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PubMed2004

Locally advanced and metastatic breast cancer with cartilaginous and/or osseous metaplasia showing excellent response to chemotherapy.

Breast cancer with cartilaginous and/or osseous metaplasia is considered a rare disease, but several cases have been reported recently. We report a case of breast cancer with cartilaginous and/or osseous metaplasia that was StageIV,(T4bN0M1b (PUL)), on the basis of the Japanese General Rules for Clinical and Pathological Recording of Breast Cancer, which responded well to chemotherapy. A 58-year-old women visited our hospital with a chief complaint of a palpable breast mass that had increased in size in March 2002. It was 20 x 15 x 14 cm and occupied the entire right breast. Chest computed tomography (CT) demonstrated multiple lung metastases. Histology of the biopsy specimens revealed a spindle-shaped cell carcinoma. It was ER(-), PgR(-), and HER2/neu Score 0. CAF was given to the patient as preoperative chemotherapy. Five cycles of treatment yielded improvement at the primary site and improvement of the metastatic lung lesions, which was judged as a partial response. Subsequently, one cycle of weekly paclitaxel 80 mg/m2 and oral administration of 5'-DFUR 800 mg/day were given. In November 2002, the patient underwent a right simple mastectomy with whole-layer skin grafting from the abdomen. The final pathological diagnosis was a rare type of breast cancer with cartilaginous and/or osseous metaplasia. Preoperative chemotherapy had caused necrosis in most of the tumor cells, and the efficacy was judged as Grade 2. From the third week postoperatively, weekly paclitaxel (80 mg/m2) was given. Six months after the operation, the multiple lung metastases were completely eliminated and new metastasis to liver or bone or local recurrence have not been observed.

Breast Neoplasms↗

PubMed1997

Myomammary flap of pectoralis major muscle for breast reconstruction: new technique.

Simple mastectomy and modified radical mastectomy is still the preferred surgical technique for management of breast cancer, as it is always in the second stage (II). Breast reconstruction in Egypt is always accompanied by reduction mammoplasty of the other breast. The new method utilizes a myomammary flap from the other side. This flap depends on the other breast being of moderate or large size. The flap being transferred depends on the pedicle of the pectoralis major tunneled under the skin. The new technique utilizes the nipple on the healthy side to reconstruct the nipple of the new breast at the same time. A reduction mammoplasty was achieved in healthy contralateral huge breasts. A total of 23 female patients were submitted for breast reconstruction using a pectoralis major myomammary flap from the other relatively large breast. The flap depended on a blood supply from the pectoral branch of the thoracoacromial artery. Good cosmetic results were achieved in 60% of cases, fair results in 25%, and unsatisfactory results in 15%. In conclusion, this new technique of breast reconstruction is suitable especially for patients with large, healthy breasts and for relatively poor patients.

Adolescent↗

PubMed2001

Malignant adenomyoepithelioma of the breast with lung metastases: report of a case.

Adenomyoepithelioma of the breast is a rare lesion, and has a bicellular pattern of epithelial and myoepithelial cells which are regularly distributed in the tubular structures based on the histologic and ultrastructural features. It is thought to be a benign or a low-grade malignant disease. We herein describe a case of malignant adenomyoepithelioma of the breast with lung metastases in an 86-year-old woman. A primary massive tumor in the left breast grew rapidly within a short period of time. A simple mastectomy with sampling of the axillary lymph nodes was performed. The obtained lymph nodes did not include any metastatic lesions. Malignancy was evidenced by the presence of a high mitotic rate and severe nuclear atypia. Three months after the operation, radiology showed multiple lung metastases, and the patient died 2 weeks thereafter. Reviewing the literature, nine similar cases were reported, and the prognosis of malignant adenomyoepithelioma of the breast with distant metastases was very poor with the time of recurrence varying after initial treatments. Malignant adenomyoepithelioma should be followed up with careful screening for distant metastases.

Aged↗

PubMed1977

Prognosis and treatment in minimal breast cancer.

Of 176 patients with minimal breast cancer, 138 had intraductal carcinoma in situ, 21 minimally invasive carcinoma, and 17 lobular carcinoma in situ. Various modalities of treatment were used including radical, modified radical, and simple mastectomy with and without radiation therapy. Long-term postoperative follow-up was available in all but five patients and ranged from one year to twenty-one years. Actuarial analysis projected a twenty year survival of 93.2 per cent for the entire group. Analysis of survival figures based on each of the several treatment modalities showed no definite advantage of one form of treatment over another. The data suggest that minimal breast cancer is a prognostically favorable diagnosis, provided invasive carcinoma is not present or does not develop in the opposite breast. It is also indicated that breast cancer is potentially a bilateral disease and that follow-up and treatment of the opposite breast must be of major concern in the care of these patients.

Adult↗

PubMed1982

Recurrent and metastatic cystosarcoma phyllodes.

During a 30 year period (1950 to 1980), 42 patients with cystosarcoma phyllodes were seen at the Mayo Clinic. Ten patients (24 percent) had recurrence of metastasis. The malignant or metastatic potential could not be identified or predicted by histologically evaluating tumor contour, stromal atypia, or mitotic activity. Spread was chiefly by a hematogenous route, and no patient with metastasis survived. Five of the 10 patients died from their disease 2 to 7 years after treatment. Simple mastectomy appears to be the surgical treatment of choice.

Abdominal Neoplasms↗

PubMed1985

Breast carcinoma in situ. A retrospective review of 112 cases with a minimum 10 year follow-up.

We have retrospectively reviewed 112 cases of in situ carcinoma of the breast treated between 1960 to 1972, with a minimum 10 year follow-up to correlate treatment with outcome. We concluded that bilateral simple mastectomy with low axillary dissection is the treatment of choice for intraductal or lobular carcinoma in situ. This conclusion was based on the early age at diagnosis, the high incidence of bilaterality, and the long latency and probable progression from the in situ stage to the invasive stage. Lesser procedures can be endorsed for those patients of advanced age or who have associated medical problems whose life expectancy is estimated to be 10 years or less. Patients who refuse bilateral mastectomy should undergo biopsy of the involved or opposite breast at 3 to 5 year intervals regardless of physical findings or mammographic suspicions, especially when severe epithelial dysplasia is encountered in the biopsy specimens. This nonpalpable but potentially curable lesion remains difficult to detect even by mammography.

Adult↗

PubMed1992

Low-grade angiosarcoma of the skin of the breast: a complication of lumpectomy and radiation therapy for breast carcinoma.

A case of low-grade angiosarcoma arising in the skin of a breast previously irradiated for breast carcinoma is reported. Initially, an asymptomatic breast mass was detected. Excisional biopsy and axillary lymph node dissection revealed a 1.5-cm infiltrating ductal carcinoma with 21 negative lymph nodes. The neoplasm was staged as T1, N0, M0. The patient was entered in a research protocol and was treated with high-dose external beam (4,860 rad) and iridium implant (1,860 rad) irradiation. Seven years later the patient developed low-grade angiosarcoma of the breast skin. The lesion recurred following excision and eventually was treated by simple mastectomy. The patient never had evidence of lymphedema. Cutaneous angiosarcomas occurring as a complication of lumpectomy and radiation therapy for breast carcinoma are rare. In some reported cases the patients have had lymphedema, a known factor predisposing to angiosarcoma. Furthermore, almost all cases previously reported have been high grade. This case suggests that radiation therapy for breast carcinoma may also be complicated by low-grade angiosarcoma.

Breast↗

PubMed1988

Offering patients a choice of surgery for early breast cancer: a reduction in anxiety and depression in patients and their husbands.

Thirty patients with early breast cancer have been studied prospectively to assess whether being offered a choice of surgery (simple mastectomy or wide excision plus radiotherapy) influences levels of anxiety and depression pre- and post-operatively. A significantly higher percentage of the patients not offered a choice of surgery experienced clinical levels of anxiety and depression pre-operatively and up to 2 months post-operatively compared with patients offered a choice; the results were also similar for the husbands of these patients. At 6 months, differences between the 2 groups were not statistically significant, although the trend remained the same with more patients not offered a choice of treatment showing high levels of anxiety and depression. Patients offered a choice of surgery had similar pre-operative levels of anxiety and depression to patients with benign breast disease and patients undergoing surgery for non-cancerous conditions. This study indicates that with proper counselling patients and husbands suffer less stress if they are allowed to take an active part in the treatment of their cancer.

Adult↗

PubMed1993

Malignant phyllodes tumours of the breast. A clinical and pathological analysis of 55 cases.

55 cases of malignant phyllodes tumours of the breast are described. 36 patients (i.e. 65.5%) of the studied group survived 5 years with no evidence of disease after surgery. It was proved that a simple mastectomy is sufficient therapy for patients with tumour limited to the breast. Metastases to the axillary lymphatic nodes are very rare. The main reason for treatment failure is distant metastases in the lungs. The only prognostic factor in the studied group was the grade of histological malignancy, determined by such criteria as the ratio between the malignant sarcomatous tissue and that typical for phyllodes tumour, the degree of cell polymorphism, mitotic activity, and possible multidirectional differentiation (towards malignant neoplasms of soft tissue and bones).

Adult↗

PubMed2005

Intracystic papillary carcinoma of the breast in a male patient diagnosed by core needle biopsy: a case report.

We report a case of intracystic papillary carcinoma (IPC) of the breast in a 71-year-old man in whom diagnosis was made by core needle biopsy. He came to our hospital complaining of a left subareolar mass. Imaging diagnosis was a cyst with an intracystic component. Since aspiration biopsy cytology was interpreted as a borderline lesion, the decision was made to proceed with core needle biopsy. Pathological examination of the specimen revealed the intracystic component to be non-invasive papillary carcinoma. So the patient underwent simple mastectomy without axillary node biopsy. From the final pathological result, no invasion was identified.

Aged↗

PubMed2005

Objective and noninvasive detection of sub-clinical lung injury in breast cancer patients after radiotherapy.

AIMS: We employed technetium-99m hexamethylpropylene amine oxime (Tc-99m HMPAO) lung scan to detect sub-clinical lung injury after radiation therapy of 60 female patients diagnosed with right breast cancer. METHODS: The degree of pulmonary vascular endothelium damage was represented as lung/liver uptake ratios (L/L ratios) calculated on Tc-99m HMPAO lung scan. All patients underwent simple mastectomy and post-operative radiotherapy of approximately 50 Gy. We divided the patients into three groups according to the interval between radiotherapy and lung Tc-99m HMPAO lung scan: Group 1 included 20 patients who received the lung scan within 1-3 months after radiotherapy, group 2 included 20 patients were within 3-9 months after radiotherapy, and group 3 included 20 patients were more than 9 months after radiotherapy. In addition, 20 age-matched normal women were included as the control group. RESULTS: The L/L ratios were 0.32+/-0.04 for normal controls, 0.59+/-0.10 for group 1, 0.55+/-0.07 for group 2, and 0.34+/-0.04 for group 3, respectively. Based on our preliminary results, we found that sub-clinical lung injury and significantly increased L/L ratio in breast cancer patients received radiotherapy may occur within the first 6 months after radiotherapy. However, the L/L ratio is markedly decreased after 9 months. CONCLUSION: Our findings concluded that the degree of pulmonary vascular endothelium damage represented as the L/L ratio on Tc-99m HMPAO lung scan has the potential to be a sensitive, objective and noninvasive method to detect sub-clinical lung injury in breast cancer patients received radiotherapy.

Adult↗

PubMed2004

[Management of phyllodes tumors of the breast at the National institute of oncology of Rabat, Morocco].

OBJECTIVES: Phyllodes tumors of the breast (PTB) are rare fibro epithelial tumors. Their terminology, histological classification and their treatment are exposed to controversy. The aim of our work is to underline the epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours through a retrospective study and a review of the literature. PATIENTS AND METHODS: We reviewed at the National Institute of Oncology of Rabat, Morocco, between 1985 and 1998, all the files of patients with histological certainty of PTB, doubtful PTB were excluded. We collected epidemiological, clinical, histological, therapeutical, prognostic and evolutive features of these tumours. STATISTICS: quantitative parameters were represented by mean +/- S.D. and qualitative parameters by percentage or effective. RESULTS: We studied nine cases of PTB, which represented 0.09% of all primitive tumors of the breast treated at our institution during the study period. All our patients were female. Mean age was 37.3 +/- 10.07 years. Two of our patients (22.2%) had a history of fibroadenoma and 44.4% were nulliparous. Mean delay before consulting was 60.7 +/- 17.56 months and the median tumour size was 13 +/- 7.47 cm. Pathological findings were six benign or borderline phyllodes tumours (66.7%) and three cystosarcomas phyllodes (33.3%). The treatment consisted in simple mastectomy in seven cases (77.8%) and tumorectomy in two cases (22.2%). All the surgical margins were clear. Two of the three cystosarcomas phyllodes received adjuvant external bean radiation therapy 50 Gy on the thoracic chest wall. After a median outcome of 3 +/- 2 years ranging from 3 to 74 months, we did not note any relapse or metastasis. DISCUSSION AND CONCLUSION: In our series, PTB happened exclusively in females. History of fibroadenoma within 22.2% of the patients suggests the hypothesis of a filiation between these two entities. Their distinctive features were young age in diagnosis, long delay before consulting, important tumor size, predominant benign and borderline histological types, treatment mainly surgical and good local and distant control.

Adult↗

PubMed2004

Sentinel lymph node biopsy in juvenile secretory carcinoma.

A 9-year-old girl presented with a 3-year history of a right breast mass. Excisional biopsy showed a secretory carcinoma. A treatment plan of simple mastectomy and axillary sentinel lymph node biopsy was chosen. She remains free of disease at 3-year follow-up. Sentinel lymph node biopsy offers an approach to stage the axillary lymphatic basin with a lower complication rate than formal dissection. The authors advocate its use in the treatment of pediatric breast cancer.

Breast Neoplasms↗

PubMed2006

Breast carcinoma metastasis and meningioma. A case report.

BACKGROUND: The simultaneous occurrence of meningioma and breast cancer with or without brain metastasis is an unusual but well-known event. However, contiguous occurrence of meningioma and brain cancer metastasis is a less rare evidence and we are aware of only one previously published case in the literature. CASE DESCRIPTION: A 72-year-old woman presented with headache, nausea and vomiting, and diminished mentation and memory. Seven years ago, she had had simple mastectomy at another hospital. Histopathologic examination had been reported as breast carcinoma. The patient had not gone to the controls and was unaware of the diagnosis. Cranial MRI examination of the patient showed two extraaxial masses. Histopathologic examination of the lesion at the frontal convexity, which was reported as en plaque meningioma radiologically, revealed meningioma but the other tumor at the sylvian fossa resembling the other meningioma was reported as breast carcinoma metastasis at histopathologic examination. CONCLUSIONS: Although meningiomas have well-known radiological features, the other pathologies like breast metastasis may simulate them. A possible hormonal relationship between breast cancer and meningioma has not been clarified. We are not sure that this has played a role in dissociation of both tumor cells in our case.

Aged↗

PubMed2005

[Angiosarcoma in an irradiated breast: a case description].

Post-radiotherapy cutaneous angiosarcomas have been described in different locations, including the breast. We present a case of cutaneous angiosarcoma of the breast, diagnosed 6 years after a carcinoma of the breast had been treated with radiation. The patient was a 44-year-old female with a history of ductal carcinoma (CA) of the right breast treated with tumorectomy, axillary lymphadenectomy, chemotherapy (FEC) and radiotherapy, who 6 years later presented with a violaceous, indurated plaque with a satellite nodule on the same breast. The histology of the skin biopsies showed angiomatous proliferation throughout the entire dermis, with no cellular atypia. Considering the patient's symptoms, history and the changes observed via mammography, it was decided to completely excise the lesion followed by a simple mastectomy, with the diagnosis of angiosarcoma being confirmed. The patient was later treated with paclitaxel, and the disease was apparently controlled. Despite this fact, two years and one month later, the angiosarcoma recurred on the internal area of the mastectomy scar. The patient was treated with paclitaxel, and surgical excision of the lesion area was once again performed. This complication usually appears 5-10 years after treatment with radiotherapy, so angiosarcoma should be ruled out if any angiomatous lesions later appear on skin that had been irradiated.

Adult↗

PubMed2002

[Male breast cancer: 19 case reports].

Breast cancer is rarely encountered in men. In developed countries, it accounts for less than 1% of cancers in men, whereas in women it represents about 23% of all cancers. A retrospective review was performed on 19 cases of men who underwent surgery for breast carcinoma between 1989 and 2000. The aim of this work was to analyse epidemiological and etiological aspects, circumstances of discovery, pathological characteristics, therapy modalities as well as prognostic factors. The mean age was 65.3 years. A high incidence of overweight, diabetes, hypertension and hypercholesterolemia was found. The most frequent clinical presentation was a firm subareolar lump, at a low stage (stage I 23% and stage II 41%). The most common pathological type was an infiltrating ductal carcinoma (89%). Hormone receptors where most often positive (92% for oestrogen and 100% for progesterone receptors). 84% of patients underwent simple mastectomy and axillary dissection, 74% chest wall irradiation after surgery, 26% received chemotherapy and 42% hormonal therapy. Median follow-up was 52 months. The estimated 2-year overall survival (OS) and disease-free survival (DFS) was respectively 93% and 87.5% and the 5-year OS and DFS respectively 86% and 75%. The management of male and female breast carcinoma is identical, as well as their prognosis at equal stages. However male breast carcinoma is more often diagnosed at a more advanced stage, thus a breast screening in men would permit a sooner diagnosis and a better prognosis.

Adult↗

PubMed1976

The pattern of spread and survival in 596 cases of breast cancer related to clinical staging and histological grade.

Carcinoma of the breast in 596 patients diagnosed between 1949 and 1966 at the Reading group of hospitals has been evaluated. All operable cases were treated by simple mastectomy and post-operative radiotherapy to the chest wall and regional nodes. Tumours were graded for malignancy either routinely or retrospectively on all patients with carcinoma simplex or scirrhous carcinoma, and the relation of grading to the subsequent development and distribution of metastases studied. Recurrence developed in 348 patients, 184 of whom suffered local recurrence. Eighty-three per cent of locally recurrent cases developed generalised metastases. The incidence of pulmonary and liver metastases was significantly increased in Grade II and III tumours compared with Grade I. Very significant differences in the survival rates between grades were noted, unfavourable to the higher grade tumours; and the influence of grading on prognosis is discussed.

Adenocarcinoma, Scirrhous↗

PubMed1987

Phyllodes tumour of the breast: response to radiotherapy.

A 47 year old woman presented with a rapidly growing recurrence in the chest wall following simple mastectomy for a malignant phyllodes tumour of the breast. Radical megavoltage irradiation led to histologically confirmed complete regression of her tumour.

Breast↗