Two of the most important prognostic indicators for breast cancer are tumor size and extent of axillary lymph node involvement. Data on 24,740 cases recorded in the Surveillance, Epidemiology, and End Results (SEER) Program of the National Cancer Institute were used to evaluate the breast cancer survival experience in a representative sample of women from the United States. Actuarial (life table) methods were used to investigate the 5-year relative survival rates in cases with known operative/pathologic axillary lymph node status and primary tumor diameter. Survival rates varied from 45.5% for tumor diameters equal to or greater than 5 cm with positive axillary nodes to 96.3% for tumors less than 2 cm and with no involved nodes. The relation between tumor size and lymph node status was investigated in detail. Tumor diameter and lymph node status were found to act as independent but additive prognostic indicators. As tumor size increased, survival decreased regardless of lymph node status; and as lymph node involvement increased, survival status also decreased regardless of tumor size. A linear relation was found between tumor diameter and the percent of cases with positive lymph node involvement. The results of our analyses suggest that disease progression to distant sites does not occur exclusively via the axillary lymph nodes, but rather that lymph node status serves as an indicator of the tumor's ability to spread.

Postgrad Med J 2003;79:416-417 Brunner's gland hamartomas are rare tumours of the duodenum. These lesions have previously been described as being benign, with no malignant potential. A case report is presented of a Brunner's gland hamartoma, whose histology revealed a focus of well marked epithelial dysplasia. This case suggests a dysplastic stage in the natural history of Brunner's gland hamartoma, and questions the malignant potential of these lesions. Brunner's gland hamartomas are rare duodenal tumours and an unusual cause of gastrointestinal bleeding. Since the first description of a Brunner's gland hamartoma in 1876 there has been controversy to the aetiology and pathogenesis of this lesion. Several case reports have described these lesions as non-dysplastic and entirely benign. However a case report is presented, representing a Brunner's gland hamartoma with a dysplastic focus. This case report illustrates that these lesions do appear to become dysplastic and raises the question of malignant potential. CASE REPORTA 79 year old white man presented with a collapse and melaena. He had a history of stable angina for three years, mild chronic obstructive pulmonary disease, and a previous transient ischaemic attack. He was taking 75 mg of aspirin daily and took minimal alcohol. Examination revealed a soft non-tender abdomen and a blood pressure of 114/75 mm Hg, with no significant postural drop. Haematological investigations revealed anaemia, with a haemoglobin concentration of 92 g/l. On the second day the haemoglobin dropped to 72 g/l and an upper gastrointestinal endoscopy was performed.At endoscopy a 2 cm pedunculated lesion, with an ulcerated crater, was noted in the second part of the duodenum (fig 1). There were no signs of active bleeding and the lesion was biopsied at this stage. The patient was transfused and subsequently maintained his haemoglobin.Histology revealed a submucosal lesion with complex, crowded architecture and features consistent with a Brunner's gland hamartoma. However, in the deeper layers of the specimen, some nuclear atypia with occasional mitotic figures was seen. Given these findings a repeat endoscopy was performed and the lesion was removed by snare polypectomy using coagulation current.Histology of the resected specimen revealed it to predominantly composed of lobules of relatively bland appearing Brunner's glands. However throughout the specimen there were foci of obvious dysplasia with some foci showing more pronounced cytological changes (fig 2). DISCUSSIONDuodenal tumours, both malignant and benign, are rare. Brunner's gland hamartomas and adenomas account for up to 1% of small bowel tumours.1 Normal Brunner's glands are alkaline mucus-secreting and are found predominantly in the duodenum, extending to the proximal jejunum.2 Brunner's gland hamartomas are most often found in the proximal duodenum (57%), 2 representing the normal Brunner's gland distribution. The majority are pedunculated (88%), 2 and are commonly 1-2 cm in diameter. Clinical presentation is variable, an...

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Correlation of p53 expression with 5-year survival and histopathological parameters was examined immunohistochemically in two groups of 30 patients with oesophageal carcinoma (5-year survivors versus non-survivors). Tumour type, sex, operative procedure and age were matched. Some 64 per cent of squamous carcinomas and 79 per cent of adenocarcinomas were p53 positive. Normal squamous, normal glandular and metaplastic glandular epithelia were negative. Dysplastic squamous and glandular epithelium adjacent to tumours was positive when the tumour was positive and negative when it was not. Univariate analysis showed that nodal status (P = 0.001), and grade and depth of invasion (both P = 0.01) correlated with outcome. Correlation of tumour grade with outcome, when the most poorly differentiated area is used, is a novel finding for oesophageal carcinoma. The p53 status was not significantly associated with survival or any of these parameters.