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Breast tumor progression: the clonal theory now challenged. The “portrait” of most breast tumors remains stable during progression from in situ to the metastatic state.

Stable portrait of breast tumors during progression. Data from
biology, pathology, and genetics.

By Marc Lacroix et al. Laboratoire Jean-Claude Heuson de Cancérologie
Mammaire (Breast Cancer Lab), Institut Jules Bordet, Bruxelles
(Brussels), Belgique (Belgium).
Endocrine-Related Cancer 11, 497-523 (2004)  

http://www.geocities.com/m.lacroix/erc1.htm

It is widely believed that breast cancer dissemination involves a
succession of clinical and pathological stages starting with carcinoma
in situ, progressing into invasive lesion and culminating in
metastatic disease. Such changes have frequently been attributed to
the sequential acquisition of various alterations in a single cell
followed by clonal selection and expansion, thus leading to
intra-tumor diversity. According to this multi-step view, extensive
genotype and phenotype (marker expression, grade) shift may occur in a
same tumor during progression; this may lead to the coexistence of
molecularly and/or pathologically different areas in a same lesion. An
increasing number of data of various natures appear now to challenge
this conception: only a few distinct "portraits", with relations to
estrogen receptor (ER)-status and grade, may be found among tumors.
Moreover, although undergoing increasing genetic alteration, most
individual lesions largely maintain their phenotype when they evolve
from in situ to the metastatic state. While many of the data presented
here are related to ductal tumors, lobular cancer is also discussed.
Moreover, a discussion on breast tumor stem cells is incorporated.

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