[Immunocytochemical estrogen receptor determination in metastatic breast cancer].
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Biomedical subjects
Publications and source records attributed to H C Kübler.
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Unlike exfoliative cytology for detection of cervical neoplasia and its precursors, the cytologic detection of invasive and intraepithelial neoplasia of the vulva still presents some problems. In cases of Paget's disease of the vulva--a special form of intraepithelial neoplasia with typical histological features--primary cytologic diagnosis is possible. The cytologic criteria that led to preoperative detection are demonstrated on two cases of Paget's disease of the vulva. However, a Paget carcinoma has still to be excluded histologically.
This is a case report on a giant cell sarcoma or malignant osteoclastoma of the mammarian gland. Clinical diagnosis of this very rare tumor was of an exulcerating breast carcinoma. Histologically, this tumor shows epulis-like giant cells. Pathogenetically, a metaplasia of stromal cells, and of the glandular epithelium, is discussed. A simple mastectomy with extirpation of the axillary lymph nodes was performed. No metastases were found.
The biochemical detection of ER in breast cancer is of high value for the prognosis and planning of treatment. The conventional biochemical assays of ER are expensive, time-consuming and give little information on the topography and heterogeneity of receptor-protein in the tissue. Observations of different study groups showed a good correlation between the results of the biochemical assay and the monoclonal method in frozen sections. This ER-detection method was used on 34 fine needle aspirates from patients with breast cancer. 30 samples (88.2%) contained sufficient cells for analysis. The value of this method was proven and the results correlated to the measurement resulting from the biochemical assay. In 24 of the 30 fine needle aspirates we found good semi-quantitative correlation between the biochemical assay and the monoclonal method. Cytology, including ER-detection, permits definition not only of the receptor state, but also of the definition of the tumor. The employment of ER-detection in fine needle aspirates is useful in the following cases: Small tumors, which do not supply enough tissue to practice all in vitro tumor tests, as well as in metastasising tumors, in which surgical intervention or histological confirmation is not always necessary. The preoperative knowledge of ER may soon permit a different surgical therapy.
Clinical and ultrasonographic examination are the usual methods of diagnosis for carcinomas of the fallopian tubes and ovarian carcinomas. It is only in rare cases that the diagnosis is based on the cytology of the cervical smear. The use of cytology--more exactly, the cytological examination of secretion in Douglas' space in cases of vaginal hysterectomies--for the detection of ovarian and tubal carcinomas that cannot be diagnosed by clinical and paraclinical procedures, is a rather unusual and rarely described method. However, it is quite justified, as demonstrated by the detection of two carcinomas of the fallopian tubes within a short time.
So far there has been only one incidence of a malignant tumour associated with Netherton's syndrome, a rare skin disease consisting of congenital ichthyosiform erythroderma, atopic dermatitis and trichorrhexis nodosa (bamboo hair). The aetiology and clinical consequences are discussed on the occasion of a carcinoma of the vulva occurring in a case of a patient with Netherton's syndrome, both phenomena being interlinked.
In the years 1968 till 1982, 900 conisations of uterine cervix were performed, 90% of which were diagnostic interventions. During the follow-up period, the mean age of the patients with carcinoma in situ decreased 4 years, the mean age from patients with microcarcinoma 3.2 years. In 64% the conisation was carried out due to a positive or suspekt smear. Conisations, performed during pregnancy, were not associated with any additional complications for mother or child. Taking a big conus resulted more often in a total extirpation of the neoplastic changes, without increasing the complication rate. The average hospital stay was 8.7 days. It was only prolonged in patients with secondary hemorrhage. 33% of all neoplastic changes were extirpated totally. In 85% of the women who had follow-up only after incomplete extirpation of the neoplasia by conisation, there was no recurrence. The rest did show the neoplasia again, often in a more serious way. The overall complication-rate was 7.4%.
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