Biomedical subjects
Publications and source records attributed to J I Burn.
We report a case of a 47-year-old woman presenting with small bowel obstruction due to intussusception of an inflammatory fibroid polyp. A review of the literature describes the clinical and pathological features.
Breast cancer in young women is an unusual problem which has acquired a poor prognostic reputation in the eyes of many clinicians. We have reviewed all 59 patients with malignant disease of the breast aged 35 years or less managed in the Breast Unit at Charing Cross Hospital between 1974 and 1984. After exclusion of 5 patients (2 with lymphomas, 1 with fibrosarcoma, and 2 with inadequate available data), 54 patients were available for analysis. More than 3 months delay from first symptoms to presentation was seen in 45 per cent and 36 per cent were considered 'late' at initial clinical staging (T3-4, N2-3 or M1). Nevertheless, a 5-year survival of 66 per cent was seen among the 29 patients with sufficient length of follow-up. Distribution among the main histological types was very similar to that found in a consecutive series of 264 breast cancers of all age groups in our unit. We conclude that breast carcinomas in young patients do not significantly differ in type or behaviour from other age groups and that with treatment similar to other premenopausal patients, a prognosis comparable to older patients can be expected.
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The status of oestrogen and progesterone receptors has been measured in 147 primary breast tumours. In addition to the measurement of cytoplasmic oestrogen receptors, the ability of these receptors to bind to oligo(dT)-cellulose has been assessed. This indicates the capability for activation of cytoplasmic receptors to a form able to bind in the nuclear compartment in vivo and thus be part of a functional receptor pathway. All the receptor concentrations measured were increased in the postmenopausal group of patients. All nuclear oestrogen receptors in this group were available for labelling at 4 degrees C, in contrast to the premenopausal group. The apparent functionality of the oestrogen receptor pathway could be equally assessed either by the co-presence of cytosol progesterone receptor with nuclear oestrogen receptor (30 or 4 degrees C) or with activated cytosol oestrogen receptor. The presence of activated cytosol oestrogen receptor was as reliable (80%) as the presence of either nuclear oestrogen receptor at 30 (83%) or 4 degrees C (81%) in predicting the response of breast tumours to endocrine therapy.
The concentrations of oestrogen receptors (ER) and progesterone receptors (PgR) were measured in the tumours from 47 patients with advanced primary carcinoma of the breast who were immediately treated by endocrine therapy after confirmatory histology. All patients were followed-up for at least 3 months and 27 patients for 18 months. The ER and PgR content in their primary tumour was correlated with the response to treatment, the duration of remission and the survival rate. The actual concentrations of ER and PgR were found to be better indicators of endocrine responsiveness than the mere presence of these receptors, particularly in the postmenopausal group. The remission rate improved with increasing concentrations of ER but not with increasing concentrations of PgR in the primary tumour. The predictability was enhanced when ER and PgR concentrations were considered together. Patients with ER concentrations above 150 fmol/mg cytosol protein and PgR concentrations above 100 fmol/mg cytosol protein in the same tumour were in remission after 18 months of treatment. At this time, only two of the 14 patients with ER and PgR concentrations below these levels were in remission and six had died of the disease.
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The synchronous relationship between oestrogen (ER) and progesterone (PgR) receptor status in primary tumours and their nodal metastases has been analysed in 26 patients. All patients with ER-negative primary tumours were found to have ER-negative axillary nodes but of those with ER-positive tumours only 65% had, correspondingly, all nodes ER-positive. The concentration of ER in the nodes was found to be significantly lower (P less than 0.001) than that in the primary tumour. PgR information was unobtainable in 3 patients. Of the remainder, 75% of those having PgR-negative tumours had all nodes PgR-negative but only 36% of those with PgR-positive tumours had all nodes PgR-positive. PgR levels were found to be generally lower in the axillary nodes but this did not reach statistical significance. The clinical relevance of these findings is discussed.
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