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PubMed1991

Primary malignant fibrous histiocytoma of the breast. A report of four cases and review of the literature.

Clinical, light microscopic and immunohistochemical features of four cases of primary malignant fibrous histiocytoma (MFH) of the breast are presented. Twenty-eight cases have been reported previously. We found that the prognosis of primary MFH located in the parenchyma of the breast is comparable to the prognosis of other MFH located superficial to the fascial level. We therefore conclude that simple mastectomy is adequate surgical therapy for MFH located in the breast. The possible beneficial effects of adjuvant therapy need further investigation.

Adult↗

PubMed1997

Primary T-cell lymphoma of the breast with lymphoepithelial lesion. A case report.

Fine-needle aspiration, histomorphologic and immunologic findings in a case of primary T-cell lymphoma of the breast are reported. The tumor cells were diagnosed as large cell lymphoma with lymphoepithelial lesion and no nuclear multilobulation. No serologic evidence of HTLV-1 infection was detected. After simple mastectomy, lymph node dissection and chemotherapy, the patient is now doing well, having been followed for 30 months. To our knowledge, this is the first case report of primary T-cell lymphoma of the breast with prominent lymphoepithelial lesion, no nuclear lobularity, and an indolent clinical course.

Aged↗

PubMed1984

Osteosarcoma of breast recurring with mediastinal obstruction.

A case of osteogenic sarcoma of the breast in an 82-year-old woman is described. It was treated by simple mastectomy but recurred and caused mediastinal obstruction. Radiotherapy gave only mild symptomatic benefit. Previous publications in osteosarcoma of the breast are reviewed.

Aged↗

PubMed1974

Characteristics of Paget's carcinoma of the nipple and problems of its negligency.

The analysis of 73 cases revealed Paget's disease of the nipple, known as a precancerous state, to be a special form of the intraductal mammary cancers. In the majority of the cases, apart from a superficial exulceration malignant transformation in the glandular substance is present. Thus, the treatment schedules have to be similar to those of other mammary cancers; in cases localized to the nipple, simple mastectomy with axillary block dissection, is suggested; in cases with tumors of the glandular substance, radical mastectomy according to Halsted is suggested. The frequent negligency is partly a result of an earlier attitude of the physicians being too conservative with therapeutic procedures.

Adult↗

PubMedDate not supplied

Diagnostic cytopathology in type II angiosarcoma of the breast: a case report.

BACKGROUND: The rare occurrence of angiosarcoma of the breast is reflected in limited descriptions of fine needle aspiration (FNA) cytomorphologic findings in this neoplasm. We present a case of angiosarcoma of the breast and discuss the pitfalls in diagnostic cytopathology that can potentially lead to incorrect diagnoses in such cases. CASE: A 45-year-old woman presented with a 2-year history of a right-sided breast mass. FNA cytology revealed a hypocellular smear composed of cohesive ductal epithelial cells; isolated or loosely arranged, round to spindle-shaped fibroblastlike cells; and projectile growths of round, oval and polygonal cells on loose tangles of connective tissue. The background was hemorrhagic, with scattered foam cells. The overall cytologic diagnosis was inconclusive but suggested phyllodes tumor (of borderline malignancy). Excisional biopsy was performed, followed by simple mastectomy. Histologic features were consistent with angiosarcoma, a diagnosis that was supported by immunohistochemical studies. CONCLUSION: On FNA smear, 49.1% of isolated atypical cells were positive for the endothelial marker CD34; however, cytomorphologic appearance of these cells resembled that of CD34-negative active mesenchymal cells. Angiosarcoma rarely occurs in the breast, and a definitive diagnosis is difficult based on cytologic examination of hypocellular smears alone. However, the presence of atypical round, oval and polygonal cells on loose tangles of connective tissue, suggesting sheared vasculature, can be an important diagnostic feature.

Biomarkers, Tumor↗

PubMedDate not supplied

Adenomyoepithelioma of the breast. A review of three cases with reappraisal of the fine needle aspiration biopsy findings.

OBJECTIVE: To describe the fine needle aspiration cytology findings of adenomyoepithelioma of the breast, with histologic correlation. STUDY DESIGN: The author reviewed the cytologic findings of three cases of adenomyoepithelioma of the breast in the files of Pamela Youde Nethersole Eastern Hospital in a three-year period, 1998-2000. The diagnosis was confirmed by histologic examination, immunohistochemical study and electron microscopy. RESULTS: All cases showed similar cytologic findings. The direct smears and cytospin preparations contained an obvious biphasic cell population. There were clusters and sheets of benign apocrine cells admixed with clumps of bland-looking oval to spindle cells. The apocrine cells contained larger, round nuclei; prominent solitary nucleoli; and ample eosinophilic, granular cytoplasm. In contrast, the spindle cells had oval nuclei, fine chromatin, inconspicuous nucleoli and scanty amphophilic cytoplasm. A small number of named nuclei and foamy macrophages was noted in the background. The characteristic stromal elements seen in fibroepithelial tumor of the breast were not found. The myoepithelial nature of the spindle cells was confirmed by immunohistochemical and ultrastructural studies. Subsequent simple mastectomy and wide local excision were performed on cases 1 and 2, respectively, revealing focal carcinomatous transformation in the adenomyoepitheliomas. The carcinoma cells, however, were not sampled in the initial cytologic specimens. CONCLUSION: The cytologic features of adenomyoepithelioma, though variable and subtle, are characteristic enough for diagnosis. Recognition of the peculiar combination of benign apocrine cells and clumps of nondescript spindle cells should alert the cytologist to this rare but distinct entity, which carries a propensity for malignant transformation.

Adult↗

PubMedDate not supplied

Treatment of early-stage breast cancer in the elderly: a health-outcome-based approach.

PURPOSE: To evaluate the post-lumpectomy treatment of a nonpalpable, stage I, T1b tumor, mammographically detected, in a 74-year-old woman without comorbidities. METHODS: A Markov process, through 120 monthly cycles, was used to model patient progression through a treatment program, employing literature data and a health-outcome utility. Treatments considered were: observation; radiation totaling 5,000 cGy over six weeks; tamoxifen, 20 mg/day, for five years; simple mastectomy; and radiation therapy plus tamoxifen. Health states included absence of disease (NED), loco-regional recurrence, distant metastasis, age-sex-race (ASR)-adjusted death, cancer mortality, treatment complications, and post-mastectomy death. Transition probabilities were established from the literature. Health-state utilities were determined from the responses of health care professionals to a basic reference gamble. RESULTS: Quality-adjusted life years (QALYs) were determined to be 8.19 for radiation plus tamoxifen, decreasing to 8.04 for mastectomy, a difference of only a 0.15 years (1.8 months). Sensitivity analysis, however, showed relative stability in the ranking among treatment options. CONCLUSION: Although the model showed little difference between QALYs with the treatments, the combination of radiation and tamoxifen provides the optimal therapy for this case.

Aged↗

PubMedDate not supplied

Analysis of three decision-making methods: a breast cancer patient as a model.

PURPOSE: To compare three decision making techniques using a common clinical problem. METHODS: Two recently developed methods, the analytic hierarchy process (AHP) and the analytic network process (ANP), were compared with a Markov process in the evaluation of the optimal post-lumpectomy treatment strategy for an elderly woman with a mammographically detected, nonpalpable early-stage breast cancer. The following treatment alternatives were considered: observation, radiation, tamoxifen, combination radiation and tamoxifen, and simple mastectomy. All three decision methods incorporated patient preferences. RESULTS: The models agreed on the ranking of the preferred treatment, radiation and tamoxifen, but there were variations in the rankings of the other treatment choices. Individual differences between the three models were uncovered. The Markov process provided estimates of quality-adjusted life expectancy and distribution of health events. Both AHP and ANP required less development time than the Markov process. CONCLUSION: All three methods may be useful tools to the clinician in analyzing complex medical problems. The Markov is the most labor-intensive method but provides detailed results, whereas the AHP and the ANP give only rank orders of the alternatives. The most important considerations in choosing between these methods are time to project completion and the detail of information sought.

Antineoplastic Agents↗

PubMedDate not supplied

Unusual breast tumors: primary lymphoma. A case report.

An 82-year-old woman presented with a right breast lump with erythematous reaction of the overlying skin and corresponding lymph nodes. Cytological examination of the breast lesion and lymph nodes suggested a lymphoid proliferation. Frozen section revealed carcinoma with lymphoid stroma. Simple mastectomy was performed because of the extent of the lesion. Histological diagnosis was non-Hodgkin type B large-cell lymphoma. Primary breast lymphomas behave similarly to lymphomas of similar histologic types occurring in other sites. The authors illustrate the diagnostic difficulties and the usefulness of complementary techniques in the diagnosis of an unusual breast mass.

Aged↗

PubMed2002

Long-term prognosis of teenagers with breast cancer.

We report 4 new cases of breast carcinoma in teenage girls diagnosed by use of histochemical and immunohistochemical methods. These cases of breast carcinoma in women under 20 years of age were found in the files of our department in the last 24 years (1976-2000). The patients had operable breast carcinomas corresponding to various histologic types (1 invasive ductal carcinoma associated with fibroadenoma, 2 secretory carcinomas, and 1 invasive lobular-type carcinoma). Simple mastectomy with low axillary lymph node dissection was performed in 2 postpubertal patients. Only 1 patient received adjuvant chemotherapy (case 4). After follow-up ranging from 76 to 126 months, 3 patients are alive and disease-free and 1 has disseminated metastatic disease. The correlations with prognosis-related risk factors (stage, age, previous benign lesions, family history, histologic types, hormonal receptors, and pregnancy) were examined.

Adenocarcinoma↗

PubMed2006

Primary adenoid cystic carcinoma of the breast: case report and review of the literature.

Adenoid cystic carcinoma (ACC) of the breast is a rare neoplasm accounting for 0.1% of all breast carcinomas, and presenting most commonly as a painful breast mass. In contrast to the aggressive nature of ACC at other sites, ACC of the breast has a favorable prognosis, lymph node involvement or distant metastases seldom occur. Treatment is basically of simple mastectomy. Chemotherapy, radiation and hormonal treatment have been infrequently used and evaluated. We report a case of ACC of the breast managed with mastectomy and review the literature.

Journal Article↗

PubMed2002

Breast-conserving therapy in the management of early stage breast cancer: Our experience in 103 cases.

PURPOSE: The aim of this study is to determine whether our results in breastconserving therapy of 103 patients with earlystage breast cancer are comparable to those of other facilities or not. MATERIALS AND METHODS: From January 1990 to October 1999, 103 patients with earlystage breast cancer were treated by breastconserving surgery and whole breast irradiation. All patients were of Stages I or II, and the greatest dimensions of primary tumor were less than 3 cm. The median followup time was 47 months from the completion of postoperative radiotherapy. Local, regional and distant failure rates, and survival rate were presumed using the KaplanMeyer method. RESULTS: One patient suffered from local recurrence 30 months later. She was followed by simple mastectomy and kept from further recurrence. No regional relapse occurred. Distant metastases were seen in three patients:two patients in bones, and one patient in a bone and the liver after 19, 35, and 32 months, respectively. One patient died from disseminated cancer in 41 months. Only one patient died due to intercurrent disease. Both 5year and 10year diseasefree survival rates were 94.2%, and both 5year and 10year causespecific survival rates were 98.3%. CONCLUSION: Our results were comparable to previously reported data. In this stage although the followup time was too short to define the longterm outcome, it suggested that breast conserving therapy was acceptable and effective in the management of earlystage breast cancer.

Adult↗

PubMedDate not supplied

Clinical characteristics of mammary carcinoma in male cats.

There is little information regarding mammary tumors in male cats. The purpose of this study was to characterize the clinical characteristics of mammary carcinoma in male cats, compare this malignancy to the disease in female cats, and identify prognostic factors. Thirty-nine male cats with mammary carcinoma were identified. One pathologist reviewed the biopsies from all cats, and complete follow-up information regarding outcome was available for 27 cats. Information collected included signalment, age at neutering, history of progestin therapy, age at tumor diagnosis, size of tumor, type of surgery (lumpectomy, simple mastectomy, or radical mastectomy), results of clinical staging, adjunctive therapies, time to local recurrence, survival, and cause of death. The mean age at tumor diagnosis (12.8 years) was slightly older than that reported in female cats. The incidence of local tumor recurrence in 9 of 20 (45%) cats was similar to that reported in females. A history of progestin therapy was present in 8 of 22 (36%) cats for which this information was known. The median time to local recurrence was 310 days (range 127-1,363 days), and overall median survival was 344 days (range 14-2,135 days). Tumor size and lymphatic invasion were identified as negative prognostic factors. This study indicates that mammary carcinoma in the male cat has many similarities to the disease in females, with an aggressive clinical course in most cats.

Animals↗

PubMed1976

Combination of conservative surgery and irradiation for cancer of the breast.

In patients with relatively advanced local or axillary disease, or both, a simple mastectomy followed by irradiation gives the best local and regional control rates. From the existing data, one can state unreservedly that women with early breast cancer take no chance on their life by having a treatment method which preserves the breast. In conjunction with the wedge excision, even if the axilla is clinically negative, a dissection of the low and central axilla brings enough information to decide on elective chemotherapy.

Breast Neoplasms↗

PubMed2006

[Surgical methods for the treatment of breast phyllodes tumors--a report of 319 cases].

UNLABELLED: Breast phyllodes tumors (FT) belong the fibroapitelial group of breast tumors arising in terminal ductulo-lobular unit (TDLU). Their incidence do not exceed 1% of all breast tumors. Biologicaly they can be divided into benign, borderline and malignant group. Incomplete tumor excision can be the reason for local reccurence. Malignant form of FT metastazise hematogenous most often in the lung. There is no uniform surgical opinion about the treatment FT. METHODS: We analyzed histopathology features of 319 FT of the breast surgicaly removed on Departement of surgery Institut of oncology and radiology of Serbia between 1.1.1985.-31.12.1994. Retrospective study of surgical treatment 84 patients with FT of the breast (69 benign, 4 borderline and 11 malignant) and 5 year follow up after surgery we analysed. RESULTS: local reccurence after surgery was found in 17 (20,2 %) patients(14 benign , 2 borderline and 1 malignant FT), pulmonary metastases in 6 (7,1%) patients with malignant FT. DFI was 21,3 months for local reccurences and 25,1 months for pulmonary metastases. DFS for al forms of FT was 71 % (p =0,7104) in 5-year follow up. CONCLUSION: According to biological behavior we propose wide excision for benign and borderline forms and simple mastectomy for malignant FT, and voluminous benign and borderline forms. Axillary disection is not necessary because lymphatic spread of malignant FT is unfrequent.

Breast Neoplasms↗

PubMed1989

An autopsy case of breast carcinoma with prominent lipid-secretions in the metastatic foci.

A 70-year-old woman was treated with a simple mastectomy followed by a course of 5000 rad to the breast and chemotherapy with 5-fluorouracil for breast cancer. About 15 months later, the patient died of widespread metastases. An autopsy revealed no recurrent cancer in the breast. The metastases were seen in bones (sternum, ribs and spine), pleura, spleen, uterus, ovaries, small intestine, adrenal glands, and lymph nodes (hilar, periaortic and mesenteric). Histologically, the resected tumor was a solid-tubular carcinoma with an infiltrative growth pattern. At autopsy, the tumor cells in the metastatic foci contained an abundance of lipids in the cytoplasm, while the tumor cells in the primary tumor contained small amounts of lipids.

Adenocarcinoma↗

PubMed1993

Metastasis from breast lobular carcinoma to an endometrial polyp. Report of a case with immunohistochemical study.

A case of lobular carcinoma of the breast metastatic to an endometrial polyp is described. The patient underwent a simple mastectomy and axillary lymphadenectomy because of infiltrating lobular carcinoma diagnosed three years before. Abdominal ultrasound revealed an endometrial polyp. An endometrial biopsy was performed but only scanty material insufficient for diagnosis was obtained. A total hysterectomy and bilateral salpingo-oophorectomy was made. The uterus contained a large polyp which microscopically showed sheets and ribbons of small atypical cells infiltrating the stroma. Immunohistochemical stains were positive for epithelial cell markers. To our knowledge this is the first case of an infiltrating lobular carcinoma metastasizing to an endometrial polyp.

Aged↗

PubMed1979

Efficiency of postoperative radiation in carcinoma of the breast. A comparison between two methods.

The results of simple mastectomy and postoperative irradiation of the chest wall and the regional lymph nodes in a series of 256 patients with primary carcinoma of the breast (between 1970 and 1972) were compared with those in a series of 155 patients (from 1963 to 1965) treated with radical mastectomy and postoperative irradiation of the regional lymph nodes. A statistically significant difference (p less than 0.01) was found between the chest wall recurrences in the group of patients with irradiation of the chest wall and the group without. No evidence indicates that routine postoperative irradiation should be harmful. Distant metastases in the 1970--1972 group were less frequent (13%) than in the 1963--1965 group (29%)9 The age-corrected 4-year survival rates for stages I and II were 83 per cent for the 1970--1972 group and 78 for the 1963--1965 group. The age-corrected 10-year survival rates for states I and II were 60 per cent.

Age Factors↗