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[Juvenile secretory carcinoma of the breast. Apropos of a case in a 4-year-old girl].

The authors report the case of a juvenile secretory carcinoma of the breast in a 4 year old girl. The study of the first local excision leads to the thought of a "duct ectasia with a luminal benign papilloma". At the age of 6 years, there is a local relapse. A second local excision is performed and connected with simple mastectomy and an axillary node sampling. The pathological examination shows the aspect of a multifocal secretory juvenile carcinoma of the breast without lymph node axillary metastase. The authors emphasize the cystic appearance of the first tumor and the distinctive histologic pattern of this particular breast carcinoma.

Breast Neoplasms↗

Sarcomas of the breast: a clinico-pathological study of 67 patients with long term follow-up.

A national Danish series of 68 breast sarcomas from 66 women and one man (age 17-86 years) was investigated. Tumour sections from 22 stromal sarcomas (SS), 24 phyllodes tumors of malignant type (MCSP), seven phyllodes tumors of borderline type (BLCSP), four malignant fibrous histocytomas (MFH), eight liposarcomas, two angiosarcomas and one leiomyosarcoma were reviewed retrospectively, and all patients were traced with a minimum follow-up of 15 years. Tumor contours appeared to be the best prognostic factor in predicting the risk of metastatic spread. Stromal overgrowth of MCSP was considered less utilizable due to difficulties in distinguishing between MCSP with marked stromal overgrowth and SS, which we consider as a variety of MCSP and which only showed slightly increased death rates compared to MCSP (45% versus 38%). Both angiosarcomas and the leiomyosarcoma proved lethal, and the other sarcoma subtypes had a death frequency of about 50%, with the exception of BLCSP, neither of which proved lethal. All patients, who died from metastases, were dead within 5 years irrespective of treatment. No positive lymph nodes were identified at the time of primary treatment, supporting the findings of previous investigators. We therefore advocate simple mastectomy or local excision with a wide margin as sufficient treatment of breast sarcomas. The indications for adjuvant therapy is as yet unclarified.

Adolescent↗

Adenomyoepithelioma of the breast. A case report with an immunohistochemical study.

We treated a 62-year-old woman with adenomyoepithelioma of the breast, an extremely rare tumor, which showed a bicellular pattern of ductal and myoepithelial elements bearing some histologic resemblance to pleomorphic adenoma of the salivary gland. The tumor was made up of cells positive for actin and S-100 protein, and some positive for epithelial membrane antigen (EMA). Thus, this tumor showed biphasic differentiation towards myoepithelial cells and to duct epithelial cells. Compared with findings in related tumors reported in the literature, the myoepithelial cells in the present tumor were less frequently spindle-shaped and had abundant eosinophilic or clear cytoplasm. A simple mastectomy was done and at the time of writing 20 months later there has been no recurrence. Adjuvant chemotherapy was not prescribed.

Actins↗

[A case of tubular adenoma of the breast preoperatively suspected to be an advanced cancer].

A very rare case of a tubular adenoma of the breast is reported. The patient, 59-year-old woman, was admitted to hospital because of a large, left breast tumor. The tumor, 11 cm in diameter, was adhered to the surface skin. Because a malignancy was suspected, an incisional biopsy was first carried out. A pathologic examination revealed it to be a tubular adenoma, and a simple mastectomy was chosen as the operative procedure because a latent malignancy was not ruled out. The removed tumor was grossly cystic and a histological examination supported the finding that it was a non-malignant tubular adenoma.

Adenoma↗

Successful chemotherapy for cystosarcoma phyllodes in a young woman.

Cystosarcoma phyllodes is a rare neoplasm of the breast. The tumor contains both stromal and epithelial elements. Local excision or simple mastectomy is usually curative. Most recurrences are local and can be controlled with excision. We treated a 23-year-old woman in whom disease had metastasized to the lungs with six courses of doxorubicin hydrochloride and cisplatin at three-week intervals and achieved complete remission.

Adult↗

[A case of breast cancer with a chondrosarcomatous appearance].

A case of a breast tumor which showed the appearance of invasive ductal carcinoma and chondrosarcoma is reported. The patient was a 36-year-old female. Simple mastectomy and lymph node dissection were performed for the tumor. Local recurrence and metastases to the contralateral breast, lymph nodes, subcutaneous tissue, and bones arose after the operation. She died of the disease 2 years and 3 months after the operation. It is thought that this tumor had formed as a result of metaplasia of the carcinomatous tissue, since a histological transition between the carcinoma and sarcoma was demonstrated.

Adult↗

[Primary non-Hodgkin's lymphoma of the breast--report of 8 cases].

Eight cases of primary Non-Hodgkin's lymphoma (NHL) of the breast are reported. Almost all presented as a painless movable mass without nipple retraction, edema in the overlying skin, satellite skin nodules or bloody nipple discharge. Most of the cases belonged to B cell lymphoma. Wide local excision or simple mastectomy combined with chemotherapy or radiotherapy were adopted in the treatment of these patients. The average survival was 28 months. Since prognosis of NHL is worse than that of breast carcinoma and is easily misdiagnosed as breast cancer, it is important to take vigilance in the differential diagnosis.

Adult↗

Total mastectomy: indications and techniques.

Total mastectomy is an effective operation for patients who are candidates for a prophylactic mastectomy. This operation removes a larger percentage of breast tissue than subcutaneous mastectomy. The cosmetic results of total mastectomy with immediate reconstruction compare favorably with those of subcutaneous mastectomy.

Adult↗

The result of breast reconstruction after mastectomy for breast cancer in 109 patients.

One hundred and eleven breast reconstructions after a mastectomy for carcinoma in 109 patients are reported. Depending on the quality of muscle and skin coverage, reconstructions were performed either with a latissimus dorsi musculocutaneous flap or a subpectoral prosthesis (including expander prosthesis). The follow-up involved 90 patients. The purely aesthetic results as well as the very positive result of reconstruction with regard to appearance in clothing, participation in sports, and self-esteem were of great importance to the patients. The difference in ptosis, the most obvious shortcoming in our reconstructions, is discussed. Attention is given to the importance of flap planning and the restoration of the anterior axillary fold in the latissimus dorsi flap reconstructions. The disappointing results of tissue expansion and the shortcomings of the nipple-areola reconstructions are discussed.

Adult↗

[Multiple primary malignant tumors of rhabdomyosarcoma in an upper arm and breast cancer].

Multiple primary malignant tumors of rhabdomyosarcoma in a upper arm and cancer of breast are extremely rare. In September 1970, a female, aged 86 years, underwent the first resection operation performed on a pleomorphic rhabdomyosarcoma of the right upper arm. She underwent radiation therapy (8000 rads at the operative field) postoperatively. In August 1980, a simple mastectomy was performed for a cancer of the right breast. In December 1984, fourteen years after her first operation, a recurrence was detected. The tumor recurred five times during the next two years and was resected each time. The patient died of cachexia sixteen years after the first operation.

Aged↗

Secretory (juvenile) carcinoma of the breast in an adult woman.

A case of secretory (juvenile) carcinoma of the breast is reported in a 31-year-old woman. Secretory carcinoma in adults is rare, only twenty-seven cases previously reported. It is known to have a more favourable prognosis than the conventional ductal carcinoma. The most adequate treatment appears to be a simple mastectomy with low axillary dissection.

Adult↗

[Cutaneous angiosarcoma of the breast following surgery and irradiation of breast adenocarcinoma].

We are reporting a localised skin angiosarcoma of the breast. As far as we can tell this is only the fourth time this condition has been published. The tumour appeared 6 years after a conservative lumpectomy with removal of lymphatics and follow-up radiotherapy had been carried out for an adenocarcinoma of the breast. This tumour was characterised by the presence of several round blue-coloured nodules in the skin with some inflammation surrounding them. The glandular tissue underneath was normal, as was the opposite breast, and there was no spread. The patient was pyrexial and a syndrome of inflammation persisted until the tumour had been removed by a simple mastectomy. We have discussed the clinical and histological aspects of this case and compared them with those found in the literature. Differential diagnosis with in particular Stewart-Treves syndrome has been emphasized. The treatment consists in wide excision and sometimes followed by radiotherapy or chemotherapy. The prognosis is very poor, survival never having been more than 22 months. Finally the role of irradiation in the causation of this tumour has been discussed. (Our patient is alive after 2 years without any sign of a recurrence).

Adenocarcinoma↗

Changes in the treatment and prognosis of breast cancer.

The data of 331 women with breast cancer treated in the Second Department of Surgery, Helsinki University, during the period 1976-1980 (patient material, treatment, prognostic factors) is evaluated and compared with an equally large patient material treated during the period 1951-1961 in the same hospital. A breast lump was the main symptom in 94% and the tumour was found by the patient in most cases. Only two patients were younger than 30 years. The median delays to the first medical contact and to operative treatment were 30 and 20 days respectively. The delay had no influence on the prognosis. Also, the age of the patients and the localization of the tumour had no significant effect on the prognosis. Simple mastectomy with axillary lymph node excision was the main operative treatment in the present material whereas Halsted's radical mastectomy was frequently performed in the previous study. Operative radicality was the same in both studies. The prognosis has improved in all clinical stages. The present relative five year survivals in stages I-IV were 95, 83, 53 and 18%, whereas in the previous study they were 75, 58, 41 and 0%, respectively. The improvement in stage II-IV breast cancers is probably due to advances in radio- and chemotherapy. However, the improvement in the prognosis of stage I and to a lesser extent of stage II breast cancers cannot be explained on this basis alone. Neither do the shorter delays in treatment fully explain the differences in the prognosis. The most frequent sites of metastasis were bone and lung/pleura where almost half of the total metastasis occurring during the follow-up were found.

Adult↗

[A case of advanced male breast cancer treated effectively with estrogen].

A 47-year-old man was admitted because of a left axillary tumor. A biopsy of the tumor disclosed adenocarcinoma. The bone survey showed multiple sclerotic metastases. Thirteen months after his first admission, a left breast tumor developed and a simple mastectomy revealed a papillotubular carcinoma. Skin metastases appeared postoperatively and were exacerbated with accumulation of pericardial effusion and a high CEA level (401.7 ng/ml) despite radiation and chemotherapy. Estrogen therapy with diethylstilbestrol sodium phosphate was started, resulting in the disappearance of pericardial effusion and skin metastases. The patient remains well 10 months after starting estrogen therapy with a normal CEA level.

Adenocarcinoma↗

Hypophosphataemic osteomalacia misdiagnosed as metastatic carcinoma. A case report.

A 60-year-old woman presented with diffuse bone pain 12 months after simple mastectomy. During investigation for metastatic disease it was realized that her pain had preceded the mastectomy by 2 years and that the biochemical and radiological findings were inconsistent with metastatic disease. The findings of phosphaturia, hypophosphataemia, normocalcaemia and normal renal function without hyperparathyroidism are discussed in the light of the rarity of such findings in a 60-year-old adult and, in particular, in a patient with cancer of the breast.

Breast Neoplasms↗

Primary inflammatory carcinoma of the female breast: staging and treatment possibilities.

Primary inflammatory carcinoma of the breast, which is considered inoperable, has a prognosis that has led to therapeutic nihilism. Treatment of 81 such patients between 1954 and 1981 is reported here. When first seen, 28 patients had clinically localized disease (median survival 48 months) and 53 had regional disease (median survival 26 months). Thus there is a significant difference in survival rates (p less than 0.05). Of the 81 patients, 32 were treated primarily with radiotherapy (Baclesse), 37 were treated with chemotherapy then radiotherapy followed by chemotherapy maintenance, and 12 were treated with chemotherapy followed by extended simple mastectomy and chemotherapy maintenance. For the three treatment protocols, survival times for patients with localized disease were 50, 45, and 50 months and for patients with regional disease survival times were 13, 32, and 47 months, which demonstrates that patients with metastatic disease benefit from chemotherapy and perhaps in selected cases surgery. Thirty-five percent of the 28 patients with localized disease and 20% of the 53 patients with regional disease survived 5 years, for an overall 5-year survival rate of 26%. Of the 13% of patients who survived 10 years, 18% had localized disease and 10% had regional disease. Both clinical staging and treatment factors are important in the prognosis for patients with primary inflammatory carcinoma of the female breast.

Adult↗

[Problems of a stage-based therapeutic approach to surgery in breast carcinoma (author's transl)].

A therapeutic concept dependent on staging of breast carcinoma is presented: 1. Stage T0-T1 N0 M0: wide local excision or quadrant resection with axillary lymph-node excision. 2. Stage T2 and T3 N0-N1: simple mastectomy (Patey). 3. Stage T4 or N2: radical mastectomy (Rotter). 4. Stage N3 or M1: tumour excision according to the T-stage, lymph-node excision, local excision of affected distant lymph nodes. With equal therapeutic results the smaller and cosmetically-preferable surgical procedure is to be recommended.

Breast Neoplasms↗