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Biomedical subjects

C S Dowle

Publications and source records attributed to C S Dowle.

18 recordsLinked to original sources
PubMed1992

Aspiration cytodiagnosis of breast carcinoma in pregnancy and lactation with immunohistochemical and electron microscopic study of an unusual mammary malignancy with pleomorphic giant cells.

We have reviewed our experience with 8,706 needle aspiration cytology (NAC) of the breast which were done from January 1983 to June 1991. During our study we diagnosed four cases of breast carcinomas (three ductal type and one with pleomorphic giant cells) in pregnant or lactating women; in all of these the cytologic findings corresponded with the subsequent tissue diagnosis and cell block preparations. Considering that carcinoma of breast during pregnancy and lactation is rare and is second only to cervical cancer, it was felt that its diagnosis by NAC was useful for timely management. In the case in which pleomorphic giant cells were present as an integral component of the tumour, immunohistochemical and electron microscopic study was done. This is discussed in view of our recent experience with this unusual tumour.

Adult↗
PubMed1992

Fine needle aspiration cytodiagnosis of apocrine carcinoma of the breast.

The cytopathological appearances of 14 cases of apocrine breast carcinoma diagnosed by fine needle aspiration cytology are described and the features compared to those seen in apocrine cells aspirated from benign cystic and solid lesions. Significant atypia must be observed before a diagnosis of apocrine carcinoma can be entertained.

Biopsy, Needle↗
PubMed1991

A case of neurilemoma (schwannoma) that mimicked a pleomorphic adenoma (an example of potential pitfall in aspiration cytodiagnosis).

Needle-aspiration cytology of a case of benign neurilemoma (Schwannoma) from the neck is presented. It was clinically diagnosed as an enlarged lymph node, while on aspiration cytology, it was diagnosed as a pleomorphic adenoma. An excision biopsy, however, was diagnostic of neurilemoma. A review of cytologic material was undertaken, and it was felt that the cytologic features in Papanicolaou stained preparations in the aspirate were present that initially should have enabled the correct cytodiagnosis and distinction from a pleomorphic adenoma. The findings presented in this study were considered to be an example of a potential pitfall in the aspiration cytodiagnosis of a neurilemoma.

Biopsy, Needle↗
PubMed1991

The diagnostic impact of needle aspiration cytology of the breast on clinical decision making with an emphasis on the aspiration cytodiagnosis of male breast masses.

Our experience with a total of 7,231 needle aspirates of the breast was reviewed. Ninety-nine cases from the total of 7,231 aspirates studied were from male patients. While an aspiration cytodiagnosis of gynecomastia was made in most of these cases, carcinoma was diagnosed in four cases. Although a clinical distinction between male breast cancer and gynecomastia is often difficult, we found needle aspiration cytology a very useful initial investigation for making this distinction.

Adolescent↗
PubMed1990

Flow cytometric and histological analysis of ductal carcinoma in situ of the breast.

Using archival paraffin wax embedded tumour we have investigated histological grade, DNA ploidy, S phase fraction and proliferative index in 74 patients with symptomatic ductal carcinoma in situ (DCIS) of the breast. Nine patients developed local recurrence, six invasive in character. No patients with the cribriform subtype of DCIS developed local recurrence. The cribriform subtype showed a significantly lower rate of DNA aneuploidy and a lower proliferative index than the other subtypes. Cribriform tumours were almost exclusively well differentiated in contrast with the comedo and solid variants. Our results suggest the cribriform variant is less aggressive than other subtypes of DCIS. This has possible implications for management of these lesions.

Adult↗
PubMed1989

c-myc oncogene product expression and prognosis in operable breast cancer.

The 62 kDa protein product of the c-myc oncogene (p62 c-myc) is thought to be involved in the control of normal cellular proliferation and differentiation. We have measured oncoprotein levels using a flow cytometric assay in 141 operable breast cancers and have correlated levels with prognostic variables, patient survival and disease free intervals. High levels of p62 c-myc were associated with well differentiated tumours. There was no correlation with tumour DNA index, lymph node or oestrogen receptor status. C-myc oncoprotein levels were not predictive of patient survival or disease free interval. This relationship of oncoprotein levels with tumour histological grade is in keeping with the suggestion that the c-myc oncogene is important in the control of cellular differentiation. The other findings imply that measurement of c-myc oncoprotein levels does not yield useful prognostic information.

Breast Neoplasms↗
PubMed1989

In situ carcinoma of the breast.

The optimal management of ductal carcinoma in situ of the breast is controversial. With the introduction of the National Mammographic Breast Screening Programme the condition will be encountered more frequently. We have reviewed 76 patients from a 12-year period treated by one surgeon (R.W.B.) at the Nottingham City Hospital. Fifty-nine patients had either ductal carcinoma in situ or lobular carcinoma in situ; 17 patients had Paget's disease. The mean age at diagnosis was 54 years and the commonest mode of presentation was with a palpable breast lump. Pre-operative mammography was performed in 31 patients with ductal carcinoma in situ and 28 were reported as showing malignancy. Patients with a lesion in the breast parenchyma were treated either by mastectomy (simple, subcutaneous or 'wedge'--see text) or by lumpectomy and radiotherapy. Patients with Paget's disease were treated by simple mastectomy, wedge mastectomy or a cone excision of the nipple and underlying tissue. The mean follow-up period was 65 months. Patients treated by any of the procedures less than simple mastectomy had a significant chance of developing local recurrence. A detailed histological review was made and grade, microinvasion, calcification, necrosis and completeness of excision were assessed for each tumour. None of these factors was correlated with subsequent local recurrence.

Adult↗
PubMed1988

Breast self-examination for the early detection of breast cancer.

The early results are presented from a programme of education for Breast Self-Examination (BSE) for self-referral; 32,000 women in one health district, between the ages of 40 and 65 years, were invited by letter for education in BSE. Since the study began (1981-85), 153 breast cancers have been diagnosed, and they have been compared with the 153 breast cancers in the same age group presenting in the same health district immediately prior to the start of the study. A significant amelioration of prognostic factors is seen in the study group. However, at this time there is no significant difference in survival between the Study and the Control groups. The benign to cancer biopsy ratio is 1.2:1.

Adult↗
PubMed1987

Prognostic significance of the DNA content of human breast cancer.

The DNA content of paraffin embedded primary tumour tissue has been measured by flow cytometry in 354 patients with operable breast cancer. Tumour ploidy significantly correlated with tumour size, histological grade, and with menopausal status. No significant correlation with oestrogen receptor status or lymph node involvement was found. Patients with diploid cancers had a significantly improved short term survival and disease-free interval (DFI) compared with patients having aneuploid tumours. However, no difference in survival or DFI was shown after longer term follow-up (median 84 months). Multivariate analysis showed no independently significant prognostic value for tumour ploidy. No patient in this study received adjuvant therapy.

Aneuploidy↗
PubMed1987

Preliminary results of the Nottingham breast self-examination education programme.

Between June 1979 and December 1984, 49,573 women (study population) between the ages of 45 and 64 years and living in one health district were invited to attend breast self-examination sessions as part of the DHSS 'UK Trial of Early Detection of Breast Cancer'. Of the women invited 50.2 per cent attended for education. A total of 319 breast cancers were diagnosed in the study population during this period. The tumour characteristics, patient prognostic groups and survival have been compared with a control population consisting of the 319 consecutive breast cancers diagnosed immediately before the start of the DHSS trial, in women of the same age group and living in the same health district. There has been a significant reduction in the size at presentation of operable tumours (P less than 0.01) and there has been a small (3.4 per cent) reduction in lymph node involvement, but this is not significant. The rates of presentation of both in situ and advanced carcinoma have not significantly changed following the introduction of a breast self-examination education programme. At this stage no overall survival difference has been identified between the two groups but the median follow up of the study population is limited (25 months).

Breast↗
PubMed1987

An evaluation of transmission spectroscopy (lightscanning) in the diagnosis of symptomatic breast lesions.

A prospective study of transmission spectroscopy (lightscanning) has been performed on 285 women presenting with symptomatic breast disease to one outpatient clinic. Of the 41 patients with histologically confirmed breast cancer lightscanning detected 36 (87.8%). In the study group 164 patients had both lightscans and mammography performed and, of the 30 biopsy-proven carcinomas in this group, lightscanning detected 26 (87%) and mammography 25 (83%). Lightscanning was positive in five of the six non-invasive breast cancers and in 13 of the 15 invasive carcinomas 2 cm or less in diameter. No carcinoma was misdiagnosed as benign when the results of both investigations were combined.

Adolescent↗
PubMed1987

Oestrogen receptors in primary and advanced breast cancer: an eight year review of 704 cases.

ER content of primary tumour tissue has been examined in 704 patients presenting with operable breast cancer. The median follow-up is now 84 months and no patient has received adjuvant therapy of any kind. ER status is related to histological grade, menopausal status, initial site of metastases and subsequent response to endocrine therapy. A significant advantage in terms of survival is found in ER positive patients which is confined to those lymph node positive at mastectomy. DFI is also significantly related to ER status in lymph node positive patients. Survival after the symptomatic presentation of metastases and the institution of endocrine therapy is prolonged in patients with ER positive tumours. The overall response rate to endocrine therapy in assessable patients with ER positive tumours is 32%. By combining the ER status and histological grade of tumour tissue, a group of patients comprising 28% of those assessable to endocrine therapy can be identified (ER positive, grade I and II) with a response rate of 46%.

Aged↗
PubMed1987

Tumour aneuploidy, prognostic parameters and survival in primary breast cancer.

Cellular DNA content of primary tumours from 280 patients with operable breast cancer was determined by flow cytometry using nuclei from paraffin sections stained with DAPI, and 199 of these patients were followed for 8-13 years after surgery. Tumours from 67 patients have also been analyzed for their DNA content using single cell suspensions from fresh tumour tissue stained with mithramycin and ethidium bromide, and the results compared with those obtained from paraffin blocks of the same tumours. Overall 60% of the tumours contained cells with abnormal DNA content (DNA-aneuploid populations). Survival and disease free interval were not significantly different in patients with DNA-diploid and DNA-aneuploid tumours when analysed by Mantel's life table method. There was however, an early advantage for patients with DNA-diploid tumours: during the first 30 months after surgery DNA-aneuploidy was associated with higher rate of recurrence and shorter survival. DNA-aneuploidy was strongly related to histological grade. Thus 11/49 (22%) grade I, 60/102 (59%) grade II, and 96/129 (74%) grade III tumours were DNA-aneuploid. Although there was no significant difference in survival of patients with DNA-diploid and DNA-aneuploid tumours overall, there appears to be an unexpected association between DNA-aneuploidy and better survival in grade II patients (P less than 0.01); a similar trend was observed for grade I patients. Although the proportion of DNA-aneuploid tumours was similar in oestrogen receptor positive and negative tumours, DNA-aneuploidy was associated with lower levels of oestrogen receptors in comparison to DNA-diploid tumours. Comparison between the modal DNA values of fresh and paraffin embedded samples showed high rate of comparability (64/67, P less than 0.0001).

Aneuploidy↗
PubMed1987

The breast pain clinic: a rational approach to classification and treatment of breast pain.

Three hundred and fifty women complaining of breast pain symptoms of sufficient severity to interfere with their normal lifestyle were reviewed in a special breast pain clinic over a 5 year period. Seventy-two patients (21%) had spontaneous resolution of breast pain and they required reassurance only before discharge. Of the remaining 278 patients, accurate classification of breast pain syndromes was achieved in 89%, the commonest syndrome being cyclical breast pain which accounted for 54% of the women followed up. The remaining womens' breast pain was classified as trigger zone (14%), continuous (8%), Tietze's disease (5%), spinal root (4%), duct ectasia (4%) and psychological depression (2%). In the remaining 25 patients (9%) the breast pain could not be classified. The experience from this clinic is that a majority of women complaining of severe breast pain symptoms can be accurately classified and appropriate therapy instituted.

Breast↗
PubMedDate not supplied

Value of fine needle aspiration cytology of the breast, with an emphasis on the cytodiagnosis of colloid carcinoma.

The fine needle aspiration (FNA) cytologic evaluation of 6,941 lesions of the breast was reviewed, with an emphasis on the cytodiagnosis of colloid carcinoma. The most common benign breast diseases in this series were fibroadenomas, cysts and fibrocystic conditions. All cases with an FNA diagnosis of suspicious were biopsied; a number of these were found to be carcinoma of the breast. In cases with an FNA diagnosis of carcinoma of the breast, a plan of management was immediately adopted on the basis of that diagnosis. Thirteen cases of colloid (mucinous) carcinoma of the breast were diagnosed by FNA cytology; in all, the cytodiagnosis was confirmed by the subsequent histologic diagnosis. The distinctive cytologic criteria that may be useful for making an FNA diagnosis of colloid carcinoma of the breast are discussed, and the FNA differences between the pure and mixed types of colloid carcinoma are noted.

Adenocarcinoma, Mucinous↗
PubMedDate not supplied

The value of needle aspiration cytology of the breast, with an emphasis on the diagnosis of breast disease in young women below the age of 30.

Our experience with 4,739 needle aspirations of the breast was reviewed, with an emphasis on the diagnosis of carcinoma in young women under the age of 30 years. Among benign diseases, fibroadenomas were most frequently seen in younger women (24.3% of 919 cases) while cysts were most frequently seen in women 30 years of age and older (20.0%). Fibrocystic conditions were identified in approximately 30% of the women in each group. All younger women with suspicious diagnoses had fibrocystic disease at biopsy; in older women, 75% of the suspicious cases proved to be carcinomas while 25% proved to be fibrocystic diseases. Carcinomas were diagnosed cytologically in 1.3% of younger women and in 9.7% of older women. In young women, in whom breast carcinoma is a rare disorder, it is important that carcinoma be diagnosed without delay so that an appropriate plan of management can be adopted. These findings suggest that needle aspiration cytology can accurately make that diagnosis.

Adolescent↗