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PubMed1980

Angiosarcoma of the breast.

A case of angiosarcoma of the breast with a fatal outcome is reported, and the world literature on this rare type of breast tumor is reviewed. Familiarity with the clinical and pathologic features of this entity is essential in avoiding underdiagnosis and delay of definitive treatment. The three-year survival rate of reported cases was 38%. However, the three-year, disease-free survival was only 14%. Five cases with five-year, disease-free survival have been reported to date. Eighteen patients (21%) showed contralateral breast involvement; in half of these, it occurred before other evidence of tumor dissemination. Simple mastectomy appears to be the optimal treatment of choice, since axillary node involvement is extremely rare. The role of irradiation and chemotherapy as adjuvant therapy remains to be evaluated.

Adult↗
PubMed1981

Kinetic parameters and the course of the disease in breast cancer.

The correlation between the labeling index (LI) of the primary mammary tumor and the course of the disease after initial treatment was studied prospectively on 128 patients. The surgical specimens of breast tumors were incubated in vitro with tritiated thymidine and autoradiographies were performed. Patients were treated by a simple mastectomy and axillary lymph nodes dissection; patients in whom one or more lymph nodes were found to be involved received postoperative radiotherapy. None of the patients received adjuvant chemotherapy. As the LIs were not known at the time of treatment, their values did not influence the choice of therapy. The follow-up period is greater than six years for all patients. The higher the LI, the shorter were the time intervals from initial treatment to first relapse or from first relapse to death. Moreover, significant correlations were found between the LI and the relapse-free survival and the survival rates. The proportion of relapses was particularly small in the group with the low LI. The shape of the curve suggests that the outcome in this group will be better than that in the group with a high or a median LI. The LI kept its prognostic value after multiple adjustments for other prognostic factors such as the staging, the size of the tumor, the number of metastasis bearing axillary lymph nodes, the presence of an inflammatory reaction, and hormonal status. The LI is significantly correlated with the histologic grading and in particular with its mitotic components. Thus, proliferative activity assessed by LI or the mitotic index appears to provide significant independent prognostic information.

Breast Neoplasms↗
PubMed1982

Inflammatory breast cancer treated with surgery, chemotherapy and allogeneic tumor cell/BCG immunotherapy.

Thirteen consecutive patients with inflammatory breast cancer were treated with a regimen consisting of cyclic chemotherapy, extended simple mastectomy, and immunotherapy utilizing irradiated allogeneic breast cancer cells admixed with BCG. When surgery was performed after two or more cycles of 5-U, doxorubicin hydrochloride, and cyclophosphamide, there was complete eradication of detectable tumor in three of 11 operative specimens. Two patients had surgery prior to our evaluation and four had prior chemotherapy. Chest wall radiation was initiated after 8-10+ months of chemotherapy at the doxorubicin cardiotoxicity limits. Seven untreated patients, all premenopausal, were compared to our previous series which employed either irradiation after several courses of chemotherapy or irradiation alone. The current series has two relapses (eight months, 25 months) at a median follow-up time of 21 months (range, 8-26 months). In the previous chemoradiotherapy trial, all nine premenopausal patients had relapsed within 25 months, with a median disease free interval of 17 months. In the trial using radiotherapy alone, all ten patients had relapsed by 19 months (median disease free interval, nine months). The present regimen appears to improve control of the disease and further investigation of both surgery and immunotherapy intercalated with cyclic chemotherapy appears warranted in this disease.

Adult↗
PubMed1982

Carcinoma of the male breast in West Africans and a review of world literature.

Twelve West African men with carcinoma of the breast were treated at the Lagos University Teaching Hospital over a ten-year period, 1971-1980. These cases represent 2.4% of both male and female breast carcinomas treated at the hospital. The mean age was 56.3 years. The left breast was involved 11 times more often than the right. There were no other associated malignancies. Tumor was preceded by gynecomastia in 22% of the cases. Neither trauma, estrogen therapy, nor irradiation appeared to be etiologic factors. The majority of the lesions were advanced. Simple or extended simple mastectomy followed by external radiotherapy was the treatment of choice. There were long delays before patients sought help at a hospital. This was in part because local remedies were tried before resorting to a hospital. The five-year survival rate was 22.2%. The advanced stage of the tumor before surgery rather than race accounted for the low survival rate.

Adenocarcinoma↗
PubMed1983

Multimodal treatment of locoregionally advanced breast cancer.

Fifty-two patients with locally advanced primary breast cancer (T3, T4/N2, N3) without distant metastases were treated with three cycles of combination chemotherapy consisting of 5-FU, Adriamycin and cyclophosphamide (FAC) and immunotherapy with Bacillus Calmette-Guerin (BCG) followed by local therapy (simple mastectomy and/or radiotherapy to breast/chest wall and regional lymphatics) and adjuvant chemotherapy to complete two years of treatment. Forty-nine of 52 (94%) patients were rendered free of clinically detectable disease. The median disease-free interval was 24 months. At a median follow-up time of 60 months, 40% of patients remained free of disease, off all therapy. Those patients who completed two years of therapy and started adjuvant chemotherapy promptly after local treatment had a 48% disease-free survival at five years. Local recurrences were observed in 21% of patients. Distant metastases developed in 40% of patients. Despite good tolerance, treatment compliance was poor. The complete remission rate with this multimodal approach is high and long-term disease-free survival is achieved in a considerable number of patients.

Adult↗
PubMed1983

Secretory carcinoma of the breast in adults. Light and electron microscopic study of three cases with review of the literature.

Three adult cases of secretory carcinoma of the breast were studied by both light and electron microscopy. Histologically the tumors revealed three patterns, namely, solid, microcystic and ductal. Ultrastructurally the tumor cells contained large numbers of membrane-bound intracytoplasmic secretory vacuoles. In addition, numerous intracytoplasmic as well as intercellular lumina containing abundant secretory material were noted. Secretory carcinoma in adults is rare with only twenty cases reported previously in the literature. It is known to have a better prognosis than the usual ductal carcinoma. The most appropriate treatment appears to be an extended simple mastectomy.

Adult↗
PubMed1985

Long-term survival following cancer of the male breast in Northern Ireland. A report of 81 cases.

Eighty-one patients with cancer of the male breast were studied. The majority (79) presented with a mass in the breast and in 8 patients the tumor was found by chance. Two patients presented with serosanguinous discharge. Average duration of symptoms was 11.9 months. Thirty patients had Stage I, 25 had Stage II, 16 had Stage III, and 8 had Stage IV disease. Fifty-three patients had simple mastectomy, nine had lumpectomy, six had radical mastectomy, and five had biopsy only. Eight had no local surgery. Overall 5- and 10-year survival allowing for all causes of death was 38% and 17%, respectively. Cox's (1972) proportional hazard regression model was used to assess the contribution of various factors to survival. Age at presentation, postoperative hormone therapy, postoperative radiotherapy, site of the primary tumor within the breast, and type of local surgery did not contribute to survival. Only the stage of disease contributed to survival and did so in the expected direction.

Actuarial Analysis↗
PubMed1985

Angiosarcoma of the breast. Two case reports and a review of the literature.

Two cases of angiosarcoma of the breast are presented. They are of particular interest in that one patient is a long-term survivor, the 19th reported to date, and the other presented with contralateral breast involvement without evidence of disseminated disease. The world literature is reviewed and a discussion is presented of the clinical features, treatment, histopathologic features, and prognosis of this rare breast neoplasm. Tumor size and degree of tumor differentiation are the most important prognostic indicators, and in general a simple mastectomy is the treatment of choice. The value of adjuvant irradiation and chemotherapy is uncertain.

Adult↗
PubMed1988

Patient compliance with aggressive multimodal therapy in locally advanced breast cancer.

This study of compliance was performed to determine whether a medically indigent population with breast carcinoma that has been neglected is an appropriate group for inclusion in an aggressive combined treatment program. After incisional biopsy, 28 locally advanced breast cancer (LABC) patients received two cycles of cytoxan, Adriamycin, 5-Fluorouracil, and tamoxifen (CAFT) followed by a simple mastectomy and level I axillary dissection. After surgery, patients received four additional cycles of CAFT alternating with three cycles of 15 Gy to the chest wall and regional lymphatics. Compliance was defined as overall compliance, the percentage of patients completing the protocol as described; and appointment compliance, the ratio between treatments or appointments attended versus those scheduled. Overall compliance was 75% (21 of 28 patients). The total number of appointments scheduled was 1054 (mean, 37 +/- 2), and the total attended was 965 (mean, 34 +/- 3), giving an appointment compliance rate of 91.7%. Compliance did not vary significantly with age, marital status, nationality, the presence of complications, or delay to diagnosis. Compliance did decrease significantly with time. There was 100% overall compliance at 2 months, 82% at 6 months, and 75% at 1 year. We conclude that although our patients had neglected their disease and were medically indigent, they were highly motivated patients once in therapy. This suggests that complex treatment regimens are feasible as well as effective for the treatment of LABC.

Adult↗
PubMed1975

In situ intraduct carcinoma of the breast: a long term follow-up study.

Twenty-eight patients with in situ intraduct carcinoma of the breast are reviewed. Two patients had bilateral tumours. The numbers of patients treated by wide local excision, simple mastectomy and mastectomy with axillary dissection were approximately equal; none of these patients died of carcinoma. The conclusions regarding prognosis and treatment of in situ intraduct carcinoma of the breast are discussed.

Adult↗
PubMed1979

Colour lymphography in clinical surgery.

In 38 patients undergoing femoral artery profundaplasty and in 18 having simple mastectomy with pectoral node biopsy, a 6.2 per cent solution of sodium sulphan blue was injected peripherally to outline the lymph nodes in the groin or axilla. Nodes and vessels were easily seen and the technique is now in routine use.

Breast Neoplasms↗
PubMed1979

Bone scanning: its lack of value in the follow-up of patients with breast cancer.

Three hundred and fifty-four women with primary operable breast cancer had a bone scan performed within 6 weeks of a simple mastectomy. Eight (2.3 per cent) were positive, but 7 of these patients had radiological evidence of bony metastases. Follow-up bone scans 1 year postoperatively on 278 patients showed only 12 (4.3 per cent) positive, and of these, 9 had other radiological evidence of metastatic disease. At 2 years postoperatively there were 13 (9.2 per cent) positive bone scans amongst 141 patients. Only 2 of these 13 had no other evidence of metastases. Although a bone scan is a useful investigation in patients with bone pain, there is no place for routine bone scanning in either the staging or follow-up of women with operable breast cancer.

Adult↗
PubMed1982

The clinical syndrome of mammary duct ectasia.

Over an 11-year period in one surgeon's practice, mammary duct ectasia constituted 5.5 per cent of all breast diseases treated by operation. A total of 78 patients undergoing major duct excision for mammary duct ectasia has been studied to determine the success of the standard operative treatment. Good results were obtained when the indications for operation were nipple retraction, nipple discharge or a sub-areolar mass. By contrast, generally poor results were obtained in 9 patients in whom the indication for operation was recurrent para-areolar sepsis; two of these ultimately came to simple mastectomy.

Adult↗
PubMed1984

Lymph node imprint cytology for the rapid assessment of axillary node metastases in breast cancer.

Lymph node imprint cytology was performed on 86 nodes from 13 consecutive patients with breast cancer undergoing simple mastectomy with axillary node sampling, and a prospective comparison with paraffin section was made. The results showed a diagnostic sensitivity and specificity of 0.93 and 0.98 respectively. The predictive value of a positive result was 0.98. This technique can be used to identify patients with Stage I disease rapidly, thereby allowing their exclusion from treatment with peri-operative chemotherapy.

Axilla↗
PubMed1984

The value of serial bone scanning in operable breast cancer.

The value of initial and serial isotope bone scans was assessed in 685 patients with operable primary breast cancer. Nineteen (2.8 per cent) patients had a positive initial scan and negative skeletal radiographs; only nine of these developed other evidence of metastatic disease after a mean follow up of 21 months. Five hundred and ten patients had serial scans up to five years after simple mastectomy; 51 (10 per cent) had scan conversion, of whom 37 developed clinical or radiological confirmation of recurrent disease at a mean follow-up of 13 months. Compared with clinical or radiological methods for the detection of first metastases serial bone scans gave a mean lead time of five months in 15 patients and no lead time in the remaining 22 patients. Twelve of forty-five patients with radiologically proven bone metastases had negative scans. Neither initial or serial bone scanning is clinically useful or economically viable as a routine screening or follow-up procedure for patients with operable breast cancer.

Adult↗
PubMed1985

The efficacy of lower axillary sampling in obtaining lymph node status in breast cancer: a controlled randomized trial.

Four hundred and seventeen patients with operable breast cancer treated by simple mastectomy were randomly allocated to have node sampling or total axillary clearance. There was no significant difference in the incidence of node positivity. One hundred and thirty-five patients had node sampling and were randomized at the completion of this procedure to have axillary clearance or to have no further surgery. All node positive patients who went on to have a clearance had positive samples, confirming the accuracy of the sampling technique.

Breast Neoplasms↗
PubMed1987

Predictive power of progesterone receptor status in early breast carcinoma.

Progesterone receptor status (PgR) and oestrogen receptor status (ER) were examined in 332 women with stage I-II breast carcinoma treated at a single centre either by simple mastectomy with (n = 283) or without (n = 6) axillary clearance, or by segmental mastectomy with (n = 18) or without (n = 25) axillary clearance and radiotherapy; median follow-up time was 40 (range 10-60) months. Neither the concentration nor the presence of PgR related to either disease-free interval or survival. However both the presence and the concentration of ER were found to be associated with a longer disease-free interval amongst patients with stage II tumours (P less than 0.01). From this study it appears that progesterone receptor status does not predict outcome in early breast carcinoma.

Adult↗