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PubMed1980

Secretory carcinoma of the breast.

Nineteen examples of a very rare type of carcinoma of the breast have been studied. The carcinoma is unusual in that it has exaggerated secretory features previously reported only (with one exception) in juveniles. But not all the patients in our series were juveniles; they ranged in age from 9 to 69 years (median age, 25 years). Six were 30 years of age or older. Eighteen patients were female and 1 was a 9-year-old boy. Treatment varied from local excision of the tumor to radical mastectomy. Four of the 11 patients who had axillary node dissection had metastatic deposits showing the same secretory features as the primary neoplasm. One of these 4 patients, a 25-year-old woman, died within ten months with disseminated tumor. Because this distinctive pattern of carcinoma is not limited to children and adolescents, we propose that it be called "secretory carcinoma." Since, of the 19 patients, 4 (21%) had axillary node metastases and 1 (5%) died with disseminated tumor, an extended simple mastectomy is recommended as the initial treatment for patients more than 20 years of age.

Adolescent↗
PubMed1977

Secretory (juvenile) carcinoma of the breast.

A case of secretory (juvenile) carcinoma of the breast is reported in a 26-year-old multiparous woman who had been taking oral contraceptives for 7 months. The tumour recurred 8 months after local resection and axillary metastases were found at radical mastectomy. No further recurrence has been detected but the follow-up period is only 8 months. It is emphasized that secretory carcinoma of the breast originally described in children occurs also in adults. Early reports stressed the slow rate of growth, often with intervals of many years before recurrence, and the small risk of metastatic spread, many cases being cured by local resection. However, axillary metastases have been found in approximately 15% of the recorded cases. Consequently it is recommended that the initial treatment should be simple mastectomy with at least a low axillary resection.

Adult↗
PubMed1975

[Cystosarcoma phylloides of the breast. Analysis of 58 cases].

Cystosarcoma phylloides (c.p.) is a rare fibroepithelial neoplasm of the mammary gland exhibiting considerable histological variations ranging from the aspect of hypercellular fibroadenoma to that of pleomorphic sarcoma. In this study, 58 cases of c.p. were graded according to their histology into 3 groups of increasing malignancy-benign tumors: 23 cases (42%), borderline tumors: 16 cases (27%) and malignant tumors: 18 cases (31%). Their clinical properties and evolution have been compared. These tumors were found exclusively in women, most often during the 5th and 6th decade of life (age range from 19 to 81 years). In two thirds of the cases, the history of the disease was shorter than 6 months. The symptoms were generally scant. Only in 2 cases were severe local lesions observed. The postoperative clinical course has been followed for at least 5 years in 32 instances. Recurrences were observed in 5 patients, the histology being as a rule the same as that of the primary tumor. The 12 patients with benign tumors are well 5 years or more after operation. One of the patients presenting a malignant tumor died of lung embolism soon after mastectomy. 2 out of 10 patients with borderline tumors died within 6 years with metastases of the mammary tumor. Our analysis confirms the experience that c.p. are relatively benign but often recurring neoplasms that rarely disseminate. As far as prognosis and treatment are concerned, tumors of questionable dignity should be considered malignant. To avoid such vague terms as "benign or malignant c.p." we support OBERMANN'S suggested separation of c.p. into "cellular fibroadenoma" and "periductal fribrosarcoma". Wide local excision for small and benign tumors is recommended. All other forms require simple mastectomy. Prophylactic dissection of the axillary lymph nodes is not necessary as these tumors usually disseminate hematogenously. Roentgen therapy or chemotherapeutic agents are not useful in treatment.

Adult↗
PubMed1993

Angiosarcoma of the breast following lumpectomy, axillary lymph node dissection, and radiotherapy for primary breast cancer: three case reports and a review of the literature.

INTRODUCTION: One of the risks of therapeutic irradiation is the development of secondary malignant tumors. In this paper three cases are reported of angiosarcoma of the breast following breast-conserving surgery and irradiation for primary breast cancer, and the literature is reviewed. METHODS AND MATERIALS: Until now, 13 other cases of postirradiation angiosarcoma of the breast have been reported. The mean interval between treatment of primary breast cancer and the development of angiosarcoma in these 16 patients is 76 months. The clinical aspect is typical with multiple bluish or purple nodules of the skin, purple discolorations, erythematous maculas or areas, sometimes combined with ulceration, edema, or a palpable mass. Mammography does not necessarily raise suspicion and the interpretation of fine-needle aspiration or biopsy may be difficult. RESULTS: In all patients mastectomy was performed, Follow-up data are available for 12 cases. Two patients died of extensive local recurrences and one of distant metastases. CONCLUSION: Angiosarcoma of the previously irradiated breast is an extremely rare tumor and diagnosis may be difficult. The number of patients with long-term follow-up after breast-conserving therapy is growing fast. Therefore, the authors advise to pay special attention to uncommon skin changes of the treated breast, since clinical suspicion is the main clue to the diagnosis of postirradiation angiosarcoma. The primary therapy is (simple) mastectomy if wide tumor-free margins can be achieved. There is no indication for standard adjuvant chemotherapy or irradiation.

Aged↗
PubMed2004

Primary sarcoma of the breast.

BACKGROUND AND OBJECTIVES: Primary sarcoma occurring in breast is rare and comprises 0.5-1% of all breast neoplasm. Majority of the series include both stromal and cystosarcoma phyllodes, only a few hundred cases of sarcomas other then cystosarcoma are reported. PATIENTS AND METHODS: We carried out a retrospective analysis of 19 patients with primary sarcoma of the breast treated between 1982 and 2002. RESULTS: Mean age of the patients was 38.6 years (12-70 years). Gradually progressive swelling was the commonest presenting feature. There were eight cases of angiosarcoma, four cases of spindle cell sarcoma, two each of pleomorphic sarcoma and stromal sarcoma, and one each of malignant fibrous histiocytoma, embryonal rhabdomyosarcoma, and sarcoma (NOS). Eight of these were high-grade (42%). Eight patients underwent either radical or modified mastectomy, three underwent wide excisions, and one underwent quadrantectomy. Ten (52.6%) patients received postoperative adjuvant radiation. Two patients received chemotherapy. After a mean follow-up time of 34.5 months (median 25 months), eight patients failed. Failure was local in five, opposite breast in one, and both local and distant in two. The disease free survival at 3-year was 39%. In univariate analysis only the margin of first surgery was found to be a significant predictor of survival (P = 0.05). CONCLUSIONS: Primary sarcomas of the breast are aggressive tumors. Surgical treatment should consist of at least simple mastectomy. All attempts should be made to achieve a negative margin as this appears to be the only factor influencing survival in these patients.

Adult↗
PubMed1997

Clinicopathological characteristics of primary breast cancer in older geriatric women: a study of 39 Japanese patients over 80 years old.

The number of primary breast cancers occurring in elderly women is increasing in Japan. Optimization of treatment regimens in this age group requires precise evaluation of the biological aggressiveness of these tumors as well as the performance status and extent of tumor spread. In 39 breast cancer patients who were at least 80 years old, we examined several parameters; the form of surgical therapy, the lymph node status, presence or absence of distant metastases, the histological type and grade of atypia, and overexpression of the c-erbB-2 oncoprotein in the cancer cells. They were correlated with the clinical outcome of the patient. Of the 33 patients who underwent a mastectomy and axillary lymph node dissection, five died from cancer recurrence. Only one out of 22 patients without lymph node metastases died from cancer, while four out of the eight patients with metastases to three or more lymph nodes died from cancer recurrence within 2.7 years of surgery. The overall survival curves also differed between patients with low-risk histological tumors or grade 1 or 2 invasive ductal carcinoma and those with grade 3 invasive ductal/lobular carcinoma. Overexpression of c-erbB-2 also affected survival. Regional recurrence occurred in three out of the six patients for whom only lumpectomy or simple mastectomy was performed. These results indicate that, although primary breast cancer occurring in patients over 80 years old was largely of low-grade malignancy, patients with three or more lymph node metastases, invasive ductal/lobular carcinomas of grade 3, or c-erbB-2 overexpression frequently exhibited an aggressive clinical course.

Aged↗
PubMed1997

[Changes in radical surgery of breast carcinoma in the last 20 years].

UNLABELLED: The retrospective analysis of 383 female patients with breast cancer of all tumor stages from the department of surgery (323 patients since 1979) and the department of gynaecology (58 patients since 1993) shows the abandonment of the radical mastectomy according to Rotter-Halsted (116 patients until 1989), acceptance of the modified radical mastectomy (178 patients since 1979) and introduction and rise of the breast conserving operations (67 patients since 1983). In 1992 there was an extension of breast conservation treatment from T1 N0 to T2 N1-2 tumors (tumor diameter till 4 cm). Operation technique: 1. Circular incision above the tumor, 2. tumor excision in histologically healthy tissue, 3. lower axillary dissection (level I and II with > or = 10 lymph nodes), 4. no suture of the gland and drainage without suction, 5. postoperative computerised high energy radiotherapy of the conserved breast (Clinic of radiotherapy of the University of Leipzig). Because of the high operation risk a simple mastectomy without axillary dissection was performed in 22 of 383 patients. RESULTS: 3 of 383 patients died = 0.78% postoperatively due to tumor independent complications. One local tumor recurrence was observed 6 years after breast conserving therapy in 25 patients operated until 1992. In 42 patients operated since 1993 a tumor recurrence did not occur so far. The 5-year-survival-rate in 153 patients of all tumor stages amounted to 64%, in node-negative patients 80.3%, in node positive patients 51.7%. RECOMMENDATIONS: Breast conservation will be always recommended if the relation between tumor diameter and breast volume permits a cosmetic attractive result.

Breast Neoplasms↗
PubMed1998

Male breast cancer: a 22-year experience.

AIMS: To carry out a retrospective study of male breast cancer over a 22-year experience. METHODS: Data from 121 male patients with breast cancer treated between the years 1972 and 1994 at the Surgical Clinic of Ankara Oncology Hospital were reviewed. Distribution of cases according to stage was: 2.5% stage I, 28.9% stage II, 55.4% stage III and 13.2% stage IV (AJCC staging method). The surgical treatment for 23 of the patients (19%) was Halsted's radical mastectomy or modified radical mastectomy. Seventy-three cases (60.3%) had total mastectomy without axillary node dissection and 25 (20.7%) had local tumour excision only. Seventy-two of 121 patients had adjuvant treatment. RESULTS: In general the prognosis of men with breast cancer was worse than for women. In the analysis of patients in stages I, II and III-A (operable disease group), the 5-year survival rates were 73% in axillary node-negative patients and 77% in those with tumours sized under 5 cm (P<0.001). In these patients, univariate analysis demonstrated that axillary status (relative risk of death in positive status vs. negative=3.6), tumour size (relative risk in T3 vs. T1-2=2), surgical treatment type (relative risk in simple mastectomy vs. radical mastectomy=1.9) and adjuvant chemotherapy (relative risk if no chemotherapy=1.4) were statistically significant factors associated with survival. CONCLUSIONS: Cox's regression model revealed that axillary status, tumour size and type of surgical treatment were the most important independent prognostic factors (P<0.001).

Adult↗
PubMed1978

Survival and recurrences five years after selective treatment for breast carcinoma.

110 consecutively diagnosed breast-cancer patients in all stages were included in a study to evaluate a selective surgical and radiotherapeutical treatment. The surgical treatment was total mastectomy and exploration of the axilla, with lymphnode biopsy and peroperative cytological examination. Axillary dissection was done only when this examination showed metastases. No radiotherapy was given to the axilla in patients with lateral cancers in the absence of metastases, or with limited metastasization (no periglandular growth, no growth in apical nodes). In medial and central cancers, radiotherapy was applied to the parasternal and supraclavicular nodes irrespective of axillary involvement. A staging system with a combined clinical and histopathological classification was used and formed the basis for the selective treatment. The corrected 5-year survival for the whole material was 80%, for those without axillary metastasis (Stage I) 95% and for those with axillary metastasis (Stage II) 68%. Six women were alive with known distant metastases. Of 63 patients without identified axillary metastases at the time of surgery, axillary recurrences occurred in only 3 (5%). It was concluded that patients without axillary metastases can be reliably selected by the peroperative examination used, and that in this group simple mastectomy results in a high disease-free survival. Early diagnosis and a possible beneficial effect of the actual therapeutic programme might both have contributed to the high overall survival.

Adult↗
PubMed2003

Phyllodes tumor of breast.

Phyllodes tumors account for 0.3%-0.5% of all the breast tumors. They are usually benign but malignant variants exist and have the potential to metastasize. Surgery is the mainstay of treatment as there is no proven benefit of adjuvant chemotherapy or radiotherapy. Wider excision with 1 cm clear margins is recommended in cases where the resection margins are involved. Simple mastectomy is recommended even for large benign tumors as there is increased likelihood of recurrence. We are presenting a case of 42 years old female with benign phyllodes tumor and a brief review of literature on the subject.

Adult↗
PubMed1986

Multimodal therapy for locally advanced breast cancer.

Thirty-one women with stage III breast cancer were prospectively treated with two cycles of cyclophosphamide (Cytoxan), doxorubicin hydrochloride (Adriamycin), fluorouracil, and tamoxifen citrate followed by a simple mastectomy with level I axillary dissection. Postoperatively, four additional cycles of the combination chemotherapy alternating with three cycles of 1500 rad (15 Gy) to the chest wall and lymphatics were given. Seventy-seven percent of patients had a greater than 50% reduction in tumor size after the initial chemotherapy. No tumor size progressed during therapy, and a single patient remained inoperable. Pathologic findings revealed nine patients with only microscopic residual tumor. Nuclear vacuolization was present in 42.8% of tumor cells after chemotherapy vs 14.2% of cells before chemotherapy. The mean follow-up for the groups is 24.3 months. To date, nine patients have had recurrence with only one isolated local recurrence. This therapy is effective in reducing primary tumor size and allows a limited mastectomy to be done with minimal morbidity.

Adult↗
PubMed1976

Gigantic cystosarcoma phyllodes in a man with gynecomastia.

A 70-year-old man had a breast tumor for 50 years. The tumor, which weighed 8.6 kg, proved to be a malignant cystosarcoma phyllodes. It was successfully removed by a simple mastectomy with low axillary dissection, and a skin graft was performed. The lesion was associated with gynecomastia, and it is believed to have represented a cystosarcomatous transformation of a giant fibroadenoma.

Aged↗
PubMed1986

Angiosarcoma of the breast.

The clinical histories, operative reports, and pathologic slides of 20 patients seen between 1907 and 1984 with diagnoses of angiosarcoma, hemangiosarcoma, and hemangioendothelioma were reviewed. The mean age of the 19 female patients and one male patient was 40.05 years (range, 16 to 67 years). Ten patients had the right breast involved, and five patients had contralateral breast involvement. Presenting symptoms included a mass in 20 patients, pain in ten patients, and breast discoloration in six patients. Before referral, ten patients had the misdiagnosis of a benign breast lesion. Because of the deceptively benign appearance of many angiosarcomas, these lethal tumors are often misdiagnosed as benign hemangiomas. Simple mastectomy is the treatment of choice, while adjuvant therapy remains to be evaluated.

Adolescent↗
PubMed1996

The treatment and prognosis of patients with phyllodes tumor of the breast: an analysis of 170 cases.

BACKGROUND: The study addresses the controversial prognostic and therapeutic aspects of phyllodes tumor of the breast. METHODS: Records of 170 women with phyllodes tumor of the breast were reviewed. On the basis of the criteria proposed by Azzopardi and Salvadori et al., including estimation of tumor margin, growth of the connective tissue component, mitoses, and cellular atypia, the entire series was divided into three histotypes of phyllodes tumor, i.e., benign (92 cases, 54.1%), borderline (19 cases, 11.2%), and malignant (59 cases, 34.7%). Ninety-eight patients (57.6%) were treated by wide local excision (79 benign, 15 borderline, and 4 malignant), 43 (25.3%) by simple mastectomy (13 benign, 4 borderline, and 26 malignant), and 29 (17.1%) by radical mastectomy (all malignant). RESULTS: Of the 170 treated patients, 141 (82.9%) survived 5 years without evidence of disease. In the Cox multivariate analysis the histotype of the tumor was the only independent prognostic factor: 5-year NED survival was observed in 95.7% of the patients with benign phyllodes tumor, 73.7% with borderline phyllodes tumor, and 66.1% with malignant phyllodes tumor. After a wide local excision 98.7% of the patients with benign tumor, and 80% with borderline tumor, were cured. Local recurrence was found in 14 patients (8.2%) (4 benign, 3 borderline, and 7 malignant); 10 of these underwent reoperation (7 wide local excision, 3 radical mastectomy) and survived 5 years NED. CONCLUSIONS: The histotype of phyllodes tumor (benign, borderline, and malignant), assessed on the basis of the criteria proposed by Azzopardi and Salvadori et al., was the only prognostic factor in our group of patients. Based on the data from literature and our own observations, we observed that a wide local excision, with an adequate margin of normal breast tissue, is the preferred initial therapy for phyllodes tumor of the breast.

Adult↗
PubMed1977

Prolonged survival after immunotherapy (irradiated cancer autografts) or mammary cancers, assessed by a measure of therapeutic deficiency.

Sixteen women, twelve with stage 2 and four with stage 3 mammary cancers, were given autografts of irradiated cancer cells immediately after simple mastectomy and before postoperative radiotherapy, as a pilot trial with entry limited for ethical and operational reasons. Entry was based upon the presence of the poor prognostic features of tumor diameter exceeding 4 cm, fixation to skin or fascia or presence of axillary lymph nodal metastases. Actuarial survival curves for a period of six years show significant (p less than 0.01) prolongation of survival of the small autografted group (63% at six years) compared to that (30% at six years) of 139 ungrafted stage 2 mammary cancer patients treated by mastectomy and postoperative radiotherapy. The concept of deficiency of a treatment based upon person-years lived is introduced and used to analyze the data. The observations and analyses support the theoretical concept that irradiated autografts of cancers may sensitise residual cancer to subsequent conventional radiotherapy and in the process can activate systemic immunological restraints.

Adult↗
PubMed1978

Cystosarcoma phyllodes: a clinicopathologic analysis of 42 cases.

A retrospective clinicopathologic evaluation of 42 patients with cystosarcoma phyllodes was undertaken to determine if tumor size, contour, degree of stromal atypia and mitotic activity were reliable indicators of clinical behavior. Excluding size, the latter three determinants showed a positive correlation with prognosis and served as the basis of a classification in which 18 benign, 5 borderline and 19 malignant cystosarcomas were diagnosed. The tumors occurred in women averaging 44.3 years of age who most often presented with a palpable occasionally painful mass with a median diameter of 5 cm. Excision or simple mastectomy were the more frequent forms of therapy. Local recurrences were experienced by 6 patients and occurred in all 3 categories of tumor. Only malignant neoplasms developed systemic metastases which was observed in 4 patients 3 of which have died. On borderline tumor recurred 14 times and eventually proved fatal as a result of contiguous pulmonary involvement. A plea is made to label the stroma of malignant cystosarcomas as to the cell(s) of origin so future investigators may evaluate the effect of various soft tissue patterns on prognosis.

Adolescent↗
PubMed1979

Stromal sarcoma of breast: a light and electron microscopic study.

A case of stromal sarcoma of the breast was studied by light and electron microscopy. The tumor comprised of uniform, plump spindle cells with neither epithelial nor "metaplastic" mesenchymal elements. Ultrastructurally most of the tumor cells appeared immature containing abundant free ribosomes, variable amounts of microfilaments and profiles of rough endoplasmic reticulum, with scant intercellular collagen and elastic fibers. The cells often showed prominent nesting as well as a variety of cell junctions, including desmosomes. We believe this tumor is a poorly differentiated, precursor mesenchymal sarcoma which belongs in the category of "stromal sarcoma of breast," a term coined by Berg et al. in 1962. To our knowledge, this represents the first published electron microscopic study on this tumor. Despite a high mitotic figure count in the tumor, the patient has survived a simple mastectomy with no evidence of metastasis 30 months later.

Breast Neoplasms↗