during pregnancy presents complex management challenges due to risks to both the mother and fetus. Treatment options are limited and none are ideal. For early-stage cancers detected in the first trimester, termination may be recommended to allow standard treatment. For late-stage or aggressive cancers, delaying treatment could risk the mother's life but termination is not acceptable to all. Collaboration between medical specialists is needed to determine the safest individualized approach.
Abstract—3D ultrasound (3-dimensional sonography) when combined with sonosalpingography, it provides detailed information regarding internal and external contours of the uterus, without the need for radiation contrast material or surgical intervention. This study was done because of the need of such diagnostic modality that is highly accurate as well as least invasive. A descriptive study was conducted on 50 infertile females to assess the diagnostic value of 3-dimensional SHG in reference of diagnostic hystero-laproscopy (DHL) assuming as gold standard. It was found that sensitivity of 3-dimensional SHG reasons of tubal patency, ovarian pathology and uterine cavity was found 97.6%, 90.91% and 71.43% respectively. And diagnostic accuracy of 3-dimensional SHG in reference of DHL for tubal patency, ovarian pathology and for uterine cavity was found 96%, 92% and 96% respectively. So it can be concluded from present study that 3-Dimensional sonohysterography is an efficient tool to assess women with infertility. Its sensitivity, specificity, and diagnostic accuracy is comparable to hysterolaproscopy.
The document summarizes treatment options for cancer during pregnancy. Radiation exposure should be limited to less than 100 mGy to avoid risks to the fetus like growth restriction and malformations. Ultrasound is the preferred imaging method, while CT and PET scans should be avoided. Surgery can be done at any time, and chemotherapy is usually postponed until the second trimester to reduce fetal risks. Radiotherapy poses risks and its timing depends on fetal dose, gestational age, and tumor location. Carbon ion therapy may allow localized dose deposition while minimizing fetal exposure. Outcomes for pregnancy after cancer generally depend on cancer type.
CPD for Inservice Computing Teachers - the story of PLAN CPeter Donaldson
Case study presented at the Scottish Learning Festival 2015 on trying to implement some of the professional learning recommendations contained in Graham Donaldsons report "Teaching Scotland's Future".
The PLAN C (Professional Learning And Networking for Computing) is a national network of lead teachers and local hubs that explore learning and teaching of Computing Science. It aims to bridge the gap between CS education research findings and their wider adoption by teaching professionals.
Li Fi uses visible light communication technology to transmit data wirelessly using light. It provides higher bandwidth than Wi Fi and can be used in environments where Wi Fi is not available or restricted. Li Fi works by varying the intensity of light from LED bulbs to transmit digital signals and uses photodiodes to receive the signals. It has applications in airways, hospitals, and underwater communications and provides advantages like green IT and use of existing lighting infrastructure for internet access. However, it requires line of sight and does not work in dark or outdoor environments unlike Wi Fi.
Longrich Indonesia meluncurkan Longrich Virtual Office utk Anda sehingga Anda dapat melihat, memantau dan mengembangkan Bisnis Anda dimana dan kapan saja. Go Miliarder bersama Longrich Indonesia. Hubungi : 0811645676 ( WA ) atau PIN BBM : LONGRICH
How Rodan + Fields Is Poised For Growth At Home And AbroadLydia Harp
About Rodan & Fields, LLC
Rodan + Fields® is a direct selling skincare company founded by Dr. Katie Rodan and Dr. Kathy Fields, world-renowned dermatologists and creators of Proactiv® Solution. Rodan + Fields specializes in marketing clinically-proven skincare products with a unique business model that empowers people to become their own bosses and potentially earn substantial incomes with their growing organizations. With triple digit growth in revenues and consultants, groundbreaking product introductions and industry recognition, Rodan + Fields is a fun, fast-paced and exciting company with corporate offices located in the heart of San Francisco. https://lydiaharp.myrandf.com/
This document provides an overview of Rodan + Fields skincare products and regimens. It summarizes their mission to help people solve common skin concerns without a dermatologist visit. Key product lines and regimens are highlighted, including REDEFINE for signs of aging, ACUTE CARE for expression lines, MACRO Exfoliator for exfoliation, and AMP MD System for firmer skin. Clinical results show improvements in skin texture, wrinkles, and firmness. The document promotes taking control of skin health and aging through targeted skincare solutions.
Infographic: Backpacker’s guide to BudapestFreetour.com
Thinking about visiting Budapest, but have no clue what would be waiting for you there? What currency do they use? What should you try there? And how much would it cost after all? Get answers for all your questions from the Backpacker’s guide to Budapest infographic to learn all the most important things about the Hungarian capital.
Prabhu R. has over 4 years of experience designing and developing Windows and web applications using Microsoft SharePoint. He has extensive experience with technologies like .NET, C#, ASP.NET, SQL Server, and Visual Studio. He has implemented solutions for clients in various domains involving technologies like AngularJS, REST APIs, responsive design, and SharePoint 2013/2010. His responsibilities include developing web parts, features, workflows and more. He has experience delivering projects for clients like EY, Elsevier, P&G, and IMS.
Anthony C Smith Leadership and Interpersonal SkillsTony Smith
Anthony C. Smith led efforts to rebrand the Society of Financial Service Professionals by conducting surveys, interviews, and brand audits. A strategic plan was created to attract new members, understand members' needs, and position chapters as a key delivery point. New techniques included timely webinars and conferences, an inclusive brand story, chapter website templates, and improved communication.
Attendance at audio conferences and live events was declining. Showcase sessions by sponsoring company experts and Sponsored Education Online increased attendance and revenue.
A college's declining sales of designation programs was addressed by creating smaller certificate programs focused on target markets. This increased sales by 33% and company and faculty participation.
This document provides an introduction to Microsoft Excel. It covers topics such as the Excel window, toolbars, entering and formatting data, basic formulas, printing, saving, and creating charts. The document contains instructions for common tasks like navigating within a worksheet, selecting cells, widening columns and rows, inserting and deleting columns/rows, filling and copying cell values, and using basic formatting options. It aims to familiarize new Excel users with the main interface elements and how to perform essential worksheet operations.
WordPress plugin market research
1) 3 strategies to check out if my plugin idea is needed.
2) check out which keywords your users using.
3) who are my audience?
ANALYSIS ON THE BASIS OF 8 STEP MODAL-
FORMULATION OF RESEARCH-
Proper formulation is not done, while reading through the dissertation it seems the student got deviated from the topic.
The student could not mention the AIM/OBJECTIVES of the dissertation and it got catered. For example. For aim, to write TO ANALYSE instead of TO STUDY, the aim is the name of the topic of dissertation itself which is misguiding, objectives are very elaborative, instead of being to the point he wrote whole para.
CONCEPTUALIZING-
NEED/ SCOPE of the topic is not mentioned.
HYPOTHESIS of the project is not drawn.
RATIONALE is also not mentioned, student has directly jumped onto the methodology.
DELIMITATIONS are also mentioned.
Study design is also not prepared, whether what type of research it is going to be.
CONSTRUCTING AN INSTRUMENT FOR DATA COLLECTION-
He did mention the data collection as a step in the methodology but, did not mention any tool/ instrument for collecting data, as according to the topic it requires more of interviews from exerts, architects, professors and even students, but nothing as such is mentioned nor done in the report.
None of the primary sources are mentioned, but references are mentioned at the end of the report.
Only case studies are performed and literature studies done, but we can say that conclusion drawn by the student is the perspective of his own thoughts as he did not ask the point of view of others.
SELECTING A SAMPLE-
As proper is not collected so no step of sampling is performed, and the report is not reliable/validate/.
WRITING A RESERCH PROPOSAL-
Content is descriptive and it got scattered, intro of the topic we can is okay, but, the actual problem or aim is not clear.
Objectives are even translucent, as when the aim is not clear, the objectives designed can be misleading too.
Hypothesis is not mentioned.
Measurement procedure can not be drawn as there are no figures or percentage to be calculated.
Appendix is not mentioned
COLLECTING DATA-
Data collected, one can say is not reliable as it has no significance with what was actually required.
PROCESSING DATA-
It is not applicable only, as when collected is non reliable, so how can the coding/ decoding, or editing of the data can be done.
Neither the representation of data is applicable.
WRITING A RESEARCH-
References are drawn.
No bibliography/appendices
No variable/no evaluation/ no questionnaires.
According to Dr. Vo Dang Hung, Director of TMMC Healthcare's Oncology Center. Breast Cancer is the most popular cancer among women. Know your risks and get frequent Breast Cancer Screenings to protect yourself.
This document discusses various methods for breast cancer screening. It summarizes that mammography is effective for women over 50 but misses 30% of cancers and has a high false positive rate. Newer technologies like MRI and ultrasound have limitations as well. The document then focuses on breast thermography, which uses infrared scanning to detect temperature variations in breast tissue. It outlines the history and improved accuracy of modern thermography, citing clinical studies showing it can detect cancers earlier and with greater sensitivity than other methods. The document advocates for wider adoption of thermography in breast cancer screening.
Knowledge Discovery from Breast Cancer Databaseiosrjce
In this paper, we study various factors leading to breast cancer and also a few symptoms that act as
biomarkers for the occurrence of breast cancer in women. Totally 18 factors are taken for study. Statistical
techniques are used to analyze the influence of various factors towards the disease and test for significance of
factors is also done. Besides association rule mining is attempted to generate possible factors that may lead to
breast cancer. An attempt to classify the given dataset using information gain techniques and CHAID
techniques was done. Clustering was also done to predict the occurrence of breast cancer. The results show
that there is more possibility of developing breast cancer among married working women who have breast fed less than 2.5 years in total.
Breast cancer starts in the cells of the breast and can spread to other parts of the body. There are several types of breast cancer including ductal carcinoma in situ, invasive ductal carcinoma, inflammatory breast cancer, and metastatic breast cancer. While the exact causes are unknown, risk factors include gender, age, genetics, family history, personal history, menstrual periods, pregnancy history, and breastfeeding. Signs and symptoms include a lump or thickening in the breast. Investigations include mammography, ultrasound, and biopsy. Treatment involves surgery to remove the tumor, chemotherapy, radiation therapy, and hormone therapy. Prevention strategies incorporate lifestyle factors and screening includes clinical breast exams and mammograms.
Breast cancer starts in the cells of the breast and can spread to other parts of the body. There are several types of breast cancer including ductal carcinoma in situ, invasive ductal carcinoma, inflammatory breast cancer, and metastatic breast cancer. Risk factors include being a woman, aging, family history and genetic factors, personal history of breast cancer, reproductive history. Screening tests include mammograms, clinical breast exams, and breast self-exams. Treatment involves surgery to remove the tumor, chemotherapy, radiation therapy, and hormone therapy. Prevention focuses on maintaining a healthy weight, physical activity, breastfeeding, diet and avoiding hormone therapy when possible.
Treatment of breast cancer by chemotherapy AsifaKanwal1
This document discusses the treatment of breast cancer using chemotherapy. It begins with an introduction to breast cancer, its causes, risk factors, signs and symptoms, diagnosis, and general treatment options. It then focuses on chemotherapy as a treatment, describing the different types of chemotherapy drugs used to treat breast cancer like doxorubicin, cyclophosphamide, fluorouracil, and epirubicin. It discusses how these drugs work and their common side effects. The document provides details on chemotherapy regimens and administration methods like intravenous or oral routes. Overall, it provides a comprehensive overview of chemotherapy as a treatment for breast cancer.
Breast cancer develops from breast tissue and is one of the most common types of cancer in women. Some signs and symptoms include a lump in the breast, changes to the skin on the breast, or fluid coming from the nipple. Risk factors include female sex, older age, family history, and certain genetic mutations. Diagnosis involves exams, mammograms, and other scans. Treatment options include surgery to remove tumors, medication like chemotherapy or hormone therapy, and radiation.
Breast cancer develops from breast tissue and is one of the most common types of cancer in women. Some signs and symptoms include a lump in the breast, changes to the skin on the breast, or fluid coming from the nipple. Risk factors include female sex, older age, family history and certain genetic mutations. Diagnosis involves exams, mammograms, and other scans. Treatment options include surgery to remove tumors, medication like chemotherapy or hormone therapy, and radiation therapy.
This document compares calcification specificity in digital mammography using soft-copy display versus screen-film mammography. Breast cancer is the most common cancer in women. Digital mammography offers advantages over screen-film mammography like enhanced resolution and contrast. The study aims to compare the specificity of detecting microcalcifications, which can indicate early breast cancer, between the two imaging methods. Sixty female patients undergoing mammography were divided into groups for either screen-film or soft-copy digital mammography. Patient data and mammogram images were analyzed using statistical and imaging software to compare detection of microcalcifications between the methods.
The document discusses breast examination techniques and evaluation of breast masses. It describes how to perform a breast exam and evaluate for changes. Common benign breast conditions like fibrocystic changes and risk factors for breast cancer are outlined. The document recommends that any suspicious breast mass initially undergo mammography or ultrasound and be biopsied, as physical exam alone cannot reliably determine if a mass is benign or malignant.
Preventive oncology focuses on preventing cancer development through identifying risk factors and detecting precursor lesions early. Half of cancers arise from modifiable risk factors like smoking and diet. Screening tools like mammography, Pap smears, and HPV testing can detect cancers early and improve outcomes. For those at high risk, preventive options include vaccines, risk-reducing surgery, and lifestyle changes. Cancer treatments can impact fertility, so oncologists must counsel patients on fertility preservation options before starting treatment. Survivorship brings psychological challenges, but focusing on living well rather than the disease can help overcome fear and loneliness.
The document summarizes the state of cancer research in 2010 according to the Campbell Family Cancer Research Institute. Key points include:
- Significant advances have been made in understanding the genetic and epigenetic basis of cancer and tumor behavior. However, cures require strategies to destroy both bulk tumor cells and tumor-initiating cells.
- The immune system plays an important role in preventing tumors, but tumors evade immunity; immunotherapies aim to reactivate anti-tumor immune responses.
- Early detection through improved imaging techniques can increase cure rates for cancers caught at smaller sizes.
The document discusses fertility preservation options for breast cancer patients. It notes that chemotherapy can severely damage fertility. While oncologists' main focus is cancer treatment, discussing fertility preservation is important for patients' quality of life. Options include embryo freezing, oocyte cryopreservation, and experimental options like ovarian tissue freezing. The discussion should occur early to provide maximum choice with minimal cancer treatment delay. Barriers to discussion include perceived time constraints, though most patients value knowing their options.
Estrogen Trimestegone Effect on Breast CarcinomaOscarKwan6
Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. Risk factors for breast cancer include older age, family history, certain genetic mutations, high breast density, radiation exposure, late menopause, early menstruation, late or no pregnancy. Studies have found that oral contraceptive use is associated with a slight increased risk of breast cancer, though this risk decreases 10 years after stopping use. Certain combined hormone replacement therapies of estrogen and progestin are also associated with increased breast cancer risk apparent after 3 years of use, but risk returns to baseline within 5 years of stopping treatment.
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
The document summarizes research on the potential relationship between fertility drugs and ovarian cancer risk. It describes several studies, including a 2013 Cochrane review of 25 studies involving over 182,000 women. The Cochrane review found no evidence that fertility drugs increase the risk of invasive ovarian cancer compared to untreated subfertile women. It found a possible increased risk of borderline ovarian tumors in women treated with IVF. However, some studies showing increased risk had high risk of bias. Overall, more high-quality research is still needed to determine if a definitive cancer risk exists.
Feature story from the Garvan Institute of Medical Research's April 2013 issue of Breakthrough newsletter. More at https://www.garvan.org.au/news-events/newsletters
Similar to Qualitative and Quantitative Investigation (20)
1. Qualitative and Quantitative
Investigation of Cytology Material
from Carcinoma of the Breast with
Particular Reference to the
Demonstration of Estrogen Receptors
B. M. Brown A.I.M.L.S.
Department of Histopathology
St Thomas’ Hospital
2. Table of Contents
SUMMARY .......................................................... 3
Introduction ..................................................... 4
Aims of the project ............................................. 13
Materials and methods ........................................... 14
Summary of techniques ........................................... 16
Fine Needle Aspiration......................................... 16
Double Embedding Method........................................ 16
Periodic Acid Schiff (PAS)..................................... 18
Immunoperoxidase Indirect Method............................... 18
Results ......................................................... 20
Breast Aspirate Samples Prepared By the Double Embedding Technique
.............................................................. 24
Conclusion/Discussion ........................................... 25
Appendices ...................................................... 31
References ...................................................... 32
3. 3
SUMMARY
In total, 80 breast lumps were sampled by fine needle
aspiration for the demonstration of Estrogen Receptor Protein.
30 breast lump aspirates were used to prepare direct smears
and 50 breast lump aspirates were used to prepare pellets for
double embedding and histological sections.
Immunoperoxidase was carried out on each case by the Indirect
Immunoperoxide method, using Monoclonal Antibodies against
Carcinoembryonic Antigen (CEA), Epithelial Membrane Antigen
(EMA), Cytokeratin (CAM 4.2) (Cytok), DD9 (E7), and Estrogen
Receptor Protein (D5).
52/80 aspirates prepared were found to be positive for EMA.
16/80 aspirates were found to have Estrogen Receptor Protein
antigens. 20/80 were CEA positive. 56/80 Cytok positive and
22/50 were positive with DD9.
8/30 aspirates using a direct smear method were unreliable and
11/50 aspirates using the double embedding method were
uninterpretable.
The double embedding method gave unequivocal results proving
the aspirate was adequate. Whereas the smears gave equivocal
results due to cell adherence, smear techniques and background
staining.
4. 4
INTRODUCTION
One British woman in seventeen develops breast cancer during
her lifetime and nearly two thirds of these women eventually
die from the disease.1
In humans, breast malignancies probably arise largely from
basal cells of the ductal epithelium.
Ionizing radiation is the only known risk factor for carcinoma
of the breast and probably acts by damaging the D.N.A. of the
breast cells. Nevertheless, radiation exposure can only
account for a small proportion of tumours, and other factors,
causing risk, must occur. Many researchers believe that the
ovarian-pituitary axis may play an aetiological role.
By exerting hormonal effects, rates of cell proliferation may
be increased or decreased, and atrophy or differentiation of
stem or intermediate cells may occur.2
Women have approximately 100 times greater a chance of
developing breast cancer than men. From puberty to menopause,
the incidence of breast cancer increases rapidly but post-
menopausal, the incidence declines.
5. 5
Risk increases the longer a woman has normal ovarian function.
Premenopausal oophorectomy, without exogenous estrogen
supplements, is found to diminish the risk.2
It has also been found that child bearing alters the risk,
parous women being at greater risk than nulliparous women.
Parous women who had early pregnancies are at less risk than
parous women who have had late pregnancies. Women who suffered
interruption of their pregnancy during the first trimester,
are found to have an increased risk of breast cancer.3
Endogenous estrogens, progesterone and possibly androgens and
prolactin are thought to be involved in this risk factor and
are most likely to play a role in these pathogenic changes.
Estrogen causes proliferation of breast tissue and would
therefore be expected to increase the risk of breast carcinoma
by stimulating the growth stem and intermediate cells.
Progesterone causes alveolar cell growth in the estrogen-
primed breast, but also differentiation. It is unclear
therefore whether the net effect would be to increase or
decrease the risk.
Androgens depress mammary cell growth and would be expected to
be protective against breast carcinoma.
6. 6
Prolactin acts on the estrogen-primed breast to stimulate and
maintain lactation and since it is associated with the
function of differentiated cells rather than stimulation of
cell growth, it would be expected to decrease the incidence
risk.2
All estrogen secreting ovarian tumours have been related to an
increase in incidence of breast cancer.2
Hoover and associates4, observed an increase in risk with the
increase in numbers of prescribed estrogens. Ross and co-
workers5 observed the relative risk to increase with the total
cumulative amount of estrogens received.
High doses of estrogens can cause breast cancer. A report that
two transvestite men, receiving massive doses of estrogens to
induce breast development, subsequently developed breast
carcinoma.6 Oral contraceptives however, are a mixture of
Estrogen and Progesterone but produce a net progesteronal
effect and no alteration to risk is documented.3, 7, 8
Research is also looking at the relationship between diet and
breast cancer with special concern to dietary fat,9, 10
especially in the form of unsaturated fats, which is known to
produce mammary tumours in rodents. In the United States, an
increase in total fat consumption and an increase in
7. 7
polyunsaturated fats in daily diets has occurred. Little if
any change in the incident rate of breast cancer screening, in
white women, has been seen.11 However epidemiological studies
on inhibition or promotion of breast cancer in the hope of
finding a practical significance in the relationship between
diet and breast cancer will continue.
A lump in the breast is an important lesion for the patient.
In post-menopausal women, a single nodule in the breast is
almost certainly a carcinoma.
Screening for breast cancer is a valuable service and was
introduced in the attempt to detect the ‘early’ carcinoma and
so reduce the risk of spread and reduce the breast cancer
death rates. A bi-annual clinical examination is recommended.1
Education of women in self-examination procedures is important
especially in the detection of ‘interval cancers’ occurring
between the bi-annual check-ups.
Patients presenting with palpable breast lesions should have
samples taken for cytological examination. Samples are taken
by fine needle aspiration. This method is simple, inexpensive
and is most commonly used for preoperative assessment.12
8. 8
The advantages of the fine needle aspirate are; that it is
quicker to report than conventional surgical biopsy material;
less technically demanding; less traumatic to the patient and
viewed by the patient, as an extension of a doctor’s
examination.
Kun13 reported the first use of the Fine Needle in 1847 but
what use he made of his sample is unknown. In 1853, Sir James
Paget14 used fine needle aspiration to prepare a cell spread.
In 1930 Ellis and Martin15, a head and neck Surgeon, used a
need puncture and aspiration technique in preference to open
surgical biopsies. Dr F Stewart actually interpreted the
results and later went on to report a large series of
aspiration biopsies with repeated accurate diagnosis.16
There has been speculation as to spread of tumour cells when
using fine needle methods, but Berg and Robbens17 showed
identical 15-year survival rates in matched groups of fine
needle and surgical biopsy patients with breast cancer. In
some cases, local bruising is all that has been reported.
Breast cancer has been found in many cases to be hormone
responsive.
In 1896, an ovariectomy was found to produce regression of a
metastatic tumour.18 Since then, adrenalectomy and
9. 9
hypophysectomy have been used to achieve similar results. By
removing these organs, the source of circulating hormones,
which stimulate or support breast cancer, is removed.
This however is not considered the therapy of choice as only
20-40% of breast cancer patients are found to have tumour
regression and when chemotherapy is combined, 60% of patients
are found to have tumour regression.19
Normal target tissues for hormones, including mammary glands,
contain specific receptors. These receptor sites are
responsible for the initial interaction between the hormone
and the cell and function to trigger the biochemical chain of
events characteristic of that hormone.
It has been found that a proportion of breast tumours also
contain receptors while others do not. It is thought that when
malignant transformation occurs, the cell may retain all or
only part of the normal population of receptor sites. If the
cell retains the receptor sites, it has normal cell stimulus
by its hormonal dependence. If the cell does not retain the
receptor sites, the circulating hormones no longer recognise
it, as a target cell and endocrine control is lost. This
implies that the cells retaining receptor sites will benefit
from endocrine therapy, and those cells that do not have
receptor sites, will not.19 Therefore, steroid receptor assays
10. 10
assist the selection of patients with breast carcinomas who
may benefit from endocrine therapy. These biochemical assay
methods require fresh tissue, and elaborate equipment. By
utilising the aspiration samples and performing
immunoperoxidase methods directed against the estrogen
receptor protein, prognosis for endocrine therapy may be
aided.
Use of anti-estrogens are beneficial for patients who retain
estrogen receptors and do not undergo surgery. Drugs such as
Tamoxifen are thought to significantly reduce clonal growth,20
or may act as a competitive inhibitor to growth of the
cells.21, 22 For elderly patients, drugs such as Tamoxifen is a
save from trauma of surgery.
Immunocytochemical markers can be used to detect estrogen
receptors and with the use of other Immunocytochemical
markers, in the detection of other cell antigens, has been
found to be valuable in the diagnosis and prognosis of breast
proliferative disorders.
Estrogen receptor related protein (D5) [see note 1] is a
monoclonal antibody raised against affinity purified cytosol
estradiol receptor from human myometrium.23
Carcinoembryonic Antigen (CEA), [see note 1] is an
incompletely defined glycoprotein of 180,000 Daltons. It is an
11. 11
oncofetal antigen, which was originally found in colorectal
carcinomas but has been demonstrated in some human breast
cancers. Shousha et al, 24 suggested that there is a significant
relationship between the demonstration of CEA in breast
carcinomas and the presence of lymph node metastasis with five
and ten year survival rates.
There has also been suggestions that the presence of CEA
suggests a more aggressive tumour behaviour.25
Epithelial Membrane Antigen (EMA) [see note 2] is a large
glycoprotein >440,000 Daltons which is partially purified and
recognised by antisera raised against milk fat globule
membranes. It is found in all breast tissue and is therefore
used as a positive control for this study.26
Cytokeratin (CAM 5.2)27 (Cytok) [see note 3] is a murine
monoclonal antibody which recognises lower molecular weight
intracellular cytokeratin proteins within secretory
epithelium.
DD9 E728 is a murine monoclonal antibody, with some
discrimination for pancreatic adenocarcinomas, which binds to
a component of approximately 55.00 molecular weight. The
antigen detected has been found in breast carcinomas but its
12. 12
immunohistochemical pattern is different to that found with
antibodies against CEA and EMA28.
Notes
1. Amersham International PLC., Amersham, Bucks.
2. Dako Ltd., High Wycombe. Bucks.
3. Beckton Dickinson, Laboratory Impex, Middlesex.
13. 13
AIMS OF THE PROJECT
The aim of this project is to develop a method for
concentrating and processing the small number of cells
obtained by fine needle aspiration to paraffin wax allowing
histological sections to be cut.
The sections are then used to demonstrate and quantitate the
presence of the antibodies; CEA, EMA, Cytok, DD9, D5, and
compare with the results found with conventional smear
cytological preparations of fine needle aspiration samples.
14. 14
MATERIALS AND METHODS
In this project, 80 cases of patients with breast lumps were
investigated. 62 cases represent patients admitted into the
Outpatient Department for fine needle aspiration. Of these 62
cases, 30 had direct smears made from the sample, 32 cases
were sent to the Histopathology Department for double
embedding. The remaining 18 cases represents aspirations taken
from breast lumps received in the Histopathology Department
requiring frozen sectioning.
All the aspirates required for double embedding were fixed in
Methacarn within microcentrifuge tubes [see note 1]. All the
aspirates used for direct smear preparation were fixed in 95%
alcohol immediately following preparation.
Each case was examined Immunocytochemically by an Indirect
Immunoperoxidase method using Monoclonal Antibodies against
the antigens:
1. Carcinoembryonic Antigen (CEA)
2. Epithelial Membrane Antigen (EMA)
3. Cytokeratin (CAM 5.2) (Cytok)
4. DD9 E7 (DD9)
5. Estrogen Receptor Protein (D5)
15. 15
The following positive controls were used against each
antibody:
The positive control for CEA was a moderately differentiated
adenocarcinoma arising in the sigmoid colon.
For EMA a moderately differentiated ductal carcinoma of the
breast was used.
The control used for Cytok was a breast lump showing mild
fibrocystic disease with fibrosis and duct dilation.
A focally necrotic moderately differentiated adenocarcinoma of
the pancreas was used as a control for DD9.
Normal skin fixed using Methacarn, containing sebaceous glands
was used for D5 as a positive control.
In addition to Immunoperoxidase methods, each case was stained
by the following techniques:
1. Mayer’s alum Haematoxylin and Eosin
2. Periodic Acid Schiff (PAS)
16. 16
SUMMARY OF TECHNIQUES
Fine Needle Aspiration (Appendix 3)
In the Outpatient Department at the William Harvey Hospital,
fine needle aspiration was achieved by using a 21-gauge needle
and by a 10ml syringe pistol. [See note 1] (Fig. 1) By using
maximum suction and moving the needle tip back and forth
within the breast lump, cells were aspirated and fixed in
Methacarn fixative. (Appendix 1) or direct smears prepared and
fixed immediately following preparation in 95% alcohol. [Fig.
2a & b]
In the Histopathology Department at St. Thomas’ Hospital, fine
needle aspiration on frozen section breast lumps was achieved
by using a 21-gauge needle and a 20 ml syringe. Using a
standard technique, cells were aspirated and fixed in
Methacarn fixative
Double Embedding Method (Appendix 4)
The cells aspirated from breast lumps are received in
Methacarn fixative, within microcentrifuge tubes. By process
of centrifugation, and removal of supernatant, the cells are
transferred from Methacarn to absolute alcohol. This removes
the chloroform, which is one of the constituents of Methacarn
fixative. The absolute alcohol is removed and cells are re-
17. 17
suspended in distilled water and transferred to a ‘BEEM’
capsule, [see note 2] which allows a greater concentration of
cells. The distilled water is removed and the cells are
embedded in 5% agar. (See Appendix 4) Freezing the agar allows
better handling. They are placed onto a tissue processor, in
this form, commencing with 95% alcohol, processed and embedded
in paraffin wax. 4µ sections are cut and mounted onto slides
previously coated with a chrome gelatine solution. (See
Appendix 2)
Some of the aspirated samples contained fewer cells and these
proved difficult to see especially during the processing steps
and subsequent cutting stages. Dyes were used to aid these
stages so that the cell loss was minimised. The dyes used
were:
1% Eosin
Saturated Alcoholic Picric Acid
Lugols Iodine (1g Iodine, 2g Potassium Iodide, 100ml
D.H20)
1% Potassium Permanganate
Mayer’s/Celestine blue Iron Haematoxylin
Azure A
Notes
1. Syringe pistol (Cameco AB, Sweden)
18. 18
2. BEEM capsule 00. 1mm square tip pyramid shape. Supplied
by Agar Aids Ltd., Essex.
Periodic Acid Schiff (PAS) (Appendix 6)
This is a histochemical reaction, which demonstrates liberated
aldehydes in tissue/cells. These are found in glycogen and
neutral mucins. Glycogen and neutral mucins (and some acid
mucins) have a hexose carbohydrate fraction; it is the
adjacent 1:2 glycol groups of this that are oxidised by
periodic acid (HIO4) to give free aldehydes that re-colour
Schiff’s sulphate leucofuchsin reagent.29
Immunoperoxidase Indirect Method (Appendix 7)
In this method, the slides are incubated with two antibodies.
The first is unlabelled and the second, which is directed
against the immunoglobulin of the species in which the first
antibody is raised, is conjugated with horseradish
peroxidase.30
The slide is then treated with a substrate, usually
Diaminobenzidine (DAB), which in the presence of peroxidase
and hydrogen peroxide (H202) polymerizes to form an insoluble
brown material, which is deposited at the site of the initial
antigen/antibody reaction.
19. 19
Peroxidase and peroxidase-like enzymes are present in many
normal and neoplastic tissues including red blood cells. To
aid interpretation and to prevent false positive results,
these endogenous peroxidase substances require blocking prior
to incubation with the antibodies. This blocking procedure
includes the bleaching of haematin using hydrogen peroxidase
and periodic acid – borohydride method, which is shown in
appendix 6.
For D5, inhibition of endogenous peroxidase was inhibited
using 6% hydrogen peroxidase. The use of periodic acid and
potassium borohydride has been found to reduce the intensity
of the final staining reaction.
The use of the relevant controls is essential.31
20. 20
RESULTS
The results have been scored visually and no accurate means of
quantitation has been carried out.
The size of the pellet was estimated using an eyepiece
graticule calibrated by a stage micrometer using the following
calculation for each magnification:
number of stage micrometer divisions = µm
number of eye piece divisions
Mitosis were counted using x40 objective for five fields.
Table 1 represents the breast aspirate samples prepared by the
double embedding method.
The results were tabulated in detail and use the following
scoring system:
0 .... All cells negative
± .... Occasional positive cell
+ .... Small number of positive cells
++ .... Moderate number of positive cells
+++ .... Majority positive cells
++++ .... All cells positive
Freezing of the pellets caused no apparent distortion of the
cell morphology. Of the 50 samples prepared by the double
21. 21
embedding method. 11 samples were omitted from staining as the
nu8mber of cells present on the H&E, were found to be
insufficient for a reliable diagnosis.
14 cases were found to be CEA positive, 36 cases were EMA
positive, 32 cases Cytok positive, 22 cases DD9 positive and
11 cases were positive for D5. 30 cases were PAS positive.
If the pellets were not thoroughly washed in absolute alcohol
and distilled water to remove the Methacarn fixative, a black
precipitate was formed. It was later found that this
precipitate could be removed from sections prior to staining
by incubating the dewaxed section in saturated alcoholic
picric acid for at least five hours.
Six dyes were used on various pellets to help visualise the
cells during processing and cutting.
1% aqueous eosin was found to be valuable in the detection of
the cells during processing and cutting but could not be
removed by washing in water or 10% acid alcohol and was found
to some extent, mask the chromogen, diaminobenzidine reaction
product.
Iron haematoxylin helped to visualise the cells during
processing and cutting but this ‘dye’ also stained the nuclei
22. 22
of the cells which could cause difficulty with interpretation
of antigens located in the nucleus.
1% potassium permanganate appeared to be the best, staining
the cells clearly, allowing precise localisation of the cells
during processing and cutting. This stain required bleaching
with 1% oxalic acid prior to staining. During the
immunostaining, all the sections floated from the slides.
Saturated alcoholic picric acid demonstrated large pellets
well but small pellets were visualized during the initial
processing but when the pellets were processed to paraffin
wax, the colour was washed out and therefore did not aid
cutting.
Lugols iodine and Azure A did not stain the cells sufficiently
to be of any benefit during processing or cutting.
The pellets containing blood were the best. The blood could be
seen during processing of the pellets and cutting. When a
section was cut from the blood, cells were also found to be
present. The blood did not require special treatment prior to
staining especially with immunostaining as endogenous red cell
peroxidase-like activity was blocked prior to immunostaining.
23. 23
Table 2 represents the breast aspirate samples prepared by the
smear technique.
The results are not tabulated in detail and use the following
scoring system:
Pos .... Immunostaining present
Neg .... No immunostaining present
NT .... No tumour cells present
No cells No cells present
RBC .... Red blood cells only present
Of the 30 samples prepared by this method, 4 cases were CEA
positive, 15 cases were EMA positive, 22 cases were found to
by Cytok positive and 5 cases D5 positive.
DD9 and the PAS reaction were not used on these slides, a
colleague prepared the slides prior to this project, and
insufficient slides were found.
24. 24
RESULTS
Table 1
Breast Aspirate Samples Prepared By the Double Embedding
Technique
Results removed from this portfolio sample. If you would like
to see the complete project, then please contact Bridget on
bridget@eclipsecopywriting.com
25. 25
CONCLUSION/DISCUSSION
The quality of the pellets and smears rely mainly on the
expertise of the clinician sampling the patient’s breast lump.
If the clinician fails to sample the lump adequately, the
following procedures are of little value. Of the 18 breast
lumps sent for frozen section at St Thomas’ Hospital, which
were aspirated once a definite diagnosis had been made and
without prejudice to routine pathological investigation, 5
aspirates were found to be of no value due to insufficient
number of cells present. As the author was responsible for
aspirating these lumps, they can be regarded as taken from an
inexperienced hand. Of the 32 breast lumps received in the
histopathology department from the outpatients department at
the William Harvey Hospital, 5 aspirates were found inadequate
due to an insufficient number of cells present. It can be seen
therefore that an experienced clinician will yield a greater
number of adequate aspiration samples. 1 aspirate was
regrettably destroyed during the processing.
If an adequate breast lump aspirate is taken, the double
embedding method did seem to provide a more accurate result
section after section. At least 10 sections should be
available from even the smallest pellet and this is sufficient
to investigate the distribution of Immunocytochemical markers
26. 26
and histochemical stains with the use of adequate negative
controls. Sections can be reliably compared.
One of the advantages of the double embedding technique is the
small area within which the cells are concentrated. Little
time is spent screening the smear and valuable antibodies,
used to demonstrate markers Immunocytochemically, are not
wasted.
The smear technique proved to be unreliable as each smear was
unique. One slide from a patient may have malignant cells
present and another may not. Therefore with any immunostaining
performed, the results were likely to be equivocal.
The number of smears made from one breast lump aspirate are
minimal, usually a maximum of five slides. This leaves very
little material for other techniques.
The greatest disadvantage of the smear technique is the large
area over which the cells are spread. Time is wasted during
screening and valuable antibody is wasted as the larger area
needs to be covered.
The major disadvantage of the double embedding method is
seeing a small number of cells that may be present. The use of
dyes may not necessarily be of help as with 1% potassium
27. 27
permanganate, which caused the sections to fall off the slide
during immunostaining. Blood present in the pellet did however
aid processing and cutting and cause no problems with
subsequent staining. Perhaps the addition of one drop of blood
to each pellet is all the ‘dye’ required.
All pellets containing tumour cells were found to be EMA
positive, this would support the literature stating all breast
tumours are EMA positive.
16 pellets were found to be CEA positive but of these, not all
the malignant cells in each pellet were CEA positive.
Therefore CEA could not be used reliably to assess prognosis
of the patient as only a proportion of the malignant cells
were CEA positive. CEA was not detected in any pellets which
were benign or contained no tumour cells.
DD9 gave similar results to CEA but occasionally the result
was found to be stronger or a minimal positive reaction was
seen when CEA was negative.
34 pellets were Cytok positive.
11 pellets were found to have weak D5 positivity, which would
be regarded as patients who would react favourably to
endocrine therapy. Not all the malignant cells in a positive
28. 28
pellet were D5 positive which shows only a part of the normal
population of receptor sites were present.
The PAS reaction was found to be of no significant value and
in hindsight, a Diastase treated PAS reaction would be of more
value as this would aid in the diagnosis of adenocarcinomas of
the breast. EMA however was of value as this marker picked out
the acini of adenocarcinomas.
The number of mitotic figures was found to be of value as
their presence illustrated a more aggressive tumour. Methacarn
was a good fixative for the demonstration of mitosis, as it
arrests mitosis and then preserves the cells in this state.
No mitotic figures were seen in the breast aspirates prepared
by the smear technique. These samples were fixed in 95%
alcohol, and this may not have preserved mitosis if any were
present.
Methacarn was the fixative used in the double embedding
method, as D5 requires this fixative for optimum staining
reaction. In the smear technique, only 5/30 smears were weakly
D5 positive. This may be a false representation due to the
fixative used or this may be a true representation. As the
smears were fixed prior to this project, fixation was already
achieved using 95% alcohol and not Methacarn, which is the
29. 29
recommended fixative when demonstrating estrogen receptor
proteins with D5. Further research is required involving
various fixatives on the staining reaction of D5.
In the presence of tumour cells the immunostaining results of
the smear was similar to the pellets. However, as stated
above, each smear was unique and one slide per case could vary
from the next.
Methacarn was not the fixative of choice, but was required in
the demonstration of estrogen receptor protein. The EMA
positive cells showed intranuclear staining and Methacarn was
the suggested cause.
The aim of this project was to develop a method for
concentrating and processing fine needle aspiration samples to
paraffin wax. The use of plasma/thromboplastin as a method for
preparation of cell blocks has been documented33 but the
possibility of immunological cross-reactivity with foreign
human proteins and the fact that such reagents are not
immediately available in a histopathology laboratory, led the
author to use agar as an embedding medium.
The double embedding method used in this project is an ideal
method, which can be used by a routine laboratory requiring no
30. 30
expensive reagent or equipment. It can be used for any type of
aspiration sample or small friable histological specimens.
This method is more favourable to conventional cytological
preparations especially when a number of staining techniques
are required.
The demonstration of immunomarkers on these cases is a part of
a larger study correlating the distribution of these markers
in response to Tamoxifen and/or surgery in elderly women.
An additional required investigation is to establish whether
the role of progesterone is a significant factor in the
stimulation of carcinoma of the breast.
31. 31
APPENDICES
Appendices removed from this portfolio sample. If you would
like to see the complete project, then please contact Bridget
on bridget@eclipsecopywriting.com
32. 32
REFERENCES
1. Breast Screening project. From unknown source.
2. THOMAS, DAVID, B. (1984)
26. HYDERMAN, E., BROWN, B.M, RICHARDSON, T.C (1984)
Epithelial markers in prostatic, bladder and
colorectal cancer: An Immunoperoxidase study of
epithelial membrane antigen, carcinoembryonic
antigen and prostatic acid phosphatase
The full reference listing is not included in this portfolio
sample. If you would like to see the complete project, then
please contact Bridget on bridget@eclipsecopywriting.com