OBJECTIVETo clarify the relationship between biologic behavior and morphologic features of invasive micropapillary carcinoma (IMPC) of the breast.

METHODSTwo thousand and eighty-eight cases of clinically defined monocentric breast cancer without pre-operative biopsy (except fine needle aspiration procedure) were examined by whole mammary gland serial sectioning. The clinicopathologic and morphologic features (including microscopic and ultrastructural) of IMPC were analyzed.

RESULTSOne hundred and seventeen cases of IMPC (6.2%, 117/1 880) were diagnosed during the period of study. The incidence of lymphovascular invasion (54.7%, 58/106) and nodal metastases (76.4%, 81/106) was significantly higher in IMPC, as well as the number of metastatic node (on average 9.6) was significantly more in IMPC, as compared with that of the invasive ductal carcinoma. Microscopically, the tumor was characterized by morula-like clusters and small papillae of malignant cells floating within irregular interstitial spaces and separated by fibrous septa. Ultrastructurally, microvilli were observed on the neoplastic cell surface at the periphery of the micropapillae. There were also numerous fine intermediate filaments in the cytoplasm. Newly formed capillaries were noted in the interstitium and some tumor cells were directly in contact with endothelial cells.

CONCLUSIONSA predominant component of IMPC in breast carcinoma is associated with a higher risk of lymphovascular invasion and nodal metastasis. The aggressive behavior of IMPC can be attributed to the proliferative activity of the tumor cells, and its associated angiogenesis.

Adult ; Aged ; Breast Neoplasms ; blood supply ; pathology ; ultrastructure ; Carcinoma, Papillary ; blood supply ; pathology ; ultrastructure ; Female ; Humans ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Invasiveness

OBJECTIVETo assess the clinicopathological features of atypical cystic duct (ACD) as a precancerous lesion of the breast.

METHODSWhole mammary gland serial sections were performed on 200 cases of breast cancer without pre-operative biopsy (prior operation, fine needle aspiration or needle biopsy were routinely performed in each case). The clinicopathological findings and immunohistochemical features of ACD were investigated.

RESULTSForty-four (22%) of the 200 breast cancer patients had ACD breast lesions. The frequency of patients with ACD increased in premenopausal women (P=0.001). A number of ACD lesions displayed a histological transition to adjacent ductal carcinoma in-situ. In 16 of 44 (36%) patients with ACD, carcinoma cells stained positive for p53. In 12 of these 16 cases (75%), ACD cells also stained positive for p53 protein (P=0.001). Myoepithelial cells of ACD appeared attenuated and stained strongly for alpha-smooth muscle actin. There was no correlation between the ACD-present group and the ACD-absent group in tumor size, nodal metastasis, and immunostaining patterns of estrogen receptor (ER), progesterone receptor (PR), p53, c-erbB-2 and Ki-67 labeling index of cancerous tissues. All 44 ACD lesions showed a negative staining of c-erbB-2, regardless of the staining result in their corresponding carcinomas. The mean Ki-67 labeling index of ACD lesions was low.

CONCLUSIONSACD is frequently associated with breast cancer. It may represent a precancerous mammary lesion, supported by the frequent histological continuum between ACD and malignancy, and simultaneous p53 over-expression present in both ACD and its corresponding breast carcinoma.

Biomarkers, Tumor ; analysis ; Breast Neoplasms ; chemistry ; pathology ; surgery ; Carcinoma in Situ ; chemistry ; pathology ; surgery ; Carcinoma, Ductal, Breast ; chemistry ; pathology ; surgery ; Female ; Humans ; Precancerous Conditions ; chemistry ; pathology ; surgery ; Receptors, Estrogen ; analysis ; Receptors, Progesterone ; analysis

This paper describes the concepts of assessment theory which are necessary to implement the most desirable assessments, with a particular focus on validity and utility. Validity, classically defined as a trinity of content, criterion-related, and construct, is now encompassed by construct validity. By distinguishing between validity and validation, the process of reinforcing validity through argument-based validation is proposed. Furthermore, we refer to the concept of utility, which takes into account practicality (acceptability and cost) and educational impact, in order to make the assessment practice sustainable. Finally, we will address how learner assessment relates to program evaluation.

Globally, there are currently three major competency models for healthcare professions education: CanMEDS 2015 in Canada, Accreditation Council for Graduate Medical Education Six-Competency model in the United States, and Tomorrow's Doctors in the United Kingdom. An investigation by the Revision Committee for the Japanese National Model Core Curriculum revealed that these competency models had been utilized in seven countries. In each country investigated for revision, medical schools were allowed to implement these major competency models flexibly. Although each university has a high degree of freedom in curriculum design and educational delivery, each country is regulated by a quality assurance system that requires accreditation by the World Federation for Medical Education (WFME) and other organizations. The 2022 Revision of the Japanese National Model Core Curriculum has also been translated into English and released to the global audience in the field.

In the 2022 Model Core Curriculum for Medical Education in Japan, "Chapter 3, Educational strategies and assessment" section II. "Learner Assessment," consists of three parts : II-1. Approaches to learner assessment, II-2. Assessment methods, and II-3. Questions about learner assessment. Based on the idea that "the way assessment is done varies from institution to institution," the answer to the "Question" is deliberately not included. We hope that readers will refer to this chapter when planning learning assessments in curriculum development while considering the curriculum's background and context.