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PubMedDate not supplied

[Metaplastic carcinoma of the breast as a second neoplasm. Report of a case].

A patient with a metaplastic breast carcinoma as a second primary carcinoma after a renal pelvis neoplasm, an association not described before, is reported. Her first admission in October 1983 was due to a silent hematuria secondary to a mass in the right kidney. The histopathologic diagnosis was a grade II transitional cell carcinoma of the renal pelvis without distant or regional lymph nodes metastasis. Four years later, a right upper and outer quadrant breast mass was detected. Malignant disease was diagnosed by needle biopsy, and a simple mastectomy (Madden type) was performed. The histologic evaluation showed a metaplastic carcinoma with a pseudosarcomatous appearance: fifteen axillary lymph nodes showed only lymphoreticular hyperplasia. After surgery, the patient received locoregional radiotherapy. At present, eight years and five months after the first malignant neoplasia and four years and four months after the second malignancy, the patient is asymptomatic and free of disease. We comment the prevalence of multiple primary malignant neoplasms, the risk of developing a second tumor after a renal pelvis carcinoma, and the histologic findings and prognostic factors in metaplastic breast carcinoma.

Breast Neoplasms↗

PubMed1996

Breast infarction in a patient with chronic renal failure: a case report.

A 41-year-old woman who had chronic renal failure required a simple mastectomy for infarction of one breast. On initial presentation her condition was managed as a skin ulcer. Arterial calcification is common in chronic renal failure and its pathogenetic connection with this uncommon event is relevant to the management of "skin ulcers" in general in this population.

Adult↗

PubMed2006

Breast-conserving surgery in early-stage breast cancer (indications, local recurrences, survival, cosmetic results).

INTRODUCTION: Breast cancer is an extremely actual problem in modern medicine and surgery in particular. Constantly growing frequency, younger age of the newly diagnosed patients, severe psychological collapse of the patients and serious impairment of quality of life are only some of the factors determining actuality of the problem. AIM: The aim of the present survey is to make a retrospective comparative clinical analysis of the results obtained after breast-conserving surgery and simple mastectomy in terms of 5- and 10-year survival, local recurrences and cosmetic outcome. PATIENTS AND METHODS: Over a 19-year period, 269 breast cancer patients were treated in the Clinic. Breast-conserving surgery plus axillary lymph node dissection in levels I, II and III was performed in 66.17% of the patients. In 33.83% of the patients ablation of the mammary gland (simple mastectomy) plus axillary lymph node dissection was done. In both groups adjuvant radiation therapy was performed and patients with positive axillary lymph nodes were further subjected to chemotherapy. Adjuvant hormone therapy with anti-estrogen drugs was administered in estrogen positive patients. RESULTS: Study of the late (5- and 10-year) results showed that in complex treatment the recurrence rate in patients subjected to breast-conserving surgery (BCS) was 4.00% and in those treated by simple mastectomy (SM)--2.99%. The 5-year survival was 90.10% for the patients undergoing BCS and 88.89% for those treated by SM. The 10-year survival was 80.56% for the patients treated by BCS and 77.14% for those subjected to SM. CONCLUSIONS: Breast-conserving surgery is indicated in all patients in stage I and II of the disease and tumor measured up to 3.5 cm regardless of the axillary lymph nodes status. There is no statistically significant difference in the survival rate between the two compared groups and cosmetic results are much better in the patients subjected to breast-conserving surgery. When complex treatment is accomplished breast-conserving operations provide recurrence rate equal to that in simple mastectomy. Unfavorable prognostic factors for recurrence are younger age, bigger lump size, greater number of positive lymph nodes and estrogen/progesterone negative status.

Adult↗

PubMed1980

[The role of mammography in the diagnosis of cystosarcoma phylloides (author's transl)].

Cystosarcoma phylloides is not a single disease entity, but, a spectrum, which includes a benign, a non-metastatic malignant and a metastatic malignant form. Neither macroscopic nor microscopic examinations enable one to prediction as to whether the tumor is of a potentially metastatic kind or not. Neither pain nor infiltration or ulceration of the skin are reliable signs of malignancy; palpable axillary lymphnodes are misleading too. The treatment is composed of either a wide local excision of the tumor or a simple mastectomy. In cases where the lymphnodes have increased in size, simple mastectomy plus axillary lymphnodes dissection will be done. Since most tumor recurrence occurs following a local excision of the tumor only simple mastectomy is the surgical method of choid. The author presented two cases, examined by mammography; one case of malignant cystosarcoma phylloides malignum and one case of carcinoma. Both were similar in their clinical and radiographic presentation. Both cases demonstrate the difficulty of radiographie and pathologic diagnosis. A warning is given to radiologists not to compete with the pathologists for the histologic diagnosis but to limit themselves to suggest the presence of a possibly malignant tumor and the need for surgery.

Adult↗

PubMed1987

Adenoid cystic carcinoma of the breast. Data from the Connecticut Tumor Registry and a review of the literature.

The case records of the Connecticut Tumor Registry were reviewed from 1952-1982. There were 37 cases of adenoid cystic carcinoma of the breast (ACC) from a total of 40,350 invasive breast tumors. Patient survival, complications, and pathologic sections were reviewed. Only 14 of 27 surgical pathology slides available for review could be confirmed histologically as ACC. All patients were white females with a mean age of 64 years. The tumor remained localized to the breast in all cases. Nine patients had either radical or modified radical mastectomy, four patients had either simple mastectomy or lumpectomy, and one patient refused treatment. There was no evidence of axillary node involvement, metastases, or local recurrence after excision. At the time of follow-up, nine patients were alive and disease free and four died of disease unrelated to their breast cancer. The one patient who died of breast cancer had a radical mastectomy and survived 11.7 years after diagnosis. It is concluded that ACC has a favorable biologic behavior characterized by a prolonged clinical course and good prognosis. Simple mastectomy is all that is required as initial treatment, and a chest x-ray and thorough physical examination looking for local recurrence is all that is needed for follow-up.

Aged↗

PubMedDate not supplied

[Phyllodes tumor of the breast: diagnostic and therapeutic problems].

Phyllodes tumour (PT) is a rare breast tumor with mixed connective and epithelial components, which usually relapses topically after excision. Five patients with PT took part in the study (4 were positive for benign PT and one was positive for malignant PT at extemporary histological examination). The patients (3) with 3 cm or minus benign lesion had mass excision with a large resection of the surrounding mammary tissue. In the remaining patient with benign neoplasm (8 cm lesion) simple mastectomy was carried out. Finally the patient with malignant PT (5 cm lesion) underwent a simple mastectomy without following chemotherapy or radiotherapy. Follow-up (at 6 and 12 months) consisted of mammography and clinical examination. One out of the 3 patients treated with large resection had a local relapse which was then treated surgically. There was no evidence of relapse at 12 months in the remaining patients with benign tumor. The patient with malignant PT returned to our attention with multiple bone metastases in the thoracic lumbar tract two years later. She received multiple courses of combined radiotherapy and chemotherapy. Local relapses do not appear to affect survival: as a consequence, wide excision should be the primary treatment of benign phyllodes tumors. Total mastectomy has been indicated for malignant phyllodes tumors and for very large tumors.

Adult↗

PubMed2003

Limited surgery and tamoxifen in the treatment of elderly breast cancer patients.

A conservative approach to treating breast cancer patients was adopted for those more than 70 years of age with T1-3 and small localized T4b N0-1 lesions. It consists of tumor excision or simple mastectomy with adjuvant tamoxifen. From the prospective breast cancer database, patients 70 years or older at the time of diagnosis were identified for the period January 1990 to December 1996. Demographic, clinical, pathological, and oncologic data were retrieved. A total of 236 patients were identified. Ninety-seven patients (41%) were treated according to the conservative protocol. Of these, 74 had a tumor excision and 23 had a simple mastectomy. Their mean age was 79 years. TNM staging was stage I in 18 patients, stage II in 66 patients, and stage III in 13 patients. There was no 30-day mortality. Eleven patients were not compliant with tamoxifen use. Two patients were lost to follow-up. The mean follow-up is 51 months (range 4 to 109 months). The cumulative incidence of local and regional recurrence at 8 years is 5% and 7%, respectively. Locoregional recurrences were controlled with excision, mastectomy, or axillary dissection. The cumulative disease-specific, overall, and disease-free survival at 5 years is 86%, 64% and 46%, respectively. Tumor excision or simple mastectomy with tamoxifen offers sufficient tumor control for elderly patients. Axillary dissection and breast or chest wall radiotherapy can safely be omitted, thereby greatly reducing health care resource utilization.

Aged↗

PubMed1989

Postoperative radiotherapy and late mortality: evidence from the Cancer Research Campaign trial for early breast cancer.

OBJECTIVE: To identify any excess mortality caused by adjuvant radiotherapy for early breast cancer. DESIGN: Prospective randomised clinical trial. Two thousand subjects needed for study to have a 90% chance of detecting a difference in survival rate of 7% with 95% significance. Patients were followed up until June 1988, giving follow up of 158-216 months. SETTING: A multicentre trial mainly drawing patients from centres in the United Kingdom. PATIENTS: 2800 Women presenting with clinical stage I or II carcinoma of the breast from June 1970 to April 1975. INTERVENTIONS: One group of women (n = 1376) had simple mastectomy followed by immediate postoperative radiotherapy (1320 to 1510 rets). The remaining women (n = 1424) had simple mastectomy with subsequent careful observation of the axilla, radiotherapy being delayed until there was obvious progression or recurrence of disease locally. END POINT: Increased mortality in patients treated with radiotherapy from causes other than breast cancer. MEASUREMENTS AND MAIN RESULTS: Survival was measured from time of first treatment to death or last follow up. Deaths from any cause and from specified causes were counted as events. Comparison over the whole follow up showed a slight excess mortality in the group treated with radiotherapy (relative risk 1.04; 95% confidence interval 0.94 to 1.15). The relative risk of death from breast cancer was 0.97 (0.87 to 1.08) but that of death from other causes was 1.37 (1.09 to 1.72), the increase mainly being in women who had had tumours of the left breast (1.61 (1.17 to 2.24)) and had been treated with orthovoltage (1.85 (1.27 to 2.71)). Analysis of causes of death after five years showed a relative risk of 2.11 (1.25 to 3.59) for new malignancies and of 1.65 (1.05 to 2.58) for cardiac disease, the increase in cardiac mortality being most pronounced in patients who had had tumours of the left breast and whose treatment had included orthovoltage radiation (relative risk 2.67 (1.28 to 5.55)). CONCLUSIONS: Adjuvant radiotherapy after simple mastectomy for early breast cancer produces a small excess late mortality from other cancers and cardiac disease. The risk has to be balanced against the higher risk of local recurrence when immediate postoperative radiotherapy is not given. The balance has to be assessed for each patient, and for many patients radiotherapy will still be desirable in the initial treatment of their early breast cancer.

Breast Neoplasms↗

PubMed1978

Cystosarcoma phyllodes in young women.

A total of eight cases of cystosarcoma phyllodes in women under 25 years of age were reported to the Swedish Cancer Registry during a ten-year period (1960 to 1969). Only one of these tumors was malignant. It was successfully treated with simple mastectomy and postoperative radiation therapy. Of the remaining seven cases, six were treated with local excision of the lesion and one with simple mastectomy. In no case, did the tumor recur during a follow-up of an average of ten years. Local excision seems to be sufficient for the benign form of the tumor, whereas simple mastectomy is indicated for the malignant form. Radical mastectomy is indicated only of the tumor has invaded the pectoral fascia. The tumor rarely metastasizes to the axillary lymph nodes.

Adolescent↗

PubMed1996

Mastectomy with axillary clearance versus mastectomy without it. Late results of a trial in which patients had no adjuvant chemo-, radio- or endocrine therapy.

OBJECTIVE: Long-term outcome of comparison of mastectomy with axillary clearance to mastectomy without it. DESIGN: Second analysis of a terminated prospective randomised trial. SETTING: The Breast Clinic, Groote Schuur Hospital, Cape Town. PATIENTS: Ninety-five women aged under 76 years with stages 1 and 2 (T1-2 NO-1 MO) breast cancer. INTERVENTIONS: Radical mastectomy (mastectomy and formal axillary dissection with pectoral muscle excision) or simple mastectomy (mastectomy without axillary dissection if nodes were not clinically palpable, or local excision of the nodes if they were). OUTCOME MEASURES: Loco-regional recurrence and survival. RESULTS: Whereas initial analysis at 40 months had showed more axillary recurrences (P = 0.056) in the simple mastectomy group (leading to the termination of the trial), this difference has disappeared at 10 years (P = 0.113). There was no difference in rate of recurrence at all other sites, time to recurrence, or survival rates at 40 months or at 10 or 25 years. CONCLUSIONS: Full axillary clearance offered no better long-term loco-regional control or survival. Early analysis and marginally significant differences in axillary recurrence prompted premature termination of this trial.

Adult↗

PubMed1983

Preoperative chemotherapy followed by mastectomy for locally advanced breast cancer.

Six patients with advanced local-regional breast cancer were reviewed. Five out of the six patients previously had had radiation therapy as part of the initial therapy. All patients had preoperative cycles of combination chemotherapy, either CMF or CAF. The two stage III patients had greater than 75% reduction in measurable tumor mass, which allowed a conventional modified radical or radical mastectomy to be performed. Both of these patients are now disease free at 26 and 27 months. The four stage IV patients had lesser operations following the chemotherapy (two simple mastectomies, one simple mastectomy plus axillary resection, and one axillary debulking). Reconstruction utilized advancement flaps in three patients and split-thickness skin grafts in the other. None of the patients had postoperative wound problems, and none of the patients had further problems with local cancer control. All patients had combination chemotherapy starting two to six weeks following surgery. Preoperative chemotherapy followed by surgery plays an important role in management of locally advanced stage III and stage IV breast cancer.

Adenocarcinoma↗

PubMed1975

Subcutaneous mastectomy with immediate reconstruction of the breast.

The operation of subcutaneous mastectomy is evolving as an alternative to simple mastectomy for diseases of the breast parenchyma where preservation of the skin capsule is thought possible. Simple mastectomy is a mutilating procedure, cosmetically unacceptable to both patient and surgeon. The psychological implications of breast absence in women are now well known, and attempts to preserve the shape and volume of the breast must receive attention.

Breast↗

PubMed1990

Carcinoma of the breast in children.

Carcinoma of the breast in children is an extremely rare disease, only 44 patients have been reported in the world literature. We report on a case of breast cancer in a 9-year-old girl, who was admitted to the hospital because of a four-month history of a painless mass in the right breast. Clinical examination and mammography resulted in a strong suspicion of malignancy. The histology corresponded to juvenile secretory carcinoma, the histological type without the characteristics of prepubertal cancer cases. Electron microscopy demonstrated intracellular large vacuoles and acini filled with secretory material. The mitotic index was low, the highest measured value was 4 mitotic figures per 10 high power fields corresponding to 2.78 mitotic figures per mm2 of epithelium in the microscope field. Flow cytometry showed that the neoplastic cells were diploid and had a low S-phase fraction. A simple mastectomy including axillary evacuation was performed. No lymph node or distant metastases were found. Postoperative radiation treatment or chemotherapy were not administered. Our patient has been in follow-up for six years without recurrence. In this case simple mastectomy with axillary evacuation seems to have given a cancer-free development into adulthood. Earlier reports have also shown a favourable outcome in these tumours.

Breast↗

PubMed1993

The management of male breast cancer in Nigerians.

The outcome in 57 male patients with breast cancer has been analysed. Four patients with early disease had simple mastectomy (one case) and radical mastectomy (three cases). All four completed a 12-cycle cyclophosphamide/methotrexate/5-fluorouracil (CMF) course of chemotherapy. Two required orchiectomy after 23 and 38 months, respectively. Two patients were alive at 79 and 63 months. Fifty-three others with advanced disease had simple mastectomy (10 cases), radical mastectomy (38 cases) and no surgery (five cases), but only 33 completed chemotherapy and 11 were submitted to orchiectomy for recurrence after a mean interval of 19 months. Two patients were alive at 63 and 69 months, respectively. The overall survival rate was 7%. It is considered that in addition to late presentation (mean (SEM): 16.4 (2.1)) months and advanced disease (93%), ineffectiveness of the CMF regimen in male patients may have contributed to the poor survival rate in these Nigerian patients.

Adolescent↗

PubMedDate not supplied

Therapy and survival in male breast carcinoma: A retrospective analysis of 50 cases.

The relationship between therapy and overall survival was retrospectively investigated in 50 patients with primary male breast carcinoma. Forty-five had radical or modified radical mastectomy and 5 simple mastectomy. Thirty-five received adjuvant post-operative therapy, including radiation, hormone and chemotherapy, given separately or in combination. The mean follow-up period was 67 (range, 1-230) months. The median survival was 33 months for patients receiving surgery alone and 86 months for those who also had adjuvant therapy (p=0.003). No difference in survival was found between simple or radical/modified radical mastectomy, nor among the various types of adjuvant therapy. Adjuvant therapy was most effective in large size, node positive and poorly differentiated tumors, and retained independent prognostic significance in multivariate analysis. With the limitation due to the small number of cases, our data suggest that adjuvant therapy may improve survival in males with cancer of the breast.

Adult↗

PubMed2004

Perioperative levels of interleukin-1beta and interleukin-6 in women with breast cancer.

OBJECTIVE: Proinflammatory cytokines, such as Interleukin-1beta and Interleukin-6, are known to play an important biological role in trauma, sepsis and malignant disease. Surgery can modulate the immune system, especially in patients with malignant diseases, by influencing the serum levels of Interleukin-1beta and Interleukin-6. It is known that cytokine levels depend on the grade of tissue injury. We have investigated the serum levels of Interleukin-1beta and Interleukin-6 during the perioperative period in women with breast cancer undergoing simple mastectomy or segmental resection. The aim of the study was to analyse whether breast cancer surgery influences cytokine expression in the peripheral blood and whether the concentrations of the measured interleukines differ according to the surgical method. METHODS: Blood samples of 45 women with breast cancer (Stage I and II) undergoing simple mastectomy (n = 16) or segmental resection (n = 29) were collected at six different times: before (T1), during (T2), three hours after (T3), one day after (T4), three days (T5) and five days after (T6) surgery. The serum levels of Interleukin-1beta and Interleukin-6 were measured by ELISA. RESULTS: In both groups Interleukin-1beta serum concentrations (p < 0.05) increased significantly on the first day after surgery. On the third day after surgery the concentrations of Interleukin-1b decreased to the preoperative level. A significant difference in Interleukin-1beta concentrations as a consequence of the surgical method was not detectable. Changes in the serum levels of Interleukin-6 within the measurement period were not observed. CONCLUSIONS: Surgery in patients with breast cancer leads to increased Interleukin-1beta serum levels on the first postoperative day. It has been shown that elevated Interleukin-1beta and Interleukin-6 levels are correlated with a high rate of recurrence. Therefore, this may be of consequence to patients with malignant diseases. The method of surgery for both types, however, had no influence on the peripheral cytokine expression. Therefore, a nearly equal influence on the immune system can be stated.

Adult↗

PubMed1999

Is there a role for surgery in the treatment of mastalgia?

Breast pain is a common condition affecting most women at some stage in their reproductive life. Mastalgia is resistant to treatment in 6% of cyclical and 26% non-cyclical patients. Surgery is not widely used to treat this condition and only considered in patients with severe mastalgia resistant to medication. The aims of this study were to audit the efficacy of surgery in severe treatment resistant mastalgia and to assess patient satisfaction following surgery. This is a retrospective review of the medical records of all patients seen in mastalgia clinic in the University Hospital of Wales, Cardiff since 1973. A postal questionnaire was distributed to all patients who had undergone surgery. Results showed that of the 1054 patients seen in mastalgia clinic, 12 (1.2%) had undergone surgery. Surgery included 8 subcutaneous mastectomies with implants (3 bilateral, 5 unilateral), 1 bilateral simple mastectomy and 3 quadrantectomies (1 having a further simple mastectomy). The median duration of symptoms was 6.5 years (range 2-16 years). Five patients (50%) were pain free following surgery, 3 developed capsular contractures and 2 wound infections with dehiscence. Pain persisted in both patients undergoing quadrantectomy. We conclude that surgery for mastalgia should only be considered in a minority of patients. Patients should be informed of possible complications inherent of reconstructive surgery and warned that in 50% cases their pain will not be improved.

Journal Article↗

PubMed1989

[Breast repair using a silicone gel-filled prosthesis. Report of 21 cases].

From March 1985 to May 1988, a total of 32 breast repairs in 21 patients following mastectomy were performed in our hospital. The operative procedures included: immediate prosthesis insertion following subcutaneous mastectomy in 16 patients; subsequent prosthesis implantation following simple mastectomy in 4 patients; a transfer of latissimus dorsi skin-muscle flap with submuscular placement of prosthesis subsequent to the radical mastectomy in 1 patient. The chief indications for mastectomy are: multiple fibroadenomas, giant fibroadenoma, severe fibrocystic mastopathy and cystosarcoma phyllodes and so on. After a period of 1-38 months follow-up postoperatively, the results were satisfactory with no significant complications. It is believed that the breast repair by utilizing silicone gel-filled implant following mastectomy is a safe, reliable and more effective procedure, and is reasonable to extend its indication in latter clinical application.

Adenofibroma↗