الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Globally, Breast cancer is the second most common cancer, and the most commonly
diagnosed malignancy in women, with variations in incidence and mortality among countries all
over the world. In Egypt, it is the most common cause of cancer mortality in women (125, 126).
In recent years, the tumor microenvironment (TME) has been a research hotspot, as it is
composed of cellular and non-cellular elements that may affect the prognosis, and management
of breast cancer cases (127).
Many researches have shown that not only tumor cells affect cancer metastasis, however,
other cells in TME greatly contribute to breast cancer prognosis and breast cancer cells interact
with these cells around them in TME (128).
Host Immune responses play a major role in the prognosis of breast cancer especially,
tumor infiltrating lymphocytes (TILs) which have been reported to be clinically useful (1) and
are easily measurable in a clinical setting(129).
There are several TIL subsets, including cluster of differentiation (CD8)-positive T cells
cytotoxic T lymphocytes, which have antitumor effects, and regulatory T cells (Tregs), which
express forkhead box protein 3 (FOXP3) and negatively regulate immune responses; host
immune responses to breast cancers are believed to be controlled by the functions of both of
these cell types (130).
It seems evident that with respect to the types of TILs, high levels of CD8+ T cells and
low levels of FOXP3+ T cells are generally associated with good prognoses, their prognostic
role in luminal breast cancer remains not evident (94).
The prognosis of breast cancer cannot depend only on TIL levels based on H&E;
however, the balance between CD8+ and FOXP3+ T cells is very important to be evaluated
(109).
In the present study 70 retrospective IDC cases of managed by Modified Radical
Mastectomy without receiving neoadjuvant chemotherapy were studied. The cases were
evaluated for CD8 and FOXP3 expression in TILS and CD8/FOXP3 ratio and were correlated
with different clinicopathological parameters to suggest their role as prognostic factors in breast
cancer.
In the current study, in IDC cases the density of sTILs in the majority of cases showed
score 2 intermediate infiltrates (≥ 10% and < 50%). This finding is in accordance with Noriko
Goda et al. (111) and Reiko Fukui et al. (94) who reported that the majority of cases in their studies
showed score 2(≥ 10% and < 50%) TILs.
Of the studied 70 cases of IDC, 34 cases showed Carcinoma in situ (48.6%). Thirteen
cases only from DCIS were available for examination, comedo type necrosis (30.8%) was the
commonest pattern among the examined cases. Density of TILs examined circumferentially
around DCIS in the majority of cases showed score 3. our result was in accordance with
Miglena Komforti et al. who stated in their s