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PubMed2001

[A case of multiple liver metastases from breast cancer successfully treated with intra-arterial administration of paclitaxel].

A 57-year-old woman underwent modified radical mastectomy for left breast cancer (T4bN1M1: stage IV) in September 1999. Four-cycle CAF therapy had been administered as adjuvant therapy, but multiple recurrent tumors in the liver had grown bigger and the tumor marker (CEA) increased in value. Because CAF therapy was not effective, we tried to treat the patient with systemic and intra-arterial chemotherapy using paclitaxel. The side effects of this treatment were mild nausea and appetite loss, which required no treatments. This treatment reduced the multiple liver metastases on an abdominal CT and was thought to produce a partial response (PR). The time to response was the 101st day and PR has been continued.

Antineoplastic Agents, Phytogenic↗

PubMedDate not supplied

Invasive lobular carcinoma in a hypoplastic breast.

Breast hypoplasia is encountered as part of genetic syndromes or as a result of iatrogenic factors. The incidence of this malformation and the occurrence of breast carcinoma in such cases are unknown. The authors present a 66-year-old patient with a severe breast hypoplasia and invasive lobular carcinoma. The advanced clinical stage required neoadjuvant chemotherapy. After 5 CMF cycles with no significant effect, a modified radical mastectomy with axillary lymph node dissection was performed. The pathological report revealed an infiltrating lobular carcinoma with combined classical and alveolar growth and with minor morphological changes after the chemotherapy. Immunostaining for cell proliferation markers, apoptotic regulators, and cell adhesion molecules, such as the CD44 family and members of the cadherin-catenin group, was performed. The tumor expressed a high bcl-2/low bax ratio and lacked p53 immunoreactivity, which could explain the resistance to neoajuvant therapy. The lack of adhesion molecules, except for strong E-cadherin and beta-catenin reactivity, and weak CD44v6 expression were demonstrated. To the authors' knowledge this is the first case of an invasive lobular carcinoma in a hypoplastic breast reported in the English literature.

Aged↗

PubMed1989

The prognostic role of progesterone receptor status and age in relation to axillary node status in breast cancer patients.

The prognostic role of axillary lymph node status, progesterone receptor (PgR) status, age of the patient at operation, oestrogen receptor (ER) status and tumour diameter was studied in 443 breast cancer patients treated by modified radical mastectomy. Logistic and proportional hazard regression analyses were used to estimate the prognosis from the time of operation up to 60 months. We also estimated the prognosis from 36 to 60 months for those who had survived 36 months (conditional analysis). PgR and age gave significant information in each node class, old age and PgR negativity being disadvantages. PgR status relative to node status was more important for estimating early (24 months) prognosis, while age was of more importance later (60 months). Node status and age were the only variables giving significant information in the conditional analyses. It is thus of importance to consider the time dependency of the prognostic variables when predicting survival in breast cancer patients. No effect was found for ER status or tumour diameter.

Age Factors↗

PubMed2004

Prognostic significance of apex axillary invasion for locoregional recurrence and effect of postmastectomy radiotherapy on overall survival in node-positive breast cancer patients.

Postmastectomy irradiation substantially reduces the risk of locoregional recurrences (LRR) of breast carcinoma. However, debates continue on the prognostic factors for radiotherapy and the effect of radiotherapy on overall survival. The present study was undertaken to investigate the prognostic significance of level III positive nodes, along with the other factors for LRR, and to evaluate the effect of postmastectomy radiotherapy on overall survival among node-positive breast carcinoma treated systemically. Data from 549 consecutive node-positive breast cancer patients who underwent modified radical mastectomy and received adjuvant systemic therapy were studied retrospectively. Prognostic factors for LRR and the effect of postmastectomy radiotherapy on overall survival were analyzed. Survival curves were generated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. The 5-year locoregional recurrence rate is 7%. Apical invasion was found to be an independent prognostic factor for LRR (HR 2.6, CI 1.29-5.35) along with a finding of 4 or more positive nodes and T3 tumor. Adjuvant radiotherapy decreased LRR and improved survival significantly. Apical invasion, 4 or more positive axillary lymph nodes, and T3 tumor are the predictors of LRR, and patients with these adverse factors are candidates for adjuvant radiotherapy. Postmastectomy radiotherapy improves overall survival.

Adult↗

PubMed1993

Epithelioid leiomyosarcoma of the breast: report of a case.

A 36-year-old female presented with a palpable mass in the right breast. She received a modified radical mastectomy after admission. Brain and multiple bony metastases were noted 10 months later. Microscopically, the tumor was composed of nodules of small spindle and large round cells showing abundant eosinophilic, vacuolated cytoplasm and prominent nucleoli. No glandular or ductular differentiation could be identified. By immunohistochemistry, the tumor cells were positive for vimentin and desmin in focal areas, but negative for cytokeratin, S-100, epithelial membrane antigen, actin, myoglobin, or alpha-1-antichymotrypsin. Electron microscopy showed focally cohesive large cells maintained together by poorly-defined intercellular junctions and surrounded segmentally by thin basal laminae. Intracytoplasmic filaments were identified in some tumor cells, diffusely arranged in the cytoplasm. These findings indicate that this was a case of epithelioid leiomyosarcoma of the breast. The literature concerning this rare neoplasm is reviewed.

Adult↗

PubMed2005

[Combined use of paravertebral block and general anesthesia for breast cancer surgery].

BACKGROUND: Thoracic paravertebral block (TPVB) is reportedly a useful alternative of general anesthesia (GA) for patients undergoing major breast surgery. To provide surgical anesthesia by TPVB alone, however, demands considerable patient's discomfort during neural block and during surgery. This study was undertaken to investigate if TPVB adds to patient satisfaction when combined with GA for breast cancer surgery. METHODS: In 26 women (ASA I * II) undergoing modified radical mastectomy with axillary dissection, TPVB was performed at T 1 level and 15 ml of 0.5% ropivacaine was injected prior to induction of general anesthesia. After surgery, VAS (visual analogue scale, 0-100 mm) pain scores and postoperative medication were recorded. These data with TPVB were compared with those of 17 patients who had previously undergone similar surgical procedure without TPVB in our hospital. RESULTS: The VAS scores in patients with TPVB were 34 +/- 45 mm (mean +/- SD) on admission to the recovery room and 15 +/- 5 mm next morning. Frequency of postoperative administration of analgesics in patients with TPVB was significantly less than those without TPVB. CONCLUSIONS: Above findings suggest that combined use of TPVB and GA may be a preferable choice of anesthesia for patients undergoing major breast cancer surgery.

Amides↗

PubMed1994

[Anaphylactic reaction to aprotinin following topical use of biological tissue sealant].

Biological tissue sealant is used for facilitation of intra-operative hemostasis. It is composed of cryoprecipitated fibrinogen, bovine-thrombin and bovine-aprotinin. In this report, we describe a 38-yr-old woman in whom severe anaphylactic shock occurred immediately after the topical use of biological tissue sealant on the completion of modified radical mastectomy. The patient's past history and pre-operative laboratory values were unremarkable except for mild nasal allergy. Postoperative prick tests for bovine-serum, bovine-thrombin and bovine-aprotinin were positive. Total IgE level was normal. By the radioallergosolbent tests (RAST), specific IgE antibodies for aprotinin were elevated to the class 2 level. Drug induced lymphocyte stimulation tests (DLST) were negative. These indicated that the case was an aprotinin-induced anaphylaxis during general anaesthesia. The level of CH50, C4, C1q and C5 decreased in the serum sample immediately after the shock, but C3 was unchanged. It was considered to be a direct degradation of the complement by the proteolytic enzymes. Biological tissue sealant should be used cautiously bearing in mind the possibility of anaphylactic complication.

Adult↗

PubMed2002

Monotherapy with paclitaxel as third-line chemotherapy against anthracycline-pretreated and docetaxel-refractory metastatic breast cancer.

We describe a patient with anthracycline-pretreated and docetaxel-refractory metastatic breast cancer who achieved a complete response after third-line chemotherapy with paclitaxel. A 59-year-old woman underwent modified radical mastectomy for advanced cancer in her left breast after local arterial neoadjuvant chemotherapy with anthracycline. Postoperatively anthracycline-containing adjuvant therapy was administered. Pulmonary metastases occurred 15 months after surgery, which did not respond to 4 cycles of second-line chemotherapy with docetaxel, given at 60 mg/m(2) every 3 weeks. Therefore 210 mg/m(2) of paclitaxel was given every 3 weeks as third-line monotherapy and induced a complete response with grade 3 neutropenia and hair loss as the major adverse effects. We suggest that paclitaxel is potentially effective as third-line monotherapy for anthracycline-resistant and docetaxel-refractory metastatic breast cancer.

Anthracyclines↗

PubMedDate not supplied

Adenoid cystic carcinoma of the male breast.

We present an 82-year-old male patient who presented with complaints of gradually an increasing ulcero-proliferative lesion with persistent mucinous discharge in the left breast. Left side-modified radical mastectomy was done. This was histopathologically diagnosed as an adenoid cystic carcinoma of the left breast. Periodic acid schiff (PAS) staining confirmed the diagnosis. Three of the five axillary lymph nodes excised were positive for malignancy. Although the patient was advised to have postoperative radiotherapy, he did not comply. After 2 years, the patient again presented with local recurrence of the disease. Wide excision of the recurrent malignant nodules over the anterior chest wall was done, and the defect was covered primarily with split thickness skin grafting. Postoperative radiation was given. For the past 9 months, the patient has maintained a regular follow-up on an outpatient basis. He does not have any evidence of recurrence of the tumor--neither locally nor distant metastasis.

Aged, 80 and over↗

PubMed2000

Atypical medullary carcinoma of the breast with cartilaginous metaplasia in a patient with a BRCA1 germline mutation.

We examined a 34-year-old premenopausal woman who had noticed a left-breast lump a month previously. She had no past history of malignancies but had a family history of breast and ovarian cancers. Her mother had suffered from ovarian cancer when aged 47 years and had died of the disease at age 52. The younger two of the patient's four aunts had developed breast cancer when they were 37 and 48 years old. A physical examination showed an ill-defined mass, 1.5 cm in diameter, located in the upper outer quadrant of the patient's left breast. Mammography revealed diffuse microcalcification in both breasts but ultrasonography revealed an irregular tumorous lesion only in the left breast. Aspiration breast cytology revealed adenocarcinoma of the left breast. Modified radical mastectomy of the left breast and excision of a biopsy specimen from the right breast were carried out simultaneously. Histopathologically the left-breast tumor was an atypical medullary carcinoma with cartilaginous metaplasia, of histological grade 3, and the right-breast specimen showed fibrocystic changes with atypical ductal hyperplasia. Estrogen receptors were positive, but progesterone receptor was not detected on the tumor cells, which were immunopositive for nuclear p53 although c-erbB-2 overexpression was not observed. A nonsense germline mutation of the BRCA1 gene (exon5) was detected. The patient has been well since the operation (10 months). These findings may provide useful information about the carcinogenesis and biological behavior of BRCA1-associated breast cancers.

Adenocarcinoma↗

PubMed1997

[The effect of nicardipine hydrochloride upon the pulmonary arterial pressure].

This study examines the effects of induced hypotension with intravenous administration of nicardipine hydrochloride (NIC) upon pulmonary arterial pressure (PAP) undergoing modified radical mastectomy with neuroleptanesthesia (NLA-group; 3 cases) and inhalation anesthesia (N2O+ isoflurane; GOI-group; 3 cases). Systolic arterial pressure was reduced and maintained at 80 mmHg. During and after induced hypotension in NLA-group, heart rate (HR), cardiac index, pulmonary arterial pressure (PAP) increased remarkably. On the other hand, systemic vascular resistance index was reduced. In GOI group, no significant changes were seen in PAP. The acceleration of the autonomic baro-reflex induced by decreased blood pressure produced by NIC may be depressed under anesthesia to initiate this difference in response of HR to NIC. The data indicate that this depressive effect of NLA on this reflex is weak, and NIC is a potent systemic vasodilator with hyperdynamic hemodynamic effects in addition to an increase in right ventricular function, and PAP was increased.

Adult↗

PubMedDate not supplied

Surgical treatment of liver metastasis from breast cancer.

We report five patients who underwent laparotomy for liver metastasis from breast cancer without extrahepatic spread, with the intention to perform liver resection. All these patients had been subjected to modified radical mastectomy following systemic chemotherapy and periodical consecutive investigations to detect distant spreading. After laparotomy, patients have been regularly followed. Case 1, right trisegmentectomy in a 53-year-old woman, 36.5 months after the mastectomy. In the 17th postoperative month she continues without relapse. Case 2, hepatic artery ligature in a 41-year-old woman, 15 months after the mastectomy. In the 17th postoperative month she died. Case 3, bisegmentectomy (VI-VII) in a 51-year-old woman, 24 months after the mastectomy. In the 17th postoperative month she died. Case 4, exploratory laparotomy in a 51-year-old woman, 91 months after the mastectomy. In the 31th postoperative month she remains alive. Case 5, segmentectomy (IV) in a 59-year-old woman, 112 months after the mastectomy. In the 33th postoperative month she continues without relapse. As a conclusion, the surgical resection of liver metastasis from breast tumors after chemotherapy must be used in selected cases.

Adult↗

PubMed1997

Selective avoidance of postoperative locoregional radiotherapy in breast cancer seems to be justified.

OBJECTIVE: To try and reduce the amount of routine postoperative radiotherapy that we prescribed without causing an unacceptable rise in locoregional recurrences. DESIGN: Retrospective study. SETTING: Teaching hospital, The Netherlands. SUBJECTS: 836 women who were treated for breast cancer between January 1980 and December 1989. INTERVENTIONS: These 836 had been treated by modified radical mastectomy (n = 534), excision of the tumour and axillary dissection (n = 279), lumpectomy (n = 15), or total mastectomy (n = 8). In December 1984 we stopped giving routine postoperative irradiation to women with T1 or T2 tumours unless there was any doubt about the operative specimen. MAIN OUTCOME MEASURES: The rate of locoregional recurrence 1985-9 compared with that from 1980-December 1984. RESULTS: Only 1 patient of 836 had a clinically detectable recurrence in the internal mammary chain. There were only 2 recurrences in the 235 axillas that had not been irradiated. CONCLUSION: By a process of careful selection of patients for locoregional irradiation, the number of fields of irradiation given to patients with breast cancer can be reduced by up to 80% without causing a rise in the rate of locoregional recurrences.

Adult↗

PubMed1996

Comparison of mammographic image quality in various methods of reconstructive breast surgery.

The purpose of our study was to evaluate mammographic image quality of various methods of reconstructive breast surgery with specific reference to the possibility of diagnosis of recurrent tumors. A total of 39 patients who underwent breast reconstruction following modified radical mastectomy were subject to clinical and mammographic examination. Three groups were formed: (a) autonomous tissue reconstruction (TRAM-flap; n = 9), (b) submuscular silicon gel prostheses (n = 21), and (c) supramuscular silicon gel prostheses (n = 9). Mammographic image quality of the groups was compared by two radiologists working together using a point system where five specific criteria were valued and scored. The result was tabulated into three quality levels: good, acceptable, and limited. Mammograms were assessed as good, acceptable, or limited, respectively, as follows: group I: 7 (77.8%), 1 (11.1%), 1 (11.1%); group II: 4 (19%), 11 (52.4%), 6 (28.6%); group III: 3 (33.3%), 4 (44.5%), 2 (22.2%). The TRAM-flap method of reconstruction displays a high degree of mammographic image quality and therefore is preferable with respect to early diagnosis of recurrent tumors.

Adult↗

PubMed2002

Recurrent squamous cell carcinoma of the breast with undifferentiated features: report of a case.

Squamous cell carcinoma of the breast is a rare type of cancer, the origin of which is still uncertain. We report a case of squamous cell carcinoma of the breast with a recurrent tumor that showed undifferentiated features. The patient was a 55-year-old woman who originally presented with a left breast mass in the upper outer quadrant. Echography showed a 46 x 29 x 23-mm mass with cavity formation, and aspiration cytology confirmed a diagnosis of squamous cell carcinoma. A modified radical mastectomy with level III lymph node dissection was performed. Pathologically, the tumor was composed of squamous cell carcinoma and noninvasive ductal carcinoma. A recurrent tumor showing undifferentiated features was detected in the left forechest 3 months after the operation, and tumorectomy with partial resection of the major and minor pectoralis muscles was performed. Despite intensive therapy including chemotherapy (CEF: cyclophosphamide, epirubicin, 5-fluorouracil) and irradiation (50 Gy), the patient died from pulmonary and skin metastases 20 months after her initial operation. The squamous cell carcinoma of the breast in this patient grew rapidly and her prognosis was poor. Immunohistochemical findings indicated the possibility that the squamous cell carcinoma developed from noninvasive ductal carcinoma of the comedo type, and that the undifferentiated cells from the site of recurrence developed from dedifferentiation of the squamous cell carcinoma.

Breast Neoplasms↗

PubMed2002

Male breast carcinoma.

OBJECTIVE: To review the epidemiology, presentation, diagnosis, molecular genetics, treatment and prognosis of male breast cancer. DATA SOURCES: Articles, written in English or French, selected from the Medline database (1966 to January 2001), corresponding to the key words "male breast cancer," according to the following criteria: covering institutional experience or comparing diagnostic and treatment modalities, and epidemiologic or general reviews. STUDY SELECTION: Of 198 articles found 50 fulfilled the review criteria. DATA SYNTHESIS: Risk factors included advanced age, a positive family history, Jewish origin, black race, excess exposure to female hormones (Klinefelter's syndrome), environmental exposure (irradiation), alcohol, obesity, higher socioeconomic or higher educational status and childlessness. Gynecomastia remains a controversial factor, this term being used for both a histologic reality and a physical finding. Advanced disease is characterized by pain, bloody discharge and skin ulceration. There is no definitive diagnostic algorithm. Experience with male breast mammography is limited, and imaging is less informative for patients under 50 years of age. Fine-needle aspiration tends to overestimate the rate of malignancy. The commonest histologic finding is infiltrating ductal adenocarcinoma. Treatment includes modified radical mastectomy, followed by cyclophosphamide-methotrexate-5-fluorouracil or 5-fluorouracil-Adriamycin-cyclophosphamide chemotherapy for disease of stage II or greater. Radiotherapy does not seem to add any benefit. The disease is highly receptor-positive; however, many patients discontinue tamoxifen due to side effects. The most important prognostic factors are tumour size, lymphatic invasion and axillary node status. CONCLUSIONS: Because of the low incidence of male breast cancer, advances will be obtained mainly with the rapid transfer of newly gained knowledge in female mammary neoplasia. The increased use of adjuvant chemotherapy combined with tamoxifen postoperatively may have a positive impact on survival. Public education should be oriented toward men at higher risk to reduce the interval between appearance of symptoms and consultation. Rigorous data collection will allow for thorough reporting of risk factors and thus the possibility of characterizing the etiology of this disease.

Algorithms↗

PubMed2004

Male breast disorders in Jordan. Disease patterns and management problems.

OBJECTIVE: To highlight the features and management problems of male breast disorders in an eastern country such as Jordan. METHODS: Data regarding 33 male patients who underwent surgery for breast diseases in the Department of Surgery at Jordan University of Science and Technology, Irbid, Jordan, between the year 1996 and 2002 were analyzed. RESULTS: Gynecomastia (45.5%), ductal carcinoma (18.2%), and lipoma (12.1%) were the most frequent lesions. Endocrine testing when the clinical diagnosis was physiologic gynecomastia was not yielding. Many features of male breast carcinoma in Jordan (symptomatology, male to female ratio, high education rate, age, diagnostic yield of fine-needle aspiration, histological type, and estrogen receptor status) did not depart from the experience of others. Delayed presentation is evident from the fact that 57% of tumors were stage III. Loco-regional control was achieved by modified radical mastectomy. Tamoxifen was used in 5 patients, and chemotherapy in 4 patients. The patient with stage I is still disease free 6 years after the diagnosis. The 5-year survival rate for stages II and III was zero. Rare lesions (cystic hygroma, cystic mastopathy, fibroadenoma, duct papilloma, tuberculosis, periductal mastitis, and the previously unreported primary primitive neuroectodermal tumor of the breast) accounted for the rest of the group. The patient with primary primitive neuroectodermal tumor of right breast was treated by mastectomy and adjuvant chemotherapy. He remains disease free 31 months after the diagnosis. CONCLUSION: Unawareness and the fact that male breast enlargement is considered a social stigmata are responsible for the delayed presentation. The value of fine needle aspiration cytology and mammography is not widely appreciated. The wide spectrum of potential pathologies calls for referring all patients to specialized breast units.

Adolescent↗

PubMed2000

The analysis of prognostic factors in stage III-B non-inflammatory breast cancer.

AIMS: To evaluate factors predicting disease recurrence in patients treated for stage III-B breast cancer by neoadjuvant chemotherapy followed by surgery. METHODS: A retrospective study of 52 patients who responded to neoadjuvant chemotherapy followed by modified radical mastectomy was carried out. The parameters studied included pre-treatment tumour size, clinical axillary status, grade, lymphatic-vascular invasion, pathological axillary status, number of metastatic lymph nodes, menopausal status and oestrogen receptor status. RESULTS: In the univariate analysis, number of metastatic lymph nodes, primary tumour size, pathological axillary status and histological grade were statistically significant factors associated with recurrence of disease. Multivariate analysis demonstrated that the number of metastatic lymph nodes (relative hazard 6.1) and primary tumour size (related hazard 2.5) were the most important independent prognostic factors for recurrence. CONCLUSIONS: These results indicate that the number of involved lymph nodes after neoadjuvant chemotherapy, independent of the clinical response of primary tumour, had a most significant impact on disease free survival. Additionally primary tumour size had a marked prognostic significance in spite of clinical changes in tumours following chemotherapy.

Adult↗