乳腺癌中α- 晶状体B 链蛋白表达的临床病理研究

目的:探讨α-晶状体蛋白B链(Alpha-crystallin B chain,CRYAB)在乳腺癌中表达的临床病理学意义。方法:收集乳腺癌病例及相应的临床资料包括随访资料,应用IHC染色方法检测CRYAB在乳腺良性病变(BBD)、无淋巴结转移乳腺癌(NMBC)、有淋巴结转移乳腺癌(MBC)及配对淋巴结转移灶(PMLN)中的表达,分析CRYAB表达与乳腺癌临床病理指标(患者年龄、肿块大小、淋巴结转移情况、临床分期、组织学分型和分级、雌孕激素受体和c-cerb B2表达情况、绝经情况)间及生存状态的关系。结果:CRYAB在对照组BBD组、NMBC组、MBC组、PMLN组的阳性表达率分别为97.9%(46/47)、44.6%(37/83)、13.1%(14/107)、10.8%(11/107),其中BBD组和NMBC组,BBD组、NMBC组分别与MBC组、PMLN组均存在显著性差异。CRYAB表达与淋巴结转移(P0.001)、临床分期(P=0.001)、组织学分级(P=0.037)和雌孕激素受体表达情况(P0.001)有显著相关,无淋巴结转移组的阳性表达率显著高于有淋巴结转移组,临床晚期的阳性表达率低于临床早期,雌孕激素受体阳性病例的阳性表达率显著低于雌孕激素受体阴性病例。生存分析结果显示CRYAB阳性表达的患者生存期比CRYAB阴性表达的患者生存期更长(p=0.037)。结论:CRYAB与乳腺癌的转移、临床分期、生存状态、雌孕激素受体表达有关。     

Fas 相关死亡结构域蛋白在乳腺癌中表达的临床病理研究

目的:探讨Fas相关死亡结构域蛋白(Fas-associated death domain protein,FADD)在乳腺癌中表达的临床病理学意义。方法:收集乳腺癌病例及相应的临床资料包括随访资料,应用免疫组织化学技术检测乳腺良性病变,有/无淋巴结转移的乳腺癌及配对淋巴结转移灶中FADD的表达,观察分析FADD表达与乳腺癌患者年龄、肿块大小、临床分期、组织学类型和分级、雌孕激素受体水平等临床病理指标间的关系。结果:免疫组化检测结果显示良性乳腺病变组中FADD的阳性表达率(85.1%,40/47)与无淋巴结转移的乳腺癌组(45.8%,38/83),伴有淋巴结转移的乳腺癌组(67.3%72/107)和淋巴结转移灶(45.8%,49/107)组织中FADD阳性表率均有显著性差异(P值分别0.001,=0.022和0.001);此外,伴有淋巴结转移的乳腺癌组中FADD阳性表达率也均与其它三组中FADD阳性表达率之间具有显著性差异(P值分别为0.003,0.001和0.022)。FADD与患者的确诊年龄(P=0.049)和淋巴结转移有显著性相关(P=0.003),与肿瘤大小、临床分期、组织学类型、组织学分级、雌孕激素受体及cerb B-2的表达情况和月经史无明显相关性(P0.05)。生存分析显示FADD阳性表达的患者较FADD阴性患者的生存期更短。结论:FADD与乳腺癌淋巴结转移和预后有关。     

Nucleobindin-2 在乳腺癌中表达的临床病理意义

目的:探讨NUCB2在乳腺癌中的表达及临床病理意义。方法:收集乳腺癌病例及相应的临床资料包括随访资料应用免疫组织化学技术检测良性病变,有/无淋巴结转移的乳腺癌及配对淋巴结转移灶中NUCB2的表达,分析NUCB2表达与乳腺癌临床病理指标和生存状态间的关系。结果:免疫组化结果:显示NUCB2在BBD、MBC、NMBC、PMLN的阳性表达率分别为90.0%(45/50),82.1%(87/106)、48.2%(40/83)、47.2%(50/106)。其中,NUCB2在BBD的阳性表达率显著高于NMBC、PMLN,而与MBC无显著性差异;在MBC中的阳性表达率显著高于NMBC;在MBC中的阳性表达率显著高于PMLN。临床病理分析结果:显示乳腺癌原发灶中NUCB2表达与淋巴结转移(p=0.000)、临床分期(p=0.001)、雌激素阳性表达(p=0.020)具有显著性相关。而与年龄、肿块大小、组织学分级、组织学类型、孕激素受体、HER2表达、绝经情况无显著相关。Kaplan-Meier分析结果:显示NUCB2阳性表达病例的总生存率比阴性病例更短(P=0.004)。结论:NUCB2在乳腺癌中表达与淋巴结转移、临床分期、雌激素受体表达和生存状态相关,可能在乳腺癌恶性演进和预后中具有重要意义。     

Kallistatin在乳腺癌中表达的临床病理意义

目的:探讨Kallistatin在乳腺癌中表达的临床病理意义及预后价值。方法:收集乳腺癌档案蜡块及临床资料,分为无淋巴结转移的原发灶(NMBT),有淋巴结转移的原发灶(PBT)及配对的淋巴结转移灶(PMLN),应用免疫组化技术检测Kallistatin表达,统计学分析。结果:结果显示kallistatin在PBT组的表达高于NMBT组合和PMLN组。kallistatin的表达与组织学类型(P=0.003)、淋巴结状态(P0.001)、临床分期(P=0.002)、雌激素受体(ER)表达(P=0.046)有显著相关性。kallistatin在浸润性小叶癌中的阳性表达率高于浸润性导管癌,在PBT组的阳性表达率显著高于NMBT,临床分期越晚期阳性表达率越高,在ER阳性的病历中表达更高。Kaplan-Meier分析显示,kallistatin的阳性表达是乳腺癌患者无病生存时间短(P=0.008)和总生存时间短(P=0.006)的危险因素。在浸润性乳腺导管癌患者中,kallistatin的阳性表达与生存时间短有关(P=0.026)。还与ER阳性表达患者生存时间较短有关(P=0.010)。结论:Kallistatin在乳腺癌中的表达有较为复杂的临床病理意义,其表达提示预后不良。     

The Levels of Ki-67 Positive are Positively Associated with Lymph Node Metastasis in Invasive Ductal Breast Cancer

Breast cancer is the most common cancer in women worldwide. In this study, we evaluate the potential risk factors for lymph node metastasis in invasive breast cancer patients with axillary dissection. 147 patients were included into this prospective study. The prognostic biomarkers including Ki-67, human epidermal growth factor receptor 2 (HER-2), hormone receptor status, p53, and lymph node involvement were determined by immunohistochemistry. The association between lymph node metastasis and these biomarkers was analyzed. Lymph node metastasis was found in 62 patients out of 147 patients. The high levels of Ki-67 positive (greater than 20 %) were positively correlated with a higher incidence of lymph node metastasis, including the numbers of lymph nodes that contain tumor cells and the lymph node metastatic rate. The high rate of positive lymphovascular invasion (LVI) is associated with lymph node metastasis. However, the levels of Ki-67 positive were not correlated with the positive rate of LVI. There was also no association between lymph node metastasis and other prognostic biomarkers, such as HER-2, estrogen receptor, progesterone receptor, and p53. In addition, apart from p53, the levels of Ki-67 positive were correlated with other prognostic biomarkers. Our data suggest that Ki-67 positivity has value as a prognostic and predictive biomarker in breast cancer and may be a valuable proliferation marker in routine diagnosis of breast cancer.     

Lack of relationship between the expression of hsp27 heat shock estrogen receptor-associated protein and estrogen receptor or progesterone receptor status in male breast carcinoma

Estrogen, through estrogen receptors (ERs), may regulate the synthesis of progesterone receptors (PRs) and of a heat shock estrogen receptor-associated protein (hsp27). In female breast carcinoma (FBC) both proteins serve as surrogate indicators for the presence of functional ERs. In addition, the expression of these proteins was related to other prognostic indicators of value in female breast tumours. Endocrine disorders, hormone therapy and altered estrogen metabolism have been associated with the development of male breast cancer (MBC), suggesting that evaluation of the expression of ER, PR and hsp27 might improve our understanding of the biology of this tumour. ER and PR status and hsp27 expression were evaluated by immunohistochemistry in 16 primary MBC patients. The interrelationships between these parameters were established and compared with the clinicopathological data on the tumours. Ten (56%) MBC patients were ER-positive, 69% were PR-positive and all samples were hsp27-positive. Our series of MBC patients showed a positive correlation between ERs and PRs, however there was a lack of correlation between hsp27 and ERs or PRs. MBCs did not exhibit any correlation between the biomarkers studied and known prognostic indicators for females (e.g. Scarff-Bloom-Richardson (SBR) or modified SBR (MSBR) grade, T stage, lymph node status). This is the first published series reporting the incidence of hsp27 in MBC. The lack of association between the expression of ERs and hsp27 found in MBC differs from the results reported for FBC, moreover the expression of ERs, PRs or hsp27 did not correlate with the clinicopathological parameters that have prognostic value in females. Although the data were obtained from a relatively small sample population, our findings suggest that MBC and FBC are biologically different tumours with respect to the expression of the studied proteins.     

Expression of cyclooxygenase-2 in invasive breast carcinomas and its prognostic impact

Representative tumour sections from 468 patients with invasive breast cancer were immunostained for cyclooxygenase-2 (COX-2) and evaluated. The relationships between COX-2 expression, clinical outcome and various clinicopathological variables, including tumour vascularity and disseminated tumour cells (DTC) in the bone marrow were examined. COX-2 expression in invasive breast carcinoma cells was positively associated with oestrogen receptor and/or progesterone receptor positivity (p<0.001). Triple-negative tumours showed no/low COX-2 expression more frequently than other tumour types (p<0.001). Expression of COX-2 was not associated with breast cancer-specific survival (p=0.49, log-rank) or distant disease-free survival (p=0.67, log-rank) for all patients, including lymph node-negative, untreated patients (p>0.14, log-rank). There was also no significant association between COX-2 expression and histological grade, tumour size, nodal status, DTC in bone marrow, p53, HER2, or tumour vascularity. In conclusion, COX-2 expression in this series was associated with the presence of hormone receptors. Low COX-2 expression was observed in triple-negative breast carcinomas.     

Expression of Cathepsin D and pS2 in imprint smears of breast carcinoma

athanassiadou p.p., athanassiades p. h., daffaris p., petrakakou e. i., fflerffa ch. i. and kffirkou k. a. (1998) Cytopathology 9, 240–247
Expression of Cathepsin D and pS2 in imprint smears of breast carcinoma
The aim of this study was to add to existing information on the effects of certain tumour markers expressed by breast cancers on tumour malignancy as evidenced by size of primary and occurrence of lymph node invasion. One hundred freshly resected breast cancers were examined by immunocytochemical staining of imprint smears for Cathepsin D and pS2. Oestrogen receptor (ER) and progesterone receptor (PR) were tested for by dextrose-coated charcoal (DCC) assay and the results correlated with tumour size, histology and presence or absence of lymph node metastases at the time of surgery using χ² analysis. A significant positive correlation was demonstrated between Cathepsin D positivity and ER, PR and pS2 positivity. In tumours < 2 cm in diameter at surgery a positive correlation was observed between Cathepsin D positivity and the presence of lymph node metastases. The findings support the hypothesis that Cathepsin D may promote early metastasis, possibly by its proteolytic activity.     

E-cadherin和Cathepsin D的表达与乳腺导管癌的侵袭和淋巴结转移的关系

目的　观察上皮性钙粘素 (E cadherin)和组织蛋白酶D (CathepsinD)在乳腺导管癌中的表达并分析其与肿瘤侵袭及腋下淋巴结转移的关系。方法　应用免疫组织化学方法检测E cadherin和CathepsinD在乳腺导管癌组织中的表达。结果　乳腺导管原位癌 (carcinomainsitu ,CIS)组织中E cadherin的表达与浸润性导管癌 (infiltratingductalcarcinoma ,IDC)相比无明显差异 (P >0 0 5 )。乳腺导管癌腋下淋巴结阴性组 (nodenegativeductalcarcinoma,NNDC)中E cadherin的表达与腋下淋巴结阳性组 (nodepositiveductalcarcinoma ,NPDC)相比差异不明显 (P >0 0 5 )。乳腺导管癌间质中CathepsinD的表达CIS与IDC相比差异显著 (P <0 0 1) ,NNDC与NPDC相比差异显著 (P <0 0 5 ) ;而在癌细胞中CathepsinD的表达在上述两组中差异均不明显 (P >0 0 5 )。结论　E cadherin在乳腺导管癌的表达与肿瘤的侵袭及淋巴结转移无相关关系。CathepsinD在乳腺导管癌间质的表达与肿瘤的侵袭及淋巴结转移密切相关 ,可作为临床判定肿瘤恶性程度的一个参考指标。     

不同临床病理特征的乳腺非特殊型浸润性癌分子亚型分析

目的:探讨不同临床病理特征的乳腺非特殊型浸润性癌的分子亚型分布特点。方法:回顾性分析309例乳腺非特殊型浸润性癌患者的临床资料,根据患者年龄、绝经情况、组织学分级和淋巴结转移情况分组,每组再根据免疫组化雌激素受体(ER)、孕激素受体(PR)、人类表皮生长因子受体2(HER-2)结果分为4种不同的分子亚型,分析各组中不同分子亚型的分布特点。结果:309例乳腺非特殊型浸润性癌中Lumina A型为137例(44.3%),Lumina B型为64例(20.7%),HER-2/neu型为63例(20.4%),basal cell-like型为45例(14.6%)。不同年龄段、绝经与否、不同组织学分级和淋巴结转移情况患者的分子亚型差异均具有统计学意义(P0.05)。结论:非特殊型浸润性癌的分子亚型以Luminal A型为主,其中异型性高,转移广泛的basal cell-like型的年龄分布呈现年轻化趋势。     

Comparison of Clinicopathological Features and Treatments between Young (≤40 Years) and Older (>40 Years) Female Breast Cancer Patients in West China: A Retrospective,Epidemiological, Multicenter,Case Only Study

The incidence of young cases of breast cancer is higher in China compared to the western world. We aimed to explore differences in risk factors, clinicopathological features and treatment modes of young female breast cancer compared to older patients in West China. We collected clinical information from 12,209 female breast cancer patients in West China, including risk factors, clinicopathological features and treatment modes, from January 2010 to December 2012. Chi-square tests and the multivariate logistic regression analysis were applied for statistical analysis. There were 2,682 young (≤40 years) cases and 9,527 older cases at the time of breast cancer diagnosis. Young patients had a greater tumor diameter at diagnosis, and a higher probability of axillary lymph node and distant metastasis (P < 0.05). The progesterone receptor positive expression rate, estrogen receptor/progesterone receptor double positive expression rate, and human epidermal growth factor receptor 2 (HER2) negative expression rate was higher in young patients compared to older patients (P < 0.05). For young patients, the age at menarche was earlier, they had lower marriage rates, fewer pregnancies and births, and a lower breastfeeding rate (P < 0.05). A higher proportion of young patients underwent advanced operations, neoadjuvant and adjuvant chemotherapy, radiotherapy, and endocrine therapy compared to older patients (P < 0.05). We found significant differences in the clinicopathological features, risk factors and treatment modes between young (≤40 years) and older (>40 years) female breast cancer patients in West China. As some of these results differ from those found in the western female population, it is likely that the mechanism of tumorigenesis of young female breast cancer patients in West China may differ from that in western developed countries. Further investigation into the regional differences in breast cancer tumorigenesis is warranted.     

pSTAT3和SOCS3在人乳腺癌组织中的表达及意义

目的 研究激活STAT3( pSTAT3)蛋白和SOCS3在人乳腺癌和乳腺良性病变组织中的蛋白表达及其临床意义.方法 应用免疫组织化学检测160例乳腺癌和36例乳腺良性病变组织pSTAT3和SOCS3蛋白的表达情况,分析它们与患者临床病理特征的关系.结果 人乳腺癌组织中pSTAT3和SOCS3蛋白表达阳性率分别为69.4％和40.0％,乳腺良性病变组织中pSTAT3和SOCS3蛋白表达阳性率分别为33.3％和22.2％,前者与后者相比具有统计学意义(P＜0.01和P＜0.05);乳腺癌pSTAT3蛋白表达与肿瘤的大小、淋巴结转移和临床分期均呈显著正相关(均P＜0.01),但与患者年龄、肿瘤的组织学分级、雌孕激素受体表达和c-erBb-2表达均无显著相关(均P＞0.05);SOCS3蛋白表达与肿瘤大小呈显著正相关(P＜0.05),但与患者年龄、淋巴结转移、临床分期、肿瘤的组织学分级、雌孕激素受体表达和c-erBb-2表达均无显著相关(均P＞0.05);乳腺癌pSTAT3和SOCS3表达呈显著正相关(r=0.237,P＜0.01).结论 乳腺癌pSTAT3和SOCS3表达状况与肿瘤生长、侵袭和转移等呈密切相关,提示STAT3和SOCS3可能在乳腺癌发生发展过程中发挥了重要作用.     

Clinical Implications of TβRII Expression in Breast Cancer

Objective

To explore the relationship between TβRII [type II TGFβ (transforming growth factor β) receptor] expression and clinicopathological characteristics, and to evaluate the prognostic significance of TβRII expression in breast cancer.

Methods

Clinicopathological data and prognostic information of 108 patients with histologically confirmed breast cancer who were surgically treated at China Medical University between January 2007 and September 2008 were reviewed and the association between the clinicopathological characteristics and TβRII expression was analyzed by chi-square test and multivariate analysis. The expression of TβRII was assessed by immunohistochemistry.

Results

Of the 108 patients, 60 cases were TβRII positive and 48 cases were negative. There was no significant association between TβRII expression of the patients older than 40 years and that of the younger than 40 years (56.0% vs 50.0%; P = 0.742). The TβRII expression rate was significantly increased in patients with lymph node metastasis compared to those without lymph node metastasis (67.40% vs 46.8%; P = 0.033). Statistically significant relationships were found between increasing tumor clinical stage and high TβRII expression (P = 0.011). TβRII expression was not associated with the expression of ER(estrogen receptor)、PR, (progesterone receptor)、Her-2 (human epidermal growth factor receptor 2) (P = 0.925,P = 0.861, and P = 0.840, respectively). Patients with high TβRII expression showed poorer 5-year disease-free survival (DFS) compared to those with low expression (66.7% vs 45.6%; P = 0.028) by univariate analysis. Survival analysis demonstrated that TβRII was associated with poor DFS (P = 0.011). Subgroup analysis revealed that TβRII expression was associated with shorter DFS in patients with lymph node metastasis, ER-positive, PR-positive or Her-2-negative tumors (P = 0.006, P = 0.016, P = 0.022, and P = 0.033, respectively). Cox regression analysis revealed that high TβRII expression was related to poor 5-year DFS, and it was an independent factor for predicting the poor outcome for breast cancer patients (P = 0.016).

Conclusions

High levels of TβRII expression were associated with lymph node metastasis, increasing tumor clinical stage, and poorer 5-year DFS in patients with breast cancer. TβRII may be a potential prognostic marker for breast cancer.     

The Met receptor tyrosine kinase and basal breast cancer

Breast cancer is a complex disease that comprises cancers of distinct biologies and responses to treatment. Clinical management relies on traditional clinicopathological parameters, involving lymph node status, histological grade, as well as expression of the estrogen receptor or human epidermal growth factor receptor 2. Molecular pathology as well as protein and gene expression profiling have divided breast tumors into molecular subtypes associated with different clinical outcomes. One of these, defined as basal breast cancer, is associated with poor prognosis. Molecular mechanisms involved in the induction of basal breast cancer are poorly understood and targeted therapies for this subtype are lacking. Recent evidence using murine models identified a role for the Met receptor tyrosine kinase in the induction of murine mammary tumors with characteristics of human basal breast cancers. Moreover, elevated Met protein and RNA is associated with human basal tumors and poor outcome. These studies identify a link between the Met receptor tyrosine kinase, epithelial mesenchymal transition, and basal breast cancer. In this review, we provide an overview of murine Met models in relation to the spectrum of mouse models of breast cancer and a role for the Met receptor in basal breast cancer tumorigenesis.     

Tumor Suppressor Function of Syk in Human MCF10A In Vitro and Normal Mouse Mammary Epithelium In Vivo

The normal function of Syk in epithelium of the developing or adult breast is not known, however, Syk suppresses tumor growth, invasion, and metastasis in breast cancer cells. Here, we demonstrate that in the mouse mammary gland, loss of one Syk allele profoundly increases proliferation and ductal branching and invasion of epithelial cells through the mammary fat pad during puberty. Mammary carcinomas develop by one year. Syk also suppresses proliferation and invasion in vitro. siRNA or shRNA knockdown of Syk in MCF10A breast epithelial cells dramatically increased proliferation, anchorage independent growth, cellular motility, and invasion, with formation of functional, extracellular matrix-degrading invadopodia. Morphological and gene microarray analysis following Syk knockdown revealed a loss of luminal and differentiated epithelial features with epithelial to mesenchymal transition and a gain in invadopodial cell surface markers CD44, CD49F, and MMP14. These results support the role of Syk in limiting proliferation and invasion of epithelial cells during normal morphogenesis, and emphasize the critical role of Syk as a tumor suppressor for breast cancer. The question of breast cancer risk following systemic anti-Syk therapy is raised since only partial loss of Syk was sufficient to induce mammary carcinomas.     

TGF-��1 and BRCA2 Expression are Associated with Clinical Factors in Breast Cancer

The objective of this study was to investigate the possible association between the expression of transforming growth factor beta-1 (TGF-β1) and breast cancer type2 susceptibility protein (BRCA2) with clinical factors in breast cancer. TGF-β1, BRCA2, human epidermal growth factor receptor2 (HER2), estrogen receptor, and progesterone receptor protein levels were measured in 67 samples from breast cancer patients by immunohistochemistry. The expression of these proteins was correlated with various clinical factors including age, pathohistological grade and status of axillary lymph node implication. TGF-β1 and BRCA2 were expressed in breast cancer tissues and expression of HER2 and TGF-β1 was significantly correlated with BRCA2. The authors conclude that elevated expression of BRCA2 correlates with TGF-β1 and HER2 in breast cancer and these three factors act in synergy to promote cancer. Thus, detection of both TGF-β1 and BRCA2 may therefore assist in the prognosis and treatment of breast cancer.     

乳腺癌超声征象与ER、PR、连环蛋白p120、癌基因CerbB-2、原癌基因Her-2/neu表达的关系研究

目的:探讨乳腺癌超声征象与雌激素受体(ER)、孕激素受体(PR)、连环蛋白p120、癌基因CerbB-2、原癌基因Her-2/neu表达的关系。方法:将2014年10月至2017年10月我院收治的50例乳腺癌患者纳入本研究,术前获得患者完整乳腺超声图像资料,术后通过免疫组织化学法检测ER、PR、CerbB-2、Her-2/neu和p120的表达情况。记录超声检查与组织标本检测结果,比较不同乳腺癌超声征象中ER、PR、CerbB-2、Her-2/neu和p120的表达情况。结果:p120阴性表达率为62.00%,ER阳性表达率为50.00%,PR阳性表达率为36.00%,CerbB-2阳性表达率为74.00%,Her-2/neu阳性表达率为30.00%。病灶边缘有毛刺征、周边有高回声晕征、无淋巴结转移患者的ER阳性表达率高于病灶边缘无毛刺征、周边无高回声晕征、淋巴结转移者(P0.05);病灶边缘有毛刺征、周边有高回声晕征患者的PR阳性表达率高于病灶边缘无毛刺征、周边无高回声晕征者(P0.05);内部有微小钙化、血流显像分级2-3级、淋巴结转移患者的p120阴性表达率高于内部无微小钙化、血流显像分级0-1级、无淋巴结转移者(P0.05);内部有微小钙化、血流显像分级2-3级、淋巴结转移患者的CerbB-2阳性表达率高于内部无微小钙化、血流显像分级0-1级、无淋巴结转移者(P0.05);内部有微小钙化、淋巴结转移患者的Her-2/neu阳性表达率高于内部无微小钙化、无淋巴结转移者(P0.05)。结论:乳腺癌超声征象与ER、PR、CerbB-2、Her-2/neu和p120的表达有紧密联系,可为治疗方案拟定提供参考。     

Tumor growth fraction, expression of estrogen and progesterone receptors, p53, bcl-2 and cathepsin D activity in primary ductal invasive breast carcinoma and their axillary lymph node metastases

The aim of this paper is to determine similarities and differences between tumor cell subclones in cases of ductal invasive breast carcinoma, and which occupy primary tumor and local axillary lymph metastases. The tumor growth fraction evaluated by Ki-67 was analyzed along with the expression level of estrogen and progesterone receptors, protein p53, proto-oncogene protein bcl-2 and cathepsin D in 60 patients. Metastatic lymph node in axilla has a higher growth fraction of the tumor cells than the primary tumor (p = 0.045), as well as the higher level of bcl-2 overexpression (p = 0.014). No statistically significant difference was found in the presence of immunohistochemically identified estrogen receptors (p = 0.161) and progesterone receptors (p = 0.081) between the primary tumor and the metastatic lymph node in axilla. Likewise, no difference was found between the immunohistochemical evaluation of p53 (p = 0.356) and cathepsin D activity (p = 0.928). A higher growth fraction of the tumor cells and the higher level of bcl-2 overexpression in metastatic tumor cells indicate the more aggressive cell subclones. This study does not support the routine testing of both primary tumor and locoregional metastasis to evaluate the breast cancer hormone receptor status.