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PubMed1995

Cystosarcoma phyllodes and its surgical management.

The purpose of this study is to formulate guidelines for proper surgical management of phyllodes tumor. It is a disease often misdiagnosed by pathologists and undertreated by surgeons. In a private surgical practice from 1956 to 1984, 16 patients were treated for phyllodes tumor. Findings from this retrospective review are compared with other reported series. Eleven benign cases survived 9 to 35 years. Four with malignancies developed metastases. One such patient, however, survives 11 years postmastectomy and two years after removal of a large thigh metastasis. An algorithm is presented for proper management of phyllodes tumor consisting of needle biopsy, tumor excision with testing for margins, and simple mastectomy for tumors > 5 cm and those of any size found to be malignant or borderline on permanent section or on the recommended secondary pathologic review. Surgical removal of a solitary distant metastasis should be considered for this resistant tumor.

Adult↗
PubMed1975

Carcinoma of the breast: pathological criteria as an aid in treatment.

Pathologic and clinical features of a group of breast cancer patients were studied in an effort to find out if the prognosis of any individual case of breast cancer could be assessed preoperatively. The size, location, type of tumor, histologic grade and presence or absence of metastatic nodes were studied. Unfortunately, it was not possible to predict the prognosis with any degree of accuracy. We must agree with Haagensen, who said, "The truth is that we already know enough regarding the inferiority of lumpectomy and simple mastectomy, with or without supplementary irradiation, to conclude that it is not wise or humane to condemn a woman to be treated with these methods."

Breast Neoplasms↗
PubMed1993

Mammary ducts in the areola: implications for patients undergoing reconstructive surgery of the breast.

The use of selective excision of the nipple with preservation of the areola ("nipple coring") has been advocated for patients undergoing subcutaneous or total glandular mastectomy. This is based on the assumption that all the mammary ducts in the nipple-areola complex are located in the nipple and that the areola is devoid of mammary ductal tissue. To investigate this issue, we performed nipple coring on eight consecutive mastectomy specimens, excised the areolas, and submitted them in their entirety for histologic examination. Mammary ducts identical in appearance to extralobular ducts in the breast parenchyma were identified in the dermis of the areola in all eight cases. These ducts were present throughout the areola, including the most peripheral aspects. We conclude that mammary ducts are a normal component of the areolar dermis and that nipple coring does not result in the removal of all mammary ductal tissue from the nipple-areola complex. This observation should be taken into consideration by reconstructive surgeons considering preservation of the areola in patients undergoing subcutaneous or total glandular mastectomy.

Adult↗
PubMed1995

[Mammary phyllodes tumor. A clinico-pathological review of 14 cases].

We report a retrospective analysis of 14 female patients, aged 20 to 62 years old, with phyllodes tumors of the breast. The tumors were located in the right breast in nine patients and their diameter ranged from 2.5 to 28 cm. Six mammographies and six needle cytological examinations were performed and aided very little to the diagnosis. The preoperative diagnosis was correct in five patients and the principal differential diagnosis was fibroadenoma. Eight patients were subjected to tumorectomy, three to simple mastectomy, one to a cleaning mastectomy, one to a modified radical mastectomy and one to a subcutaneous mastectomy. The anatomopathologic study disclosed an increased stromal growth in two patients and increased stromal cellularity in six cases. Only one case had more than five mitoses per microscopic field. Phyllodes tumors are infrequent, their diagnosis requires a high degree of clinical suspicion and they have a benign biologic behaviour.

Adult↗
PubMed1996

Sequential pulmonary effects of radiotherapy detected by Tc-99m DTPA radioaerosol inhalation lung scintigraphy.

Lung damage after radiation therapy in 39 female patients diagnosed with right breast cancer was measured by Tc-99m DTPA radioaerosol inhalation lung scintigraphy (DTPA). The clearance rate of Tc-99m DTPA in the lungs was presented as the clearance rate (k; %/min) of the time-activity curve of the dynamic lung images. All patients underwent simple mastectomy, and postoperative radiation of approximately 50 Gy. We divided the patients into three groups according to the interval of time between the date of irradiation and the lung scintigraphy: group 1 included 12 patients who were examined within three months after irradiation, group 2 included 16 patients who were examined 3 to 9 months after irradiation, and group 3 included 11 patients who were examined more than 9 months after irradiation. In addition, 10 age matched normal women were included as the control. The clearance of the right lung was 0.73 +/- 0.13 for normal controls, 0.94 +/- 0.24 for group 1, 1.11 +/- 0.39 for group 2, and 0.69 +/- 0.21 for group 3. In this small series of patients with breast cancer, the results suggest that lung damage may occur within the first three months after irradiation. After three months, lung damage becomes more significant and the clearance of Tc-99m DTPA in the lungs becomes faster. However, the clearance rate declines markedly after 9 months, which is assumed to result from the recovery of lung tissue from acute irradiation damage or from pulmonary fibrotic change after radiation therapy, or from a combination of both.

Administration, Inhalation↗
PubMed1997

[Phyllodes tumors of the breast. Forty one cases].

Phyllode tumors of the breast are fibroepithelial tumors similar to fibroadenomas but with a predominant conjunctive tissue component. The aim of this work was to determine the specific diagnostic, therapeutic and prognostic features of this tumor. A retrospective series of 41 cases was collected in the gynecology-obstetrics ward from 1980 to 1991. The analysis of this series showed the following characteristics: incidence of phyllode tumors was 0.46% of all breast tumors. Mean age at diagnosis was 30 years, in 75.6% of the women were in a period of reproductive activity. Mean delay between the first clinical signs and diagnosis was 20 months. Mean size was 12 cm Diagnosis was confirmed at pathology examination in all cases. The tumor was classed grade 1 and 2 in 65.9% of the cases, grade 3 in 9.8%, grade 4 in 17.1%. Surgical treatment alone was used in all cases with large tumorectomy (48%), simple mastectomy (30%), and total mastectomy with node dissection (22%). After a follow-up of 1 to 7 years, there were 3 deaths and 11 local recurrences requiring reoperation. In the remaining cases, the outcome was favorable without recurrence or metastasis. These results together with those reported in the literature show that histological confirmation is required for the diagnosis of phyllode tumors. Surgical treatment alone is required with wide exeresis because of the voluminous tumor formation the age of the patient and the histological grade. Finally, prognosis depends on the histological characteristics of the conjunctive tissue component of the tumors.

Adolescent↗
PubMed1976

Angiosarcoma of the breast: a report of two cases and a review of the literature.

Angiosarcoma of the breast, a rare tumor with very poor prognosis and insidious early manifestations, frequently is far advanced when first detected clinically. The clinical and pathologic changes in two women with primary, unilateral angiosarcoma of the breast are reviewed and the results are compared with 46 cases already published in the literature. Both patients were middle aged with symptoms for approximately 6 months prior to operation. Both frozen section reports were benign and only called malignant on permanent section. Microscopically the tumors were composed of varying sized, tortuous, elongated vascular channels. The operation varied--a modified radical and a simple mastectomy--and both patients are free from disease 4 and 2 years following operation. It is considered that, in view of the proclivity of this tumor for hematogenous metastases, an axillary dissection may not be justified.

Adult↗
PubMed1997

Histopathological analysis of carcinoma of the male breast in Ile-Ife, Nigeria.

Carcinoma of the male breast is said to be rare. A review of the records at the histopathology laboratory of the Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, confirms the universal assertion that carcinoma of the male breast is very rare. In over nineteen years of its existence, the laboratory recorded only 10 cases of carcinoma of the male breast. This gives an incidence rate of 1.9% of a total of 513 cases affecting both male and female breasts. All cases were infiltrating ductal carcinoma: there were two cases of papillary, one each of colloid and clear cell carcinoma while the remaining were "not otherwise specified". The age range was 40-80 years with an average of 56.9 years. There was left-sided preponderance with eight cases in the left breast and two cases in the right breast. Six cases had evidence of metastasis either at the time of initial diagnosis or some months after simple mastectomy.

Adult↗
PubMedDate not supplied

Immediate TRAM flap breast reconstruction in an obese patient with relapsing benign phyllodes tumor: report of a case.

The authors present a case of relapsing benign phyllodes cystosarcoma of the breast in an obese female treated with a simple mastectomy and an immediate reconstruction using a bipedicled transverse rectus abdominis musculocutaneous (TRAM) flap. After a brief review of treatment options for phyllodes tumors, they discuss the advantages of TRAM flap breast reconstruction, suggesting that it may also be applied in obese patients.

Breast Neoplasms↗
PubMed1998

[Gynecomastia. Management of diagnosis and therapy. Apropos of 52 cases].

Gynecomastia is the commonest breast lesion in males. Fifty-two patients (mean age 24 years) operated in our department were reviewed with a mean follow-up of two years and a half. Gynecomastia occurred most frequently during puberty (63%), was bilateral (75%) and idiopathic (65%). The size of the enlargement was evaluated according to Simon's-classification based on breast-volume and skin-redundancy. 18 stage 1, 22 stage 2A, 9 stage 2B, 3 stage 3. Clinical examination and mammography determined the consistency of gynecomastia: adipose or firm. 4 different surgical managements were used: 32 subcutaneous mastectomies, 12 liposuctions, 6 liposuctions assocaited with subcutaneous mastectomy, 1 total mastectomy. One patient had liposuction on one side and subcutaneous mastectomy on the other one. All techniques gave good morphologic results. Nonetheless, the authors recommend the combination "liposuction and subcutaneous mastectomy", as this technique presents many advantages: small intraoperative blood loss, good skin redraping, short hospital stay, complete histologic examination of the material removed.

Adolescent↗
PubMedDate not supplied

[Occult breast cancer].

In 20 years we registered seven observations of breast cancer presenting as an axillary mass (BCAM), meaning 0.9% out of the global breast cancer series (767 cases). All the cases were females. The main clinical sign was only the presence of axillary lymph nodes. Diagnosis was precised by the pathological examination of the excised nodes (six observations) or needle aspiration of the axillary lymph nodes. Mammography showed tumors less than one centimeter in three out of the seven cases. As for the stadialisation, we had two cases in the II-nd stage, four patients in the III-rd stage and one in IV-th. All the patients were operated on. There were four simple mastectomies anti three Patey radical modified mastectomies. Postoperative chemotherapy and radiotherapy were performed to all the patients. Only two of the seven patients survived five years after surgery.

Aged↗
PubMed1998

Role of electron beam treatment in postoperative management of carcinoma of the breast.

The aim of post operative radiotherapy to chest wall and drainage areas in advanced breast cancer is to sterilize the possible microscopic disease. Fifty cases of post surgical breast cancers were evaluated in a prospective study of chest wall radiation therapy by electrons. Fifty women of histologically proved post operative invasive breast cancers underwent simple mastectomy with axillary dissection followed by post-operative radiotherapy (Electron) to chest wall +/- drainage area. The chest wall and IMC was treated by a direct electron beam (9/12 MeV and 12 MeV) at fixed angle. 6 MV X-ray beam was used to treat axillary apex and supraclavicular area. In some cases, supplement RT was given by 6 MV X-rays through small posterior axillary portal. The energy of electron beam was 9 MeV or 12 MeV depending on the thickness of treated area. The supraclavicular and axillary lymphatic regions were treated, by direct custom shaped anterior portal. The dose delivered was 50 Gy over 5 weeks at 2 Gy per fraction. Adjuvant chemotherapy was given to patients who were pre-menopausal with histologically proved axillary node involvement as Cyclophosphamide, Methotrexate and 5-Fluorouracil (CMF) after radiotherapy. Post menopausal patients received adjuvant tamoxifen 10 mg.bid. The overall time varied from 26 to 87 days with a median of 41.5 days (SD 11.7). The followup period varied from 4-32 months with a mean of 22 months (SD 6.4). All the fifty patients developed dense pigmentation towards the end of radiation therapy, along with patchy dry desquamation. Moist desquamation occurred in 6 patients. The median OTT in the patients who developed moist desquamation was 34.5 days. The moist reaction healed over 10-15 days after completion of radiotherapy. Lung Fibrosis (Apical lobe) occurred in four patients. The fibrosis was evident at a median of 12 months of follow up. Lymphoedema of the ipsilateral arm occurred in six patients. None of 50 patients developed late sequalae like Cardiac effects, Rib fracture, Brachial Plexopathy, Shoulder joint impairement and Soft tissue effects. Local control in this study was 96% (48 patients). The two year actuarial overall survival was 80%. In early stages survival was significantly better compared to late stages. The actuarial two year DFS was 72%. In early stages DFS was significantly better compared to late stages.

Adult↗
PubMed1998

Primary squamous cell carcinoma of the breast in a young woman--a case report and review of literature.

A thirty-four years old woman presented with pure squamous cell carcinoma of the breast, a very rare occurrence in the younger age group. A simple mastectomy with axillary clearance was performed, followed by adjuvant radiotherapy & chemotherapy. The patient is doing well, with no evidence of recurrence thirty months (2 1/2 years after the treatment. Primary pure squamous cell carcinoma of the breast is a very rare disease. The exact histogenesis still remains obscure. There seems to be no specific prognostic correlation with the morphological characteristics of squamous cell carcinoma of the breast. The clinical behaviour of this tumor is also uncertain. Thus, further study is required to determine whether primary pure squamous cell carcinoma of the breast is to be treated as a separate entity or as the common type of breast cancer (i.e. adenocarcinoma or adenocarcinoma with squamous metaplasia.)

Adult↗
PubMed1976

[Clinical problems of the breast carcinoma in situ].

A report of carcinoma in situ of the breast, including problems of diagnosis and treatment. Over a 6-year period cut of a total of 743 carcinomas of the breast, 77 carcinomas in situ were observed. The difficulties of diagnosis are reviewed. Treatment consisted of simple mastectomy. In view of the inadequate therapeutic results it is recommended that a modified radical mastectomy should also be done in all cases of carcinoma in situ of the breast. The pros and cons of postoperative radiation are discussed.

Adolescent↗
PubMed1985

Results of conservative operations for breast cancer.

The results of conservative operations for breast cancer in 1,593 patients treated at the Cleveland Clinic between 1957 through 1975 are reported. During this period, we individualized our treatment of breast cancer depending on tumor size, location in the breast, and clinical stage of the disease. The following three principal operations were performed: modified radical mastectomy in 592 patients (37%), simple (total) mastectomy in 442 patients (28%), and partial (segmental) mastectomy in 291 patients (18%). Survival results at 5, 10, and 15 years are reported. Factors important in long-term survival included stage of the disease, number of lymph node metastases, delay in therapy, size of the tumor, histologic type, and estrogen receptor status; type of operation was not a significant factor. In this series, partial (segmental) mastectomy without radiation therapy provided five- to 15-year survival rates equal to modified radical mastectomy and simple (total) mastectomy.

Adenocarcinoma, Mucinous↗