(American Journal of Pathology. 1998;153:271-278.)
© 1998 American Society for Investigative Pathology
Loss of Heterozygosity on Chromosome 11p15 during Histological Progression in Microdissected Ductal Carcinoma of the Breast
Jack H. Lichy,
Maryam Zavar,
Mark M. Tsai,
Timothy J. O'Leary and
Jeffery K. Taubenberger
From the Molecular Pathology Division, Department of Cellular
Pathology, Armed Forces Institute of Pathology, Washington, D.C.
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Abstract
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Microdissection of histologically identifiable components from
formalin-fixed, paraffin-embedded tissue sections allows
molecular genetic analyses to be correlated directly with pathological
findings. In this study, we have characterized loss of
heterozygosity (LOH) at chromosome 11p15 at different stages of
progression in microdissected tumor components from 115 ductal
carcinomas of the breast. Microdissected foci of intraductal,
infiltrating, and metastatic tumors were analyzed to determine
the stage of progression at which LOH at 11p15 occurs. LOH was detected
in 43 (37%) of 115 cases. Foci of intraductal carcinoma could be
microdissected from 85 cases, of which 30 (35%) showed LOH at
some stage of progression. LOH was detected in the intraductal
component in 26 of these 30 cases. Interstitial deletions were
characterized by using a panel of 10 highly polymorphic markers. The
smallest region of overlap (SRO) for LOH at 11p15 was bounded by the
markers D11S4046 and D11S1758. LOH at 11p15.5 showed no correlation
with estrogen receptor status, the presence of positive lymph
nodes, tumor size, histological grade, or
long-term survival. We conclude that 11p15 LOH usually occurs early in
breast cancer development but less frequently does not develop until
the infiltrating or metastatic stages of tumor
progression.
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Introduction
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Chromosome 11p15 shows high frequency loss of heterozygosity (LOH)
in multiple human malignancies, including tumors of the
breast,1-7
lung,8-12
cervix,13
testis,14,15
bladder,16
and
stomach17
and pediatric tumors of the adrenal glands and
liver.18,19
This region has also been of interest because
chromosomal breakpoints associated with the Beckwith-Wiedemann syndrome
(BWS) occur at this locus.20
In addition, physical transfer
of chromosomal fragments into cell lines has provided functional
evidence for one or more tumor suppressor genes in this
region.21,22
The application of this technique to the
breast cancer cell lines MDA-MB-435 and MCF7 has been shown to result
in suppression of metastasis23
and
tumorigenicity,24
respectively.
Previous studies of 11p15 LOH in breast
cancer have revealed one smallest region of overlap (SRO) located in
11p15.5 between the markers TH and D11S988 (Figure 1)
.4,6
These studies also
provide evidence for additional SROs in this region, one located more
centromeric in the 11p15.3 region6
and the other more
telomeric.4
This locus may therefore contain several genes
capable of contributing to the initiation or progression of breast
cancer. Multiple SROs in this region have also been reported in studies
of lung carcinomas8,11
as well as in tumors of the adrenals
and liver.18

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Figure 1. Location of markers used in this study and candidate tumor suppressor
genes. The upper map shows the position of several genes, including the
candidate tumor suppressor genes H19 and KIP2, along the region of
approximately 6 Mb analyzed in this study. The lower map shows the
positions of the genetic markers used. The map positions of the
Genethon markers are from the sex-averaged Genethon Human Linkage
Map.28
The distances between Genethon markers are indicated
below the map in centiMorgans. The marker D11S837
(ST5 gene) has been
localized within the centromeric group of BWS
breakpoints.26
The locations of the markers D11S988 and TH
are from the CHLC/GDB map. The upper and lower maps are shown in
approximate alignment. The KVLQT1 gene occupies approximately 300 kb
and encompasses the more telomeric group of BWS
breakpoints.39
The TH gene is known to be closely linked to
D11S1318, but the order of these two loci is not known with certainty.
The H19 gene has been identified on a 100-kb bacterial artificial
chromosome clone that also contains the marker D11S4046, suggesting
close proximity of these loci in the genome.
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In this study, LOH at 11p15 was characterized during breast cancer
progression. Tumors were examined for the presence of intraductal,
invasive, and metastatic foci. Each component present was isolated by
microdissection and tested for LOH at a group of markers that span the
segment of 11p15 containing the reported SROs for breast cancer. Our
results indicate that LOH at 11p15 usually is present at the stage of
intraductal carcinoma but occasionally does not occur until later
stages of progression.
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Materials and Methods
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Case Selection
The material used in this study consisted of formalin-fixed,
paraffin-embedded tissue from the archives of the Armed Forces
Institute of Pathology. The cases analyzed were selected from a group
of 964 breast cancer cases submitted to the Armed Forces Institute of
Pathology between 1975 and 1982 for which the patient's social
security number was available to facilitate determination of vital
status. A subset of these cases was selected for LOH analysis on the
basis of the availability of normal tissue and the presence of
intraductal lesions that were believed by the initial observers to be
separable by microdissection from invasive and metastatic components of
the tumor. Each tumor component present was isolated by microdissection
from 12-µm sections that had been deparaffinized with Hemo-De
(Fisher, Pittsburgh, PA). Lysates were prepared from these tissue
specimens by incubation in 200 µl of 10 mmol/L Tris, pH 8.0, 50
mmol/L KCl, 0.1 mmol/L EDTA, 0.5% Tween 20, 100 µg/ml proteinase K
for 12 to 16 hours at 55°C followed by a 5-minute incubation at
95°C to inactivate the protease. Insoluble material was pelleted by
centrifugation for 5 minutes, and the supernatant was used as the
source of DNA template for polymerase chain reaction (PCR).
LOH Analysis
All tumor components were analyzed for LOH at the polymorphic
markers D11S922, D11S988, and TH (tyrosine hydroxylase), which lie
within or near the boundaries of a previously identified minimal region
of overlap at 11p15.5,4,6
and D11S837, which maps within a
group of potentially growth-regulatory genes at 11p15.3, a region that
might represent a distinct SRO in breast cancer.25-27
Six
additional markers taken from the Genethon panel were used to
characterize the SRO in cases with LOH. The order assigned (Figure 1)
is based on the Genethon linkage data and physical mapping
studies.28-30
PCR was performed in the presence of one
32P-end-labeled primer. Products were resolved on 6%
polyacrylamide/7 mol/L urea gels and visualized by autoradiography. The
ratio of alleles present was initially evaluated by visual inspection
of an appropriately exposed autoradiogram. When allele loss was
partial, presumably due to the presence of normal cells in the
microdissected specimens, band intensities were quantitated with a
Molecular Dynamics Storm system, and reduction in allele ratio of
greater than 50% was scored as LOH. Results were considered
uninformative when the normal tissue was homozygous, when the tissue
lysate failed to amplify, or when the results could not be interpreted
unambiguously. Because nonamplifiable specimens were scored as
uninformative, the percentage of cases reported as uninformative for
each marker studied is greater than the percentage of homozygotes.
Statistical Analysis
Statistical analysis was performed using the Statistica program
package (Release 5.1, StatSoft, Tulsa, OK). Correlations were assessed
using contingency table analysis or regression methods, as appropriate.
Survival analysis was performed using Kaplan-Meier plots.
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Results
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Microdissection of Tumor Components
Tumor components used for DNA isolation were identified
microscopically on deparaffinized but unstained sections of
formalin-fixed, paraffin-embedded tissue. An adjacent section stained
with hematoxylin and eosin was examined to confirm the histological
identification of the tumor components selected for analysis. Areas of
intraductal, infiltrating, and metastatic tumor were dissected from the
unstained sections under microscopic observation, and tissue lysates
suitable for PCR analysis were prepared as described in Materials and
Methods. A total of 115 cases were dissected in this manner. Of these,
8 were intraductal carcinomas without evidence of invasion, 59 had
progressed to the invasive stage but were node negative, and 48 had
lymph node metastases. In addition, three cases (16, 90, and 103) had
carcinomas of the contralateral breast subsequent to the primary tumor,
and two cases (77 and 105) had distal metastases from which tissue was
available for analysis. All of the tumor components were analyzed for
LOH at the markers D11S922, TH, D11S988, and D11S837 to identify cases
with 11p15 LOH and to establish the stage of progression at which LOH
occurred. Specimens demonstrating LOH with one or more of these markers
were further studied with the other six markers in our panel to
characterize the SRO.
LOH at 11p15 during Breast Cancer Progression
A total of 43 of the 115 cases (37%) analyzed demonstrated LOH in
at least one tumor component. Samples of intraductal carcinoma were
available for analysis in 30 of the 43 cases (70%) showing LOH at
11p15. Three of the eight pure intraductal carcinomas (37.5%) had LOH.
LOH was detected in 19 of the 59 (32%) node-negative cases that had
progressed to the invasive stage. Intraductal components could be
identified and dissected from 15 of these 19 cases, and LOH was
detected in 13 of the 15 intraductal specimens. Of the 48 cases with
lymph node metastases, 21 (44%) demonstrated LOH in at least one tumor
component. Twelve cases in this group had dissectable intraductal
components, with 10 showing LOH. Fifteen of 18 specimens of invasive
carcinoma in this group and 18 of the 21 metastases demonstrated LOH.
The results are summarized in Table 1
.
LOH at 11p15 was therefore most commonly observed in the intraductal
component of these tumors and maintained throughout subsequent stages
of progression. However, several exceptions were observed (Figure 2)
. Of the cases with LOH, 27 had a
dissectable intraductal component in addition to material representing
later stages of progression. Of these cases, four (72, 78, 83, and 93)
did not show LOH in the intraductal carcinoma. Similarly, there were
three cases (78, 93, and 112) with LOH in the metastatic component but
not in the corresponding specimen of invasive tumor. Interestingly, two
cases (50 and 105) showed LOH in the intraductal and invasive specimens
that was not detected in the lymph node metastasis. Of three cases with
asynchronous contralateral tumors, two cases (16 and 90) demonstrated
LOH in the primary tumor but not in the subsequent tumor in the
opposite breast. In case 77, a pleural recurrence 6 years after
excision of the primary tumor demonstrated LOH, whereas the primary
tumor did not.

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Figure 2. LOH occurring at different stages in the progression of breast cancer.
Alleles showing loss in tumor specimens are indicated by
arrows. Allele ratios were determined by quantitating the bands
on a Molecular Dynamics Storm system, calculating the ratio of
(lost
allele)/(retained
allele) and dividing by the same ratio obtained
with the normal tissue. In case 72, LOH was first seen in invasive
tumor at 11p15 but in intraductal at 17q. In case 112, LOH was first
detected in the metastasis. In case 77, LOH was not seen in primary
tumor but was present in a pleural metastasis 6 years later. In case
90, LOH was present in primary tumor but not in a contralateral tumor
(labeled recurrence) 4
years later. In case 50, LOH was detected at 11p15 and 17q in invasive
tumor but only at 17q in metastasis.
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Inferences regarding the development of LOH during breast cancer
progression could potentially be inaccurate because of contamination of
the microdissected tumor components with normal cells, thereby
obscuring the LOH present in certain tumor components. To rule out this
possibility, lysates from cases showing different patterns of LOH at
different stages of progression were tested for LOH at various other
loci. As shown in Figure 2
, the detection of LOH at loci on chromosome
17q in two of these cases (50 and 72) demonstrates that the dissected
material was of sufficient purity to detect LOH if it were present.
Therefore, in a minority of cases, 11p15 LOH does not occur until
progression beyond the intraductal stage.
Analysis of the SRO for LOH at 11p15
Cases showing 11p15 LOH were further analyzed with a panel of 10
loci spanning the region from 11p15.3 to 11p15.5, previously shown to
contain SROs relevant to breast cancer (Figure 3)
. Of 43 cases with LOH, 19 showed LOH
at all informative markers, whereas 24 provided evidence of
interstitial deletions. Overall, the markers TH and D11S1318 appeared
to lie within a major SRO, with each marker detecting LOH in 100% of
informative cases whereas markers flanking this region on either side
showed reduced sensitivity for the detection of LOH. Twenty of the
twenty-four cases with interstitial deletions yielded results
consistent with loss of a continuous segment of the chromosome. Data
from four cases (41, 93, 101, and 103) suggest two regions of LOH, one
centered on the markers TH and D11S1318 and the second located more
proximally at 11p15.315.4.

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Figure 3. Sublocalization of the minimal region of LOH at 11p15 in breast cancer.
Results obtained with the 43 cases showing LOH with at least one marker
are presented. Solid circles, LOH; shaded circles,
retention of heterozygosity; open circles, uninformative
(homozygous or
nonamplifiable); M, microsatellite instability.
The solid bar to the right of the figure indicates the minimal
shared region of LOH inferred from this data set.
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Examples of the LOH data from cases critical for establishing the SRO
or for demonstrating two regions of LOH are presented in Figure 4
. Case 38 demonstrates LOH at the more
telomeric of the markers analyzed but shows retention of heterozygosity
over the centromeric segment of this region. Case 93 is an example of a
case with two regions of LOH separated by a region of retention of
heterozygosity. In this case, the allele ratios calculated for the
proximal markers D11S988 and D11S837 were significantly less than those
for the more telomeric markers TH and D11S1318, suggesting that LOH at
these two regions may have occurred at different times in the evolution
of the tumor. Such disparities in allele ratio were observed only
infrequently in this study. Case 124 shows retention of heterozygosity
at D11S4046, LOH at D11S1318, and retention of heterozygosity at more
proximal markers.

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Figure 4. Patterns of LOH at 11p15 in breast cancer. A: Case 38, showing
LOH at the distal group of markers, retention of heterozygosity at
D11S1758, D11S4146, and D11S988, defining centromeric border of SRO.
B: Case 93, with LOH at proximal and distal markers with
retention of heterozygosity between these two regions. C: Case
124, with retention of heterozygosity at D11S4046, defining telomeric
border of SRO. N, normal tissue; T, tumor. Arrowheads indicate
the allele lost in assays showing LOH. When LOH was present,
quantitation was as in Figure 2
. In cases where there was no LOH, the
numerator and denominator of the reported allele ratio were chosen so
as to yield a number less than the ideal value of 1.0.
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Analysis of patterns of LOH in cases with interstitial deletions
suggests a minimal region of overlap between D11S4046 and D11S1758. Two
cases retained heterozygosity at D11S4046, indicating that the minimal
region of overlap does not extend telomeric to this marker. At the
centromeric border of this region, one case (38) retained
heterozygosity at D11S1758 and two (38 and 101) at D11S4146, suggesting
that these markers lie proximal to a minimal region of overlap.
Clinicopathological Correlations
Survival curves for cases with and without LOH at 11p15
demonstrate no significant difference between the two groups (Figure 5)
. Other clinical and pathological data
on these cases were reviewed. No relationship was found between LOH at
this locus and estrogen receptor status, the presence of positive lymph
nodes, S phase fraction, tumor size, or histological grade.

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Figure 5. Cumulative proportion surviving
(Kaplan-Meier). Survival
curves were generated for cases with
() and without
(- - -) LOH at 11p15.
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Discussion
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Microdissection of histological sections permits the
isolation of tissue samples representing progressive stages in the
evolution of breast cancer. We have applied this method to the analysis
of LOH at chromosome 11p15, a locus known to show a high frequency of
genetic alterations in breast cancer. Our results demonstrate several
variant patterns for the occurrence of LOH at this locus during breast
cancer progression. Most commonly, we observed LOH in the earliest
stage available for analysis. In four cases, however, LOH was absent
from the intraductal tumor but present in later stages of progression.
Interestingly, in two cases, LOH seen in an invasive tumor was not
detected in synchronous lymph node metastases. The latter observation
indicates that invasive and metastatic components of an individual
tumor can, at least in a small proportion of cases, represent
genetically divergent clones rather than progressive stages in the
clonal evolution of the tumor. Although the frequency with which
genetically divergent clones arise during breast cancer evolution
cannot be determined from the present study, this phenomenon has
implications for the development of therapies targeted at specific
growth-regulatory signaling pathways and therefore merits further
investigation. Studies of microdissected multifocal prostate cancers
have similarly demonstrated evidence for genetic
heterogeneity.31-33
Our observation that 11p15 LOH is usually present by the time the tumor
has progressed to the intraductal carcinoma stage is of interest with
respect to the finding that LOH can be observed in morphologically
benign terminal duct lobular units (TDLUs) adjacent to foci of
intraductal carcinoma.34
In that study, only one of five
cases with LOH at 11p15.5 was found to have LOH in the adjacent TDLU
whereas chromosome 3p markers showed LOH with a much higher frequency
in such morphologically normal specimens. This observation, together
with our finding that LOH at this locus is usually present in the
intraductal carcinoma, suggests that loss of function of the tumor
suppressor gene at this locus may often be an event involved in the
progression from morphologically benign epithelium to intraductal
carcinoma.
Pathological data and long-term clinical follow-up for as long as 25
years following the initial diagnosis was available for most of the
cases analyzed in this study. This information was used to evaluate
11p15 LOH as a potential prognostic marker. We observed no significant
correlation between 11p15 LOH and survival, tumor stage, grade, or
presence of metastases. Presumably, the significant genetic alteration
at this locus occurs before the cell has acquired the aberrant growth
characteristics necessary for invasion and metastasis. Although some
studies have reported associations between LOH at 11p15 and clinical
parameters, one report has suggested that these correlations may
actually reflect LOH at 11q, which is believed to contain a distinct
tumor suppressor gene, rather than at 11p.6
Other
investigators have also observed a lack of correlation between 11p15
LOH and clinical parameters.4
The reasons for the apparent
discrepancy between this study and others that find no correlation
between 11p15 LOH and the development of metastases4,6
and
a report that such a correlation exists5
are not clear but
may reflect differences in the specific markers used or in the
population of breast cancer patients analyzed.
This report provides confirmatory evidence for the existence of an SRO
distal to D11S988 at 11p15.5. In our study, LOH was identified in 43
(37%) cases, of which 24 had interstitial deletions. The overall
percentage showing LOH is comparable to the 35% previously reported in
breast cancer by Winqvist et al,6
who also noted that LOH
at this locus is most often interstitial. Similar percentages of LOH
have been reported in other tumors, including lung
(43%),11
bladder (30%),16
stomach
(41%),17
and testis (59%).14
The boundaries
of the SRO appeared to be similar when data from each stage of tumor
progression were analyzed separately; that is, we did not observe a
widening of the SRO when the data from only infiltrating or only
metastatic tumor components were analyzed, as might have been expected
if additional genes from this region were involved in later stages of
tumor progression. The four cases in which LOH was not observed in the
intraductal component but was detected at a more advanced stage of
tumor progression also yielded evidence of a similar SRO. These results
are consistent with the possibility that the same gene can be involved
at different stages of tumor progression.
The SROs at 11p15 in breast cancer inferred from this and previous
studies include a major region of LOH centered on or near the marker
D11S1318 plus one or more secondary regions. LOH at these secondary
regions seems to occur only in those tumors that demonstrate LOH of the
major region. The results of Winqvist et al6
identified the
markers TH and D11S988 as boundaries of one minimal region of overlap.
A second SRO was identified more proximally, an observation similar to
our finding of several cases with two distinct regions of LOH. Data
from another study4
supported two independent regions of
LOH at 11p15.5, one between D11S1318 and D11S988 and the other located
distal to D11S1318. The major SRO defined by our data set may therefore
encompass more than one gene important in the etiology of breast
cancer. Although several studies have now reported cases with distinct
regions of LOH at 11p15, no cases have been reported in which LOH
involves the proximal (to D11S988) or distal (to D11S1318) regions
without also involving the major SRO between D11S988 and D11S1318. It
remains unclear whether this implies that genes in the proximal and
distal SROs become important only after inactivation of a gene in the
central region or, perhaps, that the mechanism of genetic loss may
occasionally permit retention of a chromosomal segment when flanking
sequences on both sides are deleted.
Minimal regions of overlap for LOH at 11p15 have been described in
several tumor types other than breast cancer. In non-small-cell lung
cancer, one study reported evidence for a telomeric SRO distal to TH,
centered on D11S922, and a second region proximal to D11S988, centered
on D11S909.11
The latter marker is close to D11S837, the
most proximal marker used in the present study. As observed in other
studies of LOH at 11p15.5, no cases demonstrated LOH exclusively at the
more proximal locus. These results suggest that the major SRO observed
in breast cancer (D11S988-TH) may not play a role in non-small-cell
lung cancer. However, studies of several other tumor types point to
minimal regions of LOH that contain the chromosomal segment identified
as the major SRO for breast cancer. Characterization of 100 carcinomas
of the bladder suggested a minimal region of overlap between D11S922
and D11S569,16
a region that includes the D11S988-TH
chromosomal segment. A study of 13 hepatoblastomas suggested a
significant region of LOH distal to the HBB locus.19
In an
analysis of 60 adenocarcinomas of the stomach,17
most cases
were found to have LOH of all informative markers, but two cases
suggested a minimal region of overlap bordered by D11S1318 and D11S988.
The chromosomal segment containing the major breast cancer SRO has also
been implicated as the locus of genes involved in cancer by other
methodologies. Direct transfer of chromosomal fragments allowed the
mapping of a tumor suppressor activity for the cell line G401 to
11p15.5.21,22
Using subchromosomal transferable fragments,
a growth-inhibitory activity for the rhabdomyosarcoma cell line RD was
mapped to a similar region.35
Studies of chromosomal translocations in several human malignancies
have mapped breakpoints within the common region of LOH at 11p15,
providing additional evidence for the presence of one or more tumor
suppressor genes in this region. A breakpoint in a rhabdoid tumor was
localized approximately 60 kb centromeric to the TH gene.36
In a myeloid leukemia, an 11p15 breakpoint was found to represent a
fusion between the Nup98 gene on 11p15 and the homeobox gene HOXA9 on
chromosome 7.37
Studies of BWS translocations have led to
the identification of at least 11 genes within a 320-kb segment
containing five of eight mapped breakpoints.38
The
potassium channel gene KVLQT1, which spans all five BWS breakpoints
localized within these 320 kb, is strongly implicated in
BWS.39
The gene encoding the cyclin-dependent kinase
inhibitor p57Kip2 maps within this region and may also play a
role.40
This segment, extending to a point approximately
100 kb centromeric to the insulin/TH/IGF2 gene cluster, lies within the
major SRO observed in breast cancer.
The remaining three mapped BWS breakpoints occur within a 1.2-Mb region
of band 11p15.3, approximately four Mb centromeric to the cluster of
five breakpoints. This region contains three genes potentially involved
in growth regulation: rhombotin, WEE1, and ST5.25-27
Another candidate tumor suppressor, H19, lies less than 200 kb
telomeric to IGF2. This gene lies telomeric to the D11S988-TH segment
but maps within the boundaries of the more telomeric SRO identified by
Negrini et al4
as well as within the SRO defined by the
present study. The tsg101 gene, which was found to undergo aberrant
splicing in several breast carcinomas, localizes to 11p15.1, a locus
centromeric to the region containing the BWS breakpoints and the common
region of LOH identified in multiple tumor types.41,42
In summary, characterization of LOH at 11p15 in a panel of breast
carcinomas demonstrated that LOH usually occurs at this locus by the
time the disease has developed to the intraductal carcinoma stage, but
may occur at a later stage of progression. Analysis of the SRO at this
locus supports localization of a tumor suppressor gene involved in
breast cancer to a region similar to loci identified by chromosome
transfer studies and analysis of BWS breakpoints, suggesting that the
same gene or genes at 11p15 may be involved in BWS, growth suppression
detected by chromosome transfer, and breast cancer.
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Acknowledgements
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We are grateful for the assistance of Annette Geissel in cutting
blocks and preparing histological sections.
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Footnotes
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Address reprint requests to Dr. Jack H. Lichy, Molecular Pathology Division, Department of Cellular Pathology, Armed Forces Institute of Pathology, 14th Street and Alaska Avenue NW, Washington, D.C. 20306-6000. E-mail: lichy{at}email.afip.osd.mil
Supported by grant DAMD 1794-J-4330 from the U.S. Army Medical Research and Materiel Command and by the intramural funds of the Armed Forces Institute of Pathology.
Accepted for publication April 7, 1998.
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