Preliminary Study on the Expression and the Significance of S-Phase Kinase Associated Protein 2 in Atypical Ductal Hyperplasia and Breast Cancer

OBJECTIVE To explore the relationship of high S-phase kinase associated protein 2 （Skp2） expression with the characteristics of breast cancer. METHODS Using a immunohistochemical method, Skp2 expression was detected and evaluated in 30 normal tissues, 30 atypical ductal hyperplasias （ADH）, 30 ductal carcinomas in situ （DCIS） and 56 invasive carcinomas （including invasive specific carcinoma and invasive nonspecific carcinoma）. The relationship between Skp2 expression and the characteristics of breast cancer was analyzed.RESULTS Skp2 expression varied among normal tissue, ADH, DCIS and invasive carcinomas （X^2=54.02, P〈0.005）. The positive level of Skp2 expression in DCIS was higher than that of normal tissue （X^2=21.82, P〈 0.005） and there was a significant difference in Skp2 between DCIS and ADH （X^2=5.08, P〈0.025） as well as between invasive carcinomas and DCIS （X^2=6.52, P〈0.01）. The positive expression level of Skp2 in invasive carcinomas with positive lymph nodes was remarkably higher compared to those with negative lymph nodes. A significant difference in Skp2 expression was found between combined histological Grades Ⅰ and Ⅱ versus Grade Ⅲ of invasive carcinomas （X^2=6.66, P〈0.01）. CONCLUSION High Skp2 expression may play an important role in carcinogenesis and biological behavior of breast cancer.

Atypical Ductal Hyperplasia of the Breast:Management of a Clinical Case at the IBN SINA Hospital Centre with Literature Review

Objective: To report a case of difficulties in the management of atypical ductal hyperplasia (ADH). Presentation of the case: Mrs. G, 50 years old, is consulting following the discovery at autopalpation of a lesion on her left breast. In its history: radical mastectomy Right Patey in 2004 for ductal carcinoma Infiltrant associated with carcinoma in situ;2 N+ /14;Positive hormone receptors. Adjuvant treatment performed: chemotherapy, radiotherapy and hormone therapy. Summary of the clinical case: Left breast examination: Superior External Quadrant nodule 5 cm × 4, mobile, hard, without inflammatory signs, there is no palpable lymph node. The surgical scar of the right breast is without particularity. Mammography and left breast ultrasound show an ACR4 lesion according to BIRADS. Microbiopsy: intradural papillomatous lesion requiring verification of the myoepithelial layer (P63 and CK5/6). Immunohistochemistry: atypical ductal hyperplasia (ADH) with no sign of transformation. Normal CA15-3 dosage. Treatment: broad surgical removal of the lesion. Analysis of the part shows a lesion with all the criteria of an HCA measuring 2 mm in its largest axis. The postoperative consequences are simple. Conclusion: The management of atypical hyperplasia is not consensual and is often undervalued. The type of lesion characterizing HCA is decisive for therapeutic orientation.

Low-Grade and High-Grade Invasive Ductal Carcinomas of the Breast Follow Divergent routes of Progression

Low-grade invasive ductal carcinoma is almost diploid, and has frequent losses of chromosome 16q, which is shared by other precancerous lesions of the mammary gland such as flat epithelial atypia （FEA）, atypical ductal hyperplasia （ADH）, and lownuclear grade ductal carcinoma in situ （DCIS）. The genetic alterations accumulate in a stepwise fashion as the precancerous lesions progress to invasve ductal carcinoma. This supports the linear progression model of breast cancer from FEA, through ADH, to low- nuclear grade DCIS as non-obligate early events in low-grade IDC evolution. In contrast, high-grade carcinoma tends to aneuploidy with complex genetic alterations--most importantly, frequent gains at chromosome 16q. Frequent losses at chromosome 16q in low-grade IDC and gains in the same arm of the same chromosome in high-grade IDC imply that these lesions are two end outcomes of different disease processes and that they do not lie in the same continuum of a process. Therefore, low-grade and high-grade IDC are two distinct diseases with a divergent route of progression.