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At least 127 records · Page 7Linked to original sources
PubMed1982

Cystosarcoma phylloides of the breast: a new therapeutic proposal.

An analysis of forty cases of cystosarcoma phylloides of the breast was undertaken to clarify the relationship between histology, surgical treatment and prognosis of this fibroepithelial tumor. Thirty-eight female patients 12 to 85 years of age, treated for this diagnosis over a 17-year period, were studied retrospectively. Histologically malignant lesions were diagnosed in 17 cases: six were treated by local excision, one by subcutaneous mastectomy with prosthetic implant, four by simple mastectomy, three by modified, two by radical mastectomy, and one by biopsy only. Of the 23 histologically benign tumors, 18 were treated by local excision, three had simple mastectomy, and one had subcutaneous mastectomy with prosthetic implant. Three recurrences, observed (7.5%) among patients with benign tumors, were locally excised. Wide local reexcision has controlled the disease to date after average follow-up of 32 months. In the malignant group, metastases developed in four patients (10%). Three of these patients are dead of disease and one is being treated by chemotherapy. Malignant histology seemed to correlate directly to the presence of pain (46.6%), size of the tumor (average 7 cm in diameter), and older age (average 52 years), but there was no correlation with prognosis. Recent reports on the subject advocate wide local excision for small benign lesions and simple mastectomy for larger or malignant ones. Our data indicates that the histologic appearance does not correlate with the clinical behavior of this neoplasm, and the choice of the procedure does not alter the long-term result, provided that the tumor is completely excised. More radical procedures than wide local excision are not justified for cystosarcoma phylloides which behaves more like a soft tissue sarcoma than a breast gland tumor.

Adolescent↗
PubMed1975

Lobular carcinoma of the breast in situ. Are we too radical in its treatment?

Twenty-four patients (average age, 46 years) with 29 instances of lobular carcinoma in situ of the breast have been treated from 1952 to 1971 at the Henry Ford Hospital (incidence, 1%). Six patients had bilateral lesions, one synchronous and 5 metachronous. The initial complaint in 23 of 24 patients was a mass in the breast. Diagnosis was based on permanent histologic section as mammorgraphy and frozen section analysis were inconclusive. Treatment consisted of radical mastectomy in six, modified radical mastectomy in five, and simple mastectomy in 20. All lymph nodes recovered showed no metastatic disease. All patients are alive and well with no evidence of disease. Based on our experience, we recommend a simple mastectomy for treatment of lobular carcinoma in situ with contraleteral bipsy examination in those instances when clinical or roentgenographic evidence suggests a pathologic process.

Adult↗
PubMed1991

Paget's disease of the nipple.

A total of 48 women with Paget's disease of the nipple (nipple eczema containing Paget cells but without a palpable lump) presented to one surgeon over a 13-year period. Temporary healing of the nipple eczema occurred in six patients. In all, 21 of 34 patients with in situ (DCIS) or invasive ductal carcinoma had mammographic abnormalities. Treatment was by simple mastectomy (37 cases), cone excision of the nipple-areola complex (ten cases) and tamoxifen (one case). DCIS was found in 45 operative specimens (96 per cent); eight had associated invasion. The DCIS was predominantly large cell solid/comedo in type and was multifocal in seven cases (19 per cent). At a median (range) follow-up of 56 (18-96) months, four of the ten patients treated by cone excision have developed a local recurrence, two of these patients have also developed metastases. Two of the 37 patients who underwent mastectomy developed loco-regional recurrences; both had invasive foci at their first operation and remain disease free at 8 years. We no longer feel that cone excision is appropriate treatment.

Adult↗
PubMed1995

Use of serial carcinoembryonic antigen and CA 15.3 assays in detecting relapses in breast cancer patients.

UNLABELLED: To evaluate the utility of CEA and CA 15.3 for early diagnosis of recurrence, serial serum determinations of both antigens were performed in 1023 patients (follow-up: 1-10 years, mean 6.2 years) with primary breast cancer (CA 15.3 in 533 cases) and no evidence of residual disease (NED) after radical treatment (radical mastectomy or simple mastectomy and radiotherapy). 246 patients developed metastases during follow-up. RESULTS: CEA and CA 15.3 were elevated ( > 10 ng/ml or > 60 U/ml, respectively) prior to diagnosis in 40% (98/246) and 41% (37/91) of the patients with recurrence, with a lead time of 4.9 +/- 2.2 and 4.2 +/- 2.3 months, respectively. When patients with locoregional recurrences were excluded, sensitivity improved to 46% (CEA) and 54% (CA 15.3), and to 64% with both tumor markers (CEA and/or CA 15.3). Higher levels of both CEA and CA 15.3 at diagnosis of recurrence, higher sensitivity in early diagnosis of relapse, and a higher lead time were found in ER+ (CEA) or PgR+ patients (CA 15.3) than in those that were negative for these receptors in the primary tumor (p < 0.001). Specificity of the tumor markers was 99% for both CEA (777 NED patients) and for CA 15.3 (444 NED patients), respectively. In conclusion, CEA and CA 15.3 are useful tools for early diagnosis of metastases, mainly in those patients with ER+ or PR+ tumors.

Antigens, Tumor-Associated, Carbohydrate↗
PubMed1978

[Pathological-anatomical aspects of organ-preserving surgical procedures for breast carcinomas (author's transl)].

This study is an attempt to evaluate the necessity of radical surgery based on the incidence of tumor remnants and lymphnode metastases in amputated breast after diagnostic excision. The material included 600 female patients, from 27-86 years old (mean age 58 years) examined at the Institute of Pathology University of Munich between 1969 and 1974. Retrospectively 36% of the specimen would have been free of tumor after en bloc resection, 21% simple mastectomy and 19% after simple mastectomy with additional axillary lymph-node disection. In fact, however, radical mastectomy was necessary in 25% for total removal of the tumor. As no methods for exact preoperative determination of tumor extension are yet known and as there is a high risk of recurrant tumor because of insufficient excision, organ-preserving surgical procedures still will be restricted to a few individual and selected cases of breast carcinoma presuming the patients consent.

Adult↗
PubMed1998

Axillary lymph node dissection for breast cancer: a decision analysis of T1 lesions.

BACKGROUND: The value of routine axillary dissection for patients with breast cancer is still being debated. The argument centers around whether the information gained by knowing the lymph node status, which aids in making the decision about adjuvant chemotherapy, justifies the morbidity. This study quantitatively analyzes the potential outcomes of routine, selective, and no axillary dissection. METHODS: A decision analysis was performed of the strategies of lumpectomy and radiation versus simple mastectomy followed by no dissection, selective dissection, or routine dissection. Factors included biologic markers to identify high-risk lesions, the morbidity of axillary dissection, the effects of adjuvant chemotherapy on lymph node-negative and lymph node-positive disease, and the life expectancy of patients with high-risk and low-risk node-negative and node-positive lesions. Sensitivity analysis was done to determine threshold levels of these factors in choosing an option. RESULTS: We discovered an advantage in quality-adjusted life expectancy (QALE) for no axillary dissection until the probability of positive lymph nodes reaches >15%; after that, selective node dissection is superior. Selective dissection is superior for lower morbidity rates of axillary dissection. Routine dissection is never a superior strategy. The difference among these strategies is small, however, with no one strategy providing a QALE greater than 1 year longer than any other. CONCLUSIONS: Axillary dissection can be avoided in patients with high-risk lesions who would be candidates for adjuvant chemotherapy regardless of lymph node status, and possibly in patients with low-risk T1a lesions, but it should be recommended for low-risk T1b and T1c lesions for which lymph node status may determine the need for adjuvant chemotherapy.

Axilla↗
PubMed1999

Primary malignant hemangiopericytoma of the breast: report of a case.

A 70-year-old woman presented with a huge tumor in her left breast, which had rapidly increased in size causing cutaneous erosion. She underwent a simple mastectomy, at which time the tumor was found to be an encapsulated multilocular cystic lesion containing dark fluid. Histological examination disclosed the characteristic features of malignant hemangiopericytoma, including the perivascular lamellar growth of atypical mesenchymal cells with vimentin-positive cytoplasm. Multiple irregular vascular luminal formation was also conspicuous. The characteristics of this lesion are discussed together with a review of the previous literature on this unusual neoplasm.

Aged↗
PubMed2001

[Peri-areolar approach in pronounced gynecomastia with focus-plasty and liposuction].

INTRODUCTION: The treatment of gigantic gynecomastia has usually been accompanied by ugly scars. METHODS: Because of our experiences in 38 patients with gynecomastia grade III, we suggest a surgical technique that not only involves a simple mastectomy and liposuction, but also a mere periareoler incision and, if necessary, repeated focusplasty and liposuction. Excessive skin can be repaired with a so-called focusplasty. RESULTS: In young patients this can successfully be achieved in one operation. CONCLUSIONS: Because skin has a minimized ability to retract in older patients, repeat operative sessions are necessary.

Adolescent↗
PubMed1998

Malignant phyllodes tumour with a noninvasive ductal carcinoma component.

A malignant phyllodes tumour with a noninvasive ductal carcinoma component is reported. The patient was an 80-year-old Japanese woman with a breast tumour detected by routine physical examination. A simple mastectomy was performed. The excised tumour was 10.5 x 9.4 x 5.4 cm in size and bulged into the skin with ulceration. The macroscopic appearance was that of a phyllodes tumour. Histologically the tumour consisted mainly of stromal components with a leaf-like structure lined by atypical ductal epithelium. The epithelial component showed gradual evolution to intraductal papillary carcinoma in a few areas. The stromal component was composed mainly of fibrosarcoma with areas of osteosarcoma and rhabdomyosarcoma. Neither stromal invasion of intraductal carcinoma nor transition between the stromal and epithelial elements was seen. Three months after the operation, death occurred, with multiple pulmonary and subcutaneous metastases. This case probably represents malignant change in both the stromal and the epithelial components of a phyllodes tumour. Since the two elements were independent, the possibility that a phyllodes tumour may be one of the origins of true carcinosarcoma is raised.

Aged↗
PubMed2006

BIS monitor findings during self-hypnosis.

OBJECTIVE: We describe BIS values for a patient undergoing breast surgery under self-hypnosis in order to access the value of global surface EEG measures occurring during this process. METHODS: Following verbal consent, a BIS(TM) monitor (Aspect Medical, Newton MA) was placed and values measured while the patient performed self-hypnosis for a simple mastectomy and sentinel node biopsy. RESULTS: Thirty-nine minutes after incision the BIS value decreased transiently to 72 followed by several other transient decreases, the lowest of which was 59. Values remained at approximately 90 throughout most of the operative period. The BIS value returned to baseline after completion of the operation. CONCLUSIONS: Our findings support the hypothesis that hypnosis is a dynamic cerebral process incorporating many changes within brain activation centers and one distinct from dissociative patterns seen under anesthesia. Current algorithms employed by the BIS(TM) monitor add little to the management of patients utilizing hypnosis for analgesia.

Aged↗
PubMed2004

Solitary fibrous tumor of the mammary gland: a potential pitfall in breast pathology.

We report three cases of solitary fibrous tumor of the breast. The patients were adult to elderly women and complained of a slowly but relentless growing lump. The tumors were fairly circumscribed and cured by means of lumpectomy or, in one case, simple mastectomy. Histologically, they featured the customary "patternless pattern" of short spindle cells haphazardly arranged in fascicles within a collagenized or myxoid ground substance. In two cases, a prominent hemangiopericytic arrangement of tumor cells around a rich vascular framework could be noticed. Cellular areas were often present and showed nuclear overlapping, clumping of chromatin, and a brisk mitotic activity. No atypical mitosis was recognized. Tumor cells were immunoreactive for CD34, bcl2, and vimentin only. On follow-up there was no evidence of either local recurrence or distant metastases. Solitary fibrous tumors of the breast may represent a significant diagnostic problem because of the close mimicry to numerous benign and malignant mammary lesions composed of spindle cells; diagnostic clues may be further obscured in cellular and actively proliferating tumors. A brief overview of mammary solitary fibrous tumor taxonomy along with the principal differential diagnoses within the breast is presented.

Antigens, CD34↗
PubMed2002

Adenoid cystic breast cancer.

BACKGROUND: Adenoid cystic carcinoma is a rare type of breast cancer that is generally reported in individual case reports or as series from major referral centers. To characterize early diagnostic criteria for adenoid cystic carcinoma and to determine whether breast-preserving surgery with radiotherapy is as effective as mastectomy for eradicating the disease, we reviewed clinical records of a large series of patients treated for adenoid cystic carcinoma of the breast at a large health maintenance organization (HMO) that includes primary care facilities and referral centers. METHODS: Using the data bank of the Northern California Cancer Registry of the Kaiser Permanente Northern California Region (KPNCR), we retrospectively reviewed medical records of patients treated for adenoid cystic carcinoma of the breast. Follow-up also was done for these patients. RESULTS: Adenoid cystic carcinoma of the breast was diagnosed in 22 of 27,970 patients treated for breast cancer at KPNCR from 1960 through 2000. All 22 patients were female and were available for follow-up. Mean age of patients at diagnosis was 61 years (range, 37 to 94 years). In 17 (77%) of the women, a lump in the breast led to initial suspicion of a tumor; in 4 (23%) of the 22 patients, mammography led to suspicion of a tumor. Median tumor size was 20 mm. Pain was a prominent symptom. Surgical management evolved from radical and modified radical mastectomy to simple mastectomy or lumpectomy during the study period, during which time 1 patient died of previous ordinary ductal carcinoma of the contralateral breast, and 7 died of unrelated disease. At follow-up, 12 of the 13 remaining patients were free of disease; 1 patient died of the disease; and 1 patient remained alive despite late occurrence of lymph node and pulmonary metastases. CONCLUSIONS: Whether breast-preserving surgery with radiotherapy is as effective as mastectomy for treating adenoid cystic carcinoma of the breast has not been determined.

Adult↗
PubMed2002

An evaluation of resident training in breast procedures.

BACKGROUND: The purpose of this study was to determine if senior residents are participating in advanced level breast cases. METHODS: A retrospective review of 1,583 breast procedures on 1,213 patients over 2 years was performed. Each case was evaluated for the type of case: (1) junior level (PGY 1 and 2)--core needle biopsy, fine needle aspirate, excisional biopsy, needle localized biopsy, lumpectomy, partial mastectomy, and simple mastectomy; and (2) senior level--stereotactic breast biopsy, sentinel lymph node biopsy, axillary dissection, and modified radical mastectomy. All cases were reviewed for level of resident involved. RESULTS: Overall, seniors performed 31% of the cases, junior residents performed 42%, and 27% were unattended by any resident. Senior level breast cases were specifically examined to compare whether a senior or junior was present. Overall, 891 defined senior cases were performed. A senior level resident attended 34% of these, leaving 66% covered by junior residents or uncovered altogether. CONCLUSIONS: It is clear when evaluating breast procedures that senior residents are less involved than junior residents. Furthermore, the fact that many of the reported cases (28%) and, more significantly, senior level cases (26%) have no resident involved leads us to conclude that senior level residents are not taking advantage of the opportunity to gain experience in performing advanced level breast procedures in our surgical program.

Breast↗
PubMed1985

Carcinoma of the breast in women 80 years of age and older: still a lethal disease.

Cancer of the breast is a frequent and potentially lethal problem in women 80 years of age and older. In our experience, many present with advanced disease which indicates the continuing need for patient and doctor education concerning the significance of a breast lump in the elderly. Although many of these patients have other diseases, only a small number, if thoughtfully managed, will not be fit for appropriate standard methods of treatment. In the majority of patients who died, death was due to the breast cancer and many who did die from other causes had the added misery of persisting or metastatic breast cancer. In those patients with potentially curable cancer, we recommend either wide local excision, axillary node dissection and irradiation, or modified radical mastectomy. When simple mastectomy alone is used, there is a very high local recurrence rate. Although the patients studied were treated before the era of tamoxifen therapy, it is noteworthy that hormone manipulation would be of value in many of these patients and in selected cases, chemotherapy should also be considered.

Age Factors↗
PubMed1992

Adjuvant tamoxifen for male breast cancer (MBC).

A study was started in 1976 whereby patients with Stage II and operable Stage III MBC were given adjuvant Tamoxifen for 1 year, increasing to 2 years from 1988. All patients had axillary nodal involvement. Primary treatment consisted of a radical mastectomy or simple mastectomy with radiotherapy. The rarity of the disease precluded a randomised trial. Thirty-nine patients are available for analysis at a median follow-up of 49 months. The actuarial survival of the Tamoxifen treated patients is 61% (range 42-80%) at 5 years compared to 44% (range 35-53%) for historical controls (P = 0.006). Disease-free survival was 56% (37-75%) vs 28% (17-33%) at 5 years (P = 0.005). There were no serious side-effects recorded. The conclusion from this, the first reported series on adjuvant Tamoxifen therapy for MBC, is that significant improvement in disease-free survival can be achieved with minimal upset to the patients. Recruitment to the study continues.

Actuarial Analysis↗
PubMed1996

Utility of C-erbB-2 in tissue and in serum in the early diagnosis of recurrence in breast cancer patients: comparison with carcinoembryonic antigen and CA 15.3.

To evaluate the utility of c-erbB-2, carcinoembryonic antigen (CEA) and CA 15.3 in the early diagnosis of recurrence, serial serum determinations of these antigens were performed in 200 patients (follow-up 1-4 years, mean 2.2 years) with primary breast cancer and no evidence of residual disease (NED) after radical treatment (radical mastectomy or simple mastectomy and radiotherapy). Eighty-nine patients developed metastases during follow-up. C-erbB-2, CEA and CA 15.3 were elevated (> 20 U ml-1, > 10 ng ml-1 or > 60 U ml-1 respectively) before diagnosis in 28%, 30% and 47% of the 89 patients with recurrence, with a lead time of 4.5 +/- 2.4, 4.9 +/- 2.4 and 4.8 +/- 2.4 months respectively. Tumour marker sensitivity was clearly related to the site of recurrence, with the lowest sensitivity found in locoregional relapse and the highest in patients with liver metastases. When patients with locoregional recurrences were excluded, sensitivity improved: 31% (c-erbB-2), 33% (CEA) and 56% (CA 15.3), with 76% having at least one of the three tumour markers. C-erbB-2 sensitivity in early diagnosis was significantly higher in patients with c-erbB-2 overexpression in tissue (8/10, 80%) than in those without overexpression (1/30, 3.3%) (P = 0.0001). Likewise, higher levels of both, c-erbB-2 and CA 15.3 at diagnosis of recurrence, higher sensitivity in early diagnosis of relapse and a higher lead time were found in PR+ patients (CA 15.3, P < 0.0001) or in PR- patients (c-erbB-2, P = 0.009). Specificity of the tumour markers was 100% for all three markers (111 NED patients). In conclusion, c-erbB-2 is a useful tool for early diagnosis of metastases, mainly in those patients with c-erbB-2 overexpression in tissue. Using all three markers simultaneously it is possible to increase the sensitivity in the early diagnosis of recurrence by 11.2%.

Bone Neoplasms↗
PubMed1985

Ten-year results of a randomized clinical trial comparing radical mastectomy and total mastectomy with or without radiation.

In 1971 we began a randomized trial to compare alternative local and regional treatments of breast cancer, all of which employ breast removal. Life-table estimates were obtained for 1665 women enrolled in the study for a mean of 126 months. There were no significant differences among three groups of patients with clinically negative axillary nodes, with respect to disease-free survival, distant-disease--free survival, or overall survival (about 57 per cent) at 10 years. The patients were treated by radical mastectomy, total ("simple") mastectomy without axillary dissection but with regional irradiation, or total mastectomy without irradiation plus axillary dissection only if nodes were subsequently positive. Similarly, no differences were observed between patients with clinically positive nodes treated by radical mastectomy or by total mastectomy without axillary dissection but with regional irradiation. Survival at 10 years was about 38 per cent in both groups. Our findings indicate that the location of a breast tumor does not influence the prognosis and that irradiation of internal mammary nodes in patients with inner-quadrant lesions does not improve survival. The data also demonstrate that the results obtained at five years accurately predict the outcome at 10 years. We conclude that the variations of local and regional treatment used in this study are not important in determining survival of patients with breast cancer.

Breast Neoplasms↗